Table 1.

Thematic representation of the realist constructs

Structure	Context	Mechanism	countervailing and/or control mechanisms	Outcome
Systems level
National and regional policies promoting integrated care initiatives	Professional and cultural alignment of stakeholders Community engagement Strategic and operational governance committees for oversight Resource and funding availability Leadership structures and dynamics Bureaucratic processes and red tape	Commitment and motivation	Inconsistent (or unsustainable) stakeholder commitment Perceived power struggles Undue pressure for teamwork	Design of integrated care initiatives
Prevalent integrated health concerns	Unmet complex health and social needs of vulnerable families Unnecessary hospitalisation and long lengths of hospital stay Strategic thinking and operational delivery Cost of integrated care initiative Perceived importance or value of integrated care	Willingness to address identified integrated health concerns	Misaligned priorities	Design of integrated care initiatives
Historical Silos	Goal-oriented care Political culture and decision-making norms Level of organisational fragmentation Multi-sectorial collaboration	Shared vision and goal	Cultural and ideological misalignment Reticence is related to the level of changes involved in the integration	Design of integrated care initiatives
Provider level
State of formalisation of integrated care	Delineated roles of the different stakeholders and agents Interorganisational environment Cultural integration Level of contribution from the partner agencies Having sufficient time to work together constructively	Shared vision Buy-in	Misaligned priorities Programme complexity Differing understanding of integrated care	Delivery of integrated care initiatives (O)
Goals of the involved agencies	Clearly defined roles and responsibilities of care providers Resource availability Training and education Freedom to share views and feedback Level of contribution from partner agencies	Shared learning Empowerment	Perceived lack of support Communication breakdown	Delivery of integrated care initiatives
Level and complexity of clients’ vulnerabilities	Considerations for programme resources and capacity Attitude towards and openness to innovation	Perceived usefulness	Resource constraints Perceived disaccord in service provision Perceived workload increase	Delivery of integrated care initiatives
Existing leadership structures	Positive team climate Workforce culture and attitude towards change The density of the care provider network Level of communication between services Organisation support from leaders	Trust perceived support	Inconsistent leadership and governance Threat to stakeholders’ interest(s) Reduced sense of safety and togetherness. Loss of control for decision-making	Delivery of integrated care initiatives
Collaborative design of the integrated care initiatives	Level of complexity of the integrated care initiative Co-production of initiative with main working groups Coordination between health and social care departments	Perceived role recognition Appreciation	Role confusion leads to frustration Perceived instability of service delivery environment Perceived non-recognition of service providers’ roles	Delivery of integrated care initiatives
Consumer level
Shared decision-making	Perceived social support	Motivation	Perceived lack of social support from family members	Improved access to care Buffering of vulnerabilities
Responsiveness to users' needs	Levels of cooperation between users and agencies Historical perceptions of social and healthcare services Resource availability	Perceived interpersonal trust	Distrust Resentment related to increased workload	Improved access to care Buffering of vulnerabilities
Accompaniment and client autonomy	Interserviceand intraservice collaborations Staff commitment	Empowerment	Perceived discordance and cultural misalignment	Improved access to care Buffering of vulnerabilities
Co-location of services Programme flexibility	The complexity of family dynamics and functioning Level of complexity of users' vulnerability Availability of skilled care providers	Perceived accessibility to required services	Perceived discordance among service providers	Improved access to care Improved health outcomes Buffering of vulnerabilities
A platform for Information sharing	Shared decision making with care providers Health literacy of services users Service user characteristics	Self-efficacy Self-determination	Perceived loss of autonomy	Improved access to care Improved uptake of Healthcare services Buffering of vulnerabilities

The mechanisms at each level are related to the actors operating at that level. For instance, the systems level included stakeholders such as managers, heads of departments and other high-level stakeholders. The organisational level stakeholders includes programme implementers and health and social care providers. Consumer-level mechanisms relate to service users and their social networks.