Table 5.

Key theme 4 – challenges to the process

Master theme	Sub-theme	Example
Challenges to health care professional training	Cost	“If the training course was very expensive then trying to justify it would be more difficult” [Physiotherapist, secondary care]
	Time	“I think that the pressures we have now to [prove] what we are doing clinically, to actually be taking more time out of work would be frowned upon” [Respiratory nurse, secondary care]
	Location	“I suppose it’s location isn’t it, I suppose if you were delivering a thing in Coventry it’s when’s a good time, are you going to do it in the day and people get time off work to come” [Physiotherapist, secondary care]
Challenges to delivery of SPACE for COPD manual	Time	“You are on a time limit as well, you’ve got to watch your timing” [Practice nurse]
	Contact with patients	“Actually I’d like to see you [the patient] four more times to talk through how you can manage yourself better and realising that actually the patient may not have the time or the inclination to come in and have all those extra appointments” [Community respiratory nurse]
	Cost of manual	“You might be presented with this beautiful book, which I don’t know how much it costs, but I wouldn’t imagine it’s that cheap to put out, so we could be wasting money for it just to prop up the coffee table or whatever” [Physiotherapist, secondary care]
	Size of manual	“It would look a bit overwhelming although just because of its size I think” [Community respiratory nurse]
	Follow-up assessments	“If we work through a particular section […] and make a note of that […] and then come back and see if they’ve got any improvements” [Practice nurse]
	Identify suitable patients	“This age group there might be elements of dementia creeping in” [Community respiratory nurse]

Abbreviation: SPACE, Self-Management Programme of Activity, Coping and Education.