The research, conducted by Mithun Raj and Maneesha Vinodini Ramesh of Amrita Vishwa Vidyapeetham together with Saket Pande of Delft University of Technology, draws on survey data from 54 rural communities in India. Rather than treating the social and political environment as a fixed backdrop, the team asked a more dynamic question: do external events — political transitions, national missions, public health crises, natural hazards — actually change the psychological machinery that drives households to adopt community-based water purification technology? Their answer is a clear yes, and it challenges the linear behavioural models that underpin much of water security planning.

The analytical core of the study is a two-stage exploratory regression framework. In essence, the researchers first examined how standard psychological determinants — trust, risk perception and social norms — predicted adoption across the pooled dataset. They then re-examined those relationships within the periods defined by distinct external events, testing whether the strength and even the direction of the associations shifted. This design allowed them to separate what they call active contextual moderators from static factors: variables that do not merely sit in the background but actively rewire the pathways between what people believe and what they do.

The results are striking in their asymmetry. Different categories of exogenous events were associated with divergent behavioural pathways. A policy shift, such as the rollout of a large-scale national initiative like the Jal Jeevan Mission, did not influence adoption in the same way as a natural hazard or a public health emergency. In some cases the predictive strength of a psychological driver grew markedly during a shock; in others it weakened or reversed in sign. Trust in the technology and its operators, the perceived risks of untreated or purified water, and the pull of what neighbours and community leaders were doing all proved to be unstable quantities — sensitive to the moment in which they were measured.

This instability is what the authors describe as emergent behaviour. In complex systems, emergence refers to patterns that arise from the interaction of many components and cannot be predicted by examining any single component in isolation. Applied here, the idea is that technology adoption in a village is not the simple sum of individual attitudes. It is a collective outcome that co-evolves with the shocks the community experiences. A flood, an election or a national campaign does not just add or subtract a fixed amount of motivation; it changes the rules by which motivation translates into action.

The practical implications reach well beyond India’s water sector. Development programmes routinely invest heavily in identifying the psychological levers of behaviour change — building trust, communicating risk, harnessing social norms — and then assume those levers will keep working as designed. The study’s findings suggest that assumption is fragile. An intervention calibrated during a period of stability may lose its predictive power the moment a crisis arrives, and one designed in the shadow of a crisis may misfire once normality returns. Flexibility, the authors conclude, is not a luxury but a requirement: water security interventions must be able to adapt as community responses vary alongside systemic volatility.

To capture this, the team proposes an Enhanced Theory of Change, a framework that explicitly distinguishes active contextual moderators from static factors and models adoption as a non-linear, emergent response rather than a straight-line progression. In conventional programme design, a theory of change typically maps inputs to outputs through a chain of assumed causal steps. The enhanced version instead treats the causal chain itself as something that can be reconfigured by external events, with the magnitude and direction of established psychological associations shifting as conditions change. This makes the framework less elegant on paper but considerably more honest about how behaviour unfolds in the real world.

The study also carries a methodological message for researchers. Exploratory regression applied in stages — first across the whole sample, then within event-defined windows — offers a template for detecting these shifts without requiring enormous datasets or exotic machinery. It is an approach that other teams studying technology adoption, from cookstoves to solar irrigation pumps, could adapt to test whether their own behavioural predictors are as stable as they assume. The authors’ collaboration, part of the Joint Center of Excellence in Water Sustainability between Amrita Vishwa Vidyapeetham and Delft University of Technology and supported by the E4LIFE International Ph.D. Fellowship Program, reflects the blend of field immersion and hydrological modelling that such work demands.

For the communities themselves, the stakes are concrete. Community-based water purification is a cornerstone of safe drinking water strategies in rural India, and a plant that stands idle because adoption stalled after an unanticipated shock represents wasted investment and continued exposure to waterborne disease. Understanding that a natural hazard can erode trust, or that a national mission can amplify the influence of social norms, gives programme designers a way to anticipate these turning points rather than discover them in retrospective evaluations. Timing, sequencing and the capacity to re-engage a community after a disruption become as important as the technology itself.

The broader lesson is one that resonates across sustainability science: context is not scenery. The environments in which behaviour change is attempted are volatile systems, punctuated by shocks that can redirect the very pathways interventions are built upon. By modelling adoption as an emergent, non-linear response — and by treating events like policy shifts and natural hazards as active moderators rather than noise — this study offers a more realistic, and ultimately more useful, picture of how rural communities come to embrace the technologies meant to secure their water. In a decade that will test water systems with climate extremes and political change alike, that realism may prove to be the most valuable technology of all.

Subject of Research: How exogenous events and emergent behaviour shape community adoption of water purification technology in rural India

Article Title: Emergent behaviour and the adoption of community-based water purification technology in rural India

Article References: Raj, M., Pande, S., & Ramesh, M. V. (2026). Emergent behaviour and the adoption of community-based water purification technology in rural India. Discover Sustainability. https://doi.org/10.1007/s43621-026-04452-7

Image Credits: AI Generated

DOI: 10.1007/s43621-026-04452-7

Keywords: water purification, rural India, technology adoption, emergent behaviour, exogenous shocks, trust, risk perception, social norms, Jal Jeevan Mission, theory of change, water security, behavioral economics

The team did not build their framework from scratch. Instead, they assembled it from a substantial body of prior work, drawing on previous studies and two scoping reviews that mapped what is already known about youth engagement in agriculture and food systems. Crucially, they also consulted stakeholders, grounding the resulting theory in the lived realities of the people and institutions it is meant to serve. This combination of systematic evidence synthesis and participatory consultation is what gives the Change Theory its practical ambition: it is intended not as an abstract model but as an initial starting point that can be adapted and contextualised to guide the design of real interventions on the ground.

At the heart of the framework is a proposal that transformation requires simultaneous change in four interlinked domains. The first covers knowledge, awareness, attitude and skills, the human capabilities that determine whether young people can actually participate in modern agri-food value chains. The second is political will, the commitment among leaders and institutions to prioritise youth in decision-making and resource allocation. The third is policies, the formal rules and programmes that either open doors or quietly close them. The fourth is partnerships, the collaborative arrangements among governments, private sector actors, civil society, researchers and young people themselves that determine whether good intentions translate into coordinated action.

What makes the theory distinctive is its insistence that these four domains are mutually reinforcing rather than independent. Training young people in agronomic or entrepreneurial skills, for example, achieves little if policies continue to deny them access to land, credit or markets. Conversely, well-drafted youth policies remain paper promises without the political will to fund and implement them, and without partnerships that connect young producers to information, technology and buyers. The authors argue that interventions targeting any single domain in isolation are likely to fail, because the systemic barriers that hold youth exclusion in place operate across all of them at once.

This systems perspective matters because agri-food systems in sub-Saharan Africa face mounting pressure. The region must feed a growing population while confronting climate change, environmental degradation and persistent food insecurity, all amid some of the highest youth unemployment rates in the world. Agriculture and related food industries remain among the largest potential sources of livelihood for young Africans, yet outdated perceptions of farming as low-status, low-return work, combined with structural barriers, keep many young people on the sidelines. The Change Theory positions youth not as beneficiaries to be helped but as agents whose participation is essential to achieving broader transformation.

The framework explicitly links youth empowerment to the United Nations Sustainable Development Goals, identifying five in particular: SDG 2 on zero hunger, SDG 8 on decent work and economic growth, SDG 10 on reduced inequalities, SDG 13 on climate action, and SDG 17 on partnerships for the goals. This alignment is more than rhetorical. By tracing how change in each of the four domains contributes to these global targets, the theory gives governments and development partners a way to argue for youth-focused investment in the language of international commitments, and a logic for measuring whether that investment is actually moving the needle on hunger, jobs, inequality and climate resilience.

One of the most practically valuable elements of the study is its attention to institutional arrangements. The authors highlight that even well-designed policies frequently stumble at implementation, undermined by challenges within the institutions responsible for delivering them. Weak coordination between ministries, fragmented donor programmes, limited accountability mechanisms and inadequate feedback from young people themselves can all erode the efficiency and effectiveness of policies on the ground. The Change Theory is designed to illuminate these pathways of failure in advance, offering implementers a structured way to anticipate where interventions will encounter institutional friction and to design around it.

The emphasis on context-specificity is equally important. Sub-Saharan Africa is not a monolith, and the constraints facing a young woman seeking to launch an agribusiness in a rural district may differ sharply from those facing an urban graduate interested in food processing or digital agriculture services. The authors stress that their theory provides a starting framework rather than a fixed prescription, and that it must be contextualised for particular countries, value chains and communities. In practice, this means that applying the Change Theory begins with diagnosis: identifying which of the four domains is most binding in a given setting, and how the domains interact locally.

For researchers, the framework opens a clear agenda. Because the theory is built from scoping reviews and stakeholder consultations, its propositions are testable and refinable. Future work can examine which combinations of interventions across the knowledge, political, policy and partnership domains produce the strongest and most durable gains in youth participation, and how those combinations vary across contexts. For practitioners, the theory offers a shared map that can align the efforts of governments, NGOs, financiers and youth organisations around a common understanding of what transformation requires, reducing the duplication and contradiction that often plague youth-focused programming.

Ultimately, the study’s central message is that youth inclusion in agri-food systems demands a systematic, integrated and coordinated strategy rather than piecemeal projects. Collaboration among stakeholders across every aspect that affects youth well-being, development and empowerment is not an optional extra but the operating condition for success. If the authors are right, the question facing the continent is not whether young people can transform agriculture and food systems, but whether governments, institutions and partners will transform the structures around them quickly enough to let them try. The Change Theory offers a rigorous, evidence-based starting point for answering that question with action.

Subject of Research: A theory of change for youth inclusion and empowerment in agri-food systems in sub-Saharan Africa

Article Title: Developing transformative pathways for youth inclusion and empowerment in agri-food systems: A change theory

Article References: Geza, W., Ngidi, M. S. C., Slotow, R., Sobratee-Fajurally, N., & Mabhaudhi, T. (2026). Developing transformative pathways for youth inclusion and empowerment in agri-food systems: A change theory. PLOS Sustainability and Transformation, 5(6), e0000255. https://doi.org/10.1371/journal.pstr.0000255

Image Credits: AI Generated

DOI: 10.1371/journal.pstr.0000255

Keywords: youth empowerment, agri-food systems, sub-Saharan Africa, theory of change, Sustainable Development Goals, food security, youth unemployment, policy implementation, stakeholder partnerships, agricultural transformation, PLOS Sustainability and Transformation, Developing

The research, conducted by an international team led by Seema Rajesh Rao of Manipal Academy of Higher Education in India alongside collaborators from the United Kingdom, the United States and Canada, was undertaken as part of the Lancet Oncology Commission on the human crisis of cancer. Its starting point is grim arithmetic. The Lancet Commission on Palliative Care and Pain Relief has estimated that more than 90 percent of patients dying from cancer experience serious health-related suffering, a term encompassing severe physical, psychological and social distress. The global burden of this suffering is projected to double by 2060, and while it may slow or plateau in wealthy nations by mid-century, the end of life in many poorer countries remains marked by unrelieved pain. Catastrophic out-of-pocket spending on cancer treatment deepens the damage, pushing families into poverty, reducing workforce participation and amplifying caregiver burden.

To chart a way forward, the team turned to a methodology borrowed from social policy and evaluation science: the theory of change framework. Rather than prescribing solutions from the top down, theory of change works backwards from a desired long-term goal, mapping the intermediate outcomes, preconditions, interventions and assumptions that must line up for that goal to be achieved. It is a technique designed for complex social problems, where simple cause-and-effect logic fails. The researchers convened 21 stakeholders from 12 countries across Asia, Africa and South America—physicians, nurses, public health experts and community participants, all with hands-on experience building or delivering palliative care in their regions. Over three months, the group took part in eight facilitated virtual workshops, each lasting more than two hours and devoted to a specific component of the causal pathway: impact, long-term outcomes, interventions, preconditions and assumptions.

The workshops were deliberately participatory. Facilitators presented evidence from a framework synthesis of palliative care in low-resource settings, existing models from around the world, and worked examples of theory of change maps, but the content itself was generated and refined by the stakeholders. Transcripts, chat logs, facilitator notes and email contributions were analysed iteratively and by consensus, with concepts sorted into the framework’s components and their relationships mapped into a causal diagram. The final product was a roadmap containing 14 preconditions, 21 interventions and 12 assumptions, all arranged along a pathway leading from concrete actions to a single, agreed impact: the development of comprehensive, sustainable and culturally relevant palliative care capable of easing cancer-related suffering in low- and middle-income countries.

One finding stood above all others: integration. The stakeholders concluded that palliative care cannot be built as a parallel, standalone service in settings where specialist teams are scarce and budgets are thin. Instead, it must be embedded within existing health systems, with core palliative care competencies distributed across primary care, oncology and other frontline services, while specialist teams support complex cases and provide systems leadership. This tiered model echoes evidence from high-income countries, where landmark randomised trials such as those led by Jennifer Temel and Camilla Zimmermann showed that early palliative care integrated alongside oncology treatment improves quality of life and, in some cases, even survival. But the study’s authors are careful to note that evidence from wealthy nations cannot simply be transplanted, because patient demographics, healthcare delivery models and societal values differ profoundly.

The systems thinking lens the researchers applied to their findings reveals why piecemeal interventions so often fail. Viewed as a complex adaptive system, palliative care development in poorer countries depends on a dense web of interacting factors: health beliefs, socioeconomic conditions, workforce capacity, medication access and health policy. Consider opioid access, one of the most glaring inequities in global cancer care. Restrictive opioid policies breed fear of opioids among clinicians and caregivers, which suppresses prescribing and consumption. With fewer people using these medicines, the access problem loses political salience, weakening the impetus for reform. The result is a self-reinforcing feedback loop in which restrictive policies perpetuate themselves. The study argues that meaningful change requires identifying and reconfiguring such feedback loops rather than tinkering with isolated components—a conclusion with implications far beyond pain management.

The roadmap’s architects also distinguished three attributes that any successful model must embody. Comprehensiveness means multidimensional, patient- and family-centred care enabled by timely referrals and seamless collaboration among oncology, palliative and primary care teams, together with equitable access to essential medicines, caregiver support and attention to the quality of death and dying. From a systems perspective, comprehensiveness is an emergent property: it arises only when policies, funding mechanisms, workforce capacity, referral systems and supply chains are structurally and functionally aligned. Sustainability, meanwhile, was described as the foundational backbone of the entire enterprise. Without robust national policies, budget allocations, effective governance and political and legal commitment at the macro level, interventions at the clinic and community levels remain vulnerable to collapse. Cultural relevance formed the third pillar, recognising that care must resonate with local values, health beliefs and community practices to be accepted at all.

Culture, in fact, emerged as an embedded determinant influencing system behaviour at every level. How people experience illness, make decisions, communicate prognosis, express grief and assign responsibility for caregiving is shaped by social norms and community practices. In many low- and middle-income countries, families and clinicians collude to withhold diagnoses from patients, a practice that obstructs advance care planning and early referral. Opiophobia is prevalent among both providers and the public, and beliefs in traditional or alternative medicine shape health-seeking behaviour. The study’s authors contend that for palliative care interventions to endure, they must be informed by local customs, delivered in culturally sensitive ways, championed by communities themselves and structured around local resource constraints. Notably, the resulting roadmap aligns closely with the World Health Organization’s six essential components of palliative care development—service integration, policy, education, medication availability, research and community empowerment—but extends that model by showing how the elements interact dynamically within real health and social systems.

The study is not without limitations. The virtual format may have dulled the quality of interaction, attendance was inconsistent, and South Asia was overrepresented relative to Eastern Europe and the Pacific. English proficiency was an inclusion criterion, introducing potential selection bias, and the sheer heterogeneity of low- and middle-income countries limits how far the findings can be generalised. Yet the participatory design, spanning three continents and multiple disciplines, produced a roadmap that its authors describe as contextually grounded, acceptable and actionable. The team situates its ceiling of accountability—the point beyond which external forces dominate—between long-term outcomes and ultimate impact, acknowledging that national policies, armed conflict, forced displacement, humanitarian emergencies, natural disasters and economic shocks all lie beyond the reach of any single intervention. The next step, the researchers say, is to test the roadmap’s feasibility, acceptability and impact across diverse settings. If it works, the payoff could be immense: a future in which a cancer diagnosis in the world’s poorest countries no longer condemns patients to a death defined by preventable pain.

Subject of Research: Palliative care development and health system integration to reduce cancer-related suffering in low- and middle-income countries

Article Title: Palliative care development as a solution to mitigate the human crisis of cancer in low- and middle-income countries: a theory of change approach

Article References: Rao, S. R., Atreya, S., Mathew, M., Rao, A. P., Walshe, C., Preston, N., Simha, S., Sullivan, R., Rosa, W. E., Rodin, G., & Salins, N. (2026). Palliative care development as a solution to mitigate the human crisis of cancer in low- and middle-income countries: a theory of change approach. Supportive Care in Cancer, 34(11), Article 1080. https://doi.org/10.1007/s00520-026-11306-5

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11306-5

Keywords: palliative care, cancer, low- and middle-income countries, theory of change, health systems, serious health-related suffering, opioid access, systems thinking, global health equity, Lancet Oncology Commission, cultural relevance, health policy

The study, led by Rupak Goswami of Ramakrishna Mission Vivekananda Educational and Research Institute in Kolkata, together with colleagues at the International Rice Research Institute, does not offer a shiny new metric. Its central claim is architectural. The authors propose a three-layer framework that wires together three well-established methods—fuzzy cognitive mapping, small-wins tracking and social network analysis—into a single evaluative system in which each layer’s outputs systematically inform the others through periodic stakeholder learning cycles. The integration, they argue, is what is novel, not the parts.

The problem the framework addresses is rooted in the nature of participatory change itself. Interventions premised on co-production do not follow linear cause-and-effect chains. Outcomes emerge through interactions among diverse actors, evolving relationships, local interpretations and iterative learning. Under those conditions, no single form of evidence can capture every dimension of change. How stakeholders understand causal pathways, how they experience change in their daily lives, and the social relationships through which innovation actually spreads all reveal different facets of the same process. Conventional monitoring, evaluation and learning approaches, the authors contend, rarely move beyond token stakeholder participation, which makes the transformative potential of participatory work difficult to define, measure and communicate to the donors and communities who underwrite it.

The framework’s first, cognitive layer connects a stakeholder-owned Theory of Change with participatory fuzzy cognitive mapping, or FCM. A Theory of Change here is not a static diagram but a deliberative, evolving explanation of how and why change is expected to occur, complete with its assumptions and competing interpretations. FCM formalises selected causal propositions from that explanation: nodes represent components of the Theory of Change, while weighted edges capture stakeholders’ elicited judgements about the direction and strength of causal influence. Crucially, the authors treat those edge weights as stakeholder judgements that can generate propositions for further examination, not as settled causal mechanisms. The maps can be simulated under changing assumptions and updated as feedback evolves, allowing stakeholders to add, remove or re-link concepts as the project unfolds.

The second, reflective layer draws on Small Wins Theory, the idea, famously articulated by organisational psychologist Karl Weick, that large social changes often arise from incremental progress rather than single breakthroughs. In this framework, small wins are tracked alongside formal monitoring indicators, pairing subjective reflection with measurable benchmarks. But the authors are careful to avoid a seductive trap: small wins are not transformations in miniature, and their accumulation is not assumed to produce transformation automatically. A small win becomes relevant to a transformative trajectory only when it alters the conditions for subsequent action—for example by strengthening collective capacities, changing decision rights, generating institutional commitments or redistributing access to resources. Evaluation therefore asks whether small wins remain isolated or become reinforced, extended and institutionalised over time.

The third, relational layer deploys social network analysis to trace how connections among actors evolve. SNA identifies key actors and their positions, exposes structural gaps, and enables targeted capacity-building and brokering. It also reveals how information and innovations spread through evolving networks, how influential actors emerge, and how social learning fosters behavioural change that can sustain outcomes after a project ends. Together, the three layers connect how stakeholders think about change, how they assess and measure it, and how they connect and learn, through iterative feedback cycles in which evaluation evolves alongside the intervention rather than judging it from outside.

What distinguishes the proposal philosophically is its embrace of what the authors call methodological bricolage. Causal maps, narratives, indicators and network data are never converted into a common metric. They remain distinct evidentiary forms whose convergences, complementarities and contradictions are examined through periodic reflection. The framework draws on realist evaluation’s interest in context-dependent causal explanation, developmental evaluation’s use of evidence within ongoing adaptation, Outcome Mapping’s attention to behavioural change, and the Most Significant Change technique’s demonstration that stakeholder narratives can reveal valued, unanticipated changes that predetermined indicators miss. Quantification itself is treated as situated and value-laden: decisions about which concepts enter a map, whose causal judgements are elicited and how network boundaries are drawn all shape what becomes visible, so those decisions must be documented.

The framework’s handling of disagreement is perhaps its most distinctive technical feature. Where stakeholder groups produce maps that share a broadly similar causal structure but differ mainly in edge weights, a documented aggregate may be constructed for exploratory simulation. But where groups disagree about the existence, direction or meaning of a causal relationship, their maps are retained as alternative causal accounts rather than averaged away. The authors report exactly such a case from the IRRI CGIAR Gender Equality West Bengal Learning Labs, where the framework was operationalised over its first two years. Women-only and mixed-group elicitations diverged on a pathway linking information to agency. Rather than reconciling the maps statistically, stakeholders surfaced the divergence in a reflection meeting as diagnostic of a gender-differentiated access barrier invisible in formal indicators, then endorsed a design response: digital literacy training and localised climate advisory services. The contested pathway was carried into the next simulation as a scenario to be tested, not a settled parameter.

That field application produced other adaptations not envisaged in the original design. Reflexive discussions revealed gaps in women’s access to climate and market information; cognitive modelling highlighted the potential of fisheries-based diversification; and network analysis identified key women farmers occupying brokerage positions. Together these insights informed iterative revisions to both the innovation bundle and its Theory of Change. The authors also stress what the framework cannot do. A changed cognitive map demonstrates a change in understanding, not necessarily a change in institutions. Network reorganisation may indicate shifting relationships but requires additional evidence to establish whether authority and benefits have actually been redistributed. Claims about adaptation, transformative potential or genuine transformation depend on cross-layer evidence concerning structural depth, breadth, institutionalisation and durability.

The authors are candid about limitations. Fuzzy cognitive mapping elicitation, repeated network panels and platform integration demand facilitator and analyst skills that are unevenly distributed, particularly among national agricultural research organisations in the Global South, and stakeholder fatigue and uneven digital infrastructure further constrain uptake. A staged or modular implementation may be more realistic than full deployment in resource-constrained settings, and for short or linear projects the marginal value may not justify the investment. The framework supplements rather than replaces donor results frameworks, and it remains conceptual, informed by ongoing Learning Lab experience but awaiting broader empirical testing. Still, its ambition is clear: to reframe evaluation as an adaptive system that evolves with the intervention, holding disagreement visible and treating transformation as something to be detected rather than presumed.

Subject of Research: An integrated three-layer evaluation framework for co-produced socio-technical innovation bundles in participatory agricultural research

Article Title: An integrated evaluation framework for co-produced socio-technical innovation bundles

Article References: Goswami, R., Mukhopadhyay, P., Chadha, D., & Puskur, R. (2026). An integrated evaluation framework for co-produced socio-technical innovation bundles. npj Sustainable Agriculture, 4(1), Article 84. https://doi.org/10.1038/s44264-026-00195-0

Image Credits: AI Generated

DOI: 10.1038/s44264-026-00195-0

Keywords: participatory action research, socio-technical innovation bundles, evaluation framework, fuzzy cognitive mapping, social network analysis, Theory of Change, small wins, agri-food systems, monitoring evaluation and learning, complexity-informed evaluation, adaptive management, gender equity

The scale of the problem the programme addresses is difficult to overstate. Psychosis and other severe mental health conditions cause substantial disability and reduced functioning across multiple domains of life, from self-care and mobility to social participation and productive work. In low- and middle-income settings, the services that exist to meet this need are often weak and predominantly biomedical, meaning they concentrate on clinical treatment while leaving the social and economic consequences of illness unaddressed. Community-Based Rehabilitation, or CBR, has emerged as a promising alternative because it takes a comprehensive and person-centred approach, aligning closely with effective case management models that have proven their worth in other areas of global health.

SUCCEED set out to harness that potential. The programme’s stated ambition was to improve quality of life, mental health outcomes, and community participation for people living with psychosis in four sub-Saharan countries. But rather than importing a model designed elsewhere and testing whether it survived transplantation, the research team — led by Julian Eaton and Olubukola Omobowale, with collaborators including Rita Tamambang, Rachel Greenley, and Grace K. Ryan — began with an open question: what would a rehabilitation intervention look like if the people who would use it, and the communities who would deliver it, helped design it from the ground up?

The methodological backbone of the answer is Theory of Change, a framework widely used in international development but less commonly applied with such rigour in mental health intervention design. A Theory of Change process asks stakeholders to articulate the long-term outcome they want to achieve and then work backwards, mapping the preconditions that must be in place for that outcome to occur, the assumptions underlying each causal link, and the interventions required to make each precondition a reality. In SUCCEED’s case, this was not a one-off workshop exercise. The team conducted multiple iterations of Theory of Change, revisiting and revising the causal map as new evidence accumulated from situation analysis, formative research, and piloting.

That iterative structure is what distinguishes the work. The first Theory of Change iterations drew on a situation analysis that documented the realities on the ground: the state of formal services, the role of traditional and faith-based healers, the economic pressures on households affected by psychosis, and the stigma that isolates individuals from the communities that might otherwise support them. Formative research then probed these findings in greater depth, generating the contextual understanding needed to specify what a feasible, acceptable intervention might look like in each setting. Early versions of the intervention were piloted, and the lessons from those pilots fed back into revised Theories of Change, which in turn reshaped the intervention itself.

To make this process transparent and reproducible, the researchers structured their reporting using two established frameworks. The GUIDED framework for intervention development provided the scaffolding for presenting the multiple Theory of Change iterations as results in their own right, rather than as background context. The TIDieR framework — Template for Intervention Description and Replication — was used to describe the final intervention in sufficient detail that other teams could understand exactly what it involves, a critical step if the programme is ever to be evaluated in a trial or adapted elsewhere. This dual framing is a deliberate answer to a common criticism of complex interventions: that their development is described so loosely that outsiders cannot tell what was done, why, or whether it could be done again.

The content of the intervention reflects the priorities that emerged from the co-production process. Consistent with CBR principles, SUCCEED is built around comprehensive, person-centred support delivered close to where people live, aiming to strengthen functioning and community participation rather than treating symptoms in isolation. The co-production approach meant that people with lived experience of psychosis, along with family members, community workers, and local service providers, were not merely consulted but were active participants in deciding what the intervention should contain, how it should be delivered, and what success would look like. The Theory of Change workshops gave these diverse stakeholders a shared language and a shared map, allowing disagreements and assumptions to surface early and be examined openly.

The authors draw two conclusions from the process that carry weight well beyond this specific programme. First, they find that Theory of Change can promote participatory processes of intervention co-development: the framework’s demand for explicit causal reasoning creates a natural structure for genuine dialogue, in which stakeholders must negotiate not just what should be done but why they believe it will work. Second, they observe that the same process generates research questions. Because every arrow in a Theory of Change diagram represents an assumption that can be tested, the completed maps double as an agenda for evaluation, pointing evaluators toward the mechanisms that matter most and the links that remain most uncertain.

Perhaps the most important message, however, concerns flexibility. The team concludes that interventions must remain flexible and open to revision, even when they possess core active ingredients. In mental health research, there is a persistent tension between the standardisation needed for rigorous evaluation and the adaptation needed for real-world contexts. SUCCEED’s development model suggests a way through that tension: hold firm to the essential components that the Theory of Change identifies as causally necessary, while allowing the surrounding details of delivery to evolve as communities, evidence, and circumstances change. The multiple iterations documented in the paper are, in effect, a record of that controlled evolution.

For the wider field of global mental health, the study arrives at a moment when funders and governments are increasingly demanding evidence that interventions in low-resource settings are not only effective but also locally legitimate and sustainable. Co-production has become a watchword, yet it is often invoked without a clear account of how participation actually shaped the result. By presenting its Theory of Change iterations as findings, the SUCCEED team has provided one of the more concrete demonstrations available of what co-produced intervention development looks like in practice — from the first situation analysis through formative research and piloting to a fully specified, replicable community-based rehabilitation package for people living with psychosis in West and Southeast Africa.

Subject of Research: Co-production of a community-based rehabilitation intervention for people living with psychosis in West and Southeast Africa using Theory of Change methodology

Article Title: Co-production using Theory of Change in the development of the SUCCEED Africa community-based rehabilitation intervention for people living with psychosis in West and Southeast Africa

Article References: Co-production using Theory of Change in the development of the SUCCEED Africa community-based rehabilitation intervention for people living with psychosis in West and Southeast Africa. (n.d.). https://doi.org/10.1371/journal.pmen.0000668

Image Credits: AI Generated

DOI: 10.1371/journal.pmen.0000668

Keywords: psychosis, community-based rehabilitation, Theory of Change, co-production, global mental health, sub-Saharan Africa, intervention development, GUIDED framework, TIDieR framework, severe mental illness, low- and middle-income countries, SUCCEED programme

The study examined the SALIENT consortium, a UK research programme funded by the Economic and Social Research Council, part of UK Research and Innovation, with additional support from the government’s Evaluation Accelerator Fund, the Department for Environment, Food and Rural Affairs and the Food Standards Agency. SALIENT’s ambition was explicitly translational: rather than conducting research in isolation and hoping policymakers would eventually take notice, the consortium set out to co-design, implement and evaluate public-facing food system interventions with government partners and food system stakeholders, targeting improvements in both health and sustainability while maintaining affordability and commercial viability. In total, forty organisations engaged with the consortium, and eight of those progressed far enough to deliver and evaluate a combined ten interventions.

To understand how and why this engagement process worked for some organisations and faltered for others, the research team, led by Sarah Shaw of the University of Cambridge’s MRC Epidemiology Unit and the University of Southampton, together with colleagues from the London School of Hygiene and Tropical Medicine, the University of Hertfordshire, the University of Liverpool and the University of Oxford, conducted a qualitative evaluation grounded in theory-based evaluation principles. The methodological approach is worth unpacking. Rather than simply asking participants whether they enjoyed the collaboration, the evaluators first constructed a theory of change, a formal description of the causal pathway through which the SALIENT process was expected to produce its intended outcomes. This artefact then served as an analytical scaffold against which the interview data could be interpreted, allowing the team to identify precisely where the assumed mechanisms of change held up and where they broke down.

The evidence base for the evaluation consisted of thirty-eight semi-structured interviews with three categories of participants: government partners, academic researchers and food system representatives. Interview transcripts were subjected to thematic analysis, a systematic qualitative method in which researchers code the data, group codes into candidate themes, and refine those themes iteratively until they capture the patterns running through the corpus. By interpreting the resulting themes in relation to the theory of change, the evaluators could trace not just what participants experienced but why the engagement process unfolded as it did, a distinction that matters enormously for anyone planning to replicate this model of collaborative research.

The first major finding concerns fragmentation. Participants described a food system landscape in which existing health and sustainability actions were scattered, disconnected and often duplicative, shaped by the differing priorities, agendas and constraints of the stakeholders involved. A local authority might be focused on food poverty, a retailer on supply chain resilience, a regulator on safety standards, and a researcher on generating generalisable evidence. None of these agendas is wrong, but their misalignment means that even well-intentioned initiatives can pull in different directions, dissipating resources and momentum. The evaluation suggests that this fragmentation is not merely an administrative nuisance but a structural barrier that any cross-sectoral collaboration must confront from the outset, ideally through explicit governance arrangements that acknowledge and mediate competing interests rather than pretending they do not exist.

Power dynamics emerged as a second, closely related theme. The researchers found that stakeholder participation was strongest when the research aligned with the stakeholder’s core goals and offered tangible benefits, and weakest when it did not. This may sound obvious, but it carries a profound implication for how collaborative research is designed. Organisations do not donate their time, staff and data to academic projects out of altruism; they engage because the collaboration serves their institutional interests, whether that is access to evidence, reputational advantage, regulatory preparedness or practical problem-solving. Where the perceived benefit was diffuse or distant, engagement thinned out. The lesson for future consortia is that the value proposition for each partner must be articulated early and honestly, and that researchers who assume stakeholders will simply rally around the scientific mission are likely to be disappointed.

The third finding is perhaps the most methodologically provocative. Pragmatic co-design processes, in which interventions were shaped jointly with stakeholders to build trust and ensure feasibility, did indeed strengthen relationships and make implementation more realistic. But the evaluation found a hidden cost: interventions designed primarily for practical acceptability sometimes had limited potential to address the critical uncertainties in the evidence base. In other words, the very compromises that made an intervention deliverable in the real world could also blunt its scientific value, leaving fundamental questions about what works and why unanswered. This tension between rigour and relevance is a perennial problem in implementation science, but the SALIENT evaluation documents it with unusual clarity, showing that co-design is not a cost-free good but a balancing act in which the research questions themselves can be diluted.

Compounding this tension, the study found that academic processes were often perceived as misaligned with stakeholders’ practical needs. Timelines built around grant cycles, ethics approvals and publication schedules rarely map neatly onto the operational rhythms of businesses and local authorities, which must respond to market pressures and political timetables. Reporting requirements, evaluation protocols and the language of research governance can feel alien to partners whose expertise lies in logistics, catering or retail. The evaluation suggests that these frictions are not trivial irritations; they shape whether stakeholders remain engaged at all, and they can determine whether the evidence produced is actually usable by the people it is meant to serve.

So what should be done differently? The authors conclude that long-term government direction, stronger accountability and appropriate incentives are needed to foster meaningful collaboration between researchers and food system stakeholders. Short, project-based funding windows, they imply, are poorly suited to the slow work of building trust across sectors. Future partnerships, the study argues, should balance flexibility with rigour, invest in sustained relationships rather than one-off consultations, and establish strong governance, communication and evaluation processes early, before disagreements about priorities and power have a chance to fester. The goal is to generate robust, scalable evidence for meaningful food system change, and the evaluation makes clear that the machinery of collaboration is not a preliminary to that evidence but a determinant of it.

The significance of this work extends well beyond the UK food sector. Governments worldwide are grappling with diet-related disease, food insecurity and the environmental footprint of agriculture, and the prevailing policy fashion favours multi-stakeholder partnerships and co-produced solutions. SALIENT’s evaluation is a reminder that these fashionable formats are neither self-executing nor universally benign. They can build trust and deliver interventions, but they can also reproduce existing inequalities of power, fragment effort and soften scientific ambition. For researchers, the message is to design engagement around stakeholders’ real incentives and to protect the evidential core of their studies. For funders and governments, the message is that meaningful food system transformation requires patient investment in the unglamorous infrastructure of collaboration: governance, accountability and time. The study, which received ethics approval from the University of Cambridge Humanities and Social Sciences Research Ethics Committees and was published open access, offers a rare, honest blueprint for the difficult work ahead.

Subject of Research: Cross-sectoral collaborative research for food system transformation

Article Title: Conducting cross-sectoral collaborative research for food system transformation: learnings from a qualitative evaluation study

Article References: Shaw, S., Huse, O., Savory, B., Cooke, N., Thompson, C., Loopstra, R., Scarborough, P., Ogilvie, D., Cummins, S., White, M., & Adams, J. (2026). Conducting cross-sectoral collaborative research for food system transformation: learnings from a qualitative evaluation study. Health Research Policy and Systems. https://doi.org/10.1186/s12961-026-01540-y

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01540-y

Keywords: food systems, cross-sectoral collaboration, co-design, qualitative evaluation, theory of change, stakeholder engagement, public health, sustainability, research policy, SALIENT consortium, power dynamics, evidence-based policy