A total of 3,600 records were retrieved after searching the databases. Sixty-four duplicates were removed, leaving 3,536 papers which were screened at the title and abstract stage, after-which 3,472 were excluded. 64 papers underwent full text screening of which ten were automatically excluded due to the absence of a full text. During full text screening, 32 papers were excluded for various reasons (see Fig. 2), leaving a total of 22 studies that met inclusion criteria and underwent data extraction.
After the first phase of data extraction, only 12 studies were appraised as rich because they contributed to CMOcs, subsequently supporting theory development. These 12 studies were also rated for rigour. Appendix 2 presents a summary of ratings for richness and rigour.
A total of 29 CMOcs were extracted from the included 12 studies. Appendix 3 presents a full list of CMOcs. From these CMOcs, nine demi-regularities or patterns were identified, which supported the refinement of the programme theories into nine final programme theories after consultative meetings with the expert panel.
Theory 1: Organisational and Management Involvement
In health services or professional associations where leadership and/or mentorship programmes for women healthcare workers (C) aligned with organizational goals and existing roles, were inclusive of all genders, and had buy-in from executive and middle management by management being involved in the programme (M-R1), then this bolstered programme success with participants as it enhanced their leadership skills, knowledge, confidence, and self-efficacy (O). This is because the organisational support encouraged involvement and participation, and obstacles related to the planning and execution of the programme were reduced (M-R2) [24–29].
Further outcomes of these leadership and/or mentorship programmes with organisational alignment and management buy-in (M-R1) were that they improved access to leadership positions for women (O), because having buy-in from management can shift the organisational culture to be more supportive and inclusive (M-R2) [24–29].
Theory 2: Mentorship Pretraining
In health services or professional associations where mentoring programmes were introduced (C), if mentoring pre-training was delivered to women healthcare workers by facilitators who provided information on the mentor-mentee dynamic (i.e. approaching mentors, how to maintain relationships with mentors) and set expectations regarding mentoring (M-R1), this improved programme outcomes including leadership self-efficacy, desire for a leadership role, and acquisition of transformational and clinical leadership skills (O). This is because mentees were more aligned with the process of mentoring and the potential benefits, and there was more engagement from mentees (M-R2) [24, 30, 31].
Theory 3: Supportive Mentors
In health services or professional associations (C) where mentorship was delivered to women healthcare workers and more senior members helped to identify and develop leadership competencies (M-R1), this improved mentees’ leadership, self-efficacy, desire for leadership roles, ease of navigating opportunities, transformational leadership skills, and fulfilment of leadership duties (O) because the support of a seasoned colleague provided confidence to the mentees and facilitated access to opportunities (M-R2) [24, 25, 27, 30, 32, 33].
Theory 4: In-put/ Co-creation/ Autonomy during Mentorship
In health services (C) where mentorship was delivered to women healthcare workers, and they were given input into the design of the programme, such as scheduling contact and allowed to develop an authentic relationship with the mentor (M-R1), this contributed to the success of the programme among mentees as evidenced by increased leadership self-efficacy, transformational and clinical leadership skills, and desire for a leadership role among mentees (O) because the participants were able to take ownership of the programme and ensured it represented their needs and availability (M-R2) [24, 30, 31].
Theory 5: Leadership Education and Content
In health services where (C) relevant and structured leadership training was delivered by content experts who taught women healthcare workers various leadership and discipline-specific topics (M-R1), this improved leadership among participants, including increased leadership self-efficacy, confidence, knowledge, skills, and desire and acquisition of leadership roles (O) because the knowledge gained was seen as applicable to their role, which inspired engagement and commitment (M-R2) [24–28].
Topics for education can include communication, conflict resolution, the feeling of belonging, leader vs. manager, mentoring vs. coaching, wellness, equity, quality improvement methods, leadership styles, critical inquiry, project management, and transformational leadership [24–28].
Theory 6: Practical Components to Support Learning
In health services or professional associations (C) where women healthcare worker participants got to integrate and practice their didactic learning from the leadership education through the incorporation of practical components, such as action learning sets, experiential learning, implementation of a project or interactive sessions (M-R1) then this enhanced leadership outcomes, such as knowledge, confidence, leadership skills and acquisition of leadership positions (O) because practical components equipped participants with a better grasp of the theoretical knowledge, and they got the opportunity to put their skills into practice (M-R2) [26, 27, 32, 34].
Theory 7: Hybrid Learning
In health services (C) where leadership programmes were delivered among women healthcare workers via both in person and online platforms (M-R1) then this led to increased leadership knowledge, skills, leadership participation and effective fulfilment of leadership roles (O). This is because providing multiplicity of ways to access the programme offered greater opportunity for engagement which enhanced learning and skill acquisition (M-R2)[25, 27, 33].
Theory 8: Leadership Skills Building
In health services or professional associations (C) where leadership development incorporated the attainment of foundational leadership skills, including negotiation, collaboration, networking, reflection, and goal setting among women healthcare workers (M-R1); then this enhanced leadership outcomes such as self-efficacy, leadership knowledge, skills, desire for a leadership role, attainment of leadership positions, and effective fulfilment of leadership roles (O), because the knowledge gained was seen as applicable to their role which inspired engagement and commitment (M-R2) [24, 25, 28, 33, 34].
Theory 9: Self-tailored Learning
In healthcare settings and professional associations (C ) where leadership education delivered to women healthcare workers was self-tailored (M-R1), this ensured the programme represented their needs and resulted in the enhancement of relevant leadership skills (O) because ownership and motivation for the programme was improved (M-R2) [32, 33, 35].