Despite extensive efforts in data collection, quality and safety measurement remains a significant global challenge, with limited understanding of how and under what conditions quality and patient safety surveillance systems function effectively. With the aim of informing the development and effective functioning of quality and patient safety surveillance systems, a rapid realist review was conducted to develop a set of theories that address how, why, for whom and in what context quality and patient safety surveillance systems work.

Rapid realist review to inform recommendations and intervention design for the monitoring and evaluation phase of the QS Signals Project, reported according to Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines.

Initial programme theories were constructed based on data collected from key articles on quality and patient safety surveillance systems, consultation with an expert panel, informal meetings with a project team charged with developing a quality and patient safety surveillance system for maternal and infant health and a review of the project’s planning documents. A three-phase iterative search of PubMed, PsycInfo, CENTRAL, CINAHL and grey literature was conducted, including studies in healthcare settings across all patient groups.

Documents were assessed for relevance (alignment with the theory under test), richness (depth of insight) and rigour (trustworthiness and coherence of data).

Context–mechanism–outcome configurations were generated, iteratively refined and grouped under relevant programme theories to contribute to theory refinement.

The review process resulted in the development of 11 final programme theories, identifying mechanisms operating at organisational and national levels. Effective systems were enabled by leadership commitment, organisational readiness for change and a supportive safety culture. Clear governance structures, including defined local and national roles, strengthened accountability and coordination. The establishment of multidisciplinary clinical advisory groups facilitated the selection of meaningful safety indicators. Sustainable financial investment and adequate human and technical resources were critical for implementation. Robust data governance frameworks enhanced trust, transparency and appropriate data use. User-centred system design improved data accessibility and usability, while feedback loops supported learning and continuous improvement.

Quality and patient safety surveillance systems function most effectively when supported by strong leadership, clear governance structures, adequate resources and a learning-oriented culture that enables the meaningful use of safety data. The findings emerging from this review provide comprehensive, practical and testable systems-level programme theories to inform future research on the development of quality and patient safety surveillance systems across diverse healthcare settings and international contexts.

Although breastfeeding is associated with lower postnatal depression and anxiety, limited research exists regarding long-term maternal mental health outcomes. This study examined the association between breastfeeding and depression and anxiety in women of later reproductive age (mid 30s to menopause).

This was a 10-year prospective longitudinal cohort study. Self-reported questionnaires were used to collect lifetime breastfeeding behaviour at 10 years, and health history including depression, anxiety and medication use was collected at each study timepoint.

A tertiary level maternity hospital in Dublin, Ireland.

168 parous women from the ROLO Longitudinal Cohort with lifetime breastfeeding behaviour and health history data available at 10 years were included (22% of total cohort). Women currently pregnant or breastfeeding at 10-year follow-up were excluded.

Mean (SD) age at study end was 42.4 (3.8) years. 72.6% (n=122) of women reported ever breastfeeding. Median lifetime exclusive breastfeeding was 5.5 weeks (IQR 35.8, range 0–190). 37.5% of women (n=63) breastfed for ≥12 months over their lifetime. 13.1% (n=22) reported depression or anxiety at 10 years, and 20.8% (n=35) reported depression or anxiety over the whole study period. Ever breastfeeding was associated with less depression and anxiety at 10 years (OR 0.34, 95% CI 0.12 to 0.94, p=0.04). Ever breastfeeding, longer exclusive breastfeeding and lifetime breastfeeding ≥12 months were associated with lower depression and anxiety over the whole study period (ever breastfeeding OR 0.4, p=0.03; exclusive breastfeeding OR 0.98/week, p=0.03; lifetime breastfeeding ≥12 months OR 0.38, p=0.04).

There may be a protective association between breastfeeding and self-reported depression and anxiety. Further studies are required to confirm the findings.

ISRCTN54392969.

Peer support in youth mental health settings holds promise as a developmentally appropriate and impactful initiative; however, research exploring implementation remains limited. To advance the field and strengthen future implementation efforts, the aim of the present study was to generate new understandings about how non-peer service providers working alongside youth peer support workers experience the peer support role in youth mental health settings.

Guided by interpretive description and tenets of a research community partnership model, semi-structured interviews were conducted with non-peer service providers (n=11) across three integrated youth services centres in British Columbia, Canada, from August to December 2020. Data were analysed inductively using a constant comparative approach to identify and construct themes.

Participants emphasised integration and supervision of youth peer support workers as essential for successful peer programming within integrated youth services, highlighting three interconnected themes: defining supervisory roles, envisioning role clarity and capacity and governance of youth peer support services.

Integrated youth services initiatives and peer-led agencies can play key roles—both directly and indirectly—to strengthen the governance and infrastructure of youth peer support.