Table 1 Definitions and reflections on contexts, mechanisms and outcomes

Contexts (C): These describe the elements and background factors that allow mechanisms to be triggered. Contexts are not limited to locations but also refer to characteristics of individual service developers, deliverers and patients. It refers also to interrelationships between actors and institutional settings and their placement within wider infrastructural settings. To understand contexts, the researcher should ask: What conditional elements or contextual components must be present for a mechanism to be triggered?

Mechanisms (M): A mechanism will be triggered, if the context is conducive to this. This conception of mechanisms has two main features: resources and reasoning. The assumption here is that if certain service resources are introduced to a specific context, they will generate changes in the actors’ reasoning. In this study, these actors are service developers, deliverers, and patients. Pairing resources with reasoning defines the mechanism. Therefore, the following question is asked to reveal mechanisms: How do the resources provided by the service impact the service deliverers, and on what assumptions, values, and beliefs do service users rely on when interacting with these resources? What is being triggered in the service, and to what particular outcome does it lead?

Outcomes (O): Outcomes describe the visible output or impact the mechanisms lead to. These outcomes can be immediate, intermediate, or long term. Therefore, in analysing outcomes, the researcher should ask: to what end does the triggered mechanism lead and what are the resulting outcomes of the triggered mechanisms in the right context?

Context–mechanisms–outcome configurations (CMOCs): Generative explanations for the observed outcomes can be produced by heuristically configuring or combining contexts (C), mechanisms (M) and outcomes (O). These CMOCs provide a causative explanation for either the working of the entire service or for specific features of the service.