OneLife Suffolk Integrated Healthy Lifestyles Service: Remaining effective during the COVID-19 pandemic
Current evidence for the successful implementation of exclusively online health behaviour change offers is limited. This is one of the first studies to provide a comprehensive exploration of implementation fidelity within a UK-based Integrated Healthy Lifestyle Service (IHLS) during the COVID-19 lockdown.
On 23 March 2020, the UK government enacted measures that were included in the Coronavirus Act 2020 and recommended that everyone (except in certain essential circumstances) must stay in their homes. Consequently, many of the elements enabling and supporting clients in OneLife Suffolk’s IHLS became impossible to deliver face-to-face. In order to continue delivery, the weight management, smoking cessation and physical activity intervention sessions were transitioned from face-to-face to exclusively online delivery.
Process evaluations of implementation fidelity . Hence, within the context of OneLife Suffolk, a process evaluation consisting of online Qualtrics survey questions was conducted with the following objectives in mind:
- How has the transition from face-to-face to online sessions affected staff adherence towards key performance indicators (KPIs)? How have staff been supported to deliver sessions remotely? How could staff be better supported to deliver intervention sessions remotely?
- How did the transition from face-to-face to online sessions affect client uptake and retention? How could clients be better supported to engage with online sessions?
A positive degree of online implementation fidelity was demonstrated during the COVID-19 lockdown for IHLS staff and clients alike across the key themes of integration, training, support, session delivery and content, and health benefits. Mixed degrees of online implementation fidelity were noted across the key themes of key performance indicators, client engagement and perceived competence.
Within a collaborative organisation, authority should be only partly tied to a given position or role and partly worked out as partners and team members agree on the best way to address a specific problem and reach a common goal. Whilst recognising that there were challenges in the speed of transition from face-to-face to online delivery, which was necessary for service continuation, positive staff comments across the key themes of integration, training, support, and session delivery and content highlights the capabilities of OneLife staff in adapting to adverse situations and developing and strengthening support links both within and outside of their own intervention teams in pursuit of a common goal.
“I am relishing the adaptations to my role and overall job expectations as I am expanding my skill set and meeting a broader range of clients. We feel we are valued, and we all believe in the products we are delivering.”
“Our nurturing approach that supports all stakeholders, staff and clients has been put to test during COVID-19 and I am thrilled to say that we have thrived under the pressure.”
Previous studies have found that exclusively online delivery often fails to facilitate the creation of a strong practitioner-client rapport, and in the case of group sessions, client-client rapport, both of which prove an effective tool for intervention adherence in face-to-face delivery. Contrastingly, largely positive client comments were noted across all emergent themes including session delivery and content, support, perceived competence, and health benefits.
“Each session (smoking cessation) still reinforces positive behaviours and really, the online stuff is no different to the face-to-face sessions I attended. I am enjoying it and each session provides me with the confidence boost again to not smoke.”
As the use of technology increases substantially during the COVID-19 crisis, so do the impacts of digital inequalities. Given the increasing dependency on technology in all spheres of life, digital inequalities put the most digitally disadvantaged more at risk of adopting adverse behaviour change habits during prolonged isolation. Hence, further mixed methods studies combining large-scale quantitative analyses with rich qualitative observations across differing cultures, populations and contexts are now warranted to ensure online health behaviour change offers are available, appropriate and beneficial for as many individuals as possible.
In the context of behavioural health interventions, the ubiquity of digital technologies and their adoption into day-to-day life translates into greater potential reach than traditional interventions, and consequently, greater potential for positive public health impact. However, the potential public health impact of these digital health behaviour change offers can only be realised to the extent of their availability, accessibility and efficacy.
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.