Making every contact count with seldom-heard groups? A qualitative evaluation of voluntary and community sector (VCS) implementation of a public health behaviour change programme in England

A qualitative exploration of service users' experiences of weight management conversations in a mental health setting

Objective

Healthcare professionals often use opportunistic weight management conversations, aligned with the Making Every Contact Count (MECC) approach, to provide motivational support to service users. While research supports this practice from the professionals' perspective, the views of service users on these interactions remain understudied. The aim of this study was to explore the experiences of service users with serious mental illness regarding weight management conversations with healthcare professionals.

Methods

Thirteen service users with serious mental illness (Nine inpatient, four community-based) participated in semi-structured 1-1 interviews exploring weight management support experiences. Transcript data was analysed using thematic analysis.

Results

Five key themes were developed: service users' experience of weight management conversations, developing therapeutic relationships, support for physical activity and weight management, deliverer characteristic preferences, and user descriptions of MECC.

Conclusions

Service users reported a lack of information about medication-related weight gain and suggested further staff training to improve therapeutic relationships and weight management support for service users with serious mental illness.

Innovation

This study uniquely explores service users' perspectives on weight management conversations within mental health care, applying MECC in a novel context. It highlights the perspective of individuals with serious mental illness on weight-related issues, challenging existing practices, and proposing strategies for integrating physical health support in mental health settings.

Communities against cancer: a qualitative study assessing the effectiveness of a community engagement initiative in improving cancer awareness for marginalised communities

BACKGROUND

Marginalised communities (including minoritised ethnic groups and people with lower socioeconomic status) often present with a late cancer stage at diagnosis, affecting survival. This is due to many factors including cultural barriers, mistrust of health services and low levels of cancer awareness. Communities Against Cancer (CAC) aimed to promote cancer awareness and healthy lifestyles and help-seeking behaviours for marginalised communities through a grant-scheme that provided funding for community-led projects, which ran from 1st January 2021 - 31st December 2022. This paper reports findings from a study that assessed whether CAC met its aims and the characteristics of successfully delivered projects.

METHODS

A qualitative approach was used involving interviews and observations of meetings and community activities, supported by documentary analysis of minutes, grant applications, reports and quantitative descriptions of grant-level data. Participants included representatives from the funder and grant distributor, community advocates, applicants and recipients of CAC funding. Thirty-seven people were interviewed, all of whom were invited to a second follow-up interview. Twenty-one participants agreed to a second interview, resulting in 58 interviews in total. Interview transcripts and observation fieldnotes were analysed thematically.

RESULTS

CAC community grants encouraged: 1) healthy behaviours (e.g. families on low incomes reported healthier diets); 2) screening and PSA testing uptake (e.g. a group representing neurodivergent people created a film of a breast screening unit, encouraging attendance); 3) awareness of signs and symptoms (e.g. one radio station for South Asian communities broadcast an episode on signs of prostate cancer, their most downloaded programme); 4) help seeking behaviours (e.g. one South Asian community group held meetings with pharmacists, primary care and hospital staff, building trust with local services). Seven characteristics were identified for successful projects (defined as meeting at least one of the initiative's aims: raising awareness of healthy behaviours, screening uptake, awareness of signs and symptoms, and help-seeking behaviour). The characteristics were: 1) projects are designed with an understanding of the community; 2) effective planning before delivery; 3) projects are co-created with the community; 4) alignment with group values; 5) building community members' confidence; 6) effective communication; 7) adaptability and evaluation.

CONCLUSIONS

The community-based grant model adopted by CAC enabled community members to self-define effective strategies to deliver cancer messages to their communities. As a result, the CAC initiative met its aims of promoting cancer awareness, encouraging healthy lifestyles and help-seeking behaviours by ensuring activites were fully tailored and co-created with marginalised communities.

How can engagement with underserved communities be enhanced? A co-inquiry informed model of stop smoking outreach

AIMS

This co-inquiry project aimed to develop a qualitatively informed model of professionally led stop smoking outreach. It involved 13 staff from a Stop Smoking Service (SSS) which operates across three Local Authorities in England (Central Bedfordshire, Bedford Borough and Milton Keynes). Staff's outreach sought to engage people from the most deprived areas who smoked but were not engaging with the service.

METHODS

The co-inquiry comprised six reflection sessions and ethnographic research which aimed to explicate and examine staff's assumptions about how outreach works, conducted over 12 months. Data included 32 diary entries, eight observations of staff's outreach events, 10 interviews with staff and eight interviews with members of the communities being targeted. Data were reflected on to develop a 'real-world' logic model and summarised using thematic analysis.

RESULTS

Professionally led outreach can raise awareness of service offers, remove access barriers and generate referrals. A non-judgemental, person-centred approach is vital through which staff carefully initiate conversations with community members about smoking, and tailor information to community members' needs and preferences. Such an approach, in combination with an e-cigarette support option, can generate interest in SSS and challenge negative perceptions. However, outreach is time-consuming for busy frontline staff, unpredictable and best implemented via effective community partnerships.

CONCLUSIONS

Our findings suggest that stop smoking advisors' outreach can contribute substantially to national ambition to create a 'smoke free generation' provided that sufficient investment is provided. Professionally led outreach, delivered in partnership with community organisations, can generate referrals among people who are disconnected from health services. Such non-traditional referral routes are likely to become more significant as smoking prevalence further declines in the general population.

Assessing fidelity of design and training of Making Every Contact Count (MECC) in a mental health inpatient setting

BACKGROUND

Making Every Contact Count (MECC) is a public health strategy which strives to enable brief interventions to be implemented through opportunistic healthy lifestyle conversations. In a mental health inpatient setting a bespoke MECC training package has been developed to encourage cascade training through a train the trainer model and to incorporate an additional regional health strategy A Weight Off Your Mind into Core MECC training to provide a focus on healthy weight management. This study evaluated the fidelity of design of MECC in the mental health inpatient setting and fidelity of the training package currently being cascaded across the region.

METHODS

Initially a documentary analysis of six documents shared through the mental health inpatient setting including MECC implementation guide, logic model, checklist and evaluation framework. Documents were analysed using the Template for Intervention Description and Replication (TIDieR) checklist and coded using the Behaviour Change Technique (BCT) Taxonomy version one (BCTTv1) and the Expert Recommendations for Implementing Change (ERIC) Taxonomy. Coding was compared against MECC guidance documents to complete the fidelity assessment. A training delivery guide, training slides and two recordings of both train the trainer and Core MECC + A Weight Off Your Mind training were analysed for behaviour change techniques (BCTs) and compared to conduct a fidelity training assessment.

RESULTS

Overall the implementation of MECC in the mental health inpatient setting had moderate fidelity to the MECC guidance, with a total of 31 BCTs identified across guidance and provider documents and a 77% adherence of provider documents to guidance. The highest level of fidelity applied to the MECC implementation guide where 86% of identified BCTs were also present. The training package showed high fidelity that both training programmes were being delivered as intended with 100% of BCT matched from training materials to training transcripts. Potential loss of fidelity through additional BCTs was present across provider documents and training transcripts.

CONCLUSION

The implementation of MECC across the mental health inpatient setting and the training package appear to be delivered as intended therefore demonstrating good fidelity and potential benefits to public health. Future research would benefit from assessing cascade training sessions from those who have completed train the trainer to evaluate ongoing fidelity of training across the trust.

Enhancing making every contact count (MECC) training and delivery for the third and social economy (TSE) sector: a strategic behavioural analysis

OBJECTIVE

To enhance Making Every Contact Count (MECC, an opportunistic approach to health promotion), training in the Third and Social Economy (TSE, all groups and organisations primarily working towards social justice, outside of the government or household) by examining the degree to which the behavioural content of MECC training tackled significant factors influencing MECC delivery.

METHODS AND MEASURES

A strategic behavioural analysis design. Semi-structured interviews with service providers (n = 15) and users (n = 5) were coded for barriers and facilitators of MECC delivery using the Theoretical Domains Framework (TDF). Existing MECC training was coded for behaviour change techniques (BCTs) and intervention functions (IFs). The degree to which BCTs and IFs addressed the key TDF domains of influences on MECC delivery in the TSE were examined using prespecified tools.

RESULTS

Seven key TDF domains of influences in MECC delivery were identified. Overall, only 9/31 linked BCTs were utilised within MECC training, with percentage utilisation of relevant BCTs for each domain ranging from 0% to 66.7%. Training adequately addressed 2/7 key domains.

CONCLUSION

The TSE and healthcare share many common key TDF domains, although there are differences in how each are relevant. Limitations and recommendations for MECC training are discussed.

Mapping regional implementation of 'Making Every Contact Count': mixed-methods evaluation of implementation stage, strategies, barriers and facilitators of implementation

BACKGROUND

The Making Every Contact Count (MECC) programme provides training and materials to support public-facing workers to encourage health-promoting behaviour change by using the day-to-day interactions between organisations and individuals. This project aimed to analyse MECC implementation through a comparative analysis of implementation stage, strategies used for implementation and enablers/barriers of the implementation process within a region in England-the North East and North Cumbria (NENC).

METHODS

A mixed-methods process evaluation was conducted applying normalisation process theory and theoretical domains framework. MECC programme documents were reviewed and mapped against specific criteria (eg, implementation strategies). An online mapping survey was conducted to establish current implementation/delivery of MECC within NENC settings (eg, local government, healthcare and voluntary community sector). Qualitative research, using individual interviews and group discussions, was conducted to establish further understanding of MECC implementation.

RESULTS

Our findings were informed by reviewing documents (n=5), surveying participants (n=34), interviews (n=18) and group discussions (n=48). Overall, the implementation of MECC within the region was at an early stage, with training mostly delivered between, rather than within, organisations. Qualitative findings highlighted factors that influence stakeholders to implement MECC (eg, organisational goals that were facilitated by MECC implementation, including the prevention agenda), supported resources that facilitate the implementation of MECC (eg, logic models) and enabling factors that promote MECC sustainability across the region (eg, buy-in from leadership and management).

CONCLUSIONS

The NENC MECC programme is built around regional leadership that supports the implementation process. This process evaluation identified key influences of MECC implementation across the region. We discuss evidence-based recommendation for policy and practice that can be taken forward to develop targeted strategies to support future MECC implementation. For example, a co-ordinated infrastructure and strategy is needed to combat delivery and implementation issues identified.

Tackling health inequalities through the development of the wider public health workforce

This article highlights how developing the public health workforce can lead to improvement of the public's health, and consequently promote health-driven prosperity in areas and populations where health inequalities are most prevalent.

Establishing an updated consensus on the conceptual and operational definitions of Making Every Contact Count (MECC) across experts within research and practice: an international Delphi Study

OBJECTIVES

The Making Every Contact Count (MECC) initiative is broadly defined as an opportunistic approach to prevention by making use of the thousands of conversations service providers have with service users every day. However, since its conception, the application of MECC has diverged and developed considerably. Thus, the current study aimed to revise the definition according to current research and practice to better describe what is and is not included.

STUDY DESIGN

A consensus building classic Delphi methodology, completed by an expert panel.

METHODS

Round 1 asked open questions around the definition of MECC. Content analysis of round 1 identified statements that were rated for agreement in round 2. Statements achieving ≥80% agreement were included in a short, long, or operational definition of MECC that were rated for agreement in round 3 (the minimum number required). An agreement of ≥80% indicated consensus.

RESULTS

Forty out of 100 contacted experts completed three rounds. Experts in practice and research were recruited internationally although most were from England. From round 1, 274 statements were generated, of which 96 achieved consensus and were included within round 3. The short and long definition received consensus in round 3, the operational definition required four rounds to reach consensus.

CONCLUSIONS

MECC is a person-centred approach to health behaviour change that, provided an individual possesses the relevant skills, can be delivered by anyone and anywhere. The distinguishing feature of MECC is not in its duration, target behaviour, or conditions for delivery, but rather in the approach taken and the mechanisms applied to conversations. Implications for research and practice are discussed, and the limits for applicability acknowledged.

Experiences of implementing the 'Making Every Contact Count' initiative into a UK integrated care system: an interview study

BACKGROUND

The 'Making Every Contact Count' (MECC) approach is in line with the current National Health Service (NHS) strategy to improve and prevent health conditions in England. Despite its importance and value for preventative healthcare, implementation of MECC varies. The aim of this study was to explore the barriers and facilitators of implementing MECC and MECC training into an integrated care system (ICS).

METHODS

Remote semi-structured interviews were conducted with staff across an ICS in the North West of England who were involved in implementing and delivering MECC across the region. Data were analysed initially using an inductive thematic analysis approach and then interpreted using the 'Capability, Opportunity, Motivation = Behaviour' (COM-B) model of behaviour change.

RESULTS

We interviewed nine stakeholders and identified three superordinate themes: (1) macro-level barriers and facilitators, e.g. funding; (2) organizational level barriers and facilitators, e.g. time and resource; and (3) individual-level barriers/facilitators for both MECC trainers and MECC agents.

CONCLUSIONS

MECC has potential to meet the needs of the public's health, but barriers to its implementation exist. MECC must be successfully embedded into organizations and regions in which it is implemented, which relies on further development of an appropriate infrastructure including sustainable funding and a shift in culture to value preventative healthcare.

Barriers and enablers to delivering opportunistic behaviour change interventions during the COVID-19 pandemic: A qualitative study in healthcare professionals

BACKGROUND

In line with public health policy, healthcare professionals (HCPs) working in the UK's National Health Service (NHS) are encouraged to deliver opportunistic health behaviour change interventions during routine consultations. The impact of the COVID-19 pandemic on healthcare delivery has been wide-ranging, but little is known about how the pandemic has affected the delivery of health behaviour change interventions. The present study aimed to examine the barriers and enablers to delivering opportunistic behaviour change interventions during the COVID-19 pandemic.

METHODS

Twenty-five qualitative semi-structured interviews were conducted in January 2022 with a range of patient-facing healthcare professionals (including nurses, physiotherapists, dieticians, doctors and midwives) working in the NHS. Data were analysed using reflexive thematic analysis.

RESULTS

Two overarching themes were generated: (1) the healthcare system's response to COVID-19, and (2) maintaining good HCP-patient relationships: reluctance and responsibility. COVID-19-related barriers included exacerbated staffing pressures and a perceived inability to use IT equipment to facilitate conversations about health behaviour change (due to poor internet connectivity or ill-equipped platforms). COVID-19-related enablers included the use of video consultations enabling less awkward and more honest conversations about health behaviours. However, some barriers and enablers remained the same as pre-pandemic, such as issues of role responsibility for discussing health behaviour change with patients, balancing holistic wellbeing advice with maintaining positive patient-HCP relationships, and reluctance to deliver opportunistic behaviour change interventions.

DISCUSSION

The increased use of remote consultations may facilitate the delivery of opportunistic health behaviour change interventions by healthcare professionals. However, there is also a strong need to improve staffing levels, in order that staff have the psychological and physical capabilities to engage patients in these conversations.

Understanding the implementation of 'Making Every Contact Count' (MECC) delivered by healthcare professionals in a mental health hospital: protocol for a pragmatic formative process evaluation

Background

'Making Every Contact Count' (MECC) is a public health strategy supporting public-facing workers to use opportunities during routine contacts to enable health behaviour change. A mental health hospital in the North East of England is currently implementing a programme to embed MECC across the hospital supporting weight management ('A Weight Off Your Mind'). Bespoke MECC training has been developed to improve staff confidence in discussing physical activity, healthy eating, and related behaviour change with service users. This article describes the protocol for a pragmatic formative process evaluation to inform the implementation plan for MECC and facilitate successful implementation of the bespoke MECC training at scale.

Methods/Design

An 18-month, mixed method pragmatic formative process evaluation, including qualitative research, surveys, document review and stakeholder engagement. This project is conducted within a mental health inpatient setting in the North East of England. Programme documents will be reviewed, mapped against MECC national guidelines, Behaviour Change Techniques (BCTs) and intervention functions within the Behaviour Change Wheel. A cross-sectional survey (n = 365) and qualitative semi-structured interviews (n = 30) will be conducted with healthcare practitioners delivering MECC to assess capability, opportunity and motivation. Data collection and fidelity procedures will be examined, including design, training and delivery dimensions of fidelity. Interviews with service users (n = 20) will also be conducted.

Discussion

Anticipated outcomes include developing recommendations to overcome barriers to delivery of and access to MECC, including whether to either support the use of the existing MECC protocol or tailor the MECC training programme. The findings are anticipated to improve fidelity of MECC training within mental health inpatient settings as well as provide evidence for MECC training at a national level. We also expect findings to influence strategic plans, policy, and practice specific to MECC and inform best practice in implementing wider brief intervention programmes.