Table 6 Failure to Cohere: TDF and NPT in practice

It was felt that the practices knew about the topics and already worked hard to achieve outcomes (TDF knowledge and beliefs about capabilities). It was felt little more could be achieved (TDF beliefs about consequences, motivation & emotion). The intervention did not seem to add value or seem different to the practice’s existing work (NPT differentiation) and staff felt it was more or less important to work to the specified intervention targets (NPT communal and individual specification). Practices felt they did not have the resources or the incentive to change systems and processes (TDF environmental context and resources and motivation; NPT coherence).

Outreach meetings tended to involve large numbers of staff with varied interests and desire to engage in work (TDF social and professional roles and skills). Levels of participation in work around the intervention varied (NPT cognitive participation: initiation and enrolment), and there was little sense of the intervention being integrated into staff routines or influencing the allocation of resources (NPT collective action: relational and contextual integration) due to how staff perceived the intervention as irrelevant to their role (TDF social and professional roles) and unlikely to impact on patient outcomes without negatively affecting patient rapport (TDF beliefs about consequences).