Illustrates the key relationships between and across NPT themes, and how this varied between participating teams.
Activities relating to coherence–the sense making work—occurred early in the process of implementation. At this stage, teams broadly fell into one of two groups, with more fixed (rule based) or more flexible (principle based) interpretations. This early formation of understanding impacted on how individuals and teams went on to enact the approach, and how they interpreted its value. The “rule-based” teams typically perceived the approach to conflict with their professional values, particularly with regards to their role as a therapist, and their relationship with patients. Teams that developed this view reported implicit learning to be more challenging to apply, and as a result perceived it to be beneficial in a narrow range of clinical contexts. This fed into the view that it conflicted with professional values, which became a barrier to implementation.The “flexible” therapists reported more activity that aligned with communal specification (working together to form a shared understanding) and also discussed a commitment to making the approach work (endeavour). The dynamic within these focus groups was more collaborative, with senior clinicians facilitating others to contribute their views, and a more open and questioning culture. These groups appeared to find it less challenging to apply the approach; and reported a belief that it could have benefits in a wide range of contexts. These teams also developed their thinking further in terms of reflexive monitoring, reporting more in-depth communal and individual specification. Subsequently, they also reported activities that would align to (hypothetical) reconfiguration–appraising the intervention in a way that would lead them to redefine or shape it to enable sustainability in future practice