Integration of main findings and alignment with programme theory
| Programme theory | Mechanisms | NPT | QIKAT-R | Contextual factors |
| Motivated clinicians join | High agreement | High agreement | High agreement (low scores) | High need |
| Collect data and engage in learning | High agreement | Medium agreement | Unclear (low scores) | High impact of constraints |
| Incentive offered | Medium agreement (CPD) | Medium agreement | No connection | Low/ medium value |
| Learn online with others | Medium agreement (flexibility) | Medium agreement (engagement) | Unclear (high learning not shown in scores) | Medium value |
| Collaborate with peers | Medium agreement (sense of community) | Medium agreement (connection with others) | Unclear (sharing of learning not shown in scores) | High need to reduce isolation |
| Advice, feedback from experts and researchers | High agreement (credibility and authority) | Medium agreement (collective action) | Low: scores did not reflect learning | High need for coaching |
| Apply QI steps and adjust | Medium influence | Medium collective action | Low: scores did not reflect learning | Medium influence due to low cost/ small scale changes |
| QI process is accepted benefits seen | Medium agreement (ownership and commitment) | Medium agreement (collective action) | Low: scores not reflected in process | Medium support of changes in own settings |
| Results promote awareness and benefits | Medium agreement (recognition and empowerment | Medium level of embedding | Low: scores not reflected in learning | Medium interest in organisations |
CPD, continuing professional development; NPT, normalisation process theory; QI, quality improvement; QIKAT-R, quality improvement knowledge assessment tool.