Table 2 Barriers identified in preliminary stakeholder engagement activities

Lack of time limiting opportunities to support self-management

NM Bridges tailored to context. Inter-professional education to highlight benefits of working in this way. Academic detailing to describe evidence-base, and benefit to patients & the wider healthcare system.

Coherence: Illustrating the difference between NM Bridges and established staff interactions with patients. Education provided on the underpinning theory and illustrating its practical application. Differentiation: understanding the difference between NM Bridges, and more traditional approaches to patient communication.

Fidelity, acceptability, adoption rates, organisational feasibility.

Observation, checklists, self-report, semi-structured interviews, AIM, FIM, NoMAD

One-off interactions (as opposed to multiple rehab sessions)

Iterative development of educational material in monthly cycles, co-design of the educational package for clinicians, continuous quality improvement through ongoing remote support and education from the research team

Collective action: Consideration, discussion, and action planning for specific demands of the specialist neuromuscular service. Integration into current service processes through team meetings, goal setting, documentation. Initiation: The staff’s motivation in trying to incorporate NM Bridges into their clinical practice.

Fidelity, acceptability, technical feasibility

Semi-structured interviews, AIM, FIM, NoMAD

Increased time requirement to complete self-reported fidelity checklist

Educational meetings and local consensus processes, where fidelity is discussed alongside problem solving strategies and adaptions to mitigate evolving barriers

Cognitive participation: Accommodating professionals’ shared and differing beliefs. Collaborative methods for incorporation of NM Bridges into ways of working.

Fidelity, acceptability, technical and organisational feasibility

Self-report, semi-structured interviews, AIM, FIM, NoMAD

Potential for decreased implementation momentum due to caseload

Audit and feedback from patients using NM Bridges to be provided to staff via weekly email to promote engagement.

Reminders: Bi-monthly emails sent from the research team to remind staff about NM Bridges and to encourage further adoption.

Collective action: Facilitating engagement through flexible training slots, availability of material such as patient workbooks, staff peer mentoring.

Reflexive monitoring (reconfiguration): Suggestions from participants that aim to modify and enhance the utility of the NM Bridges programme.

Fidelity, acceptability, adoption rates, organisational feasibility, appropriateness

Observation, checklists, self-report, semi-structured interviews, AIM, FIM, IAM, NoMAD