Table 1.

Four-stage approach to the realist evaluation of communities of practice

Stage	Activities	Analysis	Purpose
1. Theory	• Systematic review of the literature • Semi-structured interviews with sponsors and facilitators of CoPs • Formulate CMO configurations	• Qualitative -- Identify themes and categorise as outcomes, mechanisms, and contextual factors • Formulate potential CMO configurations	Provide the theoretical basis for the realist evaluation
2. Hypotheses generation	• Generate hypotheses based on CMO configurations	Rephrase CMO configurations into hypotheses	Formulate hypotheses to be tested during stage three
3. Observation	• Online survey of CoP members	Quantitative -- • Identify CMO configurations that occur with regularity • Social Network Analysis	Test and accept, reject, or modify hypotheses Examine structure of professional and social relationships and flow of information and knowledge within the CoP
4. Program specification	• Review analysis from stage three	Refine theorised CMO configurations based on testing of hypotheses	Specify CMO configurations that explain how, when and why CoPs improve healthcare practice