Healthcare professionals' experiences of supporting participants using an online weight management intervention (POWeR): A qualitative study

The problem

Obesity is a major threat to worldwide public health with 2.8 billion adult deaths per year related to being overweight or obese. The cost of treating associated health conditions is predicted to be £19.5 billion in 2015. There is demand for health professionals in primary care to provide weight management interventions for obese patients. Providing intensive interventions with personal support is costly and requires staff to have specific training, and time available. However, most practice staff have neither the training nor the time to implement intensive in-person counselling for weight management. Automated web-based programmes to support weight management might offer a potential solution. POWeR (Positive Online Weight Reduction) is a nurse supported online weight management intervention intended to foster self-regulation skills to enable users to autonomously self-manage their weight. A feasibility trial of POWeR suggested that there was greater weight loss in the nurse support than web-only and usual care groups. The aim of this paper is to describe the healthcare professionals' (HCPs) acceptance of and experiences in supporting patients in the full trial of POWeR.

The approach

Fifty-four GP practices were involved in the recruitment and supporting of 834 participants across the South-East of England. Thirteen female HCPs responsible for supporting participants in their use of POWeR took part in semi-structured telephone interviews recounting their experiences of using POWeR and supporting participants' weight change attempts. Written consent was provided and verbally reconfirmed, data were recorded, transcribed verbatim and analysed following an inductive thematic approach using a constant comparative method. Transcripts were summarised and discussed, creating a coding scheme. Codes were grouped into four main themes; HCPs' prior experience, HCPs' perceptions and use of POWeR, HCPs' perceptions and experiences of supporting participants, and the impact of POWeR.

Findings

HCP's mostly felt POWeR offered a more structured and comprehensive programme for patients than currently on offer at the practice. Providing face-to-face support was preferred by HCPs over remote (telephone/email) support, but they acknowledged that remote was sometimes preferred by busy patients. Email was not viewed as a support mechanism. The perceived impact of POWeR was mixed; it allowed conversations of weight to be initiated, and HCPs felt positive when patients did well, but frustrated when they stopped making contact. The constraints on timing of support imposed for the trial were on occasion viewed negatively - more flexibility was desired. HCPs would also have liked greater access to POWeR content to aid confidence in the support they were offering.

Consequences

POWeR was generally well received by HCPs. It could offer a cheap and structured framework for HCPs to provide patients with support for self-management of weight. Implementing in general practice may require greater flexibility in terms of support type and timing.

Credits

• Emily Smith, University of Oxford, Oxford, UK
• Lisa Pitman, University of Oxford, Oxford, UK
• Jo Kelly, University of Oxford, Oxford, UK
• Richard Hobbs
• Paul Little, University of Oxford, Oxford, UK
• Lucy Yardley, University of Oxford, Oxford, UK