OneLife Suffolk Integrated Healthy Lifestyle Service: A Process Evaluation
Across three decades of health behaviour change intervention research, efficacy/effectiveness trials represent the dominant research design; only 3% are dissemination studies.
The continued lack of evidence for the successful institutionalisation of health behaviour change interventions in ‘real world’ settings, combined with high levels of ‘unhealthy’ behaviours worldwide, makes addressing this research-to-practice gap a significant public health priority. It is recommended therefore, that process evaluations of implementation fidelity become an integral part of the delivery and evaluation of all health behaviour change intervention research.
Hence, aligned to the National Institute of Health’s (NIH) Behaviour Change Consortium (BCC) framework for tailored health behaviour interventions, a process evaluation of OneLife Suffolk’s Integrated Healthy Lifestyle Service (IHLS) was conducted across the weight management (WM), smoking cessation, health walk, and National Health Service (NHS) health check services offered. Data collection comprised individual interviews and focus groups, with emergent themes retrospectively applied into one of the five relevant NIH BCC fidelity domains of study design provider training intervention delivery intervention receipt, and enactment.
Study Design – ensures the service has been designed and implemented as intended. IHLS practitioners noted that IHLS sessions are individually tailored (e.g. individualised goals based upon history, health and ability) to promote sustainable long-term health behaviour change. However, the skeleton curriculum of the WM, smoking cessation and PA services are compliant with respective National Institute for Clinical Excellence (NICE) guidelines and consequently, internal validity was maintained throughout the services.
“We follow a skeleton curriculum but are also given the freedom to tailor sessions to specific client needs and our own delivery styles. It is fantastic and truly a one-of-a-kind service.”
Provider Training - ensures practitioners have been satisfactorily trained to deliver the intervention as intended. Although senior management members noted that general operational, data systems, clinical, and curriculum training took place on a regular basis, this training was deemed to be insufficient by practitioners and team leads. This affected confidence in delivering sessions as well as collecting and analysing client data.
“Gaining experience at OneLife has been really difficult for me. I am new and trying to organise shadowing of other practitioners has been difficult as everyone is so busy. It seems like OneLife staff are expected to bring their own knowledge and expertise.”
Intervention Delivery - ensures the service is delivered as intended. There was no formal structure for competency assessment of practitioners. Regular check-ups, evaluations and feedback sessions by senior management members and team leads experienced in the design and structure of the intervention sessions are warranted to ensure the delivery and receipt of the intervention are in line with stated aims and objectives.
“I enjoy all of the OneLife contract it's brilliant. I think it's very collaborative, very innovative and there is a euphoric feeling as you see people change. I do think we could work harder to support one another within our organisation though as it feels a little as if it’s every man for himself.”
Intervention Receipt – ensures clients can understand and perform learned activities and strategies during and beyond the intervention. Client confidence and enjoyment were high throughout all services due to the clear, concise demonstrations and instructions provided by motivated and knowledgeable practitioners.
“The sessions are easy to follow and they are suitable for everyone which is brilliant. Nobody is ever left behind.”
Enactment – ensures clients can implement the learned skills and activities in ‘real world’ settings. Session value in terms of physical and psychological benefits were recognised by clients. Further support and guidance beyond the intervention was noted by clients as something to work on. Overall, client centred, personalised interventions starting with professional and tailored guidance and providing ongoing support throughout and beyond the intervention lead to the highest success rates.
“People who complete the programme (weight management) absolutely love it and they can see all this weight they have lost, and in many cases, their partner and family has lost weight also. Their lifestyle has been changed for the better as they have so much more energy and mobility.”
Whilst recognising that there have been challenges in delivering an innovative service, these findings outline the massively positive ground level impact of IHLS staff in the pursuit for the promotion of sustainable long-term health behaviour change despite navigating the dynamic nature of an organisation in ‘real world’ settings (i.e. commissioner targets, staff resources and data systems issues).
George Sanders is a Research Fellow in Pubic Health and Obesity in the Carnegie School of Sport at Leeds Beckett University. After completing undergraduate and masters degrees at Durham and Loughborough Universities, respectively, his academic career started at Edge Hill University where he completed a Sport England funded PhD with Professor Stuart Fairclough.