148 Chapter 6 CONCLUSION AND RECOMMENDATIONS This realist review has highlighted the complexity of MLCC implementation in highincome countries. Despite strong evidence, diverse stakeholder interests and power dynamics hinder the implementation of MLCC. Concrete policies and guidelines are essential to ensure consistency in care delivery. By recognising macro-level barriers, leaders can develop strategies to overcome them. Collaborative efforts and a shared philosophy among all stakeholders, combined with strong leadership that builds trust and addresses anxiety, can create a supportive environment for MLCC. Assessing the impact of sociocultural learning theories on the education and training of healthcare professionals can provide guidance on how to promote interdisciplinary collaboration and knowledgeability. Finally, further research should focus on understanding the specific conditions under which maternity care stakeholders are able to implement, and willing to engage in MLCC. Acknowledgement The authors gratefully acknowledge the valuable contributions of Dr. Justin Jagosh during the consultations, and the various stakeholders who contributed to the two stakeholder meetings. Ethics The Medical Ethics Committee (METC) of Amsterdam UMC declared that no formal ethical approval was required for conducting this review (Ref. No. 2023.0236). For the interviews used in this review, the METC declared that the Medical Research Involving Human Subjects Act did not apply (Ref. No. 2016.484).
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