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The World Federation of Haemophilia (WFH) is a global network of national member organizations (NMOs) that advocate, collectively and individually, to improve lives of people with inherited bleeding disorders. The WFH vision of "Treatment for All" speaks to a future in which all people with an inherited bleeding disorder will have access to care, regardless of their gender or where they live. Over the last several years, initiatives including the WFH Humanitarian Aid program, the World Bleeding Disorders Registry, and Guidelines for the Management of Haemophilia and von Willebrand disease have significantly changed how the WFH and its partners work to improve and sustain care for people with bleeding disorders. Following an extensive consultation that included over 200 stakeholders from 70 countries, a Theory of Change was developed, and strategic priorities identified, to clearly define the WFH's intended impact and point of accountability to its stakeholders, and to determine how and through who those goals will be achieved. Both should help the WFH better support its NMOs and healthcare providers around the world in their efforts to improve access to diagnosis and care, as new therapies revolutionize the treatment landscape and the fallout of the global pandemic continues to challenge the ways in which we work and connect. Global collaboration of all stakeholders, based on their resources, objectives and skills, will be required to achieve these goals and to ensure more people have reliable access to safe treatment and care, regardless of their bleeding disorder, gender, or where they live. Free to Read (see URL)

OBJECTIVES Rising antimicrobial resistance is a major threat worldwide. WHO has developed a Global Action Plan and has urged all countries to develop and implement a National Action Plan. We analysed the implementation of the Cameroon National Action Plan by identifying the prioritised activities and assessing possible challenges which could limit implementation. METHODS We conducted a review of national documents on the control of antimicrobial resistance, including regulations, policies and guidelines and assessed the health system structure. Publications and other supporting documents were obtained by a systematic literature search. We applied the policy analysis triangle framework and the theory of change to analyse the National Action Plan, actors involved and the process of implementation. RESULTS The National Action Plan consisted of six strategic objectives, with the first five being a direct translation of the five pillars of the Global Action Plan. The related activities were to be implemented using a phased approach with allocated targets for each year. Several gaps were identified. There was no timeline of activities set per year, the chronology of activities was not consistent, there were no activities or objectives to ensure the sustainability of the National Action Plan like creating awareness on antimicrobial resistance and the indicators for impact evaluation were not included. Among the actors involved, the Ministry of Public Health had the highest interest in the implementation as the lead stakeholder to oversee the overall implementation. However, there was no clear source of funding, and stakeholders at the primary level of the various sectors responsible for implementation were not clearly defined. CONCLUSION Despite adequate multisectoral collaboration within the prioritised activities relevant to Cameroon, more is needed for effective implementation of the National Action Plan. The timeline of the different activities, as well as the involvement of key stakeholders at the primary level, needs to be improved. The government's overall commitment to healthcare should be increased and implementation of an action plan should commence at the district or regional level, while challenges in mobilising the necessary funds need to be overcome.

The challenges of land degradation, climate change and food insecurity have led to the introduction of conservation agriculture (CA) aimed at enhancing yield and soil quality. Despite positive biophysical results, low adoption rates have been the focus of studies identifying constraints to wider uptake. While the adoption framework is popular for measuring agricultural innovation, objective adoption measurements remain problematic and do not recognize the contextual and dynamic decision-making process. This study uses a technographic and participatory approach to move beyond the adoption framework and understand: (a) how agricultural decision-making takes place including the knowledge construction, (b) how agriculture is performed in a context of project intervention and (c) how practice adaptation plays out in the context of interacting knowledge. Findings confirm that farmer decision-making is dynamic, multidimensional and contextual. The common innovation diffusion model uses a theory of change, showcasing benefits through training lead farmers as community advocates and demonstration trials. Our study shows that the assumed model of technology transfer with reference to climate-smart agriculture interventions is not as linear and effective as assumed previously. We introduce four lenses that contribute to better understanding complex innovation dynamics: (a) social dynamics and information transfer, (b) contextual costs and benefits, (c) experience and risk aversion, and (d) practice adaptation. Investments should build on existing knowledge and farming systems including a focus on the dynamic decision process to support the 'scaling up, scaling out and scaling deep' agenda for sustainable agricultural innovations.

Educational preventing violent extremism (EPVE) programs have had (to date) little if any theoretical underpinning. Given their proliferation in jurisdictions such as Canada, Australia, the United Kingdom, and other European countries, such an absence is notable but not unexpected given the political sensitivities attached to them. These programs remain an emerging policy area which is still “finding its feet,” around which their legitimacy and efficacy is keenly debated. This paper argues for adopting theoretical principles drawn from information science research based upon information behavior models to provide a framework for the design and development of such programs and against which their efficacy can be tested. We demonstrate how this approach can be applied through thematic analysis of the theory of change models of EPVE programs implemented in England and Wales, designed to increase awareness and understanding of radicalization among young people, their carers, and professionals. This article is ground breaking and of international significance, being the first to apply learning from information science to practice in furthering policy goals around countering radicalization and extremism in the United Kingdom and other jurisdictions.

Conservation science needs more high-quality impact evaluations, especially ones that explore mechanisms of success or failure. Randomized control trials (RCTs) provide particularly robust evidence of the effectiveness of interventions (although they have been criticized as reductionist and unable to provide insights into mechanisms), but there have been few such experiments investigating conservation at the landscape scale. We explored the impact of Watershared, an incentive-based conservation program in the Bolivian Andes, with one of the few RCTs of landscape-scale conservation in existence. There is strong interest in such incentive-based conservation approaches as some argue they can avoid negative social impacts sometimes associated with protected areas. We focused on social and environmental outcomes based on responses from a household survey in 129 communities randomly allocated to control or treatment (conducted both at the baseline in 2010 and repeated in 2015-2016). We controlled for incomplete program uptake by combining standard RCT analysis with matching methods and investigated mechanisms by exploring intermediate and ultimate outcomes according to the underlying theory of change. Previous analyses, focused on single biophysical outcomes, showed that over its first 5 years Watershared did not slow deforestation or improve water quality at the landscape scale. We found that Watershared influenced some outcomes measured using the survey, but the effects were complex, and some were unexpected. We thus demonstrated how RCTs can provide insights into the pathways of impact, as well as whether an intervention has impact. This paper, one of the first registered reports in conservation science, demonstrates how preregistration can help make complex research designs more transparent, avoid cherry picking, and reduce publication bias.Mecanismos e Impactos de un Programa de Conservación Basada en Incentivos con Evidencias de un Ensayo Aleatorio de Control Resumen Las ciencias de la conservación necesitan evaluaciones de impacto de mayor calidad, especialmente aquellas que exploran los mecanismos del éxito o del fracaso. Los ensayos aleatorios de control (RCTs) proporcionan evidencias particularmente sólidas de la efectividad de las intervenciones (aunque han recibido críticas por considerarlas reduccionistas e incapaces de proporcionar conocimiento sobre los mecanismos) pero ha habido pocos experimentos de ese tipo que investiguen los efectos de la conservación a escala del paisaje. Exploramos el impacto de Watershared, un programa de conservación basada en incentivos en marcha en los Andes bolivianos, con uno de los pocos RCTs existentes de conservación a escala de paisaje. Existe un gran interés por dichas estrategias de conservación basada en incentivos pues hay quienes argumentan que pueden evitar los impactos sociales negativos que a veces se asocian con las áreas protegidas. Nos enfocamos en los resultados sociales y ambientales con base en las respuestas de una encuesta a hogares en 129 comunidades asignadas al azar para controlar o tratar (ambas encuestas realizadas en la línea base en 2010 y repetidas en 2015/16). Impusimos un control para la aceptación incompleta del programa al combinar el análisis estandarizado de RCTs con métodos de emparejamiento e investigamos los mecanismos mediante la exploración de resultados intermedios y finales de acuerdo con la teoría subyacente del cambio. Los análisis previos, enfocados en resultados biofísicos únicos, mostraron que durante los primeros cinco años del programa Watershared, la deforestación no experimentó una desaceleración y tampoco hubo mejoras en la calidad del agua a escala de paisaje. Descubrimos que Watershared influyó sobre algunos resultados medidos con la encuesta, pero sus efectos fueron complejos y algunos fueron inesperados. De este modo demostramos como los RCTs pueden proporcionar conocimiento sobre las vías de impacto, así como también si una intervención genera un impacto. Este artículo, uno de los primeros reportes registrados en las ciencias de la conservación, demuestra cómo el prerregistro puede ayudar a hacer más transparentes los diseños complejos de investigación, evitar la selección subjetiva de datos y reducir el sesgo de publicación.保护科学需要更多高质量的影响评估, 特别是那些探索成功或失败机制的评估。随机对照试验为探讨干预措施的有效性提供了稳健证据 (尽管被批评为简化方法且无法提供对机制的深入了解), 但在景观尺度上研究保护问题的此类试验还很少。我们探索了玻利维亚安第斯山脉基于激励措施的一项保护项目-Watershared 的影响, 它是目前少有的景观尺度保护的随机对照试验之一。人们对这种基于激励机制的保护方法很感兴趣, 因为一些人认为它们可以避免与保护区有关的某些负面社会影响。我们在 129 个社区通过随机分配对照组和实验组进行了家庭调查 (包括2010年基线调查和 2015/16 年重复调查), 重点关注该项目的社会和环境结果。我们通过结合标准随机对照试验分析与匹配方法来控制不完整的调查, 并根据变化理论来通过分析中间结果和最终结果确定了相应机制。之前的分析集中在单一生物物理的结果, 发现在最初的 5 年内 Watershared 项目并没有在景观水平上减缓森林砍伐或改善水质。而我们发现该项目影响了本调查关注的一些结果, 但影响是复杂的, 且有些影响超出预料。因此, 我们展示了随机对照试验如何帮助深入了解影响的途径及干预措施是否产生了影响。本论文作为保护科学中最早的登记报告之一, 展示了预登记如何有助于使复杂的研究设计透明化, 避免人为选取结果, 并减少论文发表的偏倚性。【翻译: 胡怡思; 审校: 聂永刚】.

Objectives\ud Globally, the number of people with dementia who have palliative care needs will increase fourfold over the next 40 years. The Empowering Better End‐of‐Life Dementia Care (EMBED‐Care) Programme aims to deliver a step change in care through a large sequential study, spanning multiple work streams.\ud \ud Methods\ud We will use mixed methods across settings where people with dementia live and die: their own homes, care homes, and hospitals. Beginning with policy syntheses and reviews of interventions, we will develop a conceptual framework and underpinning theory of change. We will use linked data sets to explore current service use, care transitions, and inequalities and predict future need for end‐of‐life dementia care. Longitudinal cohort studies of people with dementia (including young onset and prion dementias) and their carers will describe care transitions, quality of life, symptoms, formal and informal care provision, and costs. Data will be synthesised, underpinned by the Knowledge‐to‐Action Implementation Framework, to design a novel complex intervention to support assessment, decision making, and communication between patients, carers, and inter‐professional teams. This will be feasibility and pilot tested in UK settings. Patient and public involvement and engagement, innovative work with artists, policymakers, and third sector organisations are embedded to drive impact. We will build research capacity and develop an international network for excellence in dementia palliative care.\ud \ud Conclusions\ud EMBED‐Care will help us understand current and future need, develop novel cost‐effective care innovations, build research capacity, and promote international collaborations in research and practice to ensure people live and die well with dementia.

Over the last 20 years, the United States Agency for International Development (USAID) has supported conservation enterprises in an estimated quarter of its biodiversity programs to create incentives for stakeholders to reduce threats to biodiversity. These enterprises included timber and non‐timber forest products, and ecotourism services, among others. While reviews and guidance materials are available on the conditions needed to establish conservation enterprises, there is less information on what it takes to sustain enterprises and to achieve longer term conservation outcomes. USAID's Conservation Enterprises Learning Group developed a generic theory of change that outlines commonly held assumptions about the path from supporting enterprises to achieving biodiversity conservation. The theory of change provided a framework for cross‐site learning for past and current enterprise strategies supported by USAID. The learning group generated insights to help practitioners improve the design and implementation of this strategy, including using a monitoring and learning framework for practitioners to measure outcomes from their actions over time and share lessons with the conservation community. It is our hope that this framework will be useful for conservation organizations, funders, and researchers who are considering using, supporting, and assessing enterprises so that they can more effectively support conservation.

Objectives: DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) is designed to address fundamental, and, as yet unanswered, questions about inequalities, outcomes and costs following diagnosis with dementia. These answers are needed to improve the quality of care and equity of access to care, and therefore the quality of life, of people with dementia and their carers.\ud \ud Method: DETERMIND is a programme of research consisting of seven complementary workstreams (WS) exploring various components that may result in unequal dementia care:\ud WS1: Recruitment and follow-up of the DETERMIND cohort - 900 people with dementia and their carers from three geographically and socially diverse sites within six months following diagnosis, and follow them up for three years.\ud WS2: Investigation of the extent of inequalities in access to dementia care\ud WS3: Relationship between use and costs of services and outcomes \ud WS4: Experiences of self-funders of care \ud WS5: Decision-making processes for people with dementia and carers\ud WS6: Effect of diagnostic stage and services on outcomes \ud WS7: Theory of Change informed strategy and actions for applying the research findings\ud \ud Outcomes: During the life of the programme, analysing baseline results and then follow-up of the DETERMIND cohort over 3 years, we will establish evidence on current services and practice. DETERMIND will deliver novel, detailed data on inequalities in dementia care and what drives positive and negative outcomes and costs for people with dementia and carers, and identify factors that help or hinder living well with dementia.

Aim: To explore how participating in a randomised controlled trial affected motivation, barriers and strategies in the process of health behaviour change among individuals with prediabetes. Methods: An extension to the PRE-D trial, a qualitative study investigated the efficacy of glucose-lowering interventions (metformin, dapagliflozin or exercise) compared with a control group among individuals with prediabetes and overweight/obesity. Data were collected through separate focus group interviews with participants using semi-structured interview guides inspired by health behaviour change theories. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis with an inductive-deductive approach. Results: Four interrelated themes emerged from interviews: (1) 'self-construction of prediabetes', on how participants understood the term 'prediabetes', (2) 'altered health image', on how participants' health perceptions were affected, (3) 'personal strategies for health behaviour change', on different ways to attempt to implement behaviour changes and (4) 'the process of health behaviour change', on how participants progressed and relapsed while trying to change behaviour. Themes relate to the health belief model, self-determination theory, self-efficacy and the trans-theoretical model of change. Participants shared their experiences and thoughts during interviews and inspired each other, which led some participants to develop a new perspective on prediabetes severity and increased their motivation for behaviour change. Conclusions: How participants perceived and accepted, rejected or neglected prediabetes appeared to affect their health images and whether they realised a need for behaviour change. Their achievements during interventions, health literacy, self-efficacy and perceived support from their social networks, professionals and technological aids influenced the maintenance of health behaviour changes.

Background Midwifery continuity of care models are the only health system intervention associated with both a reduction in preterm birth (PTB) and an improvement in perinatal survival; however, questions remain about the mechanisms by which such positive outcomes are achieved. We aimed to uncover theories of change by which we can postulate how and why continuity of midwifery care models might affect PTB. Methods We followed Pawson's guidance for conducting a realist review and performed a comprehensive search to identify existing literature exploring the impact of continuity models on PTB in all pregnant women. A realist methodology was used to uncover the context (C), mechanisms (M), and outcomes (O) and to develop a group of CMO configurations to illuminate middle-range theories. Results Eleven papers were included from a wide variety of settings in the United Kingdom, Australia, and the United States. The majority of study participants had low socioeconomic status or social risk factors and received diverse models of midwifery continuity of care. Three themes-woman-midwife partnership, maternity pathways and processes, and system resources-encompassed ten CMO configurations. Building relationships, trust, confidence, and advocacy resulted in women feeling safer, less stressed, and more secure and respected, and encouraged them to access and engage in antenatal care with more opportunities for early prevention and diagnosis of complications, which facilitated effective management when compliance to guidelines was ensured. Organizational infrastructure, innovative partnerships, and robust community systems are crucial to overcome barriers, address women's complex needs, ensure quality of care, and reduce PTB risk. Conclusions Pregnant women living in different contexts in the United Kingdom, Australia, and the United States at low and mixed risk of complications and with low socioeconomic status or social risk factors experienced continuity models in similar ways, and similar underlying mechanisms may have influenced PTB outcomes. Further research is required to understand how continuity models may influence behavioral change, physiological stress levels, ethnic disparities in PTB and care coordination, and navigation of health services.

Background and Aims: \ud The Licensing Act 2003 deregulated trading hours in England and Wales. Previous evaluations have focused upon consumption and harm outcomes, finding mixed results. Several evaluations speculated on the reasons for their results, noting the role of changes in the characteristics of drinking occasions. This study aimed to test proposed mechanisms of effect for the Licensing Act 2003 by evaluating changes in characteristics of drinking occasions.\ud \ud Design, Setting and Participants: \ud \ud Interrupted monthly time–series analysis of effects in England and Wales versus a Scottish control series, using 2001–08 data collected via 7‐day drinking occasions diaries by the market research company Kantar (n = 89 192 adults aged 18+).\ud \ud Measurements: \ud Outcomes were start‐ and end‐time of each reported occasion; variation in finish time; prevalence of pre‐loading, post‐loading and late‐night drinking; and alcohol consumption (in units).\ud \ud Findings: \ud After the introduction of the Act, occasions shifted later at night in England and Wales [finish time +11.4 minutes; 95% confidence interval (CI) = 3.6–19.2]. More occasions involved pre‐loading in England and Wales relative to Scotland (0.02% increase; 95% CI = 0.01–0.03). There was no evidence of changes in variation in finish time, post‐loading, late‐night drinking or alcohol consumption.\ud \ud Conclusions: \ud The Licensing Act 2003 in England and Wales appears to have had only limited effects on the characteristics of drinking occasions. This may help to explain its lack of substantial impacts on alcohol harms

Objectives We describe a transdisciplinary theory of change for interventions to promote trauma recovery that utilizes an eco-social approach to enhance health status and well-being following trauma exposures. This four-level theory of change could be applied to other population health problems, as well. Methods This theory-development process included reviewing existing literature, identifying assumptions, defining core concepts, stating propositions, depicting concepts and propositions for clarity, and illustrating with case examples grounded in our focus on trauma. Results The resulting Eco-Social Trauma Intervention Model offers a framework for interventions that address the impact of trauma on the individual level through self-regulation, interpersonal level through relationships, community/organizational level through safety, and societal level through identities. Application of this model to intervention development for those affected by trauma is intended to promote resilience, recovery, posttraumatic growth, and positive adaptations to traumatic stress for populations, going beyond the current Western paradigm of treating individuals for psychopathology. Conclusions The Eco-Social Trauma Intervention Model offers an adaptable transdisciplinary framework for developing and researching scalable trauma interventions for individuals, communities, and populations.

Contemporary public policy increasingly emphasises a focus on outcomes, the difference that occurs in the lives of citizens from policy and activity of government. Other contemporary imperatives for effective planning include: recognition of the values of the community whom plans serve, direction towards goals and objectives, utilisation of evidence, articulation of theories of change that underpin planning and responsiveness to evaluation. This article reports a desk-based research project to assess how local government planning documents meet these imperatives. Two documents are examined for 67 councils across Australia: the major strategic document, council plan or other-named document and the cultural development plan (CDP) or other-named document that directs staff and investment aimed at cultural enrichment of the LGA. Findings indicate that the majority of councils documents appeared only concordant with one or two of these planning imperatives. No plan addressed more than three. Overall, council plans and cultural development plans did not clearly indicate their responsiveness to values of their communities, nor include objectives that formed measurable steps towards goals or formally refer to the use of evidence in decision-making. No plans included theories of change to underpin decision-making. This analysis indicates clear areas of improvement for planning for local governance.

Expansion of agricultural commodity production is driving rapid deforestation in tropical countries. Several strategies including jurisdictional planning and producer or sectoral‐level sourcing/certification have been used to counter this threat, each with its own limitations. There is growing interest in using jurisdictional sourcing (JS) as a hybrid that combines the best elements of each of these strategies. Specifically, JS involves bringing together key stakeholders in a given national or sub‐national political jurisdiction to agree on a land‐use plan that maintains forest ecosystems while promoting enhanced commodity production on degraded lands. Under JS, a key incentive for this agreement is the prospect of preferential sourcing from supply chain actors who want conversion‐free commodities. As with any conservation strategy, the key questions are what defines JS and under what conditions is it likely to work? To help address these questions, we convened a group of practitioners/experts to develop a theory of change that explicitly defines what JS entails from both the perspective of a given jurisdiction as well as a global markets point of view. We also developed generic objectives and indicators that can be used to measure performance. We then vetted our initial drafts with a wider circle of JS practitioners/experts as well as through a review of relevant literature and against seven case studies. It is our hope that this framework can be used to inform the collection of more standardized data across JS strategies being implemented in different locations and conditions. This data could, in turn, inform more systematic assessments of JS strategies and ultimately, revisions to this theory of change as our collective knowledge improves.

Efforts to shift unsustainable human behaviour are at the crux of many conservation interventions, particularly when addressing illegal or unsustainable wildlife trade. These efforts, often in the form of behaviour change interventions, have proven largely unable to counteract this pervasive issue, however, leading to calls for more robust intervention designs. In behavioural science fields like public health, design processes that integrate human behaviour theory and evidence from data collection are often developed to ground behaviour change interventions within a strong understanding of the context, thus supporting interventions that are efficient and have a higher likelihood of success. Here we detail the foundational process of designing an intervention around the use of a wildlife product by a particular group: Singaporean consumers of saiga horn (from the Critically Endangered Saiga tatarica). We employ both qualitative and quantitative data, along with human behaviour theories and past literature on the study system, to develop a comprehensive understanding of the many influences driving this target audience to purchase saiga horn products. We use this insight to identify the key influences to leverage in a behaviour change intervention: those that are both the most powerful and the most amenable to change. This work provides a reproducible process which can be used by other intervention implementers, highlights the often complex intricacies of socially influenced behaviour, and demonstrates why a methodical understanding of these intricacies is invaluable when attempting to shift human behaviour for conservation goals. A free Plain Language Summary can be found within the Supporting Information of this article.

Achieving conservation goals, such as coexistence between wildlife and humans, requires an evidence‐based understanding of the factors that shape conservation contexts. For addressing conflict between humans and wildlife, this means understanding the barriers and opportunities to changing human behaviors toward wildlife. Here, we develop a Theory of Change (ToC) to promote coexistence between livestock producers and dingoes in Australia. The ToC is based on behavior change principles and interdisciplinary research identifying four key stakeholder groups who may influence dingo management. It employs four overlapping strategies to address these barriers: (a) a media campaign to promote public awareness of dingo management practices, which may result in pressure upon governments to restrict lethal control; (b) promoting more inclusive decision‐making processes, specifically including Aboriginal Australians; (c) monitoring and evaluation of the effects of dingo management on livestock and ecosystems to identify opportunities for nonlethal dingo management; (d) campaign to encourage adoption of nonlethal management methods by livestock producers based on an understanding of sociopsychological factors that shape behaviors. The framework is a tool for conservation advocates and policymakers to implement and monitor change that facilitates both wildlife conservation and thriving rural communities.

Contemporary conservation must address social well-being while still protecting biodiversity. Accordingly, the objective of the Convention on Biological Diversity's recent Zero Draft Post-2020 Global Biodiversity Framework is to sustainably meet the needs of people while reducing biodiversity loss. However, frequent “failures” in achieving this social-ecological balance necessitates more holistic, systematic, and adaptive post-2020 conservation interventions. The Theory of Change (ToC) approach provides a useful and flexible tool to support this endeavor. However, debate persists over its usefulness, and “best” manner of use. This paper explores the elements of, and proposes a framework for developing robust conservation ToC pathways. The framework emphasizes the importance of producing a shared vision of desired results and actions, and associated causal assumptions, among actors. Furthermore, evaluation is considered key to informing required ongoing adaptation to better achieve desired results. The paper also critically explores the challenges associated with ToC, and makes recommendations for its improved use in post-2020 conservation. In particular, we aim to inform the implementation and mainstreaming of the Post-2020 Global Biodiversity Framework, especially at a national- and local-level. The framework and discussion should be relevant to a broad range of conservation actors at various scales that must address linked social and ecological objectives.

Conservation science needs more high-quality impact evaluations, especially ones that explore mechanisms of success or failure. Randomized control trials (RCTs) provide particularly robust evidence of the effectiveness of interventions (although they have been criticized as reductionist and unable to provide insights into mechanisms), but there have been few such experiments investigating conservation at the landscape scale. We explored the impact of Watershared, an incentive-based conservation program in the Bolivian Andes, with one of the few RCTs of landscape-scale conservation in existence. There is strong interest in such incentive-based conservation approaches as some argue they can avoid negative social impacts sometimes associated with protected areas. We focused on social and environmental outcomes based on responses from a household survey in 129 communities randomly allocated to control or treatment (conducted both at the baseline in 2010 and repeated in 2015-2016). We controlled for incomplete program uptake by combining standard RCT analysis with matching methods and investigated mechanisms by exploring intermediate and ultimate outcomes according to the underlying theory of change. Previous analyses, focused on single biophysical outcomes, showed that over its first 5 years Watershared did not slow deforestation or improve water quality at the landscape scale. We found that Watershared influenced some outcomes measured using the survey, but the effects were complex, and some were unexpected. We thus demonstrated how RCTs can provide insights into the pathways of impact, as well as whether an intervention has impact. This paper, one of the first registered reports in conservation science, demonstrates how preregistration can help make complex research designs more transparent, avoid cherry picking, and reduce publication bias.

It is nearly three decades since the world recognized the need for a global multilateral treaty aiming to address accelerating biodiversity loss. However, biodiversity continues to decline at a concerning rate. Drawing on lessons from the implementation of the current strategic plan of the Convention on Biological Diversity and the 2010 Aichi Targets, we highlight three interlinked core areas, which require attention and improvement in the development of the post‐2020 Biodiversity Framework under the Convention on Biological Diversity. They are: (1) developing robust theories of change which define agreed, adaptive plans for achieving targets; (2) using models to evaluate assumptions and effectiveness of different plans and targets; and (3) identifying the common but differentiated responsibilities of different actors/states/countries within these plans. We demonstrate how future multilateral agreements must not focus only on what needs to be done but also on how it should be done, using measurable steps, which make sense at the scales at which biodiversity change happens.

The use of celebrities in marketing campaigns is widespread globally, including in environmental conservation. Celebrity endorsements are pervasive, but there is limited evidence of their effectiveness. We conducted a review of celebrity‐endorsed environmental campaigns. We report on the extent to which celebrities have been used in these campaigns, whether evaluation of the endorsement has been conducted, and assess whether there is evidence that the celebrities achieved the objectives they set out to accomplish through their engagement. We searched the peer‐reviewed and grey literature in six languages from July 2018 to January 2019 and found 79 campaigns implemented in nine countries from 1976 to 2018. Two thirds of campaigns were implemented in China and reported in Chinese. Only four campaigns were evaluated, but none of the evaluations provided evidence of the effectiveness of celebrity endorsement. Evaluation focused instead on overall campaign outputs and outcomes. Claims of effectiveness were made, but the lack of measurable objectives, theory of change, outcome indicators, and critical evaluation renders it impossible to determine whether the outcomes achieved by the campaigns can be attributed to celebrity endorsement. It thus remains unclear whether celebrity endorsement can contribute to conservation efforts. It is essential for environmental practitioners and researchers to report the outcomes and lessons learned from celebrity endorsements to ensure that their future use in conservation marketing campaigns is evidence‐based, thereby improving conservation practice.

open access article Social innovation projects commonly refer to operationalized theories of change to inform strategy and to deliver intended outcomes. Community based sustainability campaigns, as one example, emphasize the elicitation of pro-environmental activities and decision-making among members of a host community, drawing on mainstream psychological theories of behaviour, motivation and cognitive (mental) processes. Locating an argument within the neurobiological base of structure determinism, this paper explores how theories of change for sustainability campaigns might be reimagined through the lens of enactive theory. Following a brief introduction to the enactive model of embodied cognition, implications associated with trying to operationalize the model to inform how theories of change are mapped out and used in sustainability initiatives are discussed. The paper concludes by drawing on insights from approaches to psychotherapy, which also endeavoured to apply this model of mind, and considers these within the strategic context of sustainability initiatives and public engagement.

Rural policy evaluation helps to understand the extent to which policies have met pre‐defined objectives, achieve value for money and learn from implementation failures. However, there is increasing debate over the quality of policy evaluation and the extent to which its methods can fully contribute to an understanding of rural policy. Responding to these calls, this paper employs a theory driven approach to policy evaluation to assess the social impacts of attempts to reduce animal disease on farms in England. Popular in other policy arenas, theory driven evaluation relies on developing a theory of change to examine the interactions between policy contexts and mechanisms and policy outcomes and determine what works for whom. Drawing on longitudinal qualitative and quantitative research, the paper identifies two mechanisms of change to evaluate the Badger Vaccine Deployment Project (BVDP) in England to reduce incidence of bovine Tuberculosis (bTB) in cattle. The papers shows how these mechanisms – ‘seeing is believing' and ‘practice similarity' – are triggered by different contextual factors leading to the failure to deliver expected policy outcomes. We also consider the advantages and limitations to theory based evaluation, and the contribution it can make to the evaluation of other rural development programmes.

There is now an extensive and highly developed literature within psychoanalysis on how best to understand the patients we work with, and their impact on the analyst or therapist, but far less on the mind of the clinician and how he or she thinks while working with the patient. One method for studying this, the Comparative Clinical Method developed by a group of European psychoanalysts, consists of a two step model: after a careful description of the interventions made by the analyst, an attempt is made to construct what is taken to be the analyst’s implicit working model, the internal template which he or she tacitly employs to conduct the analysis. In this paper I describe this model, which I then illustrate by taking a piece of published clinical material to show what an approach based on the Comparative Clinical Method might look like. Finally I make some comments on applying this model to the work of psychoanalytic psychotherapists.

To meet multiple environmental objectives, integrated programming is becoming increasingly important for the Global Environmental Facility, the financial mechanism of the Multilateral Environmental Agreements, including the UN Convention to Combat Desertification. However, integration is often not well defined. We therefore focus on identifying key aspects of integration and assessing their implementation in natural resources management projects. To that end, we draw on systems thinking literature and carry out an analysis of a random sample of Global Environmental Facility integrated projects and in-depth case studies demonstrating lessons learned and good practice. We highlight the need for projects to identify clearer system boundaries and main feedback mechanisms within those boundaries, in order to effectively address drivers of environmental change. We propose a theory of change for integrated natural resources management projects, where short-term environmental and socioeconomic benefits will first accrue at the local level. Implementation of improved integrated natural resources management technologies and practices at the local level can then be extended through spatial planning and strengthening of innovation systems. Financing and incentive mechanisms at the watershed and/or landscape/seascape level coupled with supporting policies could sustain and enhance ecosystem services at even larger scales and longer time spans. The evolving scientific understanding of factors influencing social, technical, and institutional innovations and transitions towards sustainable management of natural resources should be harnessed and integrated into influencing models and theory of change for complex social-environmental problems, such as land degradation, and be coupled with up-to-date approaches for learning, adaptive management, and scaling up. (Less)

ObjectivesInternational guidelines recommend that rehabilitation be offered to people with thoracic cancer to improve symptoms, function and quality of life. When rehabilitation interventions require a change in behaviour, the use of theory and behaviour change techniques (BCTs) enhance participation. Our objective was to systematically identify BCTs and examine their use in relation to the Capability, Opportunity, Motivation-Behaviour model and known enablers and barriers to engagement in this population.MethodBibliographic databases and grey literature were searched for controlled trials of rehabilitation interventions for adults with lung cancer or mesothelioma, with no limits on language or date. Data on the application of behavioural change theory and BCTs were extracted, categorized using the BCT Taxonomy (v1) and described according to the ‘Capability, Opportunity, Motivation-Behaviour’ model.ResultsTwenty-seven studies of exercise (n=15) and symptom self-management (n=12) interventions were identified. Four studies reported use of behavioural change theory, one study used symptom theory. Across studies, a mean (range) of 7 (1-18) BCTs were used, representing 26 of 93 possible BCTs included in the taxonomy. Most frequent enabling BCTs were ‘instructions on how to perform behaviours’ (74%), ‘behavioural practice’ (74%) and ‘action planning’ (70%). BCTs to address barriers were less frequent and included ‘information about health consequences’ (22%), and ‘verbal persuasion about capability’ (7%) to change perceptions about benefits, burden and harms.ConclusionThe application of behavioural change tools appears sub-optimal in this group of patients. Explicit use of BCTs targeting behavioural components upon which outcomes depend may improve the uptake and effectiveness of rehabilitation interventions.

The Princeton University Preparatory Program (PUPP) is a high-touch, intensive college access program aimed at providing a multiyear college preparation experience to high-achieving, low-income students in the Princeton, New Jersey, area. This report presents the theory of change and logic model of PUPP, detailing the theoretical basis for the expectation that PUPP inputs, resources, and activities will lead to the expected program outcomes, which include that program participants gain admittance to and graduate from selective colleges and universities providing comprehensive financial aid in the form of grants and scholarships.

This contribution critically assesses financial inclusion as an intervention in the development space. It examines the turn from microfinance to financial inclusion, with the introduction of new actors and practices; new ideas and ideologies; new theories of change; and new expectations toward clients. It then considers three key issues and contests the arguments made by proponents of financial inclusion about them: first, the argument that financial inclusion facilitates broader development outcomes; second, the claim that poor people gain poverty alleviation through financial inclusion; and third, the suggestion that financial inclusion is good business. In all three areas, the author highlights shortcomings in the evidence base and argues that high expectations of financial inclusion serving as a core pro†poor, private†sector led development intervention lack justification. Rather, financial inclusion should be recognized as a contested and contestable enterprise.

© 2017 The Authors Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd Background: Little progress has been made towards community participation of people with intellectual disability despite it being a policy aim since the 1980s. We aimed to identify the features of programmes designed to support community participation. Method: A scoping review was conducted of peer-reviewed literature between 2000 and 2015, about interventions to support community participation for adults with intellectual disability. Results: A small body of evidence relates to the design and effectiveness of interventions to enhance community participation. Seventeen studies reported programmes reflecting three conceptualizations of community participation (as social relationships, as convivial encounter and as belonging) that used strategies such as active mentoring, facilitative support worker practice and arts-based programmes. Conclusions: Studies showed the diverse and person-centred nature of community participation and demonstrated the need for larger-scale studies of promising interventions that include details of costs, and strategies to guide implementation of policies to support community participation.

Contains fulltext : 190759.pdf (Publisher’s version ) (Closed access) The complexity associated with how interventions result-or fail to result-in outcomes and how context matters is increasingly recognised. Logic models provide an important tool for handling complexity, with contrasting uses in programme evaluation and evidence synthesis. To reconcile these, we developed an approach that combines the strengths of both traditions, propose a taxonomy of logic models, and provide guidance on how to choose between approaches and types of logic models in systematic reviews and health technology assessments (HTA). The taxonomy distinguishes 3 approaches (a priori, staged, and iterative) and 2 types (systems-based and process-orientated) of logic models. An a priori logic model is specified at the start of the systematic review/HTA and remains unchanged. With a staged logic model, the reviewer prespecifies several points, at which major data inputs require a subsequent version. An iterative logic model is continuously modified throughout the systematic review/HTA process. System-based logic models describe the system, in which the interaction between participants, intervention, and context takes place; process-orientated models display the causal pathways leading from the intervention to multiple outcomes. The proposed taxonomy of logic models offers an improved understanding of the advantages and limitations of logic models across the spectrum from a priori to fully iterative approaches. Choice of logic model should be informed by scope of evidence synthesis, presence/absence of clearly defined population, intervention, comparison, outcome (PICO) elements, and feasibility considerations. Applications across distinct interventions and methodological approaches will deliver good practice case studies and offer further insights on the choice and implementation of logic modelling approaches.

To reduce health inequities, Chile´s Ministry of Health embarked on an ambitious process to implement policy redesign involving six public health programs that used a system-level theory of change. The process brought together a large and diverse group of national and local actors from within and outside the health sector organized in a network of program nodes, who worked together on well-defined tasks over the course of a year with high-level political and technical support. The tasks were part of a coconstructed stepwise assessment methodology, based on understanding and testing program theory and uncovering theories of inequities, drawing on realistic evaluation approaches, the social determinants of health framework, and models of effective program coverage. Almost simultaneously, the program nodes proposed new program theories to address equities with an implementation strategy, which necessarily engaged other sectors and community actors. This chapter highlights some of the lessons to explain the success of Chile´s redesign process: (a) the diversity of knowledge and experiences across nodes enriched and enabled system-level change, (b) the key distinction between theory of change and theory of inequities required to address inequities, and (c) the long-lasting transformative capital for institutional change of training a network of agents for change.

This paper describes an evaluation experiment conducted in China between 2013 and 2016 to use evaluative thinking and evaluation approaches to help build the salience of health equity as a performance measure for health systems. This project was informed by a realist evaluation approach that sought to understand the context, mechanisms, and outcomes underlying health inequities. This chapter describes a theory of change that includes descriptions of the key actors involved in the project, the mechanisms of impact, and short- and long-term outcomes. Key questions that could help assess the impact of this project are also discussed. This paper contributes to the literature on building evaluation capacity for health inequities.

Gaps in education attainment between high and low achieving children in the primary school years are frequently evidenced in educational reports. Linked to social disadvantage, these gaps have detrimental long-term effects on learning. There is a need to close the gap in attainment by addressing barriers to learning and offering alternative contexts for education. There is increasing evidence for beneficial impacts of education delivered outdoors, yet most programmes are un-structured, and evidence is anecdotal and lacks experimental rigour. In addition, there is a wealth of social-emotional outcomes reported yet little in the way of educational attainment outcomes. The current study explores the educational impact of a structured curriculum-based outdoor learning programme for primary school children: ‘Wilderness Schooling’. A matched-groups design: Wilderness Schooling (n=223) and conventional schooling (n=217), was used to compare attainment data in English reading, English writing and maths, collected at three time-points: Pre- (T1) and post-intervention (T2) and at a 6-week follow up (T3). Data show that children in the Wilderness Schooling group significantly improved their attainment in all three subjects compared to controls. Trajectories of impact indicated attainment continued to increase from baseline in the following weeks after the intervention concluded. These results allow the case to be made for the core curriculum to be conducted outdoors to improve children's learning. However, it is important to consider that there are likely to be various components of the intervention that could form a theory of change essential to reported outcomes.

Given the growing popularity of the social accountability approach to governance, we developed and tested measures of governance outcomes to evaluate maternal and reproductive health social accountability interventions. We articulate a theory of change for how CARE's Community Score Card©, a social accountability approach, 1) empowers women, 2) empowers health workers and 3) creates expanded, inclusive and effective spaces for the two to interact. Our measures worked well in surveys of women and health workers. For women, eight of 13 scales had alphas ≥.70. For health workers, five of 11 scales were ≥.70; four were .60–.69. To our knowledge, this is the first attempt to develop comprehensive measures of governance outcomes to evaluate a social accountability approach for maternal and reproductive health.

Comprehensive reviews of health system strengthening (HSS) interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. We reflect on the process of undertaking such an evidence review recently, drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. The key elements of a clear definition include, in our view, consideration of scope (with effects cutting across building blocks in practice, even if not in intervention design, and also tackling more than one disease), scale (having national reach and cutting across levels of the system), sustainability (effects being sustained over time and addressing systemic blockages), and effects (impacting on health outcomes, equity, financial risk protection, and responsiveness). We also argue that agreeing a framework for design and evaluation of HSS is urgent. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spillover effects and their contribution to meeting overarching health system process goals. We make some initial suggestions about such goals, to reflect the features that characterise a "strong health system." We highlight that current findings on "what works" are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to rethink evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks, and methods can support more coherent HSS investment.

Through an analytic autoethnography, the authors detail an experience of confrontation within the context of supervision of supervision. In the coconstructed narrative, the authors describe the events taking place before, during, and after the confrontation experience from the perspective of both the faculty supervisor and beginning doctoral-level supervisor. Finally, the authors provide an analysis of the narrative based in supervisory models and theories of change.

In recent decades, the use of evaluation has been one of the main concerns of both academics and practitioners, and there has been much controversy throughout the evaluation literature. Different perspectives of evaluation can determine the way evaluation findings are used and the contribution of evaluation to individual and organizational learning is conditioned by stakeholder participation. In this article, our main hypothesis is that stakeholder participation increases evaluation significance, ownership and utilization and, as a consequence, participatory evaluation approaches improve programme governance. We focus on the evaluation of the Rural Sustainable Development Plan in the Basque Country, a context that reveals a complex institutional network (at regional and local level) with a limited tradition of evaluation. To enhance the full scope of participatory evaluation, this article: (i) briefly reviews the theoretical discourse on evaluation utilization; (ii) describes the evaluation context (rural development policy and its governance); (iii) presents the evaluation model as applied to the mid-term evaluation of the Basque Rural Sustainable Development Plan; and (iv) analyses the use of the evaluation findings and processes according to four dimensions, namely information generation, knowledge generation, orientated-action utilization and orientated-policy utilization. Finally, we provide guidance to improve knowledge about evaluation use, participation and good governance, which could be all considered as basic tools for solid institutionalization of sustainable development strategies. Copyright © 2016 John Wiley & Sons, Ltd and ERP Environment