Background: Weight management interventions (WMI) focus on behaviour change at the individual level based on a behavioural model of choice that assumes information drives behaviour (model of responsibilisation). Attrition is often low, and concerns have been raised about interventions widening health inequalities.
One policy-based approach proposed to achieve equity is proportionate universalism. This balances targeted and universal population health approaches through actions proportionate to the needs and levels of disadvantage.
The aim of this study is to understand attrition by understanding the experiences of individuals eligible for WMI.
Methods: Semi-structured interviews with members of a triage team, the point of entry to a lifestyle programme (where WMI are one element). Descriptive data. Semi-structured life history interviews with 21 interviewees drawn from a spectrum of attrition (do not attend, drop-out and complete) and deprivation. Data were analysed using thematic analysis.
Findings: The current lifestyle programme recruited 55% of individuals that started one of the programme elements from the 40% most deprived lower super output areas (LSOAs). However, individuals from the 20% least deprived LSOAs were more likely to complete the WMI compared to individuals from the 20% most deprived LSOAs.
Interviews with the triage team revealed the lifestyle programme was rooted in a model of responsibilisation that treats everybody equally.
Completing the WMI depended on the socio-cultural environments that individuals were embedded within. Completers had the support of partners, whereby food related change was small and meaningful to the collective and food competences existed at a practice, not individual level. Individuals who do not attend lacked social support and food competences, while they were asked to change in ways that were not meaningful.
Conclusion: This research suggests that attrition is influenced by the privileges afforded to individuals because of their coincidental socio-cultural environments. Equity might have been achieved at a policy level through proportionate targeting, but the WMI was not tailored to the needs of those most in need. It is therefore suggested that it was not equitable at a delivery level. Taking a proportionate approach that delivers based on the needs of individuals would achieve greater equity.
12 Sep 2019 - 13 Sep 2019