Exploring weight loss services in primary care and staff views on
using a web-based programme

Ware, Lisa J.; Williams, Sarah; Bradbury, Katherine; Brant, Catherine; Little, Paul; Hobbs, FD Richard; Yardley, Lucy

doi:10.14236/jhi.v20i4.18

Cited by 14 publications

(15 citation statements)

References 24 publications

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“…POWeR+ was developed, as with POWeR, using the person-based approach to maximise acceptability, feasibility and engagement. [22][23][24][25] We finally created a series of 24 web-based sessions lasting up to 6 months with novel content, links to external content and e-mail reminders to encourage patients to continue to use the website weekly to track their weight, set and review eating and physical activity goals, and receive personalised advice. After entering their weight and whether or not they had achieved the goals they had set themselves the previous week, patients receive tailored feedback giving encouragement if maintaining weight loss (e.g.…”

Section: The Power+ Web-based Interventionmentioning

confidence: 99%

Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction)

Little

Stuart

Hobbs

et al. 2017

Health Technol Assess

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151

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BackgroundBehavioural counselling with intensive follow-up for obesity is effective, but in resource-constrained primary care settings briefer approaches are needed.ObjectivesTo estimate the clinical effectiveness and cost-effectiveness of an internet-based behavioural intervention with regular face-to-face or remote support in primary care, compared with brief advice.DesignIndividually randomised three-arm parallel trial with health economic evaluation and nested qualitative interviews.SettingPrimary care general practices in the UK.ParticipantsPatients with a body mass index of ≥ 30 kg/m2(or ≥ 28 kg/m2with risk factors) identified from general practice records, recruited by postal invitation.InterventionsPositive Online Weight Reduction (POWeR+) is a 24-session, web-based weight management intervention completed over 6 months. Following online registration, the website randomly allocated participants using computer-generated random numbers to (1) the control intervention (n = 279), which had previously been demonstrated to be clinically effective (brief web-based information that minimised pressure to cut down foods, instead encouraging swaps to healthier choices and increasing fruit and vegetables, plus 6-monthly nurse weighing); (2) POWeR+F (n = 269), POWeR+ supplemented by face-to-face nurse support (up to seven contacts); or (3) POWeR+R (n = 270), POWeR+ supplemented by remote nurse support (up to five e-mails or brief telephone calls).Main outcome measuresThe primary outcome was a modelled estimate of average weight reduction over 12 months, assessed blind to group where possible, using multiple imputation for missing data. The secondary outcome was the number of participants maintaining a 5% weight reduction at 12 months.ResultsA total of 818 eligible individuals were randomised using computer-generated random numbers. Weight change, averaged over 12 months, was documented in 666 out of 818 participants (81%; control,n = 227; POWeR+F,n = 221; POWeR+R,n = 218). The control group maintained nearly 3 kg of weight loss per person (mean weight per person: baseline, 104.4 kg; 6 months, 101.9 kg; 12 months, 101.7 kg). Compared with the control group, the estimated additional weight reduction with POWeR+F was 1.5 kg [95% confidence interval (CI) 0.6 to 2.4 kg;p = 0.001] and with POWeR+R was 1.3 kg (95% CI 0.34 to 2.2 kg;p = 0.007). By 12 months the mean weight loss was not statistically significantly different between groups, but 20.8% of control participants, 29.2% of POWeR+F participants (risk ratio 1.56, 95% CI 0.96 to 2.51;p = 0.070) and 32.4% of POWeR+R participants (risk ratio 1.82, 95% CI 1.31 to 2.74;p = 0.004) maintained a clinically significant 5% weight reduction. The POWeR+R group had fewer individuals who reported doing another activity to help lose weight [control, 47.1% (64/136); POWeR+F, 37.2% (51/137); POWeR+R, 26.7% (40/150)]. The incremental cost to the health service per kilogram weight lost, compared with the control group, was £18 (95% CI –£129 to £195) for POWeR+F and –£25 (95% CI –£268 to £157) for POWeR+R. The probability of being cost-effective at a threshold of £100 per kilogram was 88% and 98% for POWeR+F and POWeR+R, respectively. POWeR+R was dominant compared with the control group. No harms were reported and participants using POWeR+ felt more enabled in managing their weight. The qualitative studies documented that POWeR+ was viewed positively by patients and that health-care professionals generally enjoyed supporting patients using POWeR+.Study limitationsMaintenance of weight loss after 1 year is unknown.Future workIdentifying strategies for longer-term engagement, impact in community settings and increasing physical activity.ConclusionClinically valuable weight loss (> 5%) is maintained in 20% of individuals using novel written materials with brief follow-up. A web-based behavioural programme and brief support results in greater mean weight loss and 10% more participants maintain valuable weight loss; it achieves greater enablement and fewer participants undertaking other weight-loss activities; and it is likely to be cost-effective.Trial registrationCurrent Controlled Trials ISRCTN21244703.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 4. See the NIHR Journals Library website for further project information.

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Section: The Power+ Web-based Interventionmentioning

confidence: 99%

Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction)

Little

Stuart

Hobbs

et al. 2017

Health Technol Assess

Self Cite

151

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“…At the planning stage, the person-based approach involves carrying out mixed methods research (e.g. interviews, focus groups, observation, questionnaire studies) to systematically investigate the beliefs, attitudes, needs and situation of the people who will be using the intervention in order to identify intervention components that are likely to be necessary, feasible and salient [2, 3]. During development, further mixed methods research (e.g.…”

Section: Introductionmentioning

confidence: 99%

The person-based approach to enhancing the acceptability and feasibility of interventions

Yardley

Ainsworth

Arden‐Close

et al. 2015

Pilot Feasibility Stud

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255

269

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BackgroundThis paper provides three illustrations of how the “person-based approach” can be used to assess and enhance the acceptability and feasibility of an intervention during the early stages of development and evaluation. The person-based approach involves using mixed methods research to systematically investigate the beliefs, attitudes, needs and situation of the people who will be using the intervention. The in-depth understanding of users’ perspectives derived from this research then enables intervention developers to design or modify the intervention to make it more relevant, persuasive, accessible and engaging.MethodsThe first illustration describes how relevant beliefs and attitudes of people with asthma were identified from the existing qualitative and quantitative literature and then used to create guiding principles to inform the design of a web-based intervention to improve quality of life. The second illustration describes how qualitative “think-aloud” interviews and patient and public involvement (PPI) input are used to improve the acceptability of a booklet for people with asthma. In the third illustration, iterative think-aloud methods are used to create a more accurate and accessible activity planner for people with diabetes.ResultsIn the first illustration of the person-based approach, we present the guiding principles we developed to summarise key design issues/objectives and key intervention features to address them. The second illustration provides evidence from interviews that positive, non-medical messages and images were preferred in booklet materials for people with asthma. The third illustration demonstrates that people with diabetes found it difficult to complete an online activity planner accurately, resulting in incorrect personalised advice being given prior to appropriate modification of the planner.ConclusionsThe person-based approach to intervention development can complement theory- and evidence-based development and participant input into intervention design, offering a systematic process for systematically investigating and incorporating the views of a wide range of users.Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-015-0033-z) contains supplementary material, which is available to authorized users.

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“…By 2010, 3.4 million deaths and 3.8% of all disability-adjusted life years per year were caused by overweight or obesity [3]. Primary Care would like to provide help to obese patients, but lacks the resources needed to treat the growing number of obese adults, and practitioners frequently lack the necessary training to provide the behavioural counselling which could help people to lose weight [4]. Digital interventions (DIs) may provide a solution as they can provide behavioural weight loss support at relatively low cost without the need for practitioners to learn behavioural counselling techniques [5].…”

Section: Introductionmentioning

confidence: 99%

Providing online weight management in Primary Care: a mixed methods process evaluation of healthcare practitioners’ experiences of using and supporting patients using POWeR+

et al. 2017

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BackgroundAn online weight management intervention (POWeR+) combined with a small amount of primary care healthcare practitioner support is effective in helping patients to lose weight, but little is known about how practitioners interact with the POWeR+ intervention or their experiences of providing support for patients using POWeR+. The aim of this study was to explore practitioners’ usage of POWeR+ and their experiences of providing support to patients using POWeR+.MethodsSet within a randomised controlled trial of POWeR+, practitioners’ usage of POWeR+ was automatically captured and a qualitative process analysis was conducted employing semi-structured telephone interviews with practitioners who provided support to patients using POWeR+. The usage analysis captured how 54 practitioners used the POWeR+ intervention. Thirteen telephone interviews explored practitioners’ experiences of using POWeR+ and providing patients with face-to-face or remote (email and telephone) support. Interview data were analysed using inductive thematic analysis.ResultsUsage analysis indicated that almost all practitioners engaged with POWeR+. Pages which displayed patients’ progress and allowed practitioners to email patients were used the most. Practitioners found POWeR+ straightforward and easy to use. Some practitioners preferred providing support face-to-face, which they enjoyed more than remote support. A small number of nurses found providing non-directive support using the CARe approach (Congratulate, Ask, Remind) challenging, feeling it was the opposite of their normal approach. POWeR+ enabled practitioners to raise the topic of weight loss with patients, and POWeR+ was viewed as a superior alternative to existing weight management support which was limited in most practices. Still some practitioners found it difficult to fit providing support into their busy schedules.ConclusionsOverall, practitioners engaged well with POWeR+ and perceived providing patients with support whilst using POWeR+ as acceptable and feasible. CARe provides a potentially useful model for how practitioners can combine human and digital support in a cost-effective way, which could be useful for the management of other conditions. Some potential barriers to implementation were identified, which allowed modification of POWeR+. The findings suggest that implementing this cost-effective online weight management intervention in Primary Care would be feasible and acceptable to practitioners.Trial registrationClinicalTrial.gov, ISRCTN21244703

show abstract

Exploring weight loss services in primary care and staff views on using a web-based programme

Cited by 14 publications

References 24 publications

Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction)

Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction)

The person-based approach to enhancing the acceptability and feasibility of interventions

Providing online weight management in Primary Care: a mixed methods process evaluation of healthcare practitioners’ experiences of using and supporting patients using POWeR+

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