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Practice nurse-supported weight self-management delivered within the national child immunisation programme for postnatal women: a feasibility cluster RCT

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journal contribution
posted on 13.09.2021, 08:56 by Amanda DaleyAmanda Daley, Kate Jolly, Natalie Ives, Susan A Jebb, Sarah Tearne, Sheila M Greenfield, Lucy Yardley, Paul Little, Natalie Tyldesley-Marshall, Hannah Bensoussane, Ruth V Pritchett, Emma Frew, Helen M Parretti
Background
Pregnancy is a high-risk time for excessive weight gain. The rising prevalence of obesity in women, combined with excess weight gain during pregnancy, means that there are more women with obesity in the postnatal period. This can have adverse health consequences for women in later life and increases the health risks during subsequent pregnancies.

Objective
The primary aim was to produce evidence of whether or not a Phase III trial of a brief weight management intervention, in which postnatal women are encouraged by practice nurses as part of the national child immunisation programme to self-monitor their weight and use an online weight management programme, is feasible and acceptable.

Design
The research involved a cluster randomised controlled feasibility trial and two semistructured interview studies with intervention participants and practice nurses who delivered the intervention. Trial data were collected at baseline and 3 months later. The interview studies took place after trial follow-up.

Setting
The trial took place in Birmingham, UK.

Participants
Twenty-eight postnatal women who were overweight/obese were recruited via Birmingham Women’s Hospital or general practices. Nine intervention participants and seven nurses were interviewed.

Interventions
The intervention was delivered in the context of the national child immunisation programme. The intervention group were offered brief support that encouraged self-management of weight when they attended their practice to have their child immunised at 2, 3 and 4 months of age. The intervention involved the provision of motivation and support by nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. The role of the nurse was to provide regular external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a record card in their child’s health record (‘red book’) or using the online programme. The behavioural goal was for women to lose 0.5–1 kg per week. The usual-care group received a healthy lifestyle leaflet.

Main outcome measures
The primary outcome was the feasibility of a Phase III trial to test the effectiveness of the intervention, as assessed against three traffic-light stop–go criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme).

Results
The traffic-light criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. In the qualitative studies, participants indicated that the intervention was acceptable to them and they welcomed receiving support to lose weight at their child immunisation appointments. Although nurses raised some caveats to implementation, they felt that the intervention was easy to deliver and that it would motivate postnatal women to lose weight.

Limitations
Fewer participants were recruited than planned.

Conclusions
Although women and practice nurses responded well to the intervention and adherence to self-weighing was high, recruitment was challenging and there is scope to improve engagement with the intervention.

Future work
Future research should focus on investigating other methods of recruitment and, thereafter, testing the effectiveness of the intervention.

Funding

National Institute for Health Research (NIHR) Health Technology Assessment programme

History

School

  • Sport, Exercise and Health Sciences

Published in

Health Technology Assessment

Volume

25

Issue

49

Publisher

NIHR Journals Library

Version

VoR (Version of Record)

Rights holder

© The Authors

Publisher statement

This is an Open Access Article. It is published by NIHR Journals Library under the Creative Commons Attribution 4.0 International Licence (CC BY 4.0). Full details of this licence are available at: https://creativecommons.org/licenses/by/4.0/

Acceptance date

26/04/2021

Publication date

2021-08-02

Copyright date

2021

ISSN

1366-5278

eISSN

2046-4924

Language

en

Depositor

Prof Amanda Daley. Deposit date: 6 September 2021