Practice nurse-supported weight self-management delivered within the national child immunisation programme for postnatal women: a feasibility cluster RCT

Amanda J Daley*, Kate Jolly, Natalie Ives, Susan A Jebb, Sarah Tearne, Sheila M Greenfield, Lucy Yardley, Paul Little, Natalie Tyldesley-Marshall, Hannah Bensoussane, Ruth V Pritchett, Emma Frew, Helen M Parretti

*Corresponding author for this work

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Background: Pregnancy is a high-risk time for excessive weight gain. The rising prevalence of obesity in women, combined with excess weight gain during pregnancy, means that there are more women with obesity in the postnatal period. This can have adverse health consequences for women in later life and increases the health risks during subsequent pregnancies.

Objective: The primary aim was to produce evidence of whether or not a Phase III trial of a brief weight management intervention, in which postnatal women are encouraged by practice nurses as part of the national child immunisation programme to self-monitor their weight and use an online weight management programme, is feasible and acceptable.

Design: The research involved a cluster randomised controlled feasibility trial and two semistructured interview studies with intervention participants and practice nurses who delivered the intervention. Trial data were collected at baseline and 3 months later. The interview studies took place after trial follow-up.

Setting: The trial took place in Birmingham, UK.

Participants: Twenty-eight postnatal women who were overweight/obese were recruited via Birmingham Women’s Hospital or general practices. Nine intervention participants and seven nurses were interviewed.

Interventions: The intervention was delivered in the context of the national child immunisation programme. The intervention group were offered brief support that encouraged self-management of weight when they attended their practice to have their child immunised at 2, 3 and 4 months of age. The intervention involved the provision of motivation and support by nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. The role of the nurse was to provide regular external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a record card in their child’s health record (‘red book’) or using the online programme. The behavioural goal was for women to lose 0.5-1 kg per week. The usual-care group received a healthy lifestyle leaflet.

Main outcome measures: The primary outcome was the feasibility of a Phase III trial to test the effectiveness of the intervention, as assessed against three traffic-light stop-go criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme).

Results: The traffic-light criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. In the qualitative studies, participants indicated that the intervention was acceptable to them and they welcomed receiving support to lose weight at their child immunisation appointments. Although nurses raised some caveats to implementation, they felt that the intervention was easy to deliver and that it would motivate postnatal women to lose weight.

Limitations: Fewer participants were recruited than planned.

Conclusions: Although women and practice nurses responded well to the intervention and adherence to self-weighing was high, recruitment was challenging and there is scope to improve engagement with the intervention.

Future work: Future research should focus on investigating other methods of recruitment and, thereafter, testing the effectiveness of the intervention.

Trial registration: Current Controlled Trials ISRCTN12209332.

Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 49. See the NIHR Journals Library website for further project information.

Original languageEnglish
JournalHealth Technology Assessment
Issue number49
Publication statusPublished - 31 Aug 2021

Bibliographical note

Funding Information:
Declared competing interests of authors: Kate Jolly reports grants from the National Institute for Health Research (NIHR) Public Health Research (PHR) programme (award numbers 15/53/04 and 14/185/13) and from the NIHR Health Technology Assessment (HTA) programme (award number 13/25/20), and was a member and then sub-committee chairperson of the NIHR Programme Grants for Applied Health Research (PGfAR) programme during the conduct of the study. Natalie Ives reports grants from the NIHR Efficacy and Mechanism Evaluation programme, NIHR Research for Patient Benefit programme, NIHR PGfAR programme and Arthritis Research UK (Chesterfield, UK) during the conduct of the study. Susan A Jebb reports grants from Cambridge Weight Plan (Corby, UK) outside the submitted work and is supported by a NIHR Senior Investigator award (award number NF-SI-0617-10080). Paul Little was a member of the NIHR Journals Library Board (September 2012–September 2018). Emma Frew reports grants from the grants NIHR PHR programme, from the NIHR Fellowship programme, grants from Birmingham City Council (Birmingham, UK), grants from Yong Ning Pharmaceutical Ltd (Taizhou, The People's Republic of China) and grants from the NIHR Programme Development, outside the submitted work. Helen M Parretti reports a NIHR Academic Clinical Lectureship, during the conduct of the study, was a contributing author to a publication from a study sponsored by Novo Nordisk (no financial compensation) (Bagsværd, Denmark) and was a member of a round table discussion supported by Nutricia (Zoetermeer, Netherlands). Amanda J Daley reports grants from the NIHR PHR programme (award number 14/185/13), NIHR PGfAR programme (award number RP-PG-0618-20008) and Arthritis Research UK during the conduct of the study and is funded by a NIHR Research Professorship award (award number NIHR Academy 300026).

The research reported in this issue of the journal was funded by the HTA programme as project number 15/184/14. The contractual start date was in September 2017. The draft report began editorial review in December 2019 and was accepted for publication in October 2020. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.

Publisher Copyright:
© 2021 Daley et al.



ASJC Scopus subject areas

  • Health Policy


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