Table 1

Details of the tools, sampling and expected outcomes

StepMethods/toolsSampling/selection of respondentsAnalysis and expected outcome
Step A: reconstruction of programme theoryDesk 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 servicesNot applicable for review of documents; purposive sampling for interviews
  • Initial programme theory and a hypothetical causal pathway linking intervention inputs and expected outcomes

  • Summary of theories of organisational change in relation to their spheres of influence

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 AAll 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 survey
  • Attitudes 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 yearsPurposive, based on exposure to interventionAnalysis 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 observedDesk review and joint analysis of findingsFurther 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 districtsAn internally consistent and valid explanation of ‘what components of the intervention worked, for whom and under what conditions’