130 Chapter 6 nonlinear causal pathways.18 The impact of a complex intervention on an outcome is highly dependent on the context in which it takes place and the mechanisms that may or may not be activated.19 20 By examining the underlying mechanisms and contextual factors, this realist review aims to provide a deeper understanding of how, why, and under what circumstances MLCC can be implemented successfully in high-income countries. The main question that will be answered is: ‘How do various contextual factors influence mechanisms underlying the implementation of MLCC in high-income countries?’. The following sub-questions were posed: - What is the full set of resources that comprise MLCC? - What are the degrees of implementation of MLCC? - What is it about MLCC that enables midwives to implement this in high-income countries? - What are the intended and unintended outcomes of implementing MLCC for organisations and the healthcare system? METHODS Design A realist review was conducted to examine interactions between contexts, mechanisms, and outcomes and to gain an understanding of how MLCC can be implemented and under what circumstances. Realist review is an iterative, theorydriven approach which acknowledges that programs or interventions are not always successful and work better in certain circumstances than in others. Programs or interventions implemented in different contexts provoke different mechanisms and result in different outcomes. A realist review is not focused on determining the average effect of an intervention. Instead, the aim is to explain how, for whom, under what circumstances, and why an intervention works, based on existing evidence. The results of the synthesis are translated into a realist programme theory and are expressed in the form of context-mechanism-outcome configurations (CMOC).21-23 Table 1 gives an overview of used definitions.
RkJQdWJsaXNoZXIy MTk4NDMw