Table 1 CE-oriented definitions of realist concepts

Intervention

Refers to interventions’ implemented activities, strategies and resources [21], e.g.: citizen advisory panel meetings, or neighbourhood organized workshops.

Context

Pertains to the backdrop of an intervention and includes the pre-existing organizational structures, cultural norms of the community, the nature and scope of pre-existing networks and geographic location effects [18, 25].

Mechanism

‘Mechanism’ does not refer to the intentional resources offered or strategies implemented within an intervention. Instead, it refers to what ‘triggers’ participants to want to participate or not in an intervention. Mechanisms usually relate to cognitive, emotional or behavioural responses to intervention resources or strategies [18]. Mechanisms are usually hidden, sensitive to variations in context, and generate outcomes [1]: e.g. citizens feeling more empowered due to learning opportunities.

Outcome

Refers to intended, unintended, or unexpected intervention outcomes ([18]; e.g. sustainability, quality and integration of services (macro), citizens’ level of involvement in health and care services (e.g. in designing services) (meso), citizens’ health and wellbeing outcomes (micro).

Context-M-echanism-Outcome configuration (CMO)

To understand how certain contextual factors shape or trigger the mechanism, causal links are expressed through ‘Context-mechanism-outcome configurations’ (CMOs). Formulating and refining CMOs is largely how researchers analyse data in a realist evaluation as it allows for a deeper understanding of which (aspects of) of interventions work, for whom, under what circumstances and to what extent [48]. CMOs are also used to generate or refine programme theories, which in turn help shape the final product of an evaluation (e.g. recommendations). CMOs are also used to generate or refine programme theories.

Programme theory

Is a hypothesis about how a programme or programme component may or may not work, under what contexts and with what outcomes [32]. In this study, the guiding principles [12], which can be seen as action-oriented programme theories, were used as initial programme theories.