Table 1 Definitions of key realist concepts

Context (C)

Dynamic conditions that occur before, or exist outside of, the initiative with the potential to activate mechanisms during implementation [24]

Mechanisms of change (M)

Hidden or latent (i.e. real, but most likely not directly visible) aspects with the power to generate outcomes in a given context. Pertains to the reasoning and reactions of people in response to resources offered by the initiative [25, 26]

Outcomes (O)

Intended or unintended effects of the initiative with behavioural or system changes occurring at intermediate or long-term levels through interactions between context and mechanisms [22]