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Policy Research Programme - Understanding the role of Healthy Weight Coaches in the weight management system

Contents

Published: 30 August 2022

Version: 1.0 August 2022

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Timetable and Budget

Deadline for Stage 1 Applications 04 October 2022, 1 PM
Notification of outcome of Stage 1 Application 13 December 2022
Deadline for Stage 2 application 24 January 2023, 1 PM
Notification of outcome of Stage 2 Application June 2023
Project Start As soon as possible after contracting
Project Duration 24 Months
Budget Approximately £500,000 per project

Description

Deadline/Limit

Introduction

1. The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for a research project to understand the implementation of the Healthy Weight Coach (HWC) programme; patients’ experiences; and the components which make up effective conversations about healthy weight within this role.

Background

2. In July 2020, the government announced their strategy to tackle obesity which included a commitment to offer all Primary Care Networks (PCNs) the opportunity to train their staff to become a HWC. The new HWC training programme [1] was launched in November 2021 for primary care staff and provides the training to deliver the skills required of a HWC. Data from Health Education England estimate that around 600 individuals have completed the training to date.

3. The aim of the HWC programme is to increase the number of adults who enrol on a weight management service from primary care. The role of a HWC is to help adults living with overweight or obesity who are interested in improving their health and wellbeing by supporting and motivating them to prioritise their weight. This is tailored to the patient; for some patients, it may mean having a conversation that introduces the idea of weight management, for others it may be about providing key information that can motivate them to engage in healthier behaviours. It may mean signposting patients to weight management services available locally or nationally (or example, the Better Health Campaign) and where appropriate, may result in that patient being referred to weight management services.

4. Staff working within a PCN (for example, link workers, practice nurses, pharmacy support staff) are eligible to become a HWC as part of their substantive role. The PCN decides who signs up to the HWC online e-learning programme. Previous research among General Practitioners (GPs) and patients has shown that GPs raising the issue of weight and making referrals to weight loss programmes are acceptable to patients and GPs [2] so there is evidence to suggest that a HWC role based in primary care is an appropriate way to engage patients on healthy weight.

5. There is a need to understand how the HWC programme fits into the weight management care pathway, and how patients engaging a HWC and health and care staff who have taken up the training and implementation of the HWC role have responded to the programme. The outcomes of the research will provide understanding of how effective the training is in supporting patients to access weight management services and help inform recommendations to improve the programme, including how it is embedded into the local system.

Research priorities

6. Research is required to understand how the new HWC programme has been implemented at a local level; patients' experiences of having conversations with a HWC; and which components of a conversation with the HWC are most effective at supporting the patient to reach their goal. The research should consider how the HWC role works from both the system and patient perspective.

Implementation of the HWC role at a local level

7. The research should consider how the role of a HWC currently fits in with the weight management care pathway to understand how it is embedded in local systems. The views of staff members in GP practices and in pharmacies which have adopted the programme should be considered, and examples of good practice should be highlighted. The research questions include but are not limited to:

  • Who has taken on the role of HWC, in what type of setting, and why have they taken on the role?
  • Have they read and used the supporting guidance document? What are their views on how useful it was in implementing the role? How might it be enhanced?
  • How is the role organised? Does this vary across practices?
    • How are patients who would benefit from conversations with the HWC coach identified and appointments made?
    • Do primary care settings have priority groups that are specifically targeted?
    • How much time/how many sessions can the HWC offer each patient?
    • What records are kept of session content and outcomes?
  • Are there benefits at a practice level to supporting the HWC role? What are their expectations of the role? Has success criteria been set?
  • What are the barriers and facilitators to carrying out and managing the HWC role?
  • What have been the experiences of HWCs making referrals to WMS?
  • How can referral systems reflect that the referral is made by HWCs?
  • Beyond encouraging take up of a referral to WMS, what longer term contact does the HWC offer?
  • What additional support would help a HWC to carry out their role? (e.g., a register of HWCs, a forum to link up HWCs, clinical supervision guidance).

8. This research should illustrate and help to understand the range of practice models that have been developed in different contexts, for example looking at variation in who has taken on the HWC role within the practice, any group practice arrangements, and what types of practice are currently supporting the HWC role.  

Patients’ experiences of having a conversation with a HWC

9. The research should also capture patients’ experiences of discussing weight management with a HWC and their attitudes towards the programme. Research questions could include:

  • What was the context leading up to the patient’s referral/appointment with the HWC?
    • Was the patient actively trying to lose weight?
    • Have they previously used weight management services?
    • What was their experience of these attempts?
  • Have they had prior experience of discussing healthy weight issues with other practitioners at the practice or in a similar setting?
  • What was their understanding of the HWC role? What was their experience of having contact with a HWC?
  • What did they do as a result of their conversation with the HWC?
  • Was any additional support offered by the HWC (e.g. referral to weight management services)?
    • Did they choose to enrol in a weight management programme?
    • Did they complete the weight management programme?
    • Did they experience a change in weight after completing the programme?
  • Did they share their experience and learning from conversations with a HWC with others?
  • Were they signposted to or referred to other services (such as for smoking or mental health) by the HWC?

10. Where possible, the research should also consider the views of patients who did not take up an offer of referral to the HWC, to understand barriers to engaging with HWCs.

Components of effective conversations about healthy weight

11. The research should also consider making an effective conversation about healthy weight between a HWC and patient. We would expect this to be a conversational analysis which will identify key components needed for an effective conversation between a HWC and patient. An effective conversation is one where a patient leaves having been signposted or referred to a weight management service and/or a patient leaves wanting to make behavioural changes to support their health and wellbeing and improve their weight status.

12. The findings of this strand of the research should be used to produce a guide on effective conversation (either a video or information sheet) which can then be disseminated in the HWC training e-learning.

13. For the purposes of this research, a HWC is someone, working within primary care, who has completed the Healthy weight coach training through either the HEE or PCI eLearning platforms, received a HEE eLfH certificate of completion or a PCI certificate and is now implementing the HWC role within a primary care network, health care practice or pharmacy.

New Guidance on Health Inequalities data collection within NIHR PRP Research:

14. Health Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects. We are now assessing all NIHR research proposals in relation to health inequalities. We are asking applicants to identify in their application whether or not there is a health inequalities component or theme and how this research hopes to impact health inequalities. We are also asking researchers to collect relevant data, if appropriate for the research. Our goal is to collect information on health inequalities in research and data relating to the main outcome(s) of the proposed research. Please clearly identify in this section whether or not your application has a health inequalities component or relevance to health inequalities and detail the core set of health inequalities breakdowns that will be reported; if none please explain why. We understand that research projects have different methodologies and focus on different populations, so please explain what data will be collected and reported for the methodology you plan to use. If a health inequalities component is not included, please explain why this does not fit within your proposed research. This should only be a few sentences.

15. For quantitative research we would ideally like researchers to provide one-way breakdowns of their main outcome(s) by the following equity-relevant variables: age, sex, gender, disability, region, 5 ONS Ethnic groups, and the 5 IMD quintile groups. If more detailed cross tabulations are appropriate, please include these. This table should be submitted to NIHR PRP at the end of the project. Due to data limitations, judgement calls may be necessary about which breakdowns to report and whether to merge categories to increase counts in particular cells; we ask you to make these judgement calls yourself, bearing in mind our data curation aim of enabling future evidence synthesis work in pooling results from different studies. More details and an example table can be found in Appendix A.

For qualitative research projects, this can be purely descriptive statistics giving the number of observations against the various variables.

Further details about this new request can be found in Appendix A.

We will also be holding a Health Inequalities in NIHR PRP Research Q&A Event on 19 September 2022, more details in APPENDIX B. 

Areas out of scope for this programme of work

16. The aim of the HWC programme is to increase the number of adults who enrol on a weight management service from primary care. Measuring effectiveness of the HWC programme against this aim is out of scope. The aim of this research is to understand how the HWC role has been implemented in local systems, and how patients have responded to interactions with a HWC.

Technical requirements / Expertise required

17. The strand of the research which will assess components of effective conversations about healthy weight will require researchers with expertise in conversation analysis, preferably in health care encounters.

Outputs

18. Outputs should include:

  • interim reports and updates as agreed at project scoping;
  • draft publishable report and final publishable report, with executive and lay summary in a form suitable for policy colleagues in a 1:3:25 format; and
  • a presentation of findings to DHSC colleagues and key stakeholders.

19. The successful applicant will produce a final report, fully accessible to policymakers and members of the public and circulate to DHSC. When the study is complete, the successful applicants will place a final report summary on the NIHR Policy Research Programme website, where outputs resulting from public expenditure are available for public scrutiny. It is important the final report summaries are easily accessible to lay readers.

20. Applicants should consider the full range of potential audiences and describe how to disseminate research findings most effectively so lessons from this research affect policy and practice.

21. Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers will need research evidence to meet key policy decisions and timescales, so resource needs to be flexible to meet these needs. A meeting to discuss policy needs with DHSC officials will be convened as a matter of priority following contracting.

Budget and duration

22. We anticipate this research will require funding of around £500k. Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.

23. We expect this project to be completed within 24 months of contracting.

24. Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.

Management arrangements

25. A research advisory group including, but not limited to, representatives of DHSC, other stakeholders, and the successful applicants for the research should be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:

  • Provide regular feedback on progress
  • Produce timely reports to the advisory group
  • Produce a final report for sign off

26. Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR. Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review.

References and key documents

  1. Health Education England (2020) Healthy Weight Coaches E-learning. [Accessed July 2022)
  2. Retat, L., Pimpin, L., Webber, L. et al. (2019) Screening and brief intervention for obesity in primary care: cost-effectiveness analysis in the BWeL trial. [Accessed July 2022]

Appendix A: Further Detail on the New Guidance on Health Inequalities data collection within NIHR PRP Research

Health Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects. We are now assessing all NIHR research proposals in relation to health inequalities. We are asking applicants to identify in their application whether or not there is a health inequalities component or theme and how this research hopes to impact health inequalities. We are also asking researchers to collect relevant data related to health inequalities, if appropriate for the research. Collecting specific information about health inequalities in research submitted to the programme will allow for categorisation of health inequalities research, curation of data to aid future health inequalities research and enable policymakers to better understand the implications of health inequalities within their policy areas. This is a new request from the NIHR PRP and we will be continuing to monitor queries and adapt the process as needed. If you have any feedback on this new request, please contact us at prp@nihr.ac.uk.

Our goal is to facilitate more widespread and consistent reporting of health inequality breakdown data relating to the primary outcomes of NIHR funded research. We would ideally like researchers to focus on the following equity-relevant variables: age, sex, gender, disability, region*, 5 ONS Ethnic groups**, and the 5 IMD quintile groups. These variables are considered an ideal, but we understand that these are subject to change depending on the sample population and specific research question.

For qualitative research projects, this can be purely baseline characteristics of the participants, for example, the number of participants in each ethnic group.

For quantitative research projects, if there are multiple outcomes/effects with your stakeholders, select a small number of main outcomes as appropriate to report equity breakdowns. We will not be prescriptive about the number of the outcomes, as it will depend on the number of study design types and the nature of the project aims. We are asking for one way cross tabulations of each primary outcome by these equity-relevant variables, if appropriate for your research, together with the number of observations in each cell. If more detailed cross tabulations are appropriate for your proposed research, please include these as well. This request applies to both primary data collection studies and secondary analysis of routine data, and to causal inference studies as well as descriptive studies; however, if this is not possible due to data limitations then please explain. Due to sample size and other data limitations there may be difficult scientific and/or data security*** judgement calls to make about which breakdowns to report and whether to merge categories to increase counts in particular cells; we ask you to make these judgments yourself, bearing in mind our data curation aim of enabling future evidence synthesis work in pooling results from different studies. We also ask that researchers report breakdowns for the unadjusted as well as adjusted outcomes/effects, as appropriate.

We understand that research projects may employ different methodologies, and focus on different populations. Please explain how the variables and data collection methods chosen are appropriate to the methodologies used.

We ask that you please clearly identify in the research plan section of the application whether your application has a health inequalities component or not and detail the core set of health inequality breakdown data that will be collected, if applicable. Submission of the data collection will be a condition of the final report for all research with relevant methodologies regardless of whether the research has a health inequalities component that will need to be submitted to NIHR PRP when the grant has finished. This should only take a few sentences within the research plan section.

* Table below uses the nine regions in England, further regions can be used if using the UK as the study population. Please report region breakdown for large samples in nationally representative descriptive studies. There is no need to report this for small sample studies, for sub-national studies, or for quasi-experimental studies where it would require time-consuming re-estimation.

** White, Mixed/ Multiple ethnic groups, Asian/ Asian British, Black/ African/ Caribbean/ Black British, Other ethnic group. If the sample size is small then it is fine to report only some of the requested equity breakdowns and to merge some of the sub-groups as appropriate.

*** For guidance on how to handle data security concerns in reporting of sensitive data please see ONS guidance.

Example data table for submission at the end of the funded research project

(N.B. If there is more than one main outcome then you will require more tables and if you adjust your outcome then you will need two tables for the adjusted outcome and unadjusted outcome. For other methodologies, variable vs number of observations may be more appropriate to record participant data). This table is for an example only. It does not contain sub variables and does not illustrate any preference for certain variables, as these will be dependent on the proposed research.

VariableOutcome (an appropriate average for this subgroup, usually the mean)Number of observationsAdditional information about variation if appropriate, e.g. range, standard deviation
Age  -  -  -
Sex  -  -  -
Gender  -  -  -
Disability  -  -  -
Ethnic Group  -  -  -
IMD Group  -  -  -
Region  -  -  -

Appendix B: Health Inequalities in NIHR PRP Research Q&A Event

This event will take place on Monday, 19 September 2022 from 2:00 - 3:00pm. There will be a discussion from the NIHR PRP, the Department of Health and Social Care and other panellists followed by the opportunity for a Q&A session to help applicants navigate this new request. Please register for the event using the google registration form for the event. Any questions that are not answered during the session will be anonymously answered and published in a FAQ document on the health inequalities webpage.