Table 5.

Initial themes from the qualitative analysis of the case study data

Theme	Context	Mechanism	Outcome
Reception of GetREAL	Lack of prior information and engagement that involved all staff	Delay in staff engaging with the short term intervention	Only short term changes
Maintaining initial enthusiasm	Looking afresh and starting new activities	Stimulating strong enthusiasm and seeing service users respond positively	Carrying on new activities long term
	The training was interesting and collaborative	Felt engaged, listened to and supported	Short term changes
	Lack of equipment and staff time	Service user disappointed because they were not able to continue activities they liked.	New activities stopped
Impact of GetREAL	GetREAL featured: Predisposing meeting to engage managers and senior staff; Enabling stage with trainers working alongside each unit team for 5 weeks to deliver a tailored programme	Staff felt energised and motivated; more confident and empowering, and that they knew patients better.	More collaborative working, improved staff skills in the short term.
	GetREAL featured: Modelling ways to involve service users in developing the service	Service users started having a voice more, and giving positive feedback on the increased activities, which pleased staff.	Wider variety of activities offered to service users and their involvement was encouraged in the short term
The Legacy of GetREAL	Involvement of all staff	Staff engagement in activities was set as a norm.	The evidence for a long-term legacy following the GetREAL training was mixed. Some new activities continued long term
	Positive feedback from service users	Services users enjoyed the activities and were happy to keep them continue.
	Regular review of the action plan.	Joint planning and working
	Lack of staff available to support a range of activities and staff being too busy to extend their job roles.	No role flexibility