Abstract
Background: FIT is a counselling style intervention that uses motivational interviewing and mental imagery to increase intrinsic motivation and helps people to work towards their goals. FIT has demonstrated merit on a 1:1 basis with people who want to lose weight. However, 1:1 counselling can be costly and time-consuming for healthcare settings and lacks the potential benefits group interventions could provide such as peer support. One aim of this research was to develop, refine and evaluate a version of FIT tailored to group delivery. Alongside this, implementation was attempted with public and private healthcare practitioners as well as a local organisation.Method: Four studies were conducted, firstly a mixed method study using surveys and semi-structured interviews exploring the experiences of private and public health practitioners when attempting to implement 1:1 delivered FIT. Following on from this a group-based FIT intervention was developed and a feasibility study was conducted. The feasibility study explored recruitment and retention and informed the design of a pilot RCT. The two-armed pilot RCT was a community-based weight loss study with 111 participants with a BMI over 35 kg/m2. Questionnaires and semi-structured interviews were conducted to explore weight loss indicators, QOL and health as well as acceptance of the intervention. The final aspect involved drawing upon the previous three studies and implementing the group-based intervention into Devon Mind through a realist evaluation approach.
Results: Study one found that there were key barriers and facilitators to implementing FIT. Public health practitioners experienced many barriers and were unsuccessful in implementing FIT. The private health practitioners were more successful, and this seemed to be due to the autonomy they have within their roles to manage their time schedules. The public health practitioners experienced a lack of leadership and peer support that could have allowed them the time and resources to develop and implement their training. The participants involved in the feasibility and RCT studies were accepting of remote-based group FIT and felt that the sessions helped them utilise the knowledge and understanding they have of how to lose weight and put this into practice by increasing their motivation and desire to change. The feasibility study found that recruitment and retention were key challenges and although changes were made to the protocol these challenges persisted into the pilot RCT with over 50% of participants lost to the 12 month follow up. In the RCT both groups, intervention and control, lost a significant amount of weight by three months which was maintained at 12 months. There were no differences, for either group, in terms of QOL or health related scores. There were challenges in implementing FIT with Devon Mind which included practitioners finding the time, resources, and leadership support to make changes to their practice. A programme theory addressing these challenges was developed to support future implementation.
Conclusion: The thesis has provided evidence that group FIT is well-accepted by participants as an intervention however engagement and implementation tactics need to be addressed. The thesis also provides insight into what implementation strategy could potentially be effective for future implementation.
| Date of Award | 2024 |
|---|---|
| Original language | English |
| Sponsors | NIHR PenARC |
| Supervisor | Jackie Andrade (Director of Studies (First Supervisor)), Tracey Parkin (Other Supervisor) & Ben Whalley (Other Supervisor) |
ASJC Scopus Subject Areas
- Applied Psychology