Table 1 Implementation strategy for the CSNAT intervention (Adapted from Proctor et al 2013 [43])

Actors: stakeholder/s who delivers the implementation strategy

Each service within an organisation that is implementing the CSNAT intervention selects 2–3 practitioners to be internal facilitators (IFs); referred to within each site as ‘CSNAT Champions’. One practitioner is asked to take on the role of the ‘lead’ IF. The organisation is provided with guidance on which skills and qualities are important for the IF role (based on recommendations by Seers 2012 [26] and an overview of IF role and responsibilities.

Actions: the actions, steps or processes that need to be enacted

IF key responsibilities include:

- Cascading training on use of the CSNAT intervention to their colleagues and supporting implementation within the service.

- Acting as a positive role model regarding how to use the CSNAT intervention to support best practice (e.g. by sharing their experiences of using the CSNAT intervention).

- Supporting their colleagues in the use of the CSNAT intervention.

- Holding regular discussions with colleagues on issues related to using the CSNAT intervention in practice (both at formal meetings and during informal exchanges).

- Directing colleagues to further sources of support (e.g. training materials supplied at the ‘CSNAT training day’).

An ‘organisation’ agreement is signed by senior management to indicate they agree with providing the resources for the IFs to fulfil their role, including time.

Action target: the conceptual target the strategy attempts to impact

Knowledge about how to use the CSNAT intervention and continued motivation for its use with carers in everyday practice

Temporality: the order or sequence of the strategy

Assumption that practitioners within the service would begin the use the CSNAT intervention with carers of patients once they had received training

Dose: intensity of the implementation strategy

All IFs attend a ‘CSNAT training day’ hosted by the CSNAT team who act as external facilitators (EFs). Training delivered on the CSNAT intervention evidence base, and a detailed overview of how to use in practice (including case study examples from other practitioners). EFs support IFs with the following activities:

- Reflection on their organisation’s ethos or mission statement (often highlights they ae are there for the carers/family/friends of the patient)

- Considering how they currently became aware of carer support needs

- Planning for how they could use the CSNAT intervention in their individual practice

- Making an initial ‘implementation plan’ for their service to include thinking about how to use the intervention within the service, where to record data on carers, format of CSNAT documentation, and how they could deliver training to and support their colleagues.

All IFs provided with a ‘CSNAT training’ toolkit which includes materials covered at the training day and hints and tips on how to implement the CSNAT intervention in practice, both at individual and organisational level. Development of the toolkit was based on previous experience with services and on feedback from practitioners who have used the intervention. A power-point presentation and accompanying notes are also supplied if IFs want to make use of this in the training sessions they host for their colleagues.

All lead IFs are asked to participate in monthly one hour teleconferences with the CSNAT team (EFs) and lead IFs from other sites for the purposes of peer support and shared learning on implementing the CSNAT intervention at an organisational level. Email and telephone support also available from EFs.

Implementation outcome(s) affected: outcome the strategy targeted

Level of adoption of the CSNAT intervention within each service: for further information see Diffin et al. 2018 [18].

Justification: rationale for selection of the implementation strategy

Implementation of a complex intervention is more likely to occur if there are appropriate levels of internal and external facilitation.