Table 1.

Steps in building the program theory of the intervention.

Steps	Question	Method	Outcome
Understanding the intervention	How was the intervention supposed to work? What was the response of the actors in the system vis-à-vis the assumptions of the implementers?	Review of program documents, meeting minutes, reports, and transcripts of interviews with implementers	Input–outcome logic model connecting intervention inputs to outcomes showing possible intermediate steps (Figure 2)
Review literature	What do we know (from published literature) about how such interventions could work?	Narrative review of literature on organizational commitment, self-efficacy, workplace learning, and evaluation of training programs	Synthesis of literature on capacity-building in health with a focus on the mechanisms
Identify contextual factors	What are the conditions in the district health system that affect the expected outcome?	Review of program implementation reports, observation notes and interview transcripts	Contextual factors identified
Refine program theory	How could the intervention lead to improved organizational performance?	Integrate contextual factors and mechanisms into the initial program theory	Plausible relationship between the elements of the intervention and its expected outcomes (Figure 3)
Formulate context–mechanism–outcome (CMO) configurations	What worked, for whom, and under what conditions?	Identify configurations of CMO that could be empirically tested	CMO configurations that could be empirically tested