Practice nurse-supported weight self-management delivered within the national child immunisation programme for postnatal women: a feasibility cluster RCT

Background: Pregnancy is a high-risk time for excessive weight gain. The rising prevalence of obesityin women, combined with excess weight gain during pregnancy, means that there are more womenwith obesity in the postnatal period. This can have adverse health consequences for women in later lifeand increases the health risks during subsequent pregnancies.Objective: The primary aim was to produce evidence of whether or not a Phase III trial of a briefweight management intervention, in which postnatal women are encouraged by practice nurses as partof the national child immunisation programme to self-monitor their weight and use an online weightmanagement programme, is feasible and acceptable.Design: The research involved a cluster randomised controlled feasibility trial and two semistructuredinterview studies with intervention participants and practice nurses who delivered the intervention.Trial data were collected at baseline and 3 months later. The interview studies took place aftertrial follow-up.Setting: The trial took place in Birmingham, UK.Participants: Twenty-eight postnatal women who were overweight/obese were recruited viaBirmingham Women’s Hospital or general practices. Nine intervention participants and seven nurseswere interviewed.Interventions: The intervention was delivered in the context of the national child immunisationprogramme. The intervention group were offered brief support that encouraged self-management ofweight when they attended their practice to have their child immunised at 2, 3 and 4 months of age.The intervention involved the provision of motivation and support by nurses to encourage participantsto make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. The role of the nurse was to provide regular external accountabilityfor weight loss.Women were asked to weigh themselves weekly and record this on a record card intheir child’s health record (‘red book’) or using the online programme. The behavioural goal was forwomen to lose 0.5–1 kg per week. The usual-care group received a healthy lifestyle leaflet.Main outcome measures: The primary outcome was the feasibility of a Phase III trial to test theeffectiveness of the intervention, as assessed against three traffic-light stop–go criteria (recruitment,adherence to regular self-weighing and registration with an online weight management programme).Results: The traffic-light criteria results were red for recruitment (28/80, 35% of target), amber forregistration with the online weight loss programme (9/16, 56%) and green for adherence to weeklyself-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. In the qualitativestudies, participants indicated that the intervention was acceptable to them and they welcomedreceiving support to lose weight at their child immunisation appointments. Although nurses raisedsome caveats to implementation, they felt that the intervention was easy to deliver and that it wouldmotivate postnatal women to lose weight.Limitations: Fewer participants were recruited than planned.Conclusions: Although women and practice nurses responded well to the intervention and adherenceto self-weighing was high, recruitment was challenging and there is scope to improve engagement withthe intervention.Future work: Future research should focus on investigating other methods of recruitment and,thereafter, testing the effectiveness of the intervention.Trial registration: Current Controlled Trials ISRCTN12209332.Funding: This project was funded by the National Institute for Health Research (NIHR) HealthTechnology Assessment programme and will be published in full in Health Technology Assessment;Vol. 25, No. 49. See the NIHR Journals Library website for further project information