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This may be achieved in different ways, for instance, incorporation of the CPR as part of a broader guideline implementation and embedding the CPR into clinical software or a computerised clinical decision support system (CDSS) [ 10, 11].
Many of the individual components of the intervention were perceived as feasible and acceptable to both stroke survivors and stroke nurses, however, further work is needed to develop and refine the intervention components and address issues related to delivery, implementation, and embedding within nurses' existing clinical practice.
In terms of implementation and embedding, policy makers seem to have treated HealthSpace as a "log on and play" technology and assumed that intended users would need no persuasion to try it and no specific training, support, or incentives to use it.
The five nurses who delivered the intervention participated in a focus group (conducted by LK) which aimed to explore their views of delivering the intervention in practice and issues related to its design, delivery, future refinement, and its implementation and embedding within clinical practice.
A major strength of the study was in generating rich and detailed findings which are important, not just in terms of interpreting the TRACS trial results but also in understanding factors influencing introduction, implementation and embedding of complex interventions such as caregiver training into these and similar settings.
This approach enabled researchers to directly observe the day-to-day rehabilitation work of stroke unit (SU) teams and develop an in-depth understanding of contextual, organisational and professional factors influencing introduction, implementation and embedding of complex interventions into these and similar healthcare settings.
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It seeks to: build enduring relationships with all staff, service users and carers to last the length of the trial; communicate trial requirements to staff to encourage stronger implementation and hence embedding of the intervention into the setting; and to keep service users and carers engaged during the wait periods for the intervention.
Interview guides will be semi-structured and will include questions based on the RE-AIM framework, as well as Normalization Process Theory, which is a sociological theory of the implementation, embedding, and integration of new technologies and organizational innovations in complex settings [ 31, 32].
More recently, May and colleagues developed a Normalization Process Theory (NPT) to explain the implementation, embedding and integration of complex health interventions into everyday practice [ 42].
NPT is concerned with 'how and why things become, or don't become, routine and normal components of everyday work' (36 p 535) and it defines four core mechanisms that shape the social processes of implementation, embedding and integration of ensembles of social practices.
NPT is concerned with the social organisation of the work (implementation) of making practices routine elements of everyday life (embedding) and of sustaining embedded practices in their social contexts (integration) and was developed particularly in response to the evidence, which suggested that eHealth implementation, embedding and integration are difficult to achieve in practice [ 29- 31].
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