Table 2 Example data mapped to NPT constructs, and recommendations

Coherence

What is the meaning of the intervention to the different stakeholders?

Staff Workshop- Staff need to view it as an opportunity to better care for patients/ improve delivering care- “this is innovative, interesting and important”; “What can we do better?”; “I aspire to any feedback given by the patients on how to improve the experience during dialysis”

Patient Workshop- Patients need to view it as an opportunity to improve communication with clinicians/ improve health condition - “improvement in interaction with consultant”; “getting response back”; “improvement in health condition”

On-site emphasis on value, through materials and support:

Making data available to all staff after completion

Presentations during team meetings with all unit staff to help them understand how this data will be used, who will use this data to emphasise the value.

Local materials (FAQ sheets and invitation letters) produced for patients to inform them about the value of completing ePRO.

Trained specific staff members to discuss with patients the value of completing ePRO regularly and how it would be used.

Modifying patient materials to emphasise how completion can support conversations with HCPs.

Cognitive participation

What roles need to be undertaken to deliver the intervention and who is able to perform them?

Observations- The haemodialysis and outpatient units operate with different level of staff with specific responsibilities. Managers- The unit manager can manage the intervention and assign tasks to specific staff. Implementers- Healthcare assistant workers and other support workers were could take on the collection of ePRO due to their availability.

Local tailoring of who delivered which elements of the intervention:

Work with the unit manager to identify the most appropriate staff who can manage the intervention and deliver specific elements of the intervention.

Individually discuss the role of consultants in reviewing the ePRO data

Collective action

What are the existing routines and practices which the intervention must work alongside?

Staff Workshop- Staff emphasised the need to understand how to best embed the ePRO in their routine, to minimise disruption to other tasks. This included knowing how to support patients and answer patient questions about completion. “How to complete [collect ePRO]”; “reassure patients that filling out the survey for their benefit”; “when is the best time/ day to do it [collect ePRO]”; “Explaining why you’re doing it”

Patient workshop- Patients are concerned about having space (physical and mental) and privacy, timing in relation to when it will be reviewed- “Would I have the option to do this from home prior to my appointment?”; “the waiting room is non-existent. It is a very busy corridor and very disturbing to any thought process”; “privacy is a big issue in the so-called waiting area of my clinic”

Observation- Units in different sites practice symptom collection differently. Some clinicians are required to directly report symptoms in the patients’ electronic patent record. Patient symptoms are discussed during team/hand over meetings. The intervention must be embedded in the routine practice of providing dialysis in HD units. It must also be embedded in the rapid flow of outpatient units.

Local tailoring of when and where the ePRO is completed:

Allowing the staff responsible for collecting ePRO to perform the task any time during their shift.

Ongoing in-person training with selected staff to build their understanding of the aim and value of collecting ePRO.

Providing reminders to patients to complete their ePRO ahead of the ePRO review to give them the opportunity to complete it in their preferred location.