Step A: reconstruction of programme theory | Desk review of intervention design, proposal, annual district-level plans, reports and interviews with the people who designed and are implementing the intervention. Review of theories of behavioural change in health services | Not applicable for review of documents; purposive sampling for interviews | |
Steps B1 and B2: data collection—quantitative (process) | Construct survey questionnaire based on a review of theories of behavioural change in healthcare organisations and reconstruction of initial programme theory from step A | All health managers in intervention and control district who agree to participate (about 100 in all; about 60 in Tumkur and 40 in Raichur) | Key outcome variables for surveyAttitudes to training programmes and district planning Organisational commitment Self-efficacy Attitude towards receiving and providing supervision Statistical analysis to determine relationship among variables and effect of exposure to intervention
|
Step C: data collection—qualitative (context and outcomes) | Assess action plans before, during and after intervention; assess performance and outcomes using routine institutional data and interview participants and non-participants at district and taluka level to understand changes in the course of 3 years | Purposive, based on exposure to intervention | Analysis of the qualitative data to understand how planning and supervision practices changed in the course of the intervention as well as how other contextual determinants influenced these changes |
Step D: analysis (context–mechanism–outcome configurations) | Analyse findings from B2 and C to understand the relationship between various elements in the hypothetical causal chain and the contribution of contextual factors to the outcomes observed | Desk review and joint analysis of findings | Further refining of the initial programme theory by the improved understanding from the application of qualitative and quantitative methods |
Steps E and F: (validation and refining the theory) | Formulate context–mechanism–outcome configurations and verify through fresh data collection as well as re-looking at the earlier findings (steps B2 and C) | Purposive sampling of participant and non-participant health managers in both districts | An internally consistent and valid explanation of ‘what components of the intervention worked, for whom and under what conditions’ |