171 General discussion REFLECTIONS I will now address three overarching reflections based on the learning processes associated with the data of this thesis: 1) learning from resistance, 2) the particularities of the DCIA context and related challenges when implementing MCD, and 3) methodological challenges when researching the impact of MCD. In this section, I address challenges since we learn most from reflecting on such aspects for future MCD research and implementation processes. Reflection 1 Learning from resistance Despite various positive results from MCD evaluation studies (Haan et al., 2018; Hem et al., 2015; Janssens et al., 2015; Molewijk, Verkerk, et al., 2008), stakeholders often struggle when they start to use MCD or try to implement MCD. Especially when ESS or MCD is relatively new for their specific context. Publications on MCD hint toward this, e.g., that participants think they do not need MCD or that the conversation method is unsuitable for a specific target group (Van der Dam, 2013). Resistance of staff versus negative evaluations of MCD can work two ways: general resistance of staff (for example about their work conditions) might create negative MCD evaluations, while negative MCD evaluation can also be a reason for the expressed resistance toward MCD. There is surprisingly little specific literature on negative experiences or resistance during and regarding ESS or MCD. I wish to reflect on the notion of resistance by explaining how one can look at resistance and reflect on possible ways of dealing with participants’ resistance when implementing an intervention such as MCD. In general, ‘resistance’ refers to an attitude in which one opposes or rebels against something or someone. Resistance is especially apparent in organizations when changes are expected of staff (Kayzel, 2002, p. 86; Schermerhorn et al., 2002, pp. 460–461). In this regard, resistance is defined as a ‘negative behavioral intention toward the introduction of changes in the structure, culture or way of working in an organization’ (Metselaar & Cozijnsen, 1997, p. 35). Resistance is then seen as undesirable, leading to stagnation during a learning process. Based on this view on resistance, a focus on avoiding or ignoring resistance often arises (Kayzel, 2002, pp. 86–87). Resistance is said to cause stagnation. Yet, to a certain degree, stagnation – or general challenges – will always be part of a learning process when implementing a new intervention. Understanding 7