Table 7.

Representative quotes on the implementation of the EIRA intervention according to their negative or positive influence

CFIR Construct/Domain (Definition)	Positive influence	Negative influence
Intervention source/ Intervention characteristics (Perception of key stakeholders about whether the intervention is externally or internally developed)	“Well, the intervention has been designed by the people that work in these issues, people in primary care who I believe are working more on these issues” (PHC centre M)
Adaptability/Intervention characteristics (The degree to which an intervention can be adapted, tailored, refined, or reinvented to meet local needs)	“Because there was the flexible part where you conduct the visit like, a bit following the needs of the patients …” (PHC centre J) “There was no strict protocol saying you have to give the form, you must do this, so naturally, we have adapted it to our own practice, because there was no specific rule on how to do it. I think we had this freedom and we have delivered.” (PHC centre G)	I feel it was something recycled, that was already there, and when people read it’s just another leaflet, if it focused more on our customs or our ways, maybe people would pay more attention (PHC centre D)
Complexity/ Intervention characteristics (Perceived difficulty of the intervention, reflected by duration, scope, radicalness, disruptiveness, centrality, and intricacy and number of steps required to implement)		“If they had 3 problems (behaviours), for instance, better stepwise, not everything in the same session … For me it’s better stepwise. Maybe 2, but 3 is complicated. If you are going to introduce changes in food, I think it’s too much change … “(PHC centre B)
Needs & Resources of Those Served by the Organization/Outer setting (The extent to which patient needs, as well as barriers and facilitators to meet those needs, are accurately known and prioritized by the organization)	I think for many patients this research has been a push, they had set aside these things and now they thought “this is the time!”. An opportunity for them, and many are really thankful. Because of personal reasons, for some it has not been very successful, for others it has been very beneficial, and they are very thankful, and they explain this to me when I see them again, some feel really happy about it. (PHC centre I)	“I think people don’t want to take responsibility for anything. And parents arrive to the emergency room and say “I believe they have a fever”. They have not even checked with the thermometer! They don’t want responsibilities. People don’t want, and if you don’t take responsibility, how can you change attitude? “(PHC centre A) Yes, because they thought we would provide a miracle diet just for them, and it was of course impossible, what we did was general, explaining types of diet, how to shop for food … For me, when we prepared it I found it very practical, but of course, many came with “but my problem is, my problem is”, “for this specific thing you have to see your EIRA nurse to get this, this is a bit more general”, we explained what to look for in the labels, the calories, saturated fat and such, but naturally they expected a form with the miracle. That was not happening, what can you do. (PHC centre G) “With respect to physical activity, the resources of the Community were limited.” “There were no resources.” “There were none. Only the Red Cross for people over 65 years and for something free of charge, not for profit, we had little. Neighbourhood associations …” (PHC centre K)
External Policy &Incentives/Outer setting (A broad construct that includes external strategies to spread interventions, including policy and regulations (governmental or other central entity), external mandates, recommendations and guidelines, pay-for-performance, organization, and public or benchmark reporting)		“… adapting to a different working method seems easy but it’s not, because you have to break habits that are difficult to change, particularly from a certain age, where you have another perspective of things” (PHC centre M) “… at least most nursing staff comes from workplaces very different from primary care, they come at an age when it’s very difficult that the years or the few years until retirement they change” (PHC centre M) “I think, perhaps, we are not supported by the management, the preventive policy …”; “This requires institutional policies from the start. But this has not happened yet” (PHC centre B)
Structural characteristics/Inner setting (The social architecture, age, maturity, and size of an organization)	I believe that having a small team has helped (PHC centre J)	The volatility of staff. You have a team and suddenly half of them are not there anymore. (PHC centre B)
Culture/Inner setting (Norms, values, and basic assumptions of a given organisation)	“I believe this is not your average centre, above the area, […] I believe that yes, always … in trying new things” (PHC centre K)	The outlook needs to change [..] for managers, for professionals, … (PHC centre B)
Relative priority/Inner setting (Individuals’ shared perception of the importance of the implementation within the organization)	“… losing weight is more important than the pharyngitis” (PHC centre “A”) “I believe that a GP or a primary care nurse should work on this half of their time” (PHC centre “A”)	“There have been periods with a full agenda … And other issues have been prioritized.” (PHC centre “J”) “I don’t think a project about this is a priority” (PHC centre H)
Leadership engagement/Inner setting (Commitment, involvement, and accountability of leaders and managers with the implementation)		The only preventive activity that I know the director is involved in are vaccinations. And this for me is the example, the administration needs to organise, organise and offer the means to implement. (PHC centre B) I think that they should be involved, you know, what we discussed, that to achieve something it’s not only at our level, also for the managers (PHC centre B)
Available resources/Inner setting (The level of resources dedicated for implementation and on-going operations, including money, training, education, physical space, and time)	For this to be feasible, we already said, we need time, maybe we were already doing this, maybe in other centres because of high demand could not integrate these activities in their daily practice. So this is the time needed (PHC centre G)	“We need more space” (PHC centre K) “We have too many patients, we are too willing, we have too much material. What we lack is time, that’s it, in short.” (PHC centre A)
Access to Knowledge & Information/Inner setting (Ease of access to digestible information and knowledge about the intervention and how to incorporate it into work tasks)	And yet, the two PBI sessions (in-person group feedback session), maybe then I don’t know, us discussing, being there even discussing something among us, because at home on your own you go over it time and time again … But when you are with other people and discuss it, maybe others see what you don’t see, or you say “maybe not, I thought it was perfect and the reality is it can improve”. (PHC centre J)	Yes, I mean, there were two trainings. One face to face, which was good because you could interact, yes, and then it’s true that people were rather unhappy with the online interview course, people didn’t like it. We did not like it, it was not useful, … (PHC centre G)
Formally appointed internal implementation leaders/Process (Individuals from within the organization who have been formally appointed with responsibility for implementing an intervention as coordinator, project manager, team leader, or other similar role)	“There is always somebody appointed to lead, isn’t it? That’s my experience, anyhow. So that nobody can say …”; (PHC centre A)	In the community commission, where I was, it helped a bit in connecting with other people, I used to call, … and, I don’t remember anybody leading, more as a team. I really don’t remember who the leader was. Well, then, it has worked, but I really don’t think it’s because of the leadership. (PHC centre H)
External change agents/Process (Individuals who are affiliated with an outside entity who formally influence or facilitate intervention decisions in a desirable direction)	“thanks to your help, well, we have been able to do it” (PHC centre D)
Reflecting & evaluating/Process (Quantitative and qualitative feedback about the progress and quality of implementation accompanied with regular personal and team debriefing about progress and experience)	And what you used to send, the bulletins, were also very useful. (PHC centre I)	Well, maybe the sessions, when there was a session just for EIRA, we asked “do you have any issue to discuss? No, well...”, then each of us tends to their business (PHC centre J)