Digital Weight Management Programme
The study aims to evaluate the implementation and operation of the new referral pathways for musculoskeletal (MSK) and elective surgical care patients into the Digital Weight Management Programme, taking into account the feasibility, acceptability and inclusivity of these pathways.
Specifically, the evaluation aimed to understand:
- How the referral pathways have been implemented in local service environments and any barriers or facilitators to this process.
- How acceptable the process is for patients and different groups of healthcare provider staff.
- Whether some patient groups are being disproportionately referred to DWMP or are disproportionately not subsequently engaging with the programme.
Participant Information Sheet for those taking part in interviews
Background
The National Health Service (NHS) in England is piloting an extension of access to the NHS Digital Weight Management Programme (DWMP) to include referrals for patients with osteoarthritis of the knee and/or hip (musculoskeletal referrals) and referrals for patients on elective surgical care waiting lists (elective surgical care referrals). The DWMP is a digitally delivered service, which offers diet and physical activity advice at different levels of personalisation, with the stated aim of supporting behavioural and lifestyle changes so that individuals can manage their weight and improve their health. Before these pilots, the DWMP could only be accessed by patients with hypertension or diabetes, or both, who were also living with obesity.
Eleven musculoskeletal (MSK) sites and ten elective surgical care sites are piloting the new condition-specific referral pathways into the DWMP. There is marked variation across the sites in the number of patients referred and the number who go on to engage with the programme.
Hence there is a need to understand: why there is such variation in the initial process of referral for both patient groups; any population groups who are particularly well or poorly served; any issues or constraints with respect to staff experience; and why only 60-70% of patients referred then go on to engage in the service. Establishing a greater understanding of the nature and sources of these variations to the referral could inform improved operation of referral pathways and future spread and scale-up of the service.
The evaluation will consist of four work packages:
WP1. Analysis of quantitative referral data. We will analyse data already collected by NHS England from the pilot sites with regards to the number of people referred to different DWMP services and the take-up of these services by patients. Based on this analysis, consolidated with our learning from the scoping stages, we will identify a sample of eight pilot sites (four for the MSK pathway and four for the elective care pathway) for in-depth qualitative research that represent ‘high’ and ‘low’ referral rates (two of each for each pathway). We will be mindful of the need to ensure demographic and regional representativeness across the pilot sites, especially with regards to diversity and inclusion.
WP2. Qualitative evaluation of the referral process. This will involve interviews with professionals at each site who are involved in the implementation and operation of the referral process and interviews with patients who were offered the DWMP (including those who declined and those who accepted referral, regardless of completion). It will include mapping the referral process, facilitators and barriers, with particular attention given to the key sequential patient contact points, modes of communication, patient-practitioner interaction, and transition into the DWMP.
WP3. Deliberative workshop. To further clarify and validate our findings, two 90-minute, online workshops – one for the MSK pathway, and one for elective surgery – will be facilitated with professional representatives from the full range of pilot sites (not limited to those in the qualitative analysis) and patient representatives identified from across multiple sites. Each workshop will present early findings as a series of structured themes that will be deliberated and prioritised to identify key learning for future scale-up.
WP4. Sharing of learning. The findings from WP2 and WP3 will be synthesised to generate evidence relevant for current practice and future scale-up and spread. This will include a rich description of how referral processes have been implemented in different sites, what barriers and facilitators to implementation and reach were, and the acceptability and experiences of different patient groups and healthcare practitioners.
- Justin Waring (Co-PI)
- Jon Sussex (Co-PI)
- Maggie Bradford
- Stephanie Stockwell
- Zuza Marciniak-Nuqui
- Saoirse Moriarty
Outputs
Results from this evaluation project will be written up in a report and published in the NIHR Journals Library (HSDR programme), and we will also share the findings from this project in a number of ways, both written and oral.
Project Duration
November 2023 - October 2024