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JONES, Susan, BROWN, Tamara J., WATSON, Patricia, HOMER, Catherine, FREEMAN, Charlotte, BAKHAI, Chirag and ELLS, Louisa (2024). Commercial provider staff experiences of the NHS low calorie diet programme pilot: a qualitative exploration of key barriers and facilitators. BMC Health Services Research, 24 (1): 53.
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PDF (Additional File 1 presents an overview of pilot areas, delivery models and programme structure)
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PDF (Additional File 2 provides a completed COREQ checklist)
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PDF (Additional File 3 provides information on NPT and the focus group question framework)
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PDF (Additional File 4 provides the codebook and an example of data linkage)
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PDF (Additional File 5 provides further findings and quotations from the data)
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Abstract
Background: The National Health Service Type 2 Diabetes Path to Remission programme in England (known as the NHS Low Calorie Diet programme when piloted) was established to support people living with excess weight and Type 2 Diabetes to lose weight and improve their glycaemic control. A mixed method evaluation was commissioned to provide an enhanced understanding of the long-term cost effectiveness of the pilot programme, its implementation, equity and transferability across broad and diverse populations. This study provided key insights on implementation and equity from the service providers’ perspective. Methods: Thirteen focus groups were conducted with commercial providers of the programme, during the initial pilot rollout. Participants were purposively sampled across all provider organisations and staff roles involved in implementing and delivering the programme. Normalisation Process Theory (NPT) was used to design the topic schedule, with the addition of topics on equity and person-centredness. Data were thematically analysed using NPT constructs with additional inductively created codes. Codes were summarised, and analytical themes generated. Results: The programme was found to fulfil the requirements for normalisation from the providers’ perspective. However, barriers were identified in engaging GP practices and receiving sufficient referrals, as well as supporting service users through challenges to remain compliant. There was variation in communication and training between provider sites. Areas for learning and improvement included adapting systems and processes and closing the gap where needs of service users are not fully met. Conclusions: The evaluation of the pilot programme demonstrated that it was workable when supported by effective primary care engagement, comprehensive training, and effective internal and external communication. However, limitations were identified in relation to programme specifications e.g. eligibility criteria, service specification and local commissioning decisions e.g. pattern of roll out, incentivisation of general practice. A person-centred approach to care is fundamental and should include cultural adaptation(s), and the assessment and signposting to additional support and services where required.
| Item Type: | Article |
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| Additional Information: | ** From Springer Nature via Jisc Publications Router ** Licence for this article: http://creativecommons.org/licenses/by/4.0/ ** Acknowledgements: The authors would like to acknowledge the Patient and Public Involvement team who have worked on the coproduction of the Re:Mission study, including Ken Clare, Abimbola Ojo, Jennifer Teke, Mike Willis, Gulsoom Akhtar, Beth Clegg and Clair Goddard. The authors would like to acknowledge Clare Helm from NHS England, who has worked on the coproduction of this study; identification of study aims, gatekeeper to participants who were previously unknown to the interviewers and provided feedback on an earlier draft of this manuscript. The authors would also like to acknowledge all members of the steering and oversight groups who are involved in the Re:Mission study including the clinical leads Dr Mark Ashton and Dr Chirag Bakhai. The Re:Mission study includes a multidisciplinary team of academics from across the North of England. The authors would like to acknowledge all members of the team including Dr Duncan Radley, Karina Kinsella, Dr Jamie Matu, Dr Simon Rowlands, Dr Tanefa Apekay, Dr Stuart Flint, Prof Janet Cade, Dr Adam Martin, Dr Maria Bryant, Dr Jordan Marwood, Dr Wendy Burton, Mick Martson, Pooja Dhir and Tamla Evans. Particular thanks to Dr Kevin Drew, Prof Maria Maynard and Prof Jim McKenna for commenting on the draft. **Journal IDs: eissn 1472-6963 **Article IDs: publisher-id: s12913-023-10501-y; manuscript: 10501 **History: collection 12-2024; online 10-01-2024; published_online 10-01-2024; accepted 19-12-2023; registration 19-12-2023; submitted 12-06-2023 |
| Uncontrolled Keywords: | Obesity, Delivery of health care, Normalisation process theory, Re:Mission, Diet, Diabetes |
| Identification Number: | https://doi.org/10.1186/s12913-023-10501-y |
| SWORD Depositor: | Colin Knott |
| Depositing User: | Colin Knott |
| Date Deposited: | 16 Jan 2024 11:48 |
| Last Modified: | 16 Jan 2024 12:30 |
| URI: | https://shura.shu.ac.uk/id/eprint/32976 |
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