Strengths and limitations
CMO
The sample consisted of primary care physicians who implemented digital innovation for polypharmacy management. Only physicians who had participated in the study between 2018 and 2020 and were part of the intervention group during that period were included in the data analyses. It is likely that physicians recruited for the study at a later date had different initial conditions, because technical problems had been resolved and better communication strategies had been developed. Non-participation in the survey could be ascribed to physicians not using digital innovation regularly at the time of data collection and, therefore, being unable to provide responses.The inferences drawn from the two strands of qualitative and quantitative data analysis were merged to create a comprehensive understanding of the digital innovation implementation process. The application of the modified methodological approach in this study enabled us to integrate the interdisciplinary evidence on the topic of contextual influences on change processes through realist evaluation. We then explored the intersection with a quantitative analysis method that uses a theory-based confirmatory approach to examine statistical relationships (SEM) [The methodological synergy effects are particularly reflected in the development of the contextual measurement instrument, in which the findings of the qualitative content analysis and CMO were integrated. Furthermore, the directions of the effects and relationships of the micro and meso levels and the corresponding measurement instruments were determined on this basis and confirmed in the mediation model. As explained in the previous section, our analyses indicate reasonable reliability as well as the convergent and discriminant validity of the measurement instruments used in this study. In addition, the requirements for mediation analysis were met. Therefore, we argue that our study provides a robust methodological basis to confirm semi-predictable patterns between contexts, underlying generative mechanisms, and outcomes in primary care settings. Future studies should plan their study design accordingly to conduct more advanced, strictly quantitative mediation analyses. In the present study design, the focus was on the triangulation of the different models in the two study phases. To minimize bias, we sequentially analyzed qualitative and quantitative data and confirmed the assumptions made in the first study phase with the findings of the second phase [