Programme theory
CMO
The programme theories, assumptions, and the logic model underpinning the danceSing care programme are shown in Supplementary Figures SProgramme theories are configured as “context-mechanism-outcome” (CMO) hypotheses in a realist evaluation. This explains how and why different outcomes are generated in different contexts. Linked sets of hypotheses are likely to be produced because different mechanisms will be activated in various contexts, resulting in various outcomes. Generally, hypotheses are developed by asking four questions: (1) For whom will this basic programme theory work and not work, and why? (2) In what contexts will this programme theory work and not work, and why? (3) What are the main mechanisms we expect this programme theory to work? (4) If this programme theory works, what outcomes will we see? The basic programme theory was in line with the aim to test the feasibility of an RCT implementing the danceSing care programme in specific UK care homes, and measuring psychosocial health markers. This is reflected by the stated realist assumptions (Table This programme theory could be further subdivided into the following theories:If the danceSing care resources are delivered to the care homes, the Activity Coordinators (ACs) would consistently deliver the programme to the residents.If the programme is delivered in the care homes, the residents would want to regularly take part.If the ACs provide the programme consistently, the participants would experience improved psychosocial health markers. Changes in pre-and post-survey data and qualitative interviews would evidence this.If the ACs are given enough organisational support such as resources and time, they would be engaged in this programme. This would therefore, establish shared learning and co-production between programme developers, care homes, and researchers.If the group sessions are adequately and consistently used, residents would feel more engaged in group activities, creating a community. This communal feeling would increase self-confidence and quality of life and reduce loneliness. This could potentially inspire future usage of the programme's resources.Further, researchers, stakeholders from the to-be-tested programme, and representatives from the UK care homes where the programme would be implemented developed the focused questions and considered the set of conditions that existed (Context), how these contexts might create change (Mechanism), and what changes would result from the mechanisms (Outcomes). The study’s hypotheses were developed based on the assumptions and the focused questions. Therefore it was necessary to collect information about context, mechanism and outcome and identify features of implementation or organisation that affect whether or not the trial works [