Table 2.

Strategies facilitating actions implementing Cardiovascular (CV) Toolkit over time [by Replicating Effective Programs (REP) phase and month].

Strategy	Actions by REP phase and month
REP phase	Pre-condition			Pre-implementation			Implementation							Maintenance and evolution
Month	1	…	6	7	…	12	13	14	15	…	25	26	27	28	…	31
1. Conduct local needs assessment	1. Establish need for the intervention 2. Determine feasibility at local site
2. Inform local opinion leaders				1. Discuss CV Toolkit with key stakeholders during site visits 2. Explain core elements and options for adapting delivery			1. Regular communication with opinion leaders throughout intervention (to learn from them what is working and inform them what is not working at other sites).
3. Develop educational materials	1. Review and select patient and provider educational materials 2. Discuss educational needs of teams at sites			1. Further local tailoring of educational materials for each site
4. Promote adaptability				1. Explain core elements and options for adapting delivery to key stakeholders during site visits			1. Interactive component							1. Collaborate with local teams to develop CV Toolkit Implementation Playbook
5. Build a coalition	1. Work with national-level partners 2. Engage with selected sites 3. Orient and elicit feedback from key stakeholders during site visits 4. Conduct needs assessment			1. Identify local champions 2. Hold broader orientation meetings 3. Orientation and adaptation at sites										1. Report on findings 2. Review business case 3. Collaborate to plan for spread 4. Collaborate to re-tailor as needed with spread
6. Conduct educational meetings	1. Discuss educational needs of teams at sites			1. Hold orientation meetings with broader clinic at each site to distribute and discuss CV Toolkit and assess educational needs			1. Use monthly reflection calls with site leads to discuss and address challenges in implementation
7. Tailor strategies	1. Refine, program, test, and load computer template in CV Toolkit package 2. Explore local resources to further tailor to site			1. Refine, program, test, and load computer template in CV Toolkit package 2. Work with national-level partners to make program adjustments and further tailor for women Veterans 3. Tailor locally with training and technical assistance 4. Explore local resources to further tailor to site 5. Develop communication plan at each site			1. Collaborate with local health coaches to tailor Gateway to site and women Veterans 2. Explore local resources to further tailor to site							1. Modify CV Toolkit as needed to continue and disseminate 2. Recustomize Implementation Playbook as needed
8. Provide local technical assistance	1. Discuss educational needs of teams at sites			1. Overall launch meeting and training 2. Train & and detail for each provider on the computer template 3. Further local tailoring with training and technical assistance of toolkit package for each site			1. Assess additional need for detailing, provider training, and technical assistance
9. Involve executive boards	1. Work with national-level partners 2. Identify effective interventions 3. Evaluate pilot results 4. Adapt pilot package for women Veterans; refine for new sites			1. Work with national-level partners 2. Review potential sites with partners			1. National-level partners send trainers for Gateway training at sites							1. Report on findings 2. Review business case 3. Collaborate to plan for spread 4. Collaborate with partners to re-tailor as needed with spread
10. Identify and prepare champions				1. Site lead identify local CV Toolkit champion at each site 2. National-level partners travel to sites to train Gateway to Healthy Living facilitator			1. National-level partners travel to sites to train Gateway to Healthy Living facilitators
11. Assess for readiness, & and identify barriers & and facilitators				1. Explore care options (health coaches, smoking cessation, MOVE!) at each of the sites during site visits 2. Conduct interviews and surveys with consenting key stakeholders
12. Develop formal implementation blueprint							1. Further local tailoring with training and technical assistance of toolkit package for each site							1. Provide and elicit feedback to make modifications to implementation process to enhance local adoption and fidelity, and facilitate dissemination to future sites 2. Research team collaborate with local implementation teams to develop CV Toolkit Implementation Playbook
13. Audit and provide feedback							1. Monitor and summarize use of computer template in deploying intervention in the clinic 2. Quarterly reports on use of computer template in deploying intervention presented to clinical teams							1. Provide and elicit feedback to make modifications to implementation process to enhance local adoption and fidelity, and facilitate dissemination to future sites
14. Purposefully reexamine the implementation							1. Assess additional need for provider training 2. Quarterly reports on use of computer template in deploying intervention presented to clinical teams 3. Document in notes any issues with use of CV Toolkit during trainings in context of each clinic setting 4. Analyze notes in ATLAS.ti software in conjunction with evaluation data 5. Use monthly reflection calls during regular implementation meetings to assess and address implementation challenges							1. Provide and elicit feedback to make modifications to implementation process to enhance local adoption and fidelity, and facilitate dissemination to future sites
15. Conduct cyclical small tests of change							1. Implement toolkit locally to ensure it works as intended with local systems and processes and make iterative changes as needed
16. Develop an implementation glossary														1. Research team collaborate with local implementation teams to develop CV Toolkit Implementation Playbook

Develop stakeholder interrelationships

Train & and educate stakeholders

Use of evaluative and iterative strategies

Adapt and tailor to context

Provide interactive assistance