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Table 3 Examples of CMO linkages within themes

From: A realist evaluation of a physical activity participation intervention for children and youth with disabilities: what works, for whom, in what circumstances, and how?

Context-mechanism-outcome configuration Sample quote
Context
 C1. Safe “He [child, 11y, ID] has problems with anxiety. He normally gets very withdrawn and stressed in new situations, at times when he doesn’t feel safe, you know. But here, I have barely seen him like that. The boys have become very good friends (M3), they do everything together. And that helps him feel safe (C1)” – parent
 C2. Learning “I will remind her [child, 15y, ID] of the things she has learnt here…and lead her back here (C2), to remind her that she can actually do it. That’s part of the whole thing I think. She learns what to do here so we can do it when we go home” – parent
 C3. Social “With the group, she [child, 16y, ID] sees that the others can do things (C2). Everybody is together, so she’s not the only one working out (C3)” – parent
 C4. Family “He [child, 11y, PD] doesn’t want me there [in activities] anymore (C2, C3). He feels safe here (C1), so he wants me to leave (O4)” – parent
Mechanism
 M1. Choice “When I got here (C3), they [staff] said to me, you can choose your activities…and most of the activities I chose (M1), I have been able to try in my time here. Some of them were very difficult but they were very fun (O5)” – child, 16y, PD
 M2. Fun “It [horse riding] is so fun and it’s fast (O5). It’s hard, but it’s fun (M2). So I like to keep trying at it (O5)” - child, 17y, ID
 M3. Friends We live in a small place, and he doesn’t have many friends at home. But [child, 9y, ID] has made friends (M3) here with all the boys (C3). And so he has had so much fun (O5) – parent
 M4. Specialised health professionals “She [staff member] is a very special person for me and my family, because she did so much for me (M4). I am so proud of what I can do now (O1)” – child, 16y, PD
 M5. Time “And [children] can try many things that would be very difficult to try for the first time at home (C2). You can try to ride a horse, you can try an electric car…everything. You do not just come for one day with a lot of strangers and then have to try [the activity] immediately…there is time (M5). And maybe it’s very scary the first time and the second, but that’s ok because there is time. You have time (M5) to learn (O1, C2)” – parent
Outcome
 O1. Achievement “So now I can do it [participation goal]! It’s very exciting and I am so happy because I never…because I could never do that before. It was the first time (O1)” – child, 16y, PD
 O2. Aspiration “After my last stay, I have started horse-riding at home. Now I want to do competitions (O2)” – child, 17y, ID
 O3. Friends “Now [at BHC] I have this friend (O3), his name is [child] and he is 16y and he has the same disability as me (C3). So we have kind of the same problems and we have the same interests. So he will come home to the same place as me. And I said if you come and visit me I will show you the football place. Because now we both love football a lot (O5)!” – child, 16, PD
 O4. Independence “She [child, 17y, ID] becomes more independent (O4) after the time (M5) we have spent here (C1, C2, C3). You can see the difference every time” – parent
 O5. Enjoyment in physical activity “I have seen him [child, 14y, ID] do everything here (C2), and now you can see that he enjoys being active and doing all of the activities (O5)” - parent
 O6. Body function and activity level outcomes “This is so great. His [child, 9y, PD] physiotherapist at home has been saying for ages that roller-skating would be so good for his balance (O6), but we just haven’t been able to try it. It’s so fantastic that you [staff] (M4) thought to try that here today” – parent/CW observation
  1. C context, M mechanism, O outcome, PD physical disability, ID intellectual disability, CW first author