Towards developing an initial programme theory: Programme designers and managers assumptions on the antiretroviral treatment adherence club programme in primary health care facilities in the metropolitan area of Western Cape Province, South Africa
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Date
2016
Journal Title
Journal ISSN
Volume Title
Publisher
Public Library of Science
Abstract
BACKGROUND
The antiretroviral adherence club intervention was rolled out in primary health care facilities
in the Western Cape province of South Africa to relieve clinic congestion, and improve
retention in care, and treatment adherence in the face of growing patient loads. We adopted
the realist evaluation approach to evaluate what aspects of antiretroviral club intervention
works, for what sections of the patient population, and under which community and health
systems contexts, to inform guidelines for scaling up of the intervention. In this article, we
report on a step towards the development of a programme theoryÐthe assumptions of programme
designers and health service managers with regard to how and why the adherence
club intervention is expected to achieve its goals and perceptions on how it has done so (or
not).
METHODS
We adopted an exploratory qualitative research design. We conducted a document review
of 12 documents on the design and implementation of the adherence club intervention, and
key informant interviews with 12 purposively selected programme designers and managers.
Thematic content analysis was used to identify themes attributed to the programme
actors, context, mechanisms, and outcomes. Using the context-mechanism-outcome configurational
tool, we provided an explanatory focus of how the adherence club intervention
is roll-out and works guided by the realist perspective.
RESULTS
We classified the assumptions of the adherence club designers and managers into the rollout,
implementation, and utilisation of the adherence club programme, constructed around
the providers, management/operational staff, and patients, respectively. Two rival theories
were identified at the patient-perspective level. We used these perspectives to develop an
initial programme theory of the adherence club intervention, which will be tested in a later
phase.
CONCLUSION
The perspectives of the programme designers and managers provided an important step
towards developing an initial programme theory, which will guide our realist evaluation of
the adherence club programme in South Africa.
Description
Keywords
Antiretroviral adherence, Primary health care facilities, Western Cape, Realist evaluation approach, Antiretroviral club intervention
Citation
Mukumbang, F.C. et al. (2016). Towards developing an initial programme theory: Programme designers and managers assumptions on the antiretroviral treatment adherence club programme in primary health care facilities in the metropolitan area of Western Cape Province, South Africa. PLOS one, 11(8): e0161790.