Table 2 Facilitators to program implementation identified by staff and patient participants, grouped by RE-AIM domains and constructs, with quotes

Reach

Individual

• Suitable to target group

i. multi-disciplinary facilitation was perceived by staff to maintain patient interest in and attention to, the lecture content

ii. individually tailored strategies e.g. tailored computer games, written material for patients to re-visit

iii. social rituals (i.e. tea break)

iv. practical aspects of the program: small group size, being centrally located and/or close to public transport, appropriate in duration

“…the computer games were fun and sometimes challenging. On the other hand, we could play the computer games at a level which suited each individual” [patient 2]

“I actually think that that (the tea time) is one of the most valuable parts of the program” P11, “I don’t think you can negate the benefits of that period in between that allowed them to engage with each other” P10

“It’s a very targeted program. Keeping very much the patient right at the forefront of the design” P3

“…they get a booklet […] they can read through the notes in advance, have the lecture and also revise it afterwards […] it helps to overcome maybe some of the challenges that are associated with cognitive impairment” P4

“small group of people was good for me because of my hearing loss” [patient 3]

“close to public transport” [patient 1], “proximity and being close to [the hospital]” [patient 2]

“it doesn’t go for too long […] I think it is well targeted to our population and our age group and therefore the cognitive impairment” [P10]

Effectiveness

Individual

• Improved job satisfaction

i. professionally rewarding

ii. meets clinical ‘need’

• Positive outcomes for patients

i. more engaged generally

ii. increased social connections

iii. normalised patient experience

a. cognitive impairment

b. low mood

• Intervention source

i. staff perceived the intervention to be internally developed and driven

• Evidence strength and quality

i. staff perceived the intervention to be evidence-based

“I think professionally, that it is a really rewarding thing to be involved in” [P3]

“in the absence of any medications to cure cognitive impairment and dementia, you know people are wanting something that they can do” [P10]

“I think… being involved in Club Connect meant they… want(ed) to kind of improve, I think I did actually notice that those consumers that I worked with [independent to the group] were quite motivated and… engaged in [psychological] therapy” [P4].

“A lot of the referrals (are) for (those) who (are) socially isolated or have limited social activities. Put these different clients in a room and you add to that social experience - you see these people who maybe once were depressed or socially isolated start to communicate with their peers” [P6]; “I have been very lonely for a long time, and more and more just by myself. Through Club Connect’s encouragement […] I’m now in a much improved mental and physical health” [patient 3]

“our cohort still carry a certain amount of stigma or shame, and it’s amazing how you see this group really come together and normalise and validate one another’s experiences” [P11], "[Club Connect] opened my mind. [I’m] not afraid of getting old" [patient 5]

“The fact that it was embedded within the team is an important thing. It’s not some project that sits outside the critical day to day function”[P7]

“There’s a lot of evidence to suggest that this kind of cognitive remediation works well in certain research populations” [P3]

Adoption

Organisation

• Networks and communications

i. regular team discussions and ‘check-ins’

ii. easy access for staff to liaise with facilitators for referrals

• Structural characteristics

i. embedding program within multi-disciplinary team allows for multi-disciplinary facilitation

ii. implementation leader: having a clinician on the team to lead or champion the project

• Implementation climate

i. team considered to be innovative

• Knowledge-beliefs about intervention

i. team members were knowledgeable about the program

ii. team members believed the program would impact change

“…because we were all on the same team and we maybe share patients and talk to each other about all those people every week. It was easy [to identify people for program]” [P7]

“Ease of making a referral to Club Connect, ability to discuss with Club Connect providers about the eligibility criteria and about specific cases to see if they would benefit from Club Connect” [P13]

“The biggest enabler is actually having the facilitator as part of the team. She’s there all the time. So, whenever you have someone come up that you think might be suitable for the group, you just run it by her and she kind of facilitates that referral” [P11]

“… because of the multi-disciplinary nature of team, you know we can, for example, with the education sessions, have different specialists come in and out quite flexibly” [P11]

“as a team, I think we’re quite an innovative team. I think we’re open to the idea of trying new projects, developing new programs” [P11]

“It’s high knowledge. Everybody on the team knows about the program” [P5]

“It’s also really good to see group programs now that there’s a lot of evidence to suggest that this kind of cognitive remediation works well” [P3]

“I think professionally, [the program] is a really rewarding thing to be involved in” [P3]

“… you sit with [patients] each week, you work together and you see a level of confidence and skill build, and it’s a pleasure” [P11]

“But I think this is testament to the idea that if you have champions of these programs, that it is achievable. It becomes just a fluid part of what you do, I think particularly when you’ve got dedicated people looking after it”[P11]

Implementation

Organisation

• Adaptability

i. perceived by staff to be easily adaptable to include patients with other needs (e.g. translation into languages other than English, adapting materials for vision or hearing impaired participants)

ii. strategies used to simplify execution, e.g. materials / scripts provided to facilitators to not only enrol patients in program, but also to facilitate sessions

“I think it’s a program that could be sort of readily modified and adapted to an array of different populations where themes of cognition, social isolation, etcetera are prevalent issues” [P11]

“… [for enrolling patients] they had a really good script where […] you can just come in and you know exactly what you need to ask” [P12]

Maintenance

Organisation

• No follow-up, therefore no data collected on ‘Maintenance’.