Table 3 Overview of CFIR constructs linked to inductive themes

 Plan

Planning process

I also think just even the collaboration between two organizations. I think the amount of effort and time that goes into a collaboration to make it work from outside, from a place where you guys [research staff] are comfortable leading it, into a community-based place that has tons of stuff going on all the time. (C7)

 Engage

Involvement of stakeholders in the planning process

I feel like it was very inclusive. We've been included in different [planning] meetings and included in the two-year celebration, and that inclusion just made it feel like we were a part of it, almost like we were a part of it from the beginning in just that inclusion. And that was really nice. (C4)

 Opinion leader

YMCA leadership

I have been a part of the team from the beginning and really helping [principal investigator] bring this program to communities. So was part of bringing SSBC to the downtown Y[MCA]. And I’m now here to support my team and to ensure that we can continue to grow this program into our YMCA and potentially in the future grow this program into other Y[MCA]’s across the country. (VP)

 Formally appointed internal implementation leader

Site lead

I am a SSBC coach as well as the site lead for [site 2]. (C6)

Implementation team

I have been on the implementation team since we started SSBC and then I also lead the SSBC program. (C7)

 Champion

Partnership spearhead

Since I started at the Y[MCA] in 2006, I worked under [champion]. She was my manager from the beginning. And her goal since then has been to help individuals and help them change their behavior and focus on the ready-to-be-fit population; so the group of people who are inactive, maybe at risk of a chronic disease. That has been her sole focus and has become my sole focus since I started here… I think this program just fits in perfectly with that strategy that the Y[MCA] has had since 2006. (C7)

 Execute

Fidelity evaluation

I've never really been a part of a research program during the research phase… So just learning how to be very diligent with paperwork and completing it. (C7)

 Reflect

Implementation processes

We’ve come up with different strategies of how to overcome different situations [during the site meetings]. We’re able to have a [research] update … so everyone gets the same amount of knowledge and has time to ask questions and get answers and everything. (C1)

 Relative advantage

Motivational interviewing training an asset for YMCA staff

I think this is exactly what we have been looking for since I started here. You know about [other YMCA program name] and same kind of thing, but we didn't learn about motivational interviewing at all and I really do think that the motivational interviewing, that is the key piece that we were kind of missing in all of our other programs. (C7)

Program structure supports client habit formation

The biggest [difference] is just how you exercise with them for the first bit. You help them with a guiding hand a bit more because you see them so often right away; it's easier to establish a relationship and actually have them commit to exercise a little bit easier. Compared to having one meeting telling them what they should do and then them just going off and doing it. (C9)

Building connections to clients

I love it SSBC. I think this is my favorite thing that I do here [at the organization], honestly. It's kind of a nice break in my day. I love what SSBC brings to people.” (C5).

I really like getting to know the participant. It's very rare that we would spend…this much one-on-one time with the same client for three weeks in a row. You really get to know them and really learn about them. It's not just the surface stuff…you really build a good relationship with these participants. I'm pretty sure if they keep coming to the Y[MCA], I'll stay connected with them for a long time…. I really enjoy that aspect. (C7)

 Relative (dis)advantage

Limited staff and client capacity of program

Currently we only have full time staff doing it. (C6)

I think scheduling-wise, how many clients would each staff be able to take on without feeling maybe burnout and still maintaining our other appointment types that we have as well. (C3)

 Adaptability

Program can be tailored to the client for benefits

All the topics are great. I like that you have the flexibility. If you needed to, you could do the exercise ahead of time and then do counseling after... I like that you have the flexibility in the meetings to discuss a different topic if that's what they want to talk about that day. The fact that it's very client-centered and not black and white, I really think that’s important. (C7)

 Complexity

Effortful work

It's not even more work as it is just-- what way to put it? It's not like you're doing more, it's just a little bit more taxing to do. I feel like you're putting more of yourself into it which you only have so much each time. (C9)

 Design quality and packaging

Professionally packaged from research team

I'm always writing out checklists for people to make sure they check all the boxes, so it's just nice having it seem like a very professionally put together program. It just makes my life as a coach so much easier; I can just really focus on the participant and delivering the program and not worry about the logistical aspects of it. (C3)

 Cosmopolitanism

Research partnership

It's re-educating the population if you will, that we are kind of at the forefront of health and partnering with the university and into your health and the community that way. I think the word is getting out that people know that if they've got a health condition, this is a safe place to come. Preventing future health issues. Having a quality research-based program within the Y[MCA], it just helps us accomplish what we're trying to do. (C3)

 Peer pressure

Supports vision for a community, health-focused gym

As part of the Y[MCA], we've sometimes maybe struggled with our identity and that people think we're just a rec[reation] center and that our staff maybe aren't trained or certified above just a fitness instructor that teaches one type of class. No, we have not only very certified and qualified staff but also training that is backed by research. (C3)

 Structural characteristics

Staff turnover

It has been going very well; in total, we have three and a half trainers. [laughter] [Staff name] is still technically a coach, but unfortunately, she’s moving away and then [another staff name], just due to scheduling, isn’t able to take participants all the time. (C1)

 Networks and communication

Community of practice among staff

Or if they have questions about SSBC-- or if we're having troubles with a participant, we give each other ideas. We talk about it a lot. (C5)

Team meetings

It's really nice to have that check-in. It feels like much more open communication. We get to hear what's going on the [research team] end, you get to hear our experiences, and it gives us all the opportunity to come together if there’s something that, say, we need a solution to, collaborate on that and see what we can find. Then it gives us, as trainers, an opportunity to get together and have that discussion as well. Sometimes we're having a bunch of one-on-one conversations. We don't have the opportunity to speak a group at the same time, so it does give that opportunity. (C2)

 Culture

Everyone should be a SSBC staff

There should be no reason why somebody opts out [of this opportunity] from our group. (M1)

The implementation totally fits in with the YMCA mission, vision—all that stuff—and our strategic direction that we've been heading for the last 15 years. (C7)

 Compatibility

Program is a good fit within YMCA

The value is with the training and what we're able to provide in terms of coaching the participants, so value to [clients] in terms of changing their health and then value to us YMCA because we're keeping these members around, and they're staying active longer, and we're able to help them get healthier. (C3)

I like what it represents. I like what the goal is to do. The goal is to have participant-led health intervention, lifestyle change. It follows all the YMCA values, which I value in my day-to-day and what I try to bring to coaching, what I try to bring all my clients. (C8)

YMCA staff well-suited to deliver program

I almost don't factor in the exercise part because it's so second nature to me. So that works well, but it's supposed to work well, right? I would have no excuse for it not working well. (C2)

I think it's one of the reasons why people work at the Y[MCA] is because we're all about building relationships and fostering this community. That’s probably the biggest thing for me – the relationships. (C7)

YMCA helps to set-up clients for long-term success

Membership is number one. Being able to tell [clients] after SSBC that I'm still going to be here, you can still come and see me, you can send me an email. You're coming to this gym… you can get hold of me. Having it here-- the access to the gym, with the pool, the AquaFit, stuff like that. Being able to bring their families in. I think our demographic here is pretty friendly... pretty accepting. Having it in the gym makes it not as nerve wracking to go to a different gym. They can get comfortable here, working with someone, and then kind of go on their own. Knowing that we're still in the office and they'll know us if they have any questions. (C5)

 Learning climate

Teamwork

We're a good team and everyone feels comfortable talking to anybody if they have a situation. (C6)

The team is great. I have known some of them previously and sometimes if I get there-- because I go in early to get myself prepped—so if I'm having a challenge, I might say “I don't know what to do about this” and I might say, “I'm thinking this or that” and they're like, “Yeah. That sounds right. Go try it. Let us know how it goes”. (C3)

 Leadership engagement

YMCA managerial support

I had that [check-in] talk with [staff name], but I know they can handle that content, it’s just helping them and pulling them of the cliff, right? I think it just comes down to us [managers] motivating them [staff], supporting them. (M1)

Site lead role

It's really helping find their [staff] schedules and getting them booked in, helping them juggle things around if all of a sudden, we get a client that wants this timeslot, it's like okay, we can shift things. The new coaches that came on, we've had a couple touch-ins. The older coaches, the first-round coaches, not so much anymore. (C6)

 Available resources

Research team support

Sometimes I'll have a question in my mind that I will want to ask one of you. Then all of a sudden, you're already here. It's easy to just ask, right? If I don't, I just email and usually within that day, I have a couple of questions answered. And if I have a follow-up to that, I'm pretty confident that it's going to be responded to that day as well. The support has been great. (C2)

 Access to knowledge and information

Implementation support tools

I use my binder, the checklist, and I think those tools help me guide the session really well with knowing that it's okay to go in other topic directions if that's the way your client wants to go. (C7)

I feel like I have all the resources and supports, the checklist and all of that. I feel very prepared to know what needs to be covered and it takes me maybe 5 to 10 minutes to go into the room, get all the equipment out that I need, the checklists, maybe flip through the coach manual. (C3)

 Knowledge and beliefs

Belief that the program is impacting the clients

I think it's been amazing. I love almost every single aspect about SSBC. I truly believe people are able to change after our meetings that we have with them. (C7)

All three of my clients have admitted to me that they've taken something away from this program that has helped their life and has made them healthier. That’s a great feeling to have. This program has done so much for not only my three participants, but for multiple participants that have been coming back to the Y[MCA] and telling me how great this program is. (C1)

 Self-efficacy

Self-efficacy increases with more experience

The more, I think, different people you interact with, the more confident you are. Some people are more confident, some meet all their goals and are super successful. Then some people don't. It's just navigating those different situations; there are always new situations. But once you've had experience with several, it's easier to think of what could be helpful to say next. (C3)

It just goes back to the more you do it, the more confident you get. (C9)

 Individual identification with organization

Committed staff

I look at it [program manual] before every session. I'm not going to go by my memory about what the session is supposed to be about. I read through the script and find that I just go over everything during that session with every client. (C6)

Just like with any skill, it gets rusty, so that's why I really try to use it in all aspects of my personal and professional life when I first went through the training because I really was like, ‘I want to hone in on this’. (C3)

 Other personal attributes

Building transferable skills for personal and professional development

I really like spending time in improving my communication skills because in my lifetime of doing that, the ability to communicate with someone better and avoid a crisis between a person or to understand them on a greater level and connect with them and feel connected, as well as understood, is really important. I feel like utilizing them in my personal or/and professional life outside of all of that is the best way to continue with them. It's not like I have to switch it on for a client and then switch it back off. It's always there to some degree.” (C4)

The training I found very valuable. It's really made a difference with not just SSBC, but it's made a difference with other clients or other people that I'm working with too. The whole training experience and understanding motivational interviewing has been a very good experience. (C6)

Learning opportunity participating in SSBC

The benefit is definitely the training and motivational interviewing; you can use that across the board with all clients any time. It’s further education for our trainers. It’s very impactful the way we speak to people and makes such a difference helping [clients] change. That is a huge benefit. (VP1)