2381/11378949.v1
Rebecca Gossage-Worrall
Rebecca
Gossage-Worrall
Daniel Hind
Daniel
Hind
Katharine D Barnard-Kelly
Katharine D
Barnard-Kelly
David Shiers
David
Shiers
Angela Etherington
Angela
Etherington
Lizzie Swaby
Lizzie
Swaby
Richard IG Holt
Richard IG
Holt
Katharine Barnard-Kelly
Katharine
Barnard-Kelly
Mike Bradburn
Mike
Bradburn
David Saxon
David
Saxon
Paul French
Paul
French
John Pendlebury
John
Pendlebury
Stephen Wright
Stephen
Wright
Glenn Waller
Glenn
Waller
Paul McCrone
Paul
McCrone
Tiyi Morris
Tiyi
Morris
Charlotte Edwardson
Charlotte
Edwardson
Kamlesh Khunti
Kamlesh
Khunti
Melanie Davies
Melanie
Davies
Marian Carey
Marian
Carey
Yvonne Doherty
Yvonne
Doherty
Alison Northern
Alison
Northern
Janette Barnett
Janette
Barnett
Richard Laugharne
Richard
Laugharne
Chris Dickens
Chris
Dickens
Kathryn Greenwood
Kathryn
Greenwood
Fiona Gaughran
Fiona
Gaughran
Sridevi Kalidindi
Sridevi
Kalidindi
Shanaya Rathod
Shanaya
Rathod
Najma Siddiqi
Najma
Siddiqi
STructured lifestyle education for people WIth SchizophrEnia (STEPWISE): mixed methods process evaluation of a group-based lifestyle education programme to support weight loss in people with schizophrenia
University of Leicester
2019
Science & Technology
Life Sciences & Biomedicine
Psychiatry
Complex intervention
Process evaluation
Schizophrenia
Psychosis
Weight management
Logic model
HEALTH
BEHAVIOR
MORTALITY
EFFICACY
FIDELITY
2019-12-20 10:30:39
Journal contribution
https://figshare.le.ac.uk/articles/journal_contribution/STructured_lifestyle_education_for_people_WIth_SchizophrEnia_STEPWISE_mixed_methods_process_evaluation_of_a_group-based_lifestyle_education_programme_to_support_weight_loss_in_people_with_schizophrenia/11378949
<h3>Background</h3><h3>STEPWISE is a theory-informed self-management education programme that was co-produced with service users, healthcare professionals and interventionists to support weight loss for people with schizophrenia. We report the process evaluation to inform understanding about the intervention and its effectiveness in a randomised controlled trial (RCT) that evaluated its efficacy.</h3><h3>Methods</h3><h3>Following the UK Medical Research Council (MRC) Guidelines for developing and evaluating complex interventions, we explored implementation quality. We considered causal mechanisms, unanticipated consequences and contextual factors associated with variation in actual and intended outcomes, and integrated treatment fidelity, using the programme theory and a pipeline logic model.</h3><h3>We followed a modified version of Linnan and Steckler’s framework and single case design. Qualitative data from semi-structured telephone interviews with service-users (n = 24), healthcare professionals delivering the intervention (n = 20) and interventionists (n = 7) were triangulated with quantitative process and RCT outcome data and with observations by interventionists, to examine convergence within logic model components.</h3><h3>Results</h3><h3>Training and course materials were available although lacked co-ordination in some trusts. Healthcare professionals gained knowledge and some contemplated changing their practice to reflect the (facilitative) ‘style’ of delivery. They were often responsible for administrative activities increasing the burden of delivery. Healthcare professionals recognised the need to address antipsychotic-induced weight gain and reported potential value from the intervention (subject to the RCT results). However, some doubted senior management commitment and sustainability post-trial.</h3><h3>Service-users found the intervention highly acceptable, especially being in a group of people with similar experiences. Service-users perceived weight loss and lifestyle benefits; however, session attendance varied with 23% (n = 47) attending all group-sessions and 17% (n = 36) attending none. Service-users who lost weight wanted closer monitoring and many healthcare professionals wanted to monitor outcomes (e.g. weight) but it was outside the intervention design. No clinical or cost benefit was demonstrated from the intermediate outcomes (RCT) and any changes in RCT outcomes were not due to the intervention.</h3><h3>Conclusions</h3><h3>This process evaluation provides a greater understanding of why STEPWISE was unsuccessful in promoting weight loss during the clinical trial. Further research is required to evaluate whether different levels of contact and objective monitoring can support people with schizophrenia to lose weight.</h3>