Using intervention mapping to develop and facilitate implementation of a multifaceted behavioural intervention targeting physical activity and sedentary behaviour in stroke survivors: Physical Activity Routines After Stroke (PARAS): intervention development study

Figures & data

Figure 1. PARAS development process.

Table 1. Stroke survivor behavioural outcomes, performance objectives and change objectives related to theoretical domains and associated themes identified from focus group data.

Stroke survivor behavioural outcomes To develop knowledge to raise awareness of the importance of physical activity and reducing sedentary behaviour in the context of stroke, and skills to increase and sustain activity levels and reduce sedentary behaviour to enable performance of activities of daily living. Performance objectives Understands benefits of physical activity and reducing sedentary behaviour after stroke Requests support to increase physical activity and reduce sedentary behaviour at the most appropriate time Selects and safely performs meaningful and sustainable physical activity and/or reduces sedentary behaviour Identifies and utilises social support to maintain physical activity behaviour and reduce sedentary time Applies behavioural goal setting, action planning and coping planning to selected physical activities and/or reducing sedentary behaviour Selects methods of self-monitoring physical activity and sedentary behaviour Self-monitors physical activity and sedentary behaviour, behavioural goal attainment and associated confidence and well-being Plans methods for maintaining physical activity or reducing sedentary behaviour
TDF Domain	Themes identified	Stroke survivor change objectives
Knowledge	Timing of information provision is important but highly individual Amount and intensity of physical activity has to increase to derive benefit Lack of knowledge about physical activity opportunities and support available prevents engagement	To have the knowledge and confidence to request information at the right time To develop skills and mastery of tools and resources to safely self-manage physical activity and sedentary behaviour
Skills	Planning and self-monitoring can facilitate engagement in physical activity and help reduce sedentary time	To have capacity and capability to master self-monitoring of physical activity
Social/Professional role	Past physical activity levels and engagement facilitates participation in physical activity and physical activity choices Being physically active with people of a similar age and varying abilities provides confidence	To identify meaningful physical activities To identify and engage social support
Beliefs about capabilities	Confidence about ability is a barrier to increasing physical activity Old age, comorbidities and fatigue limit ability to be active	To develop knowledge and capability to confidently undertake physical activity. This involves articulating reasons for change. To be able to describe personal barriers to physical activity and reducing sedentary behaviour and identify potential solutions.
Optimism	A positive attitude facilitates participation in physical activity and reduces sedentary behaviour when prompted	To be able to set behavioural goals and actions and monitor well-being when goals are achieved
Beliefs about consequences	Too much physical activity too soon could lead to further health problems including stroke recurrence Physical activity as a mechanism to return to pre-stroke self Fear of falls is a barrier Physical activity gets you out of the house Physical activity fills time post stroke	To be able to identify a physical activity that feels safe but is effective for achieving outcome goals To be able to identify meaningful, safe physical activity outcomes and select appropriate activities likely to lead to these outcomes
Reinforcement	Sense of achievement can facilitate longer-term physical activity	To identify and use appropriate tools to measure physical activity against behavioural and outcome goals To monitor wellbeing in response to goal attainment
Intentions	Recognition of the importance of physical activity but HCP information provision not sufficient to enable physical activity	To access appropriate physical activity information and advice and select meaningful activities that are more likely to lead to behavioural change
Goals	Planning physical activity in advance increases the likelihood it will be undertaken	To set appropriate and realistic behavioural and outcome goals
Memory, attention and decision processes	Having to think about everything before doing it post-stroke makes engagement in physical activity more difficult	To use appropriate tools to set realistic goals and action plan to aid memory
Environmental context and resources	Stroke specific groups provide emotional and physical support that can facilitate physical activity. Modifying home environment can facilitate physical activity and reduce sedentary time Restricted car use can impact on physical activity levels Mixed ability and co-morbidity groups can facilitate physical activity Knowledge and skills of professionals can affect uptake of physical activity Lack of longer-term physiotherapy input can affect long-term physical activity Lack of information provision, resources and available options is a barrier to physical activity Dependence on others to be able to leave home is a barrier to increasing physical activity	To identify and engage social support to enable PA To understand and access resources available within the home and locally to increase physical activity and reduce sedentary time
Social influences	Peer support groups provide a means of support and can help to facilitate physical activity	To identify and engage with social support
Emotion	Group based activities that are enjoyable and provide a means of support can facilitate physical activity Anxiety and depression is a barrier to engaging on activities	To select safe physical activities that lead to meaningful outcomes and a sense of well-being
Behavioural regulation	Planning and self-monitoring can facilitate engagement in physical activity and help reduce sedentary time	To use planning and self-monitoring tools meaningfully and review physical activity and sedentary behaviour to support maintenance

Table 2. Healthcare professional behavioural outcomes, performance objectives and change objectives alongside theoretical domains and associated themes identified from focus group data.

HCP behavioural outcomes: To improve/increase knowledge about the benefits of physical activity and reducing sedentary behaviour in the context of stroke and to develop skills to promote and sustain physical activity levels and reduce sedentary behaviour to enable stroke survivors to perform activities of daily living.
Performance objectives: Accepts supporting physical activity and reducing sedentary behaviour after stroke is beneficial for stroke rehabilitation and part of the HCP role Supports stroke survivors to successfully engage in the PARAS intervention Appropriately uses PARAS intervention resources to support stroke survivors to engage with the PARAS intervention Appropriately uses behaviour change counselling techniques to support stroke survivor’s to identify reasons for physical activity behaviour change and maintenance
Theoretical Domains	Themes	HCP change objectives
Knowledge	Training in the benefits and use of physical activity in the context of stroke rehabilitation would be beneficial	To understand the benefits of physical activity and reducing sedentary behaviour post-stroke To deliver person centred, personalised support to stroke survivors
Skills	Being able to promote physical activity tailored to individual needs is essential for promoting participation Skills to help patients overcome barriers to physical activity will facilitate longer-term engagement	Able to identify physical activity resources available to stroke survivors that meet their individual needs To support stroke survivors to undertake barrier identification and coping planning
Social/Professional role	Promoting physical activity is part of the healthcare professional’s role	Engage in training to use a range of behavioural tools to target physical activity
Beliefs about capabilities	Engaging patients in physical activity and reducing sedentary time is difficult when pre-stroke activity levels were low	To apply appropriate behaviour change counselling techniques to engage stroke survivor in behaviour change and maintenance
Beliefs about consequences	Being overweight can be a barrier to physical activity and reduction in sedentary time for stroke survivors Motivational strategies will only work on a proportion of patients Withdrawal of physiotherapy support makes promotion and support of long-term physical activity problematic	Able to identify the different barriers to behaviour change and support the formulation of appropriate coping plans Able to succeed with resistant or ambivalent stroke survivors To understand how to support stroke survivor’s long-term physical activity within the context of individual service delivery, identifying meaningful, sustainable activities and social support
Reinforcement	Seeing patients succeed is an incentive to promoting physical activity	Able to support stroke survivors to identify and achieve meaningful, sustainable physical activities and social support
Environmental context and resources	Increased availability of physical activity options for patients post stroke would be beneficial Community physical activity groups are usually targeted at higher functioning stroke survivors Promoting long-term engagement in physical activity can be difficult without an individual in the team to take on this role Tools to tailor physical activity to individual needs would be beneficial Self-monitoring tools and technologies could be useful to initiate and maintain physical activity. Funding and time are barriers to physiotherapists participating in training to effectively target and support stroke survivors to be physically active	To develop knowledge of physical activity resources available to stroke survivors To be able to adapt physical activity support to individual needs of stroke survivors and enable identification of meaningful sustainable activities and goals To be able to access and effectively apply tools to support engagement in physical activity and reduction in sedentary behaviour e.g. self-monitoring tools To be able to access training on how to support physical activity and reduce sedentary behaviour post-stroke within restrictions of current job role

Table 3. Theoretical intervention mapping targeting physical activity and sedentary behaviour of stroke survivors.

TDF Domain	Behaviour change technique (used/not used, promising/non-promising from systematic review findings)	Selection rationale	Theoretical constructs targeted and potential intervention components
Knowledge	5.1: Information about health consequences (used and promising) Definition: Provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour	Assessed as promising systematic review Supported by qualitative findings Expert consensus	Appropriate theory: Health Belief Model (HBM)Constructs: All constructs of HBMSuggested/example intervention component(s): Booklet for patients and/or DVD containing information and patient narratives Access to repository of information via HCPs to obtain details of local activities, support and resources
	5.2: Salience of consequences (not used) Definition: Use methods specifically designed to emphasise the consequences of performing the behaviour with the aim of making them more memorable (goes beyond informing about consequences)	Not supported by systematic review findings, but overruled based on small sample sizes Supported by qualitative findings Expert consensus
	3.1: Social support (unspecified) (used and promising) Definition: Advise on, arrange or provide social support (e.g. from friends, relatives, colleagues’, buddies’ or staff) or non-contingent praise or reward for performance of the behaviour. It includes encouragement and counselling, but only when it is directed at the behaviour	Supported by systematic review findings Supported by qualitative findings Expert consensus
	9.1 Credible source (used promising) Definition: Present verbal or visual communication from a credible source in favour of or against the behaviour	Supported by systematic review findings Supported by qualitative findings Expert consensus
Skills	4.1: Instruction on how to perform the behaviour (used and non-promising) Definition: Advise or agree on how to perform the behaviour (includes ‘Skills training’)	Not supported by systematic review findings, overruled based on small sample sizes and the need for instruction on how to perform specific activities safely Supported by qualitative findings Expert consensus	Relevant theory: Self-Regulation Theory (SRT)Constructs: Action planning, problem solvingSuggested/example intervention component(s): Workbook (template to be completed/populated in discussion with a HCP) and/or DVD
	6.1: Demonstration of the behaviour (used and non-promising) Definition: Provide an observable sample of the performance of the behaviour, directly in person or indirectly	Not supported by systematic review findings, overruled based on the need to demonstrate behaviour for safety Supported by qualitative findings Expert consensus
Social/Professional role	3.1: Social support (unspecified) (used and promising) Definition: Advise on, arrange or provide social support (e.g. from friends, relatives, colleagues’, buddies’ or staff) or non-contingent praise or reward for performance of the behaviour. It includes encouragement and counselling, but only when it is directed at the behaviour	Supported by systematic review findings Supported by qualitative findings Expert consensus	Relevant theory: SRT Constructs: Feedback; problem solving Suggested/example intervention component(s): Access to repository of information via HCPs to obtain details of local support and resources. Constructs are targeted by social support (e.g. positive reinforcement and sharing of information to overcome barriers).
Beliefs about capabilities	1.1: Goal setting (behaviour) (used and promising) Definition: Set or agree on a goal defined in terms of the behaviour to be achieved	Supported by systematic review findings Supported by qualitative findings Expert consensus	Relevant theory: HBM & SRT Constructs: Individual perceptions; likelihood of action; goal setting; problem solving Suggested/example intervention component(s): Information booklet and/or DVD concentrating on antecedents and pros and cons for changing behaviour. Booklet template to be completed in discussion with a HCP targeting goal setting and problem solving.
	1.2: Problem solving (used and promising) Definition: Analyse, or prompt the person to analyse, factors influencing the behaviour and generate or select strategies that include overcoming barriers and/or increasing facilitators (includes ‘Relapse Prevention’ and ‘Coping Planning’)	Supported by systematic review findings Supported by qualitative findings Expert consensus
	4.2: Information about antecedents (not used) Definition: Provide information about antecedents (e.g. social and environmental situations and events, emotions, cognitions) that reliably predict performance of the behaviour e.g. Advise to keep a record of snacking and of situations or events occurring prior to snacking	Not used in systematic review, overruled based on strength of qualitative findings Supported by qualitative findings Expert consensus
Optimism	5.4: Monitoring of emotional consequences (not used) Definition: Prompt assessment of feelings after attempts at performing the behaviour	Not used in systematic review, overruled based on strength of qualitative findings Supported by qualitative findings Expert consensus	Relevant theory: HBM & SRTConstructs: Modifying factors; self-monitoringSuggested/example intervention component(s): Booklet to be completed/populated in discussion with a HCP, reviewed and feedback provided to provide positive reinforcement
Beliefs about consequences	5.1: Information about health consequences (used and promising) Definition: Provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour	Supported by systematic review findings Supported by qualitative findings Expert consensus	Relevant theory: HBM Constructs: Individual factors; modifying factors Suggested/example intervention component(s): Information booklet and/or DVD with patient and HCP narratives
	5.3: Information about social and environmental consequences (used and promising) Definition: Provide information (e.g. written, verbal, visual) about social and environmental consequences of performing the behaviour	Supported by systematic review findings Supported by qualitative findings Expert consensus
Reinforcement	10.4: Social reward (not used) Definition: Arrange verbal or non-verbal reward if and only if there has been effort and/or progress in performing the behaviour (includes ‘Positive reinforcement’)	Not used in systematic review, overruled based on strength of qualitative findings Supported by qualitative findings Expert consensus	Relevant theory: SRTConstructs: FeedbackSuggested/example intervention component(s): Feedback from a HCP or social group relating to attainment of goals
Intentions	5.1: Information about health consequences (used and promising) Definition: Provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour 5.3: Information about social and environmental consequences (used and promising) Definition: Provide information (e.g. written, verbal, visual) about social and environmental consequences of performing the behaviour	Supported by systematic review findings Supported by qualitative findings Expert consensus	Relevant theory: HBMConstructs: Individual factors; modifying factorsSuggested/example intervention component(s): Information booklet and/or DVD with patient and HCP narratives
Goals	1.1: Goal setting (behaviour) (used and promising) Definition: Set or agree on a goal defined in terms of the behaviour to be achieved	Supported by systematic review findings Supported by qualitative findings Expert consensus	Relevant theory: SRT Constructs: Goal setting Suggested/example intervention component(s): Goal setting component within the booklet. Template to be completed in discussion with a HCP
Memory, attention and decision processes	8.3: Habit formation (not used) Definition: Prompt rehearsal and repetition of the behaviour in the same context repeatedly so that the context elicits the behaviour	Not used in systematic review, overruled based on strength of qualitative findings Supported by qualitative findings Expert consensus	Relevant theory: SRTConstructs: Goal setting; action planningSuggested/example intervention component(s): Goal setting and action planning components within the booklet. Template to be completed in discussion with a HCP
Environmental context and resources	3.1: Social support (Unspecified) (used and promising) Definition: Advise on, arrange or provide social support (e.g. from friends, relatives, colleagues’, buddies’ or staff) or non-contingent praise or reward for performance of the behaviour. It includes encouragement and counselling, but only when it is directed at the behaviour	Supported by systematic review findings Supported by qualitative findings Expert consensus	Relevant theory: SRT Constructs: Action planning; feedback Suggested/example intervention component(s): Access to repository of information about physical activity options and support via a HCP A booklet showing examples of the physical environment that can be populated (tailored to the individual)
	12.1: Restructuring the physical environment (not used) Definition: Change, or advise to change the physical environment in order to facilitate performance of the wanted behaviour or create barriers to the unwanted behaviour (other than prompts/cues, rewards and punishments)	Not used in systematic review, overruled based on strength of qualitative findings Supported by qualitative findings Expert consensus that it is not appropriate for everyone
Social influence	3.1: Social support (Unspecified) (used and promising) Definition: Advise on, arrange or provide social support (e.g. from friends, relatives, colleagues’, buddies’ or staff) or non-contingent praise or reward for performance of the behaviour. It includes encouragement and counselling, but only when it is directed at the behaviour	Supported by systematic review findings Supported by qualitative findings Expert consensus	Relevant theory: SRTConstructs: Feedback; action planning; problem solvingSuggested/example intervention component(s): Access to repository of physical activity options and support via a HCP Use of booklet to plan support around physical activity
Emotion	3.1: Social support (unspecified) (used and promising) Definition: Advise on, arrange or provide social support (e.g. from friends, relatives, colleagues’, buddies’ or staff) or non-contingent praise or reward for performance of the behaviour. It includes encouragement and counselling, but only when it is directed at the behaviour	Supported by systematic review findings Supported by qualitative findings Expert consensus	Relevant theory: SRT Constructs: Feedback; self-monitoring Suggested/example intervention component(s): Access to repository of physical activity options (e.g. local groups) via a HCP to provide ongoing support Use of booklet to monitor effect of PA on emotions and mood followed by feedback from a HCP
	5.4 Monitoring of emotional consequences (not used)	Not used in systematic review, overruled based on strength of qualitative findings Theme from qualitative research Expert consensus
Behavioural regulation	1.1: Goal setting behaviour (used and promising) Definition: Def: Set or agree on a goal defined in terms of the behaviour to be achieved	Supported by systematic review findings Supported by qualitative findings Expert consensus	Relevant theory: SRT Constructs: Goal setting; action planning; feedback; self-monitoring Suggested/example intervention component(s): Booklet template to be completed with a HCP. Provision for self-monitoring and feedback (e.g. use of pedometers).
	1.4: Action planning (used and promising) Definition: Prompt detailed planning of performance of the behaviour (must include at least one of context, frequency, duration and intensity).	Supported by systematic review findings Supported by qualitative findings Expert consensus
	2.2: Feedback on behaviour (used and promising) Definition: Monitor and provide informative or evaluative feedback on performance of the behaviour (e.g. form, frequency, duration, intensity)	Supported by systematic review findings Supported by qualitative findings Expert consensus
	2.3: Self-monitoring of behaviour (used and non-promising) Definition: Establish a method for the person to monitor and record their behaviour(s) as part of a behaviour change strategy	Supported by qualitative findings Expert consensus overruled systematic review. Feedback on behaviour required undertaking of self-monitoring.

Table 4. Theoretical intervention mapping targeting healthcare professional consultation behaviour.

TDF Domain	BCTs identified by healthcare professionals in PARAS qualitative work	Theoretical constructs targeted and potential intervention components
Knowledge	5.1: Information about health consequences 9.1: Credible source	Relevant theory: Social Cognitive Theory Constructs: Forethought capability, Vicarious learning capability Suggested/example intervention component(s): A face-to-face training programme presenting research evidence supporting increased physical activity and reduced sedentary behaviour in the context of stroke Case studies of patients who have successfully increased their physical activity levels and/or reduced sedentary time and if possible Case studies from physiotherapists who have successfully supported stroke survivors to be more physically active
Skills	1.2: Problem solving 1.4: Action planning 3.1: Social support (practical) 3.3: Social support (emotional) – includes motivational interviewing 4.1: Instruction on how to perform the behaviour (Includes skills training) 5.1: Information about health consequences 6.1: Demonstration of the behaviour	Relevant theory: Social Cognitive Theory Constructs: Forethought capability, Self-regulation capability, vicarious learning capability, Self-efficacy Suggested/example intervention component(s): A manual to accompany the face-to-face training programme which HCPs complete throughout as the training progresses Role play and demonstrations of intervention materials being used Encourage a buddy system among HCPs
Social/Professional role	5.2: Salience of consequences	Relevant theory: Social Cognitive Theory Constructs: Outcome expectancies); Forethought, Self-regulation Suggested/example intervention component(s): Verbal delivery explaining the benefits of physical activity promotion and providing ongoing support. Patient narratives
Beliefs about capabilities	1.2: Problem solving 1.4: Action planning	Relevant theory: Social Cognitive Theory Constructs: Self-regulation Suggested/example intervention component(s): Problem solving and action planning in the context of practice (i.e. teaching how to complete action planning with patients).
Beliefs about consequences	1.2: Problem solving 1.4: Action planning 4.1: Instruction on how to perform the behaviour 6.1: Demonstration of the behaviour	Relevant theory: Social Cognitive Theory Constructs: Forethought, Self-regulation, Vicarious learning Suggested/example intervention component(s): Completion of tasks within the training manual Teaching problem solving and action planning in the context of physiotherapy practice Instruction in the manual on how to action plan and problem solve A demonstration of action planning and problem solving
Reinforcement	2.5: Monitoring of outcomes of behaviour without feedback	Relevant theory: Social Cognitive Theory Constructs: Self-regulation Relevant theory: Social Cognitive Theory Constructs: Forethought, Self-regulation, Vicarious learning, Self-efficacy
Environmental context and resources	1.2: Problem solving 4.1: Instruction on how to perform the behaviour (includes skills training) 5.2: Salience of consequences 6.1: Demonstration of the behaviour 9.1: Credible source	Suggested/example intervention component(s): Provision of face-to-face training programme with accompanying manual Repository of information providing details of local physical activity groups, support and resources

Table 5. PARAS intervention components described with the Template for intervention Description and replication (TIDieR) and APEASE criteria considered in development phase.

TIDieR component	Description	APEASE criteria considered
Brief name: Provide the name or a phrase that describes the intervention	Physical Activity Routines After Stroke (PARAS)
Why: Describe any rationale, theory, or gaol of the elements essential to the intervention	See needs assessment step 1–5
What: materials: Describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers. Provide information on where the materials can be accessed (e.g. online appendix, URL).	Components provided to/used by stroke survivors Consent form and participant information sheet Intervention toolkit including: stroke survivor workbook; repository of local/national information on PA choices; self-monitoring tools (activity diary, pedometer (3DFitBud-Counter-Walking-Pedometer, 3D active, U.K.) and instructions, app advice); laminated goal summary sheet and fridge magnet pen; laminated benefits, outcomes and activities cards to aid discussion between stroke survivor and HCP and support people with speech and language problems Components provided to/used by healthcare professionals Consent form and participant information sheet HCP training brochure Dictaphone	Affordability: Portable document format (PDF) files of all the intervention tools were created, printed out and stored in a workbook file meaning extra patient specific sheets could be added to individual’s files (e.g. physical activity diary). This process allowed iterative changes to be made without large costs of reprinting manuals. Rather than creating a website with large costs linked to maintenance and development, it was decided to trial a paper-based version of the intervention initially which could be developed online at a later date. The pedometer selected had a relatively low price point (£16.99) to enable increased sued with NHS settings. Practicability: HCPs were provided with a PARAS kitbag holding all the intervention tools so they could deliver the intervention then and there rather than having to for example find out information about available resources and get back to participants at a later date. Acceptability: all components tested at co-design workshops and developed iteratively in response to feedback Equity: The stroke survivor intervention tools were designed to be inclusive so individuals with speech and language or cognitive difficulties would not be excluded as is the case in the majority of stroke research studies.
What: procedures: Describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities.	Stroke survivor procedures Supported self-management programme involving goal setting, action planning, barrier identification, coping planning and feedback around PA and sedentary behaviour. HCP procedures Training programme aimed at developing physical/sedentary behaviour counselling skills of HCPs. Initial training before delivery of intervention then feedback provided on delivery.	Acceptability, affordability and practicability: Supported self-management was identified as the most appropriate mode of delivery for the stroke survivor component following our needs assessment and co-design workshops. This type of intervention appears more sustainable than for example face-to-face structured group exercise which presents with a number of environmental and resource related barriers. Acceptability and effectiveness: Although HCPs working in community stroke care will have some experience of goal setting etc. qualitative workshops identified there were training needs in this area and it was acceptable to target these needs.
Who: For each category of intervention provider (e.g. psychologist, nursing assistant), describe their expertise, background and any specific training given.	Provider of stroke survivor component A healthcare professional (HCP) who is a credible source (e.g. well informed on stroke rehabilitation) and plays a key role in the stroke survivors community rehabilitation e.g. physiotherapist, occupational therapist, nurse. Provider of HCP component Health psychologist with experience in delivering behaviour change interventions in long-term conditions, research physiotherapist with 20 years clinical experience and 10 years research experience in developing and delivery physical activity and rehabilitation stroke interventions	Affordability, practicability and acceptability: PARAS focus groups identified delivery of the stroke survivor component should be by a healthcare professional with experience working in stroke. Using healthcare professionals embedded within community stroke teams meant these individuals already had specialist core stroke skills meaning training was not required in this area alongside training in PARAS delivery. As the intervention was designed to be delivered within usual care this meant there were not additional salary costs. Initially consideration was made to include technical instructors and rehab assistants however on discussion with these individuals it was felt they would prefer to support the delivery rather than lead on the delivery and that they were not happy to be audio-recorded as part of the fidelity assessment. Acceptability and effectiveness: As the providers of the HCP training had developed the intervention and were experienced in this field from both a therapy and a psychology perspective they were thought to be the most credible source to deliver the training. Practicability: At this feasibility stage it was decided that two members of the research team would deliver the HCP training face-to-face. This allowed the research team to highlight any iterative changes required to the training programme before scaling.
How: Describe the modes of delivery (e.g. face-to-face or by some other mechanism, such as internet or telephone) of the intervention and whether it was provided individually or in a group	Stroke survivor component First session face-to-face, follow-up sessions either face-to-face or remotely by phone dependent on patient choice. HCP training component Face-to-face for initial training, then email and phone contact to provide feedback	Acceptability: The modes of delivery were assessed as acceptable from our needs assessment, co-design workshops and questionnaires. Affordability and practicality: Our qualitative work indicted that this mode of delivery of the stroke survivor intervention was practical. As the community HCP involved in delivering the stroke survivor component were already working with the stroke survivors participating in the study it was practical for them to initially see the participants face-to-face. To lower travel costs the option of providing the review sessions by phone was provided Acceptability, affordability and practicality: The HCPs were very clear that they wanted training face-to-face as they felt E-Learning was not effective. The HCP component was delivered in a group format to each of three community teams involved. This reduced costs of training individuals. Delivering three spate sessions rather than delivering the training to everyone at once meant that the training could be fitted around the needs of each service.
Where: Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features.	Stroke survivor component UK NHS community stroke services. Delivered In patient’s homes or outpatient settings HCP training component Initial face-to-face training delivered at participating community stroke teams’ education centres.	Acceptability: Our needs assessment, co-design workshops and resource capacity mapping exercise within services identified the acceptability of the intervention location. Practicality: It was hypothesised that delivering the stroke survivor intervention within patients homes would allow the HCP to provide better support to the participants as they would have an increased understanding of the participants environmental circumstances. This was felt to outweigh costs associated with community visits. Affordability: Although travelling to the community sites to deliver the HCP training had cost implications, it was believed more HCP would attend if the trainers travelled to the participants. In the future, it is thought that this training could be delivered online but at this stage to enable as much knowledge on delivery face-to-face training was deemed most appropriate.
When and how much: Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity or dose.	Stroke survivor component At least two sessions. The first session/s targets goal setting using the workbook and other tools, there will then be a review session timed to coincide with review date for PA/sedentary behaviour goals. There is no upper limit to sessions the number is defined by patients’ support needs/availability of resources. The programme to be initiated once ‘functional rehab’ goals have been achieved and the stroke survivor is moving towards supported self-management. The time from stroke will vary dependent on needs of participant/health care professional’s opinion on the best timing/availability of resources. HCP training component Three-hour face-to-face training session. Email and phone delivery support by study team. Email feedback on the delivery of the intervention after completion with two stroke survivors.	Acceptability: Our needs assessment and co-design workshops identified what was acceptable in terms of timing and dose of delivery of the components of the intervention. Side effects/safety: Our needs assessment and co-design workshops provided evidence that the intervention training and delivery methods would be safe with minimal side effects. As the stroke survivors were already being seen by a community stroke team with specialist skills it was felt that this team would be able to effectively identify any risks associated with taking part in the intervention and potential changes in physical/sedentary behaviour. Effectiveness: It was hypothesised that all the components of the stroke survivor intervention could be delivered effectively within the two or more sessions. It was also hypothesised that all elements of the stroke survivor intervention delivery could be taught effectively within three hours with email and phone contact for support during delivery Affordability: The supported self-management approach for the stroke survivor component provided a more affordable but at the same time potentially effective method of delivery than for example a face-to-face exercise intervention.
Tailoring: If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when, and how	Stroke survivor component Support graded to individuals’ ability, preference, and values and progressed as able HCP training component The HCP training was tailored according to personal needs during the face-to-face training, email and telephone support. All participating HCPs received feedback on delivery that was tailored to their individual learning needs.	Acceptability: The needs assessment, co-design workshops and questionnaires were used to assess the acceptability of tailoring. Affordability: To enable effectiveness our needs assessment identified that a person centred individual tailored approach was required for the stroke survivors. This approach is potentially more expensive than a group based approach, however the increased potential for effectiveness should outweigh these costs. Equity: the stroke survivor component was designed to allow a person-centred tailored approach that would not exclude any stroke survivor who has the potential to move more or sit less.
How well: Planned: If intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them.	Treatment fidelity strategies for design of study HCP training. Plan for implementation setbacks e.g. map out stroke team resources prior and during study and plan in case anyone is leaving, rotating etc. Treatment fidelity strategies for monitoring and improving provider training Face to face training and standardised training manual provided to HCP. Testing of HCP acquisition skills during training and delivery. Minimise drift in HCP skills during programme delivery e.g. monitor how work books are completed and delivery of sessions through audio recording and checklist completion. Programme leads available to provide training on aspects of delivery on request. Tailor training to needs of HCPs delivering programme Treatment fidelity strategies for monitoring and improving delivery of programme Assessment of delivery of programme through audio recording and analysis of sessions and completion of workbook to enable provision of feedback and training on delivery of programme to HCPs Treatment fidelity strategies for monitoring and improving receipt of programme Assess participants understanding of programme, use of cognitive skills and ability to perform behavioural skills through completion of workbook and analysis of audio-recorded sessions Treatment fidelity strategies for monitoring and improving enactment of programme skills Review workbook completion and achievement of goals.	Practicability and effectiveness: Informed by previous delivery of physical activity interventions in diabetes and cardiovascular disease. Fidelity assessment based upon Bellg, A. J., Borrelli, B., Resnick, B., Hecht, J., Minicucci, D. S., Ory, M., & Czajkowski, S. (2004). Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychology, 23(5), 443. Acceptability: The main issue brought up by the HCPs during the devlopment phase was the need to audio-record the intervention delivery. When it was discussed that this approach was to detrmine whether our training programme was appropaite the HCPs stated they thought this was acceptable. Whether this was actually the case will be further tested in a feasbility study.

Data availability statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.