Table 4

Cognitive participation factors that facilitated or hindered TRM implementation

NPT components	Factors	Selected verbatim quotes
Initiation	Training sessions and access to expert support facilitated implementation. However, training had to be flexible and fit with the practices’ needs.	‘I’ve been trying to start the ground level approach of saying ‘this is how it should be used’, you know, used formatively and using it to look at your systems as well, and things like that’ (GP05).
Enrolment	Initial recruitment of volunteers facilitated implementation. However, most practice nurses were assigned the TRM, which initially reduced the motivation of some.	Sometimes you know that, although they’re asking you [pause] it’s going to come your way anyway (PN09).
Activation	The TRM was facilitated when findings were disseminated, and reviewers had sufficient autonomy and opportunity to enact change.	I wasn’t involved at all (PM10). I held a practice meeting afterwards to highlight that perhaps we aren’t always that good (GP06).
Legitimation	Implementation of the TRM was facilitated when individuals and practice teams were able to justify investing time and resources in its application.	‘I’m not sure if I’d have gone back to [the TRM] if it had disappeared off the horizon… you have to justify the time in order to make it happen’ (GP06). I feel I always have to justify every single working minute I have in here (PN10).