Acceptability of delivery modes for lifestyle advice in a large scale randomised controlled obesity prevention trial

Abstract

BackgroundPreventing obesity is an international health priority and women living in rural communities are at an increased risk of weight gain. Lifestyle programs are needed as part of a comprehensive approach to prevent obesity. Evaluation provides a unique opportunity to investigate and inform improvements in lifestyle program implementation strategies. The Healthy Lifestyle Program for rural women (HeLP-her Rural) is a large scale, cluster randomized control trial, targeting the prevention of weight gain. This program utilises multiple delivery modes for simple lifestyle advice (group sessions, phone coaching, text messages, and an interactive program manual). Here, we describe the acceptability of these various delivery modes.MethodsA mixed-method process evaluation was undertaken measuring program fidelity, recruitment strategies, dose delivered, program acceptability and contextual factors influencing program implementation. Data collection methodologies included qualitative semi-structured interviews for a sub-group of intervention participants [n = 28] via thematic analysis and quantitative methods (program checklists and questionnaires [n = 190]) analysed via chi square and t-tests.ResultsWe recruited 649 women from 41 rural townships into the HeLP-her Rural program with high levels of program fidelity, dose delivered and acceptability. Participants were from low socioeconomic townships and no differences were detected between socioeconomic characteristics and the number of participants recruited across the towns (p = 0.15). A face-to-face group session was the most commonly reported preferred delivery mode for receiving lifestyle advice, followed by text messages and phone coaching. Multiple sub-themes emerged to support the value of group sessions which included: promoting of a sense of belonging, mutual support and a forum to share ideas. The value of various delivery modes was influenced by participant’s various needs and learning styles.ConclusionThis comprehensive evaluation reveals strong implementation fidelity and high levels of dose delivery. We demonstrate reach to women from relatively low income rural townships and highlight the acceptability of low intensity healthy lifestyle programs with mixed face-to-face and remote delivery modes in this population. Group education sessions were the most highly valued component of the intervention, with at least one face-to-face session critical to successful program implementation. However, lifestyle advice via multiple delivery modes is recommended to optimise program acceptability and ultimately effectiveness.Trial registryAustralia & New Zealand Clinical Trial Registry. Trial number ACTRN12612000115831, date of registration24/01/2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1995-8) contains supplementary material, which is available to authorized users.

Evaluation of a large healthy lifestyle program: informing program implementation and scale-up in the prevention of obesity

“…2). As previously reported, n  = 649 women were recruited, representing ~10% of the eligible target population [47, 50]. Based on predefined and limited exclusion criteria, less than 12% of volunteers ( n  = 95) were excluded post screening (Fig.…”

“…Qualitative participant interviews revealed that group education sessions were most valued, followed by text messages and phone coaching. Overall, delivery of lifestyle advice through multiple delivery modes (group sessions, phone coaching, text messages, and a program manual) was recommended by participants to optimize program acceptability and accommodate diverse learning styles [47]. A full economic analysis is underway based on a pending 2-year data analysis and will be reported elsewhere.…”

“…The program has successfully engaged 1127 women across three large RCT’s, emphasizing that low-intensity programs appeal to women from highly diverse socio-economic, ethnic, and educational backgrounds [4, 17, 47]. Furthermore, we have shown that a combination of delivery modes (face-to-face, phone coaching, text messages, and program manuals) optimizes program acceptability and delivers effectiveness.…”

“…The HeLP-her Rural evaluation used mixed method data collection design (Additional file 1) [47]. These included the following: (1) sourcing and analyzing administration data, (2) checklists and log books completed by program leaders, (3) observations by research team, (4) anthropometric data, (5) questionnaires completed by participants, (6a) semi-structured interviews with a sub-group of participants, (6b) semi-structured interviews with rural stakeholders, and (7) an evaluation self-audit.

Administrative data and contextual data

To explore program reach and context, data from the Australian Bureau of Statistics (ABS) measuring Socio-Economic Indexes for Areas (SEIFA) of relative disadvantage was utilized [51].

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“…A criteria-based, convenience sampling approach as previously described [47, 48] involved women from ten communities (six intervention and four control). One trained researcher conducted all interviews (SK), guided by an interview schedule (Additional file 2).…”