Feasibility and acceptability of a brief routine weight management intervention for postnatal women embedded within the national child immunisation programme in primary care: randomised controlled cluster feasibility trial with a nested qualitative study

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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 impacts for women in later life and increases health risks during subsequent pregnancies. Objective: The primary aim was to produce evidence of whether a phase III trial of a brief weight management intervention where 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 three months later. The interview studies took place after trial follow-up.

Setting: Birmingham, England

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 within 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 two, three and four months of age. The intervention involved 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 within the child health ‘red book’, or using the online programme. The behavioural goal was for women to lose 0.5 kg to 1 kg per week. Usual care 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 stop-go traffic light 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 the intervention was acceptable to them and they welcomed support to lose weight at their child immunisation appointments. Whilst some caveats to implementation were raised by nurses, they felt the intervention was easy to deliver and that it would motivate postnatal women to lose weight.

Limitations: Fewer participants were recruited than planned.

Conclusions: Whilst 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.

ISRCTN Number: 12209332 Funding details. NIHR HTA programme – funding number: 15/184/14 Word count: 499

Bibliographic note

Not yet published as of 13/04/2021.


Original languageEnglish
JournalHealth Technology Assessment
Publication statusAccepted/In press - 23 Oct 2020