Participants themselves and others seeing the benefit to patients (in the Mercy Ships hospital) as opposed to just being told about a new technique or new practice

Being trained as part of a team, ie, not just on your own but with someone else from your institution—ideally a surgeon and a nurse

Supportive leadership (from a surgeon or hospital director)

Courage to persist and keep going

Credibility as being trained by Mercy Ships as an external organisation

Resistance to change from colleagues due to lack of belief in/understanding of new techniques and practices

Lack of materials

Lack of staff

Lack of support from ‘superiors’

Changing long-standing habits and attitudes is hard work