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Background Sedentary behaviour, or waking activity of low energy expenditure (e.g. sitting, reclining, or lying down), is a serious population health risk, associated with mortality and cardiovascular disease. Stroke survivors tend to be more sedentary than the general population, and have higher risks of inactivity, alongside barriers to movement such as impaired balance or confidence.Reducing sedentary behaviour was therefore identified as an important therapy after stroke. We created and tested the ‘Get Set Go’ intervention, to promote regular movement through the day. This study aimed to explore understanding, acceptability, and use of the intervention amongst healthcare staff, patients and carers. Objectives: 1) Clarify intervention mechanisms of action, 2) Assess implementation fidelity, 3) Explore staff, patients, and carers acceptability, 4) Identify contextual factors affecting success.Methods We conducted an embedded Process Evaluation (alongside a pilot cluster randomised controlled trial ‘RECREATE’), using observations of staff training and stroke care, and semi-structured interviews with staff, patients, and carers. This study took place in six stroke services (four intervention, two control), including acute inpatient and community settings, and was underpinned by MRC guidance for process evaluations.Results The process evaluation comprised 70 observations (at four intervention timepoints and three control timepoints), 52 staff interviews (40 intervention, 12 control), and 27 patient interviews (17 intervention, 10 control).Most staff and patients valued the idea of increased movement after stroke. The intervention provided some patients permission or motivation, while many others did not use the materials, or used them for a limited time. Staff awareness and intervention delivery was inconsistent, and dependent upon key personnel. Inpatient observations showed limited patient movement beyond therapy sessions .Various practical and contextual constraints revealed difficulties of reducing sedentary behaviour in acute and community stroke services – such as: integration into a complex environment, risk management, hospital and staff pressures, patient acuity and readiness.Discussion The message to move in regular short bursts throughout the day, specifically to break up long periods of rest, can be misunderstood as a general message about being active. We noted a perception of patients being ‘too good’ for the intervention, or not doing more once resuming baseline activities. The intervention was not perfectly suited to either inpatient or community settings. Limited changes to staff and patient behaviour invite us to consider whether public health messaging would benefit beyond healthcare setting, as everyone in society would benefit from reducing sedentary behaviour.