Abstract / Summary
Abstract Background Supportive supervision is widely used to improve malaria case management, but it is a complex intervention whose effects depend on how supervision is organised, resourced, perceived and embedded in routine health systems. Realist evaluation can help explain how and why such programmes generate outcomes across contexts, yet the retroductive reasoning used to develop realist programme theories is often insufficiently visible in published reports. This article describes how a multinational team operationalised collaborative retroductive analysis within a realist evaluation of malaria supportive supervision in Benin and Tanzania. Methods A mixed-methods realist evaluation of supportive supervision programmes for malaria case management was conducted by researchers from Benin, Tanzania, and the United Kingdom. To address concerns about how different researcher backgrounds and perspectives might influence programme theory development, the team developed and implemented a collaborative approach to retroductive analysis. Results The retroductive analytical process involved two phases and eight distinct stages. Across them, the team moved iteratively from engagement with empirical patterns, through abductive generation and comparison of plausible causal explanations, to retroductive scrutiny and refinement of hypothesised mechanisms and CIAMO configurations. The process also integrated insights from discussions among the research team, feedback from data collectors and input from key stakeholders, supporting the development of a refined and contextually appropriate programme theory. The resulting theory identified affective attitude, self-efficacy and perceived burden as key mechanisms whose activation depended on programme integration, regular supervision by appropriate supervisors, coaching and supervisor–supervisee collaboration. From the team’s perspective, this approach supported continuity, coherence and a shared understanding of data and results. Conclusions The approach offers practical lessons for researchers and programme evaluators working on supportive supervision, malaria case management and other complex health-system interventions in low- and middle-income countries, as well as for those conducting realist evaluations and developing programme theories in other fields.