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Table 2 Initial theories expressed as ‘If-Then’ statements

From: A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar

 • If home contexts (i.e. organisation, infrastructure, culture and philosophy, macro) align with the particular approaches to facilitation and their underpinning theories of action, and with facilitators’ characteristics, then this will prompt both anticipated and unanticipated effects on continence practice, residents, facilitators and homes.

 • If contextual conditions and characteristics of home staff, including home managers, are supportive, then this will prompt the enactment of the internal facilitator activities and practices proposed by the type A and type B programmes, including the following:

  o The interaction between facilitators, home managers and other informal leaders

  o May influence how successfully a facilitator can enact their role

  o The characteristics of leaders at various levels of the health/social care

  o Organisation will impact on implementation processes and outcomes

  o Implementation processes and practice changes will be hindered in organisations

  o Where there is limited ‘slack’ (time, space)

  o The degree of ‘fit’ between facilitation and facilitator characteristics

  o Organisation’s context and culture will impact implementation processes and outcomes

  o A home’s motivation to implement changes will influence the effect of facilitator activities

  o The nature and quality of the internal (IF)—external facilitator (EF) relationship, and the contents of the support programme (including support of a buddy) and the degree of ‘fit’ between internal facilitators and type of facilitation will prompt support and development that may have the potential to influence internal facilitator’s abilities, skills and knowledge to enact their role in practice, which could improve resident outcomes and experiences.

  o A potential for type B to have a greater effect because its holistic approach, longer intervention period and opportunities for more sustained support.

 • If research-based recommendations are introduced and integrated into the facilitation development programmes and into the homes, then this will prompt improved continence care processes, outcomes and resident and staff experiences.