Transferability of the NHS low‐calorie diet programme: A qualitative exploration of factors influencing the programme's transfer ahead of wide‐scale adoption

Author:

Burton Wendy1ORCID,Padgett Louise1,Nixon Nicola1,Ells Louisa2,Drew Kevin J.2,Brown Tamara2,Bakhai Chirag3,Radley Duncan2ORCID,Homer Catherine4,Marwood Jordan2ORCID,Dhir Pooja2,Bryant Maria15

Affiliation:

1. Department of Health Sciences University of York York UK

2. Obesity Institute, School of Health Leeds Beckett University Leeds UK

3. Larkside Practice Churchfield Medical Centre Bedfordshire UK

4. Sport and Physical Activity Research Centre Sheffield Hallam University Sheffield UK

5. Hull York Medical School University of York York UK

Abstract

AbstractIntroductionAlthough behavioural interventions have been found to help control type 2 diabetes (T2D), it is important to understand how the delivery context can influence implementation and outcomes. The NHS committed to testing a low‐calorie diet (LCD) programme designed to support people living with excess weight and T2D to lose weight and improve diabetes outcomes. Understanding what influenced implementation during the programme pilot is important in optimising rollout. This study explored the transferability of the NHS LCD Programme prior to wider adoption.MethodsTwenty‐five interviews were undertaken with stakeholders involved in implementing the LCD programme in pilot sites (health service leads, referring health professionals and programme deliverers). Interviews with programme participants (people living with T2D) were undertaken within a larger programme of work, exploring what worked, for whom and why, which is reported separately. The conceptual Population–Intervention–Environment–Transfer Model of Transferability (PIET‐T) guided study design and data collection. Constructs of the model were also used as a deductive coding frame during data analysis. Key themes were identified which informed recommendations to optimise programme transfer.ResultsPopulation: Referral strategies in some areas lacked consideration of population characteristics. Many believed that offering a choice of delivery model would promote acceptability and accessibility of the eligible population. Intervention: Overall, stakeholders had confidence in the LCD programme due to the robust evidence base along with anecdotal evidence, but some felt the complex referral process hindered engagement from GP practices. Environment: Stakeholders described barriers to accessing the programme, including language and learning difficulties. Transferability: Multidisciplinary working and effective communication supported successful implementation.ConclusionReferral strategies to reach underrepresented groups should be considered during programme transfer, along with timely data from service providers on access and programme benefits. A choice of delivery models may optimise uptake. Knowledge sharing between sites on good working practices is encouraged, including increasing engagement with key stakeholders.

Funder

National Institute for Health and Care Research

Publisher

Wiley

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