Impacts beyond primary outcomes: a mixed-methods study exploring multiple perspectives of a health system intervention in Eastern Uganda

Background Interventions aiming to improve health systems should engage people on the front lines of health care delivery. Evaluations of these interventions should focus on the multiple change processes and outcomes resulting from their implementation into dynamic social systems. The PRIME intervention was designed to build health workers’ (HWs) skills by supporting and motivating them emotionally in their challenging work environments with the goal of improving treatment and attracting patients to health centres (HC) in Eastern Uganda. We conducted a clusterrandomised trial (CRT) to evaluate the impact of PRIME on health outcomes in the community and a parallel mixed-methods study to examine the effect of PRIME from the perspective of HWs and patients enrolled in the trial.