Dodd-Reynolds Caroline J, Nevens Lisa, Oliver Emily J, Finch Tracy, Lake Amelia A, Hanson Coral L
Department of Sport and Exercise Sciences, Durham University, Durham, UK
Wolfson Research Institute for Health and Wellbeing Physical Activity Special Interest Group, Durham University, Durham, UK.
BMJ Open. 2019 Oct 31;9(10):e029718. doi: 10.1136/bmjopen-2019-029718.
Stakeholder 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.
Mixed methods evaluation: Qualitative implementation exploration with referrers and service users; preliminary analysis of anonymised quantitative service data (12 and 52 weeks).
Two leisure centres in Northumberland, North East England.
Individual interviews with referring professionals (n=5) and focus groups with service users (n=13). Individuals (n=182) referred by healthcare professionals (quantitative data).
Three 12-week programme iterations: Momenta (n=59), Momenta-Fitness membership (n=58) and Fitness membership only (n=65).
Primary 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.
Service 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.
Identification 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.
在公共卫生项目设计中进行利益相关者共同生产可能会减少“实施差距”，但可能耗时且成本高昂。与交付背景相关的迭代式原型设计提供了一种潜在的解决方案。本评估探讨了一项为期12周的基于转诊的体重管理项目“Momenta”的实施情况和经验教训，以及迭代式原型评估框架的可行性。
混合方法评估：对转诊者和服务使用者进行定性实施探索；对匿名定量服务数据（12周和52周）进行初步分析。
英格兰东北部诺森伯兰郡的两个休闲中心。
对转诊专业人员进行个人访谈（n = 5），对服务使用者进行焦点小组访谈（n = 13）。由医疗保健专业人员转诊的个体（n = 182）（定量数据）。
三个为期12周的项目迭代：Momenta（n = 59）、Momenta - 健身会员（n = 58）和仅健身会员（n = 65）。
主要结局：通过利益相关者参与形成的定性主题。次要结局包括对招募、参与、留存以及体重、体重指数、腰围和心理健康变化的初步探索。
服务使用者报告了对Momenta的积极体验。在转诊过程和从业者知识方面发现了实施差距。原型设计实现了诸如拓宽纳入标准等迭代式改进。Momenta（84.7%，45.8%）和Momenta - 健身会员（93.1%，60.3%）的参与率和12周留存率高于仅健身会员（75.4%，24.6%）。对其他初步结局（仅针对完成者）的探索表明，Momenta和Momenta - 健身会员在12周时有组内体重减轻和心理健康改善的潜力。52周的随访数据有限（开始Momenta、Momenta - 健身会员和仅健身会员项目的参与者留存率分别为32%、33%和6%），但表明Momenta - 健身会员有维持体重减轻效果的潜力。
识别转诊过程中的问题实现了实时迭代改进，而吸取的经验教训可能对更广泛地在当地实施“现成的”体重管理方案具有价值。我们针对完成者的初步数据表明，Momenta可能有减肥潜力，特别是在提供健身会员资格时。
