Normalisation and equity of referral to the NHS Low Calorie Diet programme pilot; a qualitative evaluation of the experiences of health care staff

DREW, Kevin J., HOMER, Catherine, RADLEY, Duncan, JONES, Susan, FREEMAN, Charlotte, BAKHAI, Chirag and ELLS, Louisa (2024). Normalisation and equity of referral to the NHS Low Calorie Diet programme pilot; a qualitative evaluation of the experiences of health care staff. BMC Public Health, 24 (1): 152.

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Background: Health and wellbeing can be profoundly impacted by both obesity and type 2 diabetes, while the normalisation and equity of care for people living with these non-communicable diseases remain as challenges for local health systems. The National Health Service Low Calorie Diet programme in England, aims to support people to achieve type 2 diabetes remission, while also reducing health inequalities. We have explored the experiences of health care staff who have made a referral to the LCD programme, while identifying effective and equitable delivery of programme referrals, and their normalisation into routine care. Methods: Nineteen individual semi-structured interviews were completed health care staff in the first year of the Low Calorie Diet programme. Interviewees were purposively sampled from the ten localities who undertook the Low Calorie Diet programme pilot. Each interview explored a number of topics of interest including communication and training, referrals, equity, and demands on primary care, before being subjected to a thematic analysis. Results: From the data, five core themes were identified: Covid-19 and the demands on primary care, the expertise and knowledge of referrers, patient identification and the referral process, barriers to referrals and who gets referred to the NHS LCD programme. Our findings demonstrate the variation in the real world settings of a national diabetes programme. It highlights the challenge of COVID-19 for health care staff, whereby the increased workload of referrals occurred at a time when capacity was curtailed. We have also identified several barriers to referral and have shown that referrals had not yet been normalised into routine care at the point of data collection. We also raise issues of equity in the referral process, as not all eligible people are informed about the programme. Conclusions: Referral generation had not yet been consistently normalised into routine care, yet our findings suggest that the LCD programme runs the risk of normalising an inequitable referral process. Inequalities remain a significant challenge, and the adoption of an equitable referral process, normalised at a service delivery level, has the capacity to contribute to the improvement of health inequalities.

Item Type: Article
Additional Information: ** From Springer Nature via Jisc Publications Router ** Licence for this article: ** Acknowledgements: 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 the Patient and Public Involvement team that 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. Members of the steering and oversight groups, including the clinical leads Dr Mark Ashton and Dr Chirag Bakhai, are also acknowledged by the authors for their input and involvement in the Re:Mission study design, which would have indirectly impacted upon how this research was conducted. 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 Jamie Matu, Prof Jim McKenna, Dr Maria Maynard, Pat Watson, Dr Simon Rowlands, Karina Kinsella, Dr Tanefa Apekay, Dr Stuart Flint, Prof Janet Cade, Dr Adam Martin, Dr Maria Bryant, Dr Jordan Marwood, Dr Tamara Brown, Dr Wendy Burton, Mick Martson, Pooja Dhir and Tamla Evans. **Journal IDs: eissn 1471-2458 **Article IDs: publisher-id: s12889-023-17526-2; manuscript: 17526 **History: collection 12-2024; online 11-01-2024; published_online 11-01-2024; accepted 18-12-2023; registration 18-12-2023; submitted 31-07-2023
Uncontrolled Keywords: Low calorie diet, Obesity, Inequalities, Equity, Normalisation process theory, Type 2 diabetes, Re:Mission study
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SWORD Depositor: Colin Knott
Depositing User: Colin Knott
Date Deposited: 16 Jan 2024 12:13
Last Modified: 16 Jan 2024 12:15

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