Table 3 Consolidated Framework for Implementation Research constructs consistent with factors influencing participant engagement with HENRY

1

Adaptability:

The degree to which an intervention can be adapted, tailored, refined, or reinvented to meet local needs.

Some HENRY facilitators described how they adapted programme material and activities to make sessions more engaging:

“If I started talking about trans fats and saturated fats and hydrogenated fats, they would just switch off; “I don’t know what you’re talking about”. So what I do is, I bring a tin of beans in and I would just talk about good fats and bad fats.” (HENRY Facilitator)

2

Design quality and packaging:

Perceived excellence in how the intervention is bundled, presented, and assembled.

The HENRY programme was perceived to be a high quality programme by commissioners, managers and centre staff. It was also highly acceptable to participants:

“I think it’s excellent, excellent. My favourite thing is the fact that it’s so non-judgemental. It’s just, “this is the information, it’s up to you what you do with it”, and the fact, for somebody like me, who’s very stubborn, the fact that it’s not, “these are the rules and you have to do it”, it makes me much more likely to do it.” (Parent)

3

Cost:

Costs of the intervention and costs associated with implementing the intervention including investment, supply, and opportunity costs.

The price of commissioning HENRY was described by some commissioners as being prohibitive:

“The cost of HENRY is now getting prohibitive. I’ve really stayed true generally, I’ve moved my budgets around, I paid a lot for staff to go and train. But the actual cost of the licence and then the books that you have to buy, and then the resources after that, and actually, they’re pricing themselves out of the market” (Commissioner)

4

Evidence strength and quality:

Stakeholders’ perceptions of the quality and validity of evidence supporting the belief that the intervention will have desired outcomes.

Commissioners described the value of participant outcome data to inform future commissioning decisions:

“We’ve had one of our first reports back from HENRY which is invaluable to us here, you know, because then, when I’m going to commission and strategic meeting with heads of service around this work I can demonstrate back, this is what your staffing’s been doing, this is what a difference they’re making; and that helps it stay quite high on the agenda of people.” (Commissioner)

5

External policies and incentives:

External strategies to spread interventions, including policy and regulations (governmental or other central entity), external mandates, recommendations and guidelines,

Some centre managers described how external strategies influenced the programmes that were prioritised within centres:

“Our targets are set by the local authority at an advisory board in the beginning of the year, so if you have a certain level of obese children in your area at reception class then you have to place HENRY or some sort of healthy living as a priority (Centre manager)

6

Implementation climate:

The absorptive capacity for change, shared receptivity of involved individuals to an intervention, and the extent to which use of that intervention will be rewarded, supported, and expected within their organization.

The local authorities differed in their implementation climate towards HENRY i.e. HENRY was more embedded in some areas than in others:

“It feels like the integration of HENRY in [local authority] feels a little bit tepid” (Commissioner)

7

Leadership engagement:

Commitment, involvement, and accountability of leaders and managers with the implementation.

Children’s centre managers directed the implementation of HENRY in their centres and therefore, obtaining their engagement with HENRY was important:

“The manager is pretty crucial actually because my understanding is they’ve got a lot of freedom about what’s actually delivered in their centre. I think they actually need to be committed to HENRY” (Commissioner)

8

Available resources:

The level of resources dedicated for implementation and on-going operations, including money, training, education, physical space, and time.

Funding constraints experienced at the local authority level impacted upon local implementation of HENRY, for example, the number of staff trained available to deliver the programmes:

“We would like to offer the core training to all our children centres and health visiting staff but we just don’t have the funding” (Commissioner)

9

Access to knowledge and information:

Ease of access to digestible information and knowledge about the intervention and how to incorporate it into work tasks.

Some members of staff expressed an interest in attending training on HENRY, or attending the HENRY programme itself to increase their knowledge around the programme:

“I’d love to attend a course because I think attending a course gives you a feel of it and you can really promote it. If you’ve really enjoyed it you can promote it with such gusto.” (Staff member)

10

Knowledge, & beliefs about the intervention:

Individuals’ attitudes toward and value placed on the intervention as well as familiarity with facts, truths, and principles related to the intervention.

All interviewed stakeholders placed value on HENRY and felt that it was beneficial for families that attended:

“I’ve seen HENRY have a really positive impact; really, really positive […] I think, if you have got a good facilitator, you have got a good group, the impact is massive, it really is.” (Centre manager)

11

Personal attributes:

Personal traits such as tolerance of ambiguity, intellectual ability, motivation, values, competence, capacity, and learning style.

The personal attributes of staff members responsible for delivering HENRY were influential in motivating families to attend:

“I think it’s once you know who’s going to be doing the course, that reels you in” (Parent)

12

Champions:

Individuals who dedicate themselves to supporting, marketing, and ‘driving through’ an implementation, overcoming indifference or resistance that the intervention may provoke in an organization.

The HENRY facilitators ‘championed’ HENRY in their centres, dedicating themselves to promoting the programme:

“I can’t do, say, be excited enough about HENRY. It really is a passion of mine since I’ve trained in it, and yeah, it should reach as many parents as possible. I think all parents should be offered the chance to go on it” (HENRY facilitator)

13

Engaging:

Attracting and involving appropriate individuals in the implementation and use of the intervention through a combined strategy of social marketing, education, role modelling, training, and other similar activities.

Children’s centre staff in some centres approached people to attend based on their perception of how they could benefit from attending HENRY:

“I say “oh we’ve got good HENRY course” if somebody’s talking about their baby […] they say “oh she’s such a fussy eater, she doesn’t eat very well, and I’m having such terrible trouble” and then I’ll say “we’ve got a HENRY course coming up, have you ever thought about that?” and then they’re like “what’s HENRY?” and then you explain it.” (Children’s centre staff member)