Prototyping for public health in a local context: a streamlined evaluation of a community-based weight management programme (Momenta), Northumberland, UK

Abstract

ObjectivesStakeholder co-production in design of public health programmes may reduce the ‘implementation gap’ but can be time-consuming and costly. Prototyping, iterative refining relevant to delivery context, offers a potential solution. This evaluation explored implementation and lessons learnt for a 12-week referral-based weight-management programme, ‘Momenta’, along with feasibility of an iterative prototyping evaluation framework.DesignMixed methods evaluation: Qualitative implementation exploration with referrers and service users; preliminary analysis of anonymised quantitative service data (12 and 52 weeks).SettingTwo leisure centres in Northumberland, North East England.ParticipantsIndividual interviews with referring professionals (n=5) and focus groups with service users (n=13). Individuals (n=182) referred by healthcare professionals (quantitative data).InterventionsThree 12-week programme iterations: Momenta (n=59), Momenta-Fitness membership (n=58) and Fitness membership only (n=65).Primary and secondary outcome measuresPrimary outcome: Qualitative themes developed through stakeholder-engagement. Secondary outcomes included preliminary exploration of recruitment, uptake, retention, and changes in weight, body mass index, waist circumference and psychological well-being.ResultsService users reported positive experiences of Momenta. Implementation gaps were revealed around the referral process and practitioner knowledge. Prototyping enabled iterative refinements such as broadening inclusion criteria. Uptake and 12-week retention were higher for Momenta (84.7%, 45.8%) and Momenta-Fitness (93.1%, 60.3%) versus Fitness only (75.4%, 24.6%). Exploration of other preliminary outcomes (completers only) suggested potential for within-group weight loss and increased psychological well-being for Momenta and Momenta-Fitness at 12 weeks. 52 week follow-up data were limited (32%, 33% and 6% retention for those who started Momenta, Momenta-Fitness and Fitness, respectively) but suggested potential weight loss maintenance for Momenta-Fitness.ConclusionsIdentification of issues within the referral process enabled real-time iterative refinement, while lessons learnt may be of value for local implementation of ‘off-the-shelf’ weight management packages more generally. Our preliminary data for completers suggest Momenta may have potential for weight loss, particularly when offered with a fitness membership.

The Northumberland Exercise Referral Scheme as a Universal Community Weight Management Programme: A Mixed Methods Exploration of Outcomes, Expectations and Experiences across a Social Gradient

“…The mean age of weight-related referrals to the Northumberland ERS being 49.1 years and women comprising ~2/3 of all weight-related referrals (and completers) suggests that HCPs should, for equity, also consider targeting younger patients for ERS if weight loss is the primary reason for referral. They should also explore ways to raise conversations of weight and PA with males, in accordance with a similar message we have reported recently [ 31 ]. Exploration of these factors is required in the healthcare referral setting to ensure equity of referral.…”

“…Ahern et al (2016) [ 28 ] acknowledged a perception that primary care weight loss referrals best serve “middle class, middle-aged women”, for example. Gender bias (towards women) has been reported in weight management referrals [ 29 , 30 ] and we reported that HCPs struggle to raise the conversation of weight [ 31 ], particularly with males. Promisingly, however, a few international reviews suggest that, at a community weight-management intervention level, weight related inequalities are not widened and in some instances may actually be reduced [ 24 , 32 , 33 ].…”

Co-Production Performance Evaluation in Healthcare. A Systematic Review of Methods, Tools and Metrics

“…Specifically, the use of validated tools, borrowed from medicine (e.g., General Health Questionnaire-12 [ 48 ]), health psychology (e.g., Hospital Anxiety and Depression Scale (HADS) [ 119 , 120 , 136 , 137 ]) and organisational well-being studies (e.g., Social production function scale (SPF-IL) [ 46 , 88 ]), is more widely adopted to evaluate the impacts on lay actors and professionals. Recognised and validated constructs and scales have been used mainly in experimental health research and health service management research, while scarce contributions originated from the public sector.…”

“…The number of sub-dimensions (15) also reflects the maturity of evaluation on this topic. Health status, well-being and quality of life are largely the dimensions that offer a portfolio of validated scales (e.g., health status: Patient Health Questionnaire (PHQ-9) [ 18 ]; well-being: Warwick-Edinburgh Mental Well-being Scale (WEMWBS); [ 48 , 109 , 135 , 136 ]; quality of life: EuroQol index (EQ 5D index) [ 119 , 120 ]), followed by satisfaction with service (e.g., Psychological Needs Satisfaction in Exercise Scale [ 49 ]). Interestingly, some well-known constructs in medicine and health psychology (such as enjoyment [ 43 ], self-management [ 119 , 120 ], self-efficacy [ 50 ], self-esteem [ 110 ], eustress [ 23 ], burden [ 109 ], trust [ 73 ] and issue awareness [ 99 ]) have been relatively scarcely analysed.…”

“…Improved/deteriorated or unchanged clinical indicators (e.g., waist-to-height ratio; carotid artery reactivity (CAR); blood biochemical parameters; death) [ 49 , 104 , 136 ];…”