131 Realist review of Midwife-Led Continuity of Care implementation Table 1: Glossary of Realist terms Term Definition Realist review A theory-driven approach in synthesising quantitative, qualitative, or mixed-methods research from a perspective based on Realism. It answers questions of the general format ‘What worked, for whom and in what circumstances, how and why?”.21 23 24 Programme theory An explanation for how a programme works. Realist reviews attempt to develop and test programme theory. The review usually starts by developing an initial programme theory, which will be refined using literature and stakeholder input. The final product is a refined programme theory.23 24 Context Refers to the broader contextual backdrop in which the programme is situated. Context includes the external level, the institutional level, the interpersonal level, and the individual level. As conditions in these levels may change over time, the context may reflect aspects of those changes. Contextual elements may influence the relation between mechanism and outcome; in some cases, the outcomes will influence the context.23 24 Mechanism The generative force that leads to certain outcomes. Mechanisms are the reasoning, reaction, or response (mechanism response) of the various actors to the programme resources (mechanism resource). Implementation of MLCC will offer or take away resources from stakeholders. These resources may be material, financial, social, emotional, or political. This, in turn, will trigger a certain reasoning and response from stakeholders, leading to intended or unintended outcomes. Identifying the mechanisms elevates the review from a description of ‘what happened’ to ‘why it happened, for whom, and under what circumstances’.19 20 23 24 Outcomes Outcomes result from activating different mechanisms in different contexts and are either intended or unintended and can be proximal, intermediate, or final.23 24 Context-mechanismoutcome (CMO) configurations CMO configuring is a heuristic used in realism to generate causative explanations for how a programme, or a part of a programme, works. The development of CMO configurations draws out and reflects on the relation between context, mechanism, and a certain outcome and acts as the building blocks for programme theory.19 23 24 Substantive theory Substantive theory refers to existing theories within certain disciplines that help identify mechanisms or features of context and explain how overall sets of findings fit together.25 This realist review was conducted and reported according to the RAMESES publication standards 26 and conducted from May 2023 till July 2024. The pattern of this realist review involves a set of iterative phases: identifying the review question; searching the literature and establishing initial programme theories; quality appraisal of the literature; extracting the data using CMOC; analysing and synthesising data to identify substantive theory. 6
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