Conclusion
Implementation research indicates inconsistent implementation effectiveness, possibly related to the proximal outcomes of the actual implementation behavior during the change processes. This study explored the underlying mechanisms. Empirical confirmation of contextual mechanisms expands the theories regarding the functioning of mechanisms triggered by the implementation of digital health technology. In addition, this study confirms that organizational readiness for change has a direct effect on physician adoption behavior. However, this relationship is indirectly affected by individual beliefs regarding the effectiveness of the innovation.The adoption behavior of primary care physicians correlates strongly with the degree of meso-level readiness to implement change, as well as with the extent to which physicians view the digital innovation as beneficial to their work. Innovation beliefs are related to three subdimensions that pertain to the extent to which the use of digital innovations is perceived as effective: (1) to improve patient safety, (2) to improve clinical decision-making during the course of risk and interaction analysis, and (3) to improve communication regarding the management of polypharmacy for patients in the context of ambiguous decision situations.To the best of our knowledge, this is the first study to provide new insights into in-depth local needs assessment. The adoption of digital innovations for polypharmacy management in primary care organizations can be improved by tailoring implementation strategies accordingly. Our findings contribute to the understanding of the underlying mechanisms and complex adaptive processes of social systems that operate in a primary care setting. Therefore, our approach provides methodological insights into realist evaluation and contributes to current research that seeks to illustrate the complex contextual pathways and their effect on implementation outcomes [