Table 1

Data sources and analyses approaches mapped against our adapted process evaluation framework

FrameworkDescription of framework itemData sourceAnalysis approach
ContextDescription of geographical location and summary of perinatal and maternal mortality in the intervention districtsMalawi Ministry of Health dataDescriptive summary
ReachDescription of the trainees and the pool of NPCs from which they were recruitedMalawi Ministry of Health dataThe distribution of trainees across the districts
Dose deliveredDelivery of training sessions and training supportCourse documentation
Interviews with obstetricians who provided support
Interrogation of data for variation from intended delivery of training, for example, non-attendance
Dose receivedParticipation in training by NPCs and their perceptions of what they learnCourse attendance registers
First set of interviews with opportunistic sample of 19 NPCs
Attendance counts
Thematic analysis of NPC responses to question ‘what did you learn that was new to you?’
Early implementationImplementation of initial learning in the NCP's own clinical working context particularly leadership skillsInterviews undertaken with an opportunistic sample of 12 NPCs from the seven intervention districts 6 months after module 2Interrogation of interviews for spontaneously given examples of change in their working style
Evidence of cascading of learning by NPCsInterviews with an opportunistic sample of 10 cascadeesThematic analysis of what was taught by the NPCs to cascadees
Evidence of cascading of learning from the perspective of DMOsInterviews with an opportunistic sample of five DMOsInterrogation of interviews for examples of cascading of training
Later implementationImplementation of training up to attending modules 5 and 6Interviews with 39 NPCs when attending modules 5 and 6Thematic analysis of actual use of skills used by NPCs
  • The opportunistic samples are based on the presence and availability (eg, not interfering with normal workload) of individuals at the time of the researcher's (WC) visit to the facilities.

  • DMO, District Medical Officers; NPC, non-physician clinician.