Implementation of a national programme to train and support healthcare professionals in brief behavioural interventions: A qualitative study using the theoretical domains framework

Objectives: Behaviour change interventions offered opportunistically by healthcare professionals can support patient health behaviour change. The Making Every Contact Count (MECC) programme in Ireland is a national programme to support healthcare professionals to use brief behavioural interventions. The aim of this study was to gain an in-depth understanding of the enablers of, and barriers to, embedding MECC across the healthcare system. Design: A qualitative interview study. Methods: We conducted individual semi-structured interviews to understand barriers and enablers to MECC implementation. Our sample was 36 participants (11 health promotion and improvement officers, 9 nurses, 15 allied health professionals and 1 training instructor) who have a direct role in either supporting or delivering brief interventions to patients. Data were analysed using a Framework Analysis approach guided by the Theoretical Domains Framework (TDF). Results: Eight theoretical domains influenced MECC implementation: environmental context and resources, intentions/goals, beliefs about the consequences of MECC delivery, knowledge, healthcare professionals' beliefs about their capability to deliver MECC interventions, social and professional role and identity, and reinforcement and skills. Environmental context and resources was the most strongly endorsed domain with key influencing factors including consultation type/setting, making MECC a routine part of clinical practice, a multi-professional approach, access to/visibility of resources/services, management support/expectations, impacts of the COVID-19 pandemic, and the salience of the MECC programme and the strategic fit of MECC with other health service initiatives. Conclusions: While individual factors influence national implementation of behaviour change interventions, creating enabling environments for healthcare staff is crucial for widespread adoption across healthcare systems.