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 |