Table 2 Techniques employed to increase rigour

Research design

Use of multiple theoretical perspectives to guide research design, analyses, and interpretation, helping to build a wider explanation of the phenomenon and a means of exploring a range of plausible theoretical interpretations [49],[50],[62].

Strategic selection of three cases to support greater confidence in findings. This strategy included selecting cases based on replication logic [42] and to provide good learning opportunities [41].

Pilot work [54] to refine data collection and analyses processes, including the development of a coding framework and refinement of interview guides, and inform the final study design.

Data collection

Use of key informants across four units of analysis (individual user, implementation team, organization, and larger system) and multiple data collection methods. This allowed researchers to uncover converging findings across informants, units of analysis, and data collection methods (i.e., triangulation) [49],[50].

Analysis

Maintaining a case study database [42] consisting of a complete set of all the data collected for each case and all records related to the treatment of the data during the analytic process.

Considering other plausible explanations for the findings and seeking out additional evidence where inconsistencies or contradictions existed. Both helped minimize the confirmation of preconceived ideas [42],[63] and the possibility that the researcher selectively described and explained the events to support a favoured theory or perspective.

Maintaining a chain of evidence [42] throughout data analysis (often referred to as an audit trail). This involved documenting an explicit trail that identified the links between the data collected and the interpretations/conclusions.

Member checking to verify specific factual data and to ask participants for their responses/reactions to findings.

Multiple meetings/discussions of the research team to review the analytic procedures and discuss and question the findings.