147 Realist review of Midwife-Led Continuity of Care implementation including literature and interviews, and included various stakeholder perspectives. These stakeholders had the opportunity to share their insights during the two stakeholder meetings, which further enriched the analysis. By combining these data, we were able to access the specific context in which MLCC may or may not be successfully implemented, while remaining attentive for potential rival theories. To ensure adherence to realist principles throughout the review process, the research team benefited from consultations with an expert in the field. Adhering to realist methodology, data were not appraised or weighted based on methodological hierarchies or sources but were selected based on relevance, rigour, and richness to address the research question. This method allowed the identification of mechanisms that often remain unnoticed but significantly impact the implementation of MLCC. A fundamental limitation of this review is that it did not result into a fixed, practical framework or guideline to answer the question what enables midwives to implement MLCC in high-income countries. This study has illuminated the complexity of implementing MLCC and shows that there are no ready-made solutions. To address this limitation and provide more actionable insights, a subsequent realist evaluation conducted in a specific context and using primary data, could offer tailored answers to this research question. However, a realist evaluation conducted in the context of the National Health System (NHS) shows that MLCC implementation cannot rely solely on midwives and needs effective leadership.16 Additionally, while this review included data from international sources, it is important to note that the various stakeholders consulted during the development of the programme theory were exclusively from the Netherlands. This national focus may have influenced the interpretation of results and their applicability to other contexts. However, these stakeholders were independent experts with significant knowledge of maternity care models in other high-income countries. Lastly, it is important to recognise that not all midwives wish to work in an MLCC model.50 55 56 68 Research indicates that midwives’ preferences for working in an MLCC setting are influenced by several factors, including work-life balance considerations, professional identity, and the perceived demands of MLCC.68 Therefore, it is essential to explore the specific circumstances in which midwives are able and willing to engage in MLCC. Identifying these conditions can inform targeted strategies to increase midwives’ participation and satisfaction, thereby improving the overall implementation of MLCC. 6
RkJQdWJsaXNoZXIy MTk4NDMw