41 Dissemination The standards of RAMESES will be

41 Dissemination The standards of RAMESES will be AZD9291 1421373-65-0 followed in reporting the findings of this review.38 The findings will also be published in a peer-reviewed journal that specialises in health policy, and

with a particular focus on LMICs. Limitations As with all research methods, realist reviews have some limitations. One is that, compared to systematic reviews, realist reviews are harder to reproduce, as selecting papers and following candidate theories require judgement, often based on a mixture of experience, intuition and prudence, to identify those with greatest relevance.26 In order to ensure transparency, however, we will include a summary table and methodological details of papers included in the review. It could be argued that a limitation of a realist review is that it does not provide certitude in terms of findings. From a realist perspective, however, this is not seen as a limitation, as there is no such thing as final truth or knowledge. Rather, a realist review aims to offer insights

into how decisions might be made or how interventions might fare in certain circumstances, and what the outcomes might be for whom.26 A limitation of our study is that only studies written in English will be included and this may introduce an element of language bias. The cost of translation, however, is beyond the scope of this study and the feasibility and accuracy of free web-based translation tools has not yet been determined for the purpose of realist reviews. Conclusion Health systems are complex, and even more so in an increasingly globalised world. In this paper, we present

a protocol for conducting a realist synthesis on patient mobility between LMICs, which has important, but under-studied, implications for healthcare systems. We have formulated an initial theory of cross-border healthcare use, based on domestic health system (perceived) inadequacy, in terms of supply-side and demand-side factors. This theory will inform an analysis of international cross-border patient mobility by patients from LMICs for healthcare, the results of which may better inform health policy makers (to be presented in a subsequent paper). Understanding ‘real world’ health system use is imperative for optimal outcomes, health and otherwise, Batimastat for individuals, communities and populations in the country of origin and abroad. Supplementary Material Author’s manuscript: Click here to view.(1.1M, pdf) Reviewer comments: Click here to view.(128K, pdf) Footnotes Contributors: JD conceived the original idea, formulated the preliminary theory, drafted the manuscript and approved the final document; SJB contributed to the formulation of the preliminary theory, drafted the manuscript and approved the final document. Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Competing interests: None. Provenance and peer review: Not commissioned; externally peer reviewed.

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