Table 1 Core components of Theory of Change (ToC, adapted from De Silva et al. [16])

Impact and ceiling of accountability

The impact is the ultimate outcome or goal the project seeks to achieve. The impact is delineated from the long-term outcome by the ceiling of accountability. After this point, the intervention on its own is no longer responsible for achieving the stated impact.

Improved well-being of people with mental health conditions in the metropolitan area

Outcomes

Outcomes (short-term, intermediate or long-term) are the intended results of the intervention that need to occur in order to achieve the intended impact. They are connected via logical causal pathways (indicated in the ToC map by arrows). The final or long-term outcome is the last one the programme is able to influence on its own before reaching the ceiling of accountability.

(Short-term) Sufficient number of mental health professionals recruited to cover the metropolitan area

(Intermediate) Improvement in knowledge, attitudes and practices related to recovery among mental health professionals in the metropolitan area

(Long-term) Improvement in well-being scores of people with mental health conditions receiving professional care in the metropolitan area

Interventions

These are the different components of the complex intervention.

Training for mental health professionals on recovery

Assumptions

Assumptions describe external conditions that must exist for the outcome to be achieved but lie beyond the control of the project.

Mental health professionals are sufficiently motivated to actively participate in training.

Indicators

Indicators are a targeted way of measuring each outcome in order to verify whether or not it has been achieved.

Mean difference in pre- and post-training scores among participating mental health professionals

Rationales

Rationales provide explanation for why one outcome follows another or why certain actions must be taken to achieve the desired outcome. They may be based on evidence or experience.

(Experience) Mental health professionals have identified a lack of training as one of the main barriers to delivering recovery-oriented care.

(Evidence) Randomised controlled trials have shown recovery-oriented care to be effective in improving well-being, when compared to usual care provided by mental health professionals.