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This took the form of a diagram (figure 1) and a narrative account of the theoretical basis of the intervention. The narrative identified relevant mid range theories including work motivation theory and reflective learning as well as the importance of dissonance between actual behaviour, pursued goals and outcomes. It showed the relevance of these to components of the intervention, which included feedback, reflective learning and action planning.The articulation of this theory helps in characterising the programme components, the mediating processes through which they work and the moderating factors related to participants and contexts, as well as improving the ability to measure the intervention’s impacts on practice change.Programme (impact) theory of an intervention to improve care of people with chronic medical conditions.Open in new tabFigure1 Programme (impact) theory of an intervention to improve care of people with chronic medical conditions.Meaningful programme theory uses the most appropriate possible combination of informal and formal theory to recognise dysfunction in care systems and identify its root cause(s); say what the corrective intervention is made up of (ie, its component parts); specify the range of likely outcomes (desired or not); indicate why it is likely to deliver the desired results (mechanisms); and describe how its impact will be assessed.24 As an example,<a href=”http://www.authenticcheapjerseyschina.com/” target=”_blank”>http://www.authenticcheapjerseyschina.com</a>
The Ishikawa (‘fishbone’) diagram in figure 2 is an explanatory theory that pulls together the many barriers to the effective promotion of health related behaviours in primary care practices and integrates them into a coherent map or model of the nature and sources of the problem being addressed.18 Figure3 describes the presumed causal mechanisms that make up a theory of change in an initiative designed to overcome some of these barriers.30 This initiative modified the roles of clinic staff, making it possible for them to initiate counselling on tobacco and alcohol use, diet and physical activity as soon as patients registered for care.