Realist Review

The realist review asks how outcomes arise when mechanisms are triggered in particular contexts, rather than only whether the intervention works. The protocol defines mechanisms as underlying reasoning, responses, or resources such as trust, role legitimacy, confidence, self-efficacy, perceived competence, or rapport. The protocol defines context as conditions such as ward type, staffing, organisational culture, governance, and digital infrastructure. No formal quality assessment was conducted, consistent with realist review practice focused on fitness for purpose. The peer-reviewed search identified 2,448 articles; after deduplication and screening, 40 studies were included. All 30 grey literature documents identified were excluded because they did not sufficiently address organisational practices or employment considerations for peer roles. Grey literature is recognised as a quality standard in realist reviews because it can provide evidence fragments that refine, refute, or confirm a programme theory. Quality appraisal in this realist review depends on whether evidence contributes to theory building rather than on conventional hierarchy of evidence. A limitation of the review i…