Implementation Fidelity of a Pilot Tier 3 Child Weight Management Service: A Process Evaluation
Implementation Fidelity of a Pilot Tier 3 Child Weight Management Service: A Process Evaluation
George Sanders, Dr AB Sirin-Ayva, Dr Sophie Edwards, Prof Paul Gately
Introduction
England is facing an obesity epidemic. By the time children enter primary school, 1 in 4 is already overweight or obese and, by the time they leave primary school, that figure increases to 1 in 3.
Tackling obesity and its causes is high on the public health agenda and it is clear that there is no simple solution. It is recommended that process evaluations of implementation fidelity become an integral part of the conduct of all health behaviour intervention research. The current study evaluated implementation fidelity of a pilot digital Tier 3 child weight management service in the southeast of England.
Methods
Positive views of the service were highlighted by children, young people and significant others across the key themes of:
- Programme staff and structure
- Family engagement and support
- Lifestyle changes
- Health and weight
- Emotional and psychosocial wellbeing
Lifestyle Changes
Positive: 100% Negative: 0%
“I feel I have good knowledge of nutrition & exercise, so the value of using the service was to gain reassurance & also encouragement, which I very much appreciated and I did actually learn new skills also.”
Emotional & Psychosocial Wellbeing
Positive: 100% Negative: 0%
“Non-judgmental & incredibly supportive staff passed their confidence & positive outlook across to those on the programme. Simply incredible & a game changer for us.”
Programme Staff & Structure
Positive: 100% Negative: 0%
“From start to finish, a great service, great team & a pleasure to deal with.”
Health & Weight Outcomes
Positive: 77% Negative: 23%
“We learned new skills, lost weight & are in a 100% better place mentally than before the service.”
“Programme largely generic & common sense.”
Family Engagement & Support
Positive: 91% Negative: 9%
“Practitioners always empathetic, understanding & eased our apprehensiveness.”
“Dietetic appointments a waste of time.”
Results
With regards to service staff, mixed degrees of implementation fidelity were noted across the key themes of: Family engagement & support; staff meetings & training; programme structure; and client outcomes.
Lessons learned showed that the programme’s structure and supportive approach resulted in high retention rates and consistent session attendance.
This indicated strong client commitment and satisfaction. Furthermore, significant weight loss, improved physical health, and enhanced emotional well-being were noted, highlighting service effectiveness. Overall, clients were making healthier lifestyle choices, which was reflected in both physical health improvements and positive behavioural changes.
Conclusion
This process evaluation represents one of the first efforts to document implementation fidelity of an ongoing Tier 3 child weight management service. The findings of which have subsequently informed the design, delivery and recruitment strategies of the service. In the context of child weight management services, the ubiquity of digital technologies and their adoption into day-to-day life translates into greater potential reach than traditional health behaviour change interventions, and consequently, greater potential for positive public health impact.
Results can be used to conceptualise best practices as a process to further strengthen the design, delivery and recruitment strategies of the pilot.
- Conflict of interest: None disclosed
- Funding: No funding to report