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Hi all!
 
My name is Cristina a researcher working at King's College London. I am doing a realistic review on maternity care models and having two queries (hope you can help me!)
 
1) Is it good practice to include systematic/Cochrane reviews as an included paper of a realistic review?
    Reviews were generally excluded in case studies presented in the RAMESES training materials
 
2) Are assumptions accepted when doing the CMO configurations? Or should we just extract what it is exactly reported in the paper without making assumptions? For example my case: 
 
A Cochrane review found that women who receive midwifery continuity of care models are 24% less likely to have a preterm birth (although it is not fully understood why). So my realistic review is trying to explore how  midwifery continuity of care impacts on preterm birth, what works, for what specific groups, how (the mechanisms beneath) and in what circumstances and context. My inclusion criteria briefly:

Any study design, no timeframe/country limitations 
P: pregnant women regardless of risk factors or socio-demographics 
I: midwifery continuity of care models (e.g. caseload, one-to-one, midwifery group practice)
C: Standard Care (if mentioned but not required)
O: Studies reporting mechanisms/explanations for PTB outcomes (studies mentioning PTB numbers alone but no mechanisms/explanations for findings are excluded)
 
So for example, we have one paper that compared childbearing outcomes for women with complex social factors who received caseload continuity midwifery care, and standard maternity care in the UK; and they found less preterm births numbers in caseload group than in standard care (although not significant difference). Explanations/mechanisms for this are not directly presented in the paper, but authors found that: "Vulnerable women in the continuity caseload group were significantly more likely to be referred to psychiatric services, domestic violence advocacy and other support (including translation services, early health visitor input, children's centres, housing and parenting support). This may have had a profound impact on safety, pregnancy outcomes* and ability to parent...."
 
*Considering that women who suffer domestic violence, mental health issues, social stress etc are at increased risk of preterm birth - could I assume that this increase in referral pathways and support might have a impact pregnancy outcomes including PTB..?" (although this is not explicitly mentioned in the paper, I am just drawing on other evidence, as these women may feel extra supported, trust their healthcare professional,  perhaps disclose risks promptly, etc)
 
Thank you so so much for your help :) 
 
Cristina

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