How to and how not to develop a theory of change to evaluate a complex intervention: reflections on an experience in the Democratic Republic of Congo.
How to and how not to develop a theory of change to evaluate a complex intervention: reflections on an experience in the Democratic Republic of Congo.
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DOI：
10.1136/bmjgh-2017-000617
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发表时间：
2018
影响因子：
8.1
通讯作者：
Borghi J
中科院分区：
文献类型：
--
作者：
Maini R;Mounier-Jack S;Borghi J
变革理论(ToCs)描述了干预措施如何通过一系列符合逻辑的中间结果带来长期结果，并已在几个国家被用于设计和衡量公共卫生方案的影响。由于认识到它们有能力提供监测和评价框架，它们越来越多地被用于发展部门。目标为本课程的建设通常是通过一个协商过程进行的，这要求利益攸关方反思他们的计划如何带来变化。TOC有助于明确任何潜在的假设，承认语境的作用，并提供证据来证明因果路径链的合理性。然而，尽管在理论上存在许多关于如何制定干预措施的TOC的文献，但在实践中将其应用于卫生部门的复杂干预措施的思考相对较少。本文描述了制定TOC的初始过程，以便为设计一项旨在改善刚果民主共和国政府向卫生工作者支付报酬的复杂干预措施的评估提供信息。吸取的教训包括：TOC需要了解干预如何对更广泛的体系产生影响，并在一开始就让广泛的利益相关者参与，以最大化干预成功的机会并确保所有权。利益相关者之间的权力关系也可能影响TOC话语，但通过拥有独立的调解人可以将其降至最低。我们希望这些见解对使用这种方法评估复杂干预措施的其他全球公共卫生从业者有所帮助。
Theories of change (ToCs) describe how interventions can bring about long-term outcomes through a logical sequence of intermediate outcomes and have been used to design and measure the impact of public health programmes in several countries. In recognition of their capacity to provide a framework for monitoring and evaluation, they are being increasingly employed in the development sector. The construction of a ToC typically occurs through a consultative process, requiring stakeholders to reflect on how their programmes can bring about change. ToCs help make explicit any underlying assumptions, acknowledge the role of context and provide evidence to justify the chain of causal pathways. However, while much literature exists on how to develop a ToC with respect to interventions in theory, there is comparatively little reflection on applying it in practice to complex interventions in the health sector. This paper describes the initial process of developing a ToC to inform the design of an evaluation of a complex intervention aiming to improve government payments to health workers in the Democratic Republic of Congo. Lessons learnt include: the need for the ToC to understand how the intervention produces effects on the wider system and having broad stakeholder engagement at the outset to maximise chances of the intervention’s success and ensure ownership. Power relationships between stakeholders may also affect the ToC discourse but can be minimised by having an independent facilitator. We hope these insights are of use to other global public health practitioners using this approach to evaluate complex interventions.
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DOI：
10.1136/bmj.h1258
发表时间：
2015-03-19
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moore GF;Audrey S;Barker M;Bond L;Bonell C;Hardeman W;Moore L;O'Cathain A;Tinati T;Wight D;Baird J
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影响因子：
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作者：
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影响因子：
3.2
作者：
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通讯作者：
Mutombo, Paulin Beya
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DOI：
10.1136/bmj.a1655
发表时间：
2008-09-29
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
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通讯作者：
Medical Research Council Guidance
DOI：
10.1186/s13012-016-0422-6
发表时间：
2016-05-06
期刊：
Implementation science : IS
影响因子：
--
作者：
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通讯作者：
Lund C