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Table 3 Summary of main CMOCs presented in the paper

From: Exploring factors that affect the uptake and sustainability of videoconferencing for healthcare provision for older adults in care homes: a realist evaluation

CMOC Mechanism (resource) Context Mechanism (reasoning) Outcome
Faster response supports uptake Quick access to services Staff observe that fastest response Perceived benefit in speed means it’s more likely to be used again More experience of rapid access will increase use, and becoming part of routine care
Unequal relationships hinder use Opportunity to reduce professional isolation Where staff consider themselves equal partners, videoconferencing may reduce professional isolation
However if staff feel inferior, and the staff are qualified nurses, they may be less likely to use the service
When staff consider themselves equal partners, videoconferencing will tend to be used sooner for advice Videoconferencing is more likely to be used when staff feel equal and feel the need to seek support. Increasing the uptake and sustainability
Team stability & support encourages psychological safety and innovation Provides a new and innovative way of delivering healthcare Where staff feel unsure of how to meet a resident's needs, they may seek support from a member of staff with more experience. Where there is strong team stability, members are likely to have increased psychological safety Here, it is more likely that the staff member will seek support before using the service. As their self-efficacy grows, it will become less daunting, and staff may begin to use the system independently Increased self-efficacy will help to overcome obstacles and reaffirm commitment to videoconferencing. Which will make videoconferencing more sustainable
Low confidence hinders uptake Opportunity for junior staff members to consult with a remote nurse Where staff have less experience in managing residents’ health, they may be less confident in using videoconferencing Less experienced staff will be more likely to access the service with the support of someone that is more experienced / in a more senior post An adequate ratio of senior to junior employees and a culture of supporting junior staff will increase the uptake and sustainability of videoconferencing
Opinion leader advocacy supports uptake a new method of healthcare delivery There is a pre-existing homogenous environment, which supports the exchange of opinions Staff act as informal / formal opinion leaders, sharing their view of the system. It is more likely that the impact of advocacy amongst the team will be increased More staff will trial the system and develop their self-efficacy. Depending on their experiences, this may increase uptake and sustainability
  1. Data available for all CMOCs upon request