Co-designing of an intervention to support health visitors’ implementation of practices recommended for prevention of excess weight gain in 0-2 year old children

Abstract

Background: Early rapid weight gain is a risk factor for later obesity. UK health visitors (HVs) are well-positioned to address excessive weight-gain trends in early childhood. However, HVs face unique barriers when caring for children under age two with excessive rates of weight gain. Interventions that strengthen HVs’ role by addressing key barriers and facilitators of implementation of recommended guidelines into routine practice are needed. Aim: This research engaged with HVs to systematically design an intervention to support their implementation of practice behaviours. Methods: A mixed-methods evidence synthesis and series of interactive workshops with HVs were conducted. HVs who are the recipients of the intervention provided their views of what is important, relevant, and feasible in the local context. The findings of the workshops were combined in an iterative process to inform the sequential steps of the Behaviour Change Wheel framework and guide the process of designing the intervention. Results: Theoretical analysis of the workshops revealed HVs’ capabilities, opportunities, and motivations related to addressing early-childhood obesity prevention. Intervention strategies deemed most likely to support implementation (enablement, education, training, modelling, persuasion) were combined to design a face-to-face interactive training intervention. Outcome measures to test feasibility, acceptability, and fidelity of delivery of the proposed intervention were identified. Discussion: An interactive training intervention has been designed, informed by behaviour change theory, evidence, expert knowledge, and experiences of health visitors, in an area of health promotion that is currently evolving. Future research should be directed to evaluate the acceptability and feasibility of the intervention in a pilot trial. The use of a systematic approach to the development process, identification of intervention contents and their hypothesised mechanisms of action using standard terminology provides an opportunity for this research to contribute to the body of literature on designing of implementation interventions using a collaborative approach.