26 The evaluation of these individual policy interventions is important to determine their effectiveness to document the case for extending programmes to other jurisdictions, to aid in refining programme implementation and to monitor the possibility of inadvertent consequences.
Given the few published papers that document the process of developing and refining programme theories, this paper presents methodological guidance for authors using this approach in public health research.
In Namy et al.'s (this issue) case, they reflect on lessons learned through the implementation of the Young Men Initiative in the Balkans, highlighting the need continually to refine programmes and strategies for engaging young men.
We describe the initial development stages; (1) existing evidence, (2) large scale opinion gathering and (3) developmental qualitative work, aiming (A) to gain insight into how to increase PA among the whole of year 9 (13 14 years-old) by identifying elements for intervention inclusion (B) to improve participant engagement and (C) to develop and refine programme design.
However, as we pointed out above, the aim of this study was not to end up with a final middle range theory explaining why and how primary health-care teams learn to respond to IPV, but rather to come up with refined programme theory that could be a better starting point for future cycles of realist evaluations.
Sixthly, specific data on the scope of the budgetary barriers and logistic issues (i.e. the locations of AED placement, training schedule for teachers) in implementing and refining AED/CPR programmes at the national level in Japan is unavailable.
The refining of the programme theory, starting from the initial programme logic of the designers, to a refined programme theory incorporating insight from literature, design of the programme, and its implementation context, is explained elsewhere [ 41].
This evaluation helped by providing inputs for refining the programme.
Building and refining the programme theory helped to make our assumptions clear and to better take them into account in the data collection and analysis phase.
The results of this study have highlighted the important contribution that formative research can make in informing and refining a programme to increase appropriateness and effectiveness.
