Lessons Learned From the Use of the Most Significant Change Technique for Adaptive Management of Complex Health Interventions

Figures & Tables

TABLE.

Definitions of The Challenge Initiative’s 4 Domains for Sustainable Scale-Up^a

Domain of Change	Definition
Knowledge, attitudes, practice	The progression from awareness of an innovation, to forming positive attitudes about the innovation, to the adoption of knowledge for decision-making purposes or for application in practice and policy.
Political and financial commitments	The multidimensional nature of political commitment is usually captured through the level of spending on intervention since it requires action by both the executive and legislative branches of government—implying commitment of funds and establishment of enabling policies. Statements of leaders are also commonly examined to measure political commitment.
Systems	The building blocks that make health systems function well: leadership and governance, health workforce, medical products and technologies, information and research, including data demand and use.¹²
Access and quality	Elements that impact access to family planning services, such as geographic distance, economic, administrative, awareness of services, and psychosocial issues (e.g., individual attitudes or social norms). Elements that impact the quality of services, such as choice of methods; appropriate client-provider interaction; and availability of competent providers, space, and an appropriate constellation of services.¹³

↵^a The definitions are adapted from The Challenge Initiative’s Global Toolkit on Most Significant Change, Step 2: Selecting the Most Significant Stories (https://tciurbanhealth.org/courses/program-design/lessons/most-significant-change/).