Table 1 Summary of projects 1–3

One

To increase GPs, health visitors’ and nurse practitioners’ referrals for women diagnosed with mild to moderate postnatal depression to psychological therapies, recommended by National Institute for Health and Clinical Excellence (NICE).

A questionnaire measuring constructs from Greenhalgh et al’s conceptual model of the determinants of diffusion [17], followed by qualitative interviews with seven local health professionals.

Two

To increase GPs and nurse practitioners’ referral of symptomatic patients for spirometry testing to confirm diagnosis of chronic obstructive pulmonary disease, recommended by NICE.

Single focus group with health professionals and practice managers (10 general practitioners, 3 practice managers and 3 nurses), with questions guided by constructs from the theory of planned behaviour (TPB) [15]. This was followed by a TPB questionnaire, the content of which was based upon barriers identified from the focus group.

Three

To increase GPs and nurse practitioners’ opportunistic screening of patients for alcohol misuse using a validated screening tool, recommended by NICE.

Literature review to identify barriers to screening for alcohol misuse in primary care. Barriers were organised into thematic groupings using the theoretical domains framework [13], and checked for their applicability in the local context with an opportunistic sample of health professionals (11 general practitioners and 1 nurse). This was done using a checklist summarising each of the barriers and asking the health professionals to indicate whether they considered them to apply locally. The barriers were also discussed for their relevance and amenability to change with the project stakeholder group, comprising researchers, health professionals, and members of the local, collaborating, quality improvement team.