134 Chapter 6 Analysis and synthesis process Following the realist methodology, analysis, and synthesis was an iterative process. The creation of a refined programme theory led to subsequent searches for specific aspects of the programme theory. During the coding process, memos were written to summarise the causal processes that were thought to be at work. By moving back and forth between memos, references, and whole documents, CMOCs were built iteratively. The answers to the research questions are embedded within these CMOCs, as they represent the underlying causal processes explaining how, when and why specific outcomes occur in particular contexts. Although theory is developed by synthesising a variety of sources, realist methods encompass retroductive reasoning.29 30 Retroduction uses a combination of inductive and deductive logic, complemented by insights or hunches. Retroductive reasoning identifies causal mechanisms that may underlie emerging patterns, even though they cannot be directly observed or are not explicit in the existing evidence.29 30 Therefore, the ideas and reasoning of the researchers were discussed in the research team to approach the theory from different perspectives. In the process of theory building, substantive theories were identified that could help explain how the totality of the findings might fit together. Substantive theory refers to existing theories within certain disciplines.25 A second stakeholder meeting, involving the same individuals invited to the first meeting, was then held to validate the refined programme theory. A summary of the review process can be seen in Figure 1.
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