Development Of Programme Theory Research Articles

Evaluation of a Capacity-Building Programme of District Health Managers in India: A Contextualised Theoretical Framework

BackgroundPerformance of local health services managers at district level is crucial to ensure that health services are of good quality and cater to the health needs of the population in the area. In many Low- and Middle-Income Countries (LMIC), health services managers are poorly equipped with public health management capacities needed for planning and managing their local health system. In the South Indian Tumkur district, a consortium of five non-governmental organisations partnered with the state government to organise a capacity-building program for health managers. The program consisted of a mix of periodic contact classes, mentoring and assignments and was spread over 30 months.ObjectiveIn this paper, we develop a theoretical framework in the form of a refined program theory to understand how such a capacity-building program could bring about organisational change. A well-formulated program theory enables an understanding of how interventions could bring about improvements and an evaluation of the intervention.MethodsWe described the initial program theory of the intervention through a desk review of the program documents.We then elaborated the links between the various elements of the initial program theory, taking on board implementer assumptions and participants’ perceptions, and drawing from a review of literature on organisational change in health services. Finally, we identified plausible mechanisms that could explain the expected change. We reviewed documents related to intervention implementation (program documents) and guidelines on planning and supervision in health services, in order to identify important factors pertaining to the policy environment that could affect the outcome. We integrated these contextual factors and possible mechanisms into the program theory.ResultsIn the refined program theory of the intervention, we identified various factors at individual, institutional and environmental levels that could interact with the hypothesised mechanisms, such as staff’s perceived self-efficacy and commitment to their organisations.Based on this program theory, we formulated context-mechanism-outcome configurations that can be used to evaluate the intervention and, more specifically, to understand what worked, for whom and under what conditions.DiscussionWe discuss the application of program theory development in conducting a realist evaluation. Realist evaluation embraces principles of systems thinking by providing a method for understanding how elements of the system interact with one another in producing a given outcome.

Developing and evaluating a child-centred intervention for diabetes medicine management using mixed methods and a multicentre randomised controlled trial

AimTo develop and evaluate an individually tailored age-appropriate diabetes diary and information pack for children and young people aged 6–18 years with type 1 diabetes to support decision-making and self-care with a specific focus on insulin management and blood glucose monitoring, compared with available resources in routine clinical practice.DesignFour-stage study following the Medical Research Council framework for designing and evaluating complex interventions. Stage 1: context – brief review of reviews and mixed-method systematic review; updating of database of children’s diabetes information; children’s diabetes information quality assessment and diabetes guideline analysis; and critical discourse analysis. Stage 2: intervention development – working with expert clinical advisory group; contextual qualitative interviews and focus groups with children and young people to ascertain their information preferences and self-care practices; ongoing consultation with children; development of intervention programme theory. Stage 3: randomised controlled trial (RCT) to evaluate the diabetes diaries and information packs in routine practice. Stage 4: process evaluation.FindingsThe RCT achieved 100% recruitment, was adequately powered and showed that the Evidence into Practice Information Counts (EPIC) packs and diabetes diaries were no more effective than receiving diabetes information in an ad hoc way. The cost per unit of producing the EPIC packs and diabetes diaries was low. Compared with treatment as usual information, the EPIC packs fulfilled all NHS policy imperatives that children and young people should receive high-quality, accurate and age-appropriate information about their condition, self-management and wider lifestyle and well-being issues. Diabetes guidelines recommend the use of a daily diabetes diary and EPIC diaries fill a gap in current provision. Irrespective of allocation, children and young people had a range of recorded glycated haemoglobin (HbA1c) levels, which showed that as a group their diabetes self-management would generally need to improve to achieve the HbA1clevels recommended in National Institute for Health and Care Excellence guidance. The process evaluation showed that promotion of the EPIC packs and diaries by diabetes professionals at randomisation did not happen as intended; the dominant ‘normalisation’ theory underpinning children’s diabetes information may be counterproductive; risk and long-term complications did not feature highly in children’s diabetes information; and children and young people engaged in risky behaviour and appeared not to care, and most did not use a diabetes diary or did not use the information to titrate their insulin as intended.LimitationsRecruitment of ‘hard to reach’ children and young people living away from their families was not successful. The findings are therefore more relevant to diabetes management within a family context.ConclusionsThe findings indicate a need to rethink context and the hierarchical relationships between children, young people, parents and diabetes professionals with regard to ‘partnership and participation’ in diabetes decision-making, self-care and self-management. Additional research, implementation strategies and service redesign are needed to translate available information into optimal self-management knowledge and subsequent optimal diabetes self-management action, including to better understand the disconnection between children’s diabetes texts and context; develop age-appropriate Apps/e-records for recording blood glucose measurements and insulin management; develop interventions to reduce risk-taking behaviour by children and young people in relation to their diabetes management; reconsider what could work to optimise children’s self-management of diabetes; understand how best to reorganise current diabetes services for children to optimise child-centred delivery of children’s diabetes information.Study registrationCurrent Controlled Trials ISRCTN17551624.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Explicating Practicum Program Theory

This study explicated the theory underpinning the Human Ecology Practicum Program offered in the Department of Human Ecology at the University of Alberta. The program has operated for 40 years but never been formally evaluated. Using a document analysis, focus group and individual interviews, and a stakeholder working group, we explored stakeholder perspectives on the purpose, design, and logic of the program. Findings indicated a common understanding among stakeholders about the fundamental purpose and design of the program, and about the mechanisms by which design features lead to program goals. Findings were used to develop the theory of the Human Ecology Practicum Program. In addition to providing a case example of practicum program theory development, our study demonstrates the value of involving stakeholders in theory development and supports the articulation of program theory as part of course planning and evaluation within postsecondary education programs.

Constructing and Verifying Program Theory Using Source Documentation

Abstract: Making the program theory explicit is an essential first step in Theory Driven Evaluation (TDE). Once explicit, the program logic can be established making necessary links between the program theory, activities, and outcomes. Despite its importance evaluators often encounter situations where the program theory is not explicitly stated. Under such circumstances evaluators require alternatives to generate a program theory with limited time and resources. Using source documentation (e.g., lesson plans, mission statements) to develop program theory is discussed in the evaluation literature as a viable alternative when time and resources do not permit a priori program theory development. Unfortunately, the evaluation literature is devoid of methodology illustrating how to translate source documentation into an explicitly stated program theory. The article describes the steps in using source documentation to develop and verify a program theory and illustrates the application of these steps. It concludes with a discussion about the feasibility and limitations of this methodology.

The Importance of Trust in Outdoor Education: Exploring the Relationship Between Trust in Outdoor Leaders and Developmental Outcomes

Recent studies have acknowledged the influence of the leader in the outdoor education process and have illuminated the need for strong interpersonal relationships between participants and leaders. Developing interpersonal trust is one among many ways that leaders can promote such positive interpersonal relationships between themselves and participants. Transdisciplinary literature suggests that trust in a leader can predict outcomes that are important to outdoor education. This study found a positive relationship between trust in outdoor leaders and the course outcomes of leadership development and outdoor skills development among students of National Outdoor Leadership School (NOLS) courses. Implications for program implementation and theory development are discussed.

Plot and see! Maternal comprehension of growth charts worldwide

To evaluate maternal comprehension of growth charts used in growth monitoring and promotion (GMP), a worldwide programme with important budgets but contrasting results. Systematic literature review through MEDLINE, POPLINE, Global Health, ERIC and the Cochrane Library with the keywords 'growth monitoring' or 'growth chart' limited to the title/abstract field and to the 0-5 years age range. Twenty studies from Asia (8), Africa (8) and Latin America/Caribbean (3) were included in the review. The results of the 14 non-intervention, cross-sectional studies provide convincing evidence that a third to three-fourths of carers in developing countries do not understand the growth charts. Literacy had a strong effect on women's ability to interpret the cards. Appropriate training and educational activities also increased substantially maternal comprehension as demonstrated in five of the six intervention trials. Many carers have poor comprehension of growth charts, but their comprehension increases not only with literacy, but also with training. Activities aimed at improving communication skills of health staff and at empowering parents to practice responsive parenting could greatly improve GMP outcomes.

Evaluators as educators: Articulating program theory and building evaluation capacity

AbstractThis chapter recommends an educational role for evaluators in nonformal settings, including the development of program theory and long‐term evaluation capacity building.

Concept Mapping as a Technique for Program Theory Development

The emergence of theory-driven evaluation has drawn attention to the need for practical ways for evaluators to construct program theory to achieve the benefits of the approach. This article illustrates the use of concept mapping as a technique to explicate underlying program theory in the context of family support programs. In this example, 29 professional staff members from a statewide family support program brainstormed 96 specific benefits for participant families. Fourteen direct service staff members sorted and rated the items and interpreted the map produced by multidimensional scaling analysis and hierarchical cluster analysis. Some of the benefits of the technique for evaluators conducting theory-driven evaluations are highlighted. These include helping evaluators decide what to measure, capturing the complexity of programs in the context of implementation, and managing good stakeholder-evaluator relations. The general limitations and issues of concept mapping as it applies to theory development are also discussed.

Development of Local Program Theory: Using Theory-Oriented Evaluation to Make a Difference

The aim of this article is to explicate the local program theory of an adolescent pregnancy and parenting program using a mix of methods. By bracketing these methods, local program theory is developed and subsequently used to distinguish between the validity of program theory and the validity of program implementation. Theory is then used as a tool to construct a model of how the program is supposed to work. This is followed by an assessment of the extent to which the program's theories are actually implemented in the field. The intent of using a mix of methods during this process is to gather an extensive, intensive, and comprehensive view of program case managers' thoughts about their work. Analysis is based on the evaluator's recognition of patterns of meaning that contribute to an enhanced contextual and theoretical understanding of the overall effectiveness of this program.

Experimentation and Criminal Justice Policies in the United Kingdom

Experiments have an important part to play in developing evidence-based policy and practice in criminal justice. They need, however, to be construed in realist terms if valid conclusions are to be drawn. The precise design of an experiment needs also to be tailored to the level of program theory development. In only very particular circumstances will random controlled trials (RCTs) be appropriate. An illustration of successful use of non-RCT realist experimental evaluations in repeat victimization research and policy development in Britain is given. The achievement of this fruitful relationship between research and policy development itself depended on a (perhaps unusually) favorable context.