Box 1. Facilitators and barriers of the BETTER 2 programme, described using the CFIR.9
CFIR domainKey elementBarrierFacilitator
Intervention  characteristic Complexity
  • Amount of material is overwhelming and time consuming

  • Strong evidence base (previous RCT)

  • Patients liked comprehensiveness (multifactorial approach, as opposed to specific disease or organ)

Cost
  • Intervention too costly

  • Intervention is cost effective (investing in prevention offsets acute care costs)

Outer setting Perception of fit
  • Lack of remuneration

  • Lack of resources (particularly staff)

  • Physicians’ perception that prevention practitioner's visit duplicates services

  • Other stakeholders (including managers) see CDPS as a 'hot topic'

  • Patients see visits as valuable, necessary, and& motivating

Characteristics of individuals Prevention practitioners
  • None

  • Interest in prevention 

  • Ability to support and motivate patients

Inner setting Local champion
  • Lack of local champion or losing a local champion (for example, physician left community)

  • None

Working in a team versus working as a team
  • Not working as a team (for example, team tensions, lack of relationship, competition, or unclear roles)

  • Working as a team (for example, trust or physicians appreciating prevention practitioners structuring CDPS)

Process Planning and engaging
  • Not including collaborators enough in planning process

  • Starting collaborative conversations early

Collaboration and teamwork
  • Lack of awareness/misconception of BETTER approach

  • Team members being available

  • Frequent and open conversations

  • CDPS = chronic disease prevention screening. CFIR = Consolidation Framework for Implementation Research. RCT = randomised controlled trial.