1. Development stage Identifying/developing theory Session III 1 st July 2010 13.30 – 15.00

2. 1.2. Identifying/developing theory Overall learning objective: Appreciate how to use new primary research to develop and test theories of change. © G. Borglin 2010

3. Theories of Change? A Theory of Change defines all building blocks required to bring about a given long-term goal. This set of connected building blocks, interchangeably referred to as outcomes, results, accomplishments, or preconditions is depicted on a map known as a pathway of change/change framework, which is a graphic representation of the change process.

4. Theories of Change? A Theory of Change describes the types of interventions (a single program or a comprehensive initiative) that bring about the outcomes depicted in the pathway of a change map. Each outcome in the pathway of change is tied to an intervention, revealing the often complex web of activity that is required to bring about change

5. How can I learn something new? To learn –We must understand To understand –We must listen To listen –We must attend To attend –We must travel THERE ARE NO BUSES!!!!!

6. Something about travel and culture www.youtube.com/watch?v=HN- 88hqbS7Y&feature=player_embeddedwww.youtube.com/watch?v=HN- 88hqbS7Y&feature=player_embedded

7. Theories of Change? A Theory of Change would not be complete without an articulation of the assumptions that stakeholders use to explain the change process. Assumptions explain both the connections between early, intermediate and long term outcomes and the expectations about how and why proposed interventions will bring them about. Assumptions should be supported by research, strengthening the case to be made about the plausibility of theory and the likelihood that stated goals will be accomplished.

8. Theories of Change? Theories of Change require participants to be clear on long-term goals, identify measurable indicators of success, and formulate actions to achieve goals. –show causal pathways from by specifying what is needed for goals to be achieved (e.g. we might argue that children should attend school a minimum number of days if they are going to learn). –it requires you to articulate underlying assumptions which can be tested and measured.

10. An Example Physical, Behavioural and Cognitive Symptoms of depression feedback on each other to maintain depressive mood

11. An Example One symptom of depression is reduced activity

12. An Example We predict therefore that increasing activity will lead to a decrease in ALL depressive symptoms

13. An Example We can test this prediction by designing an experiment where we measure BOTH activity levels AND depressive symptoms

14. But…. How can we get patients to increase their activity?

15. Answer…. We can educate them

16. But…. Who will educate them?

17. Answer…. Health professionals

18. But…. How will we educate health professionals?

19. Answer Interventions to promote behavioural change among health professionals Consistently Effective Interventions –Educational outreach visits –Reminders (manual or computerised) –Multifaceted interventions –Interactive educational meetings (participation of healthcare providers in workshops that include discussion or practice) Interventions of Variable Effectiveness –Audit and feedback –Use of local opinion leaders –Local consensus processes –Patient mediated interventions Interventions that have little or no effect –Educational materials –Didactic educational meetings (such as lectures)

20. But…. GP is too busy and not interested Specialist is occupied elsewhere There are no experts in this work How will we organise the delivery of this education? How will we organise the delivery of this increased activity?

21. Collaborative Care Specialist GP Case manager Patient

22. Case manager Behavioural activation including activity diary Medication management Cognitive Behavioural techniques Psycho-social support Referral to other agencies Assessing outcome (PHQ9) Process of case management - Activity -Timing - Session frequency - Duration - Phone use - Professional background & skills Tentative theoretical model © G. Borglin 2010

24. Workshop activity Work with the questions in your integrated year groups for about 30 minutes. Prepare to give a 5 minutes brief presentation to the rest of your colleagues – (longer = interrupted!) © G. Borglin 2010

25. MRC 2008 © G. Borglin 2010