Abstract
Poor participant engagement threatens the potential impact and cost-effectiveness of public health programmes preventing meaningful evaluation and wider application. Although barriers and levers to engagement with public health programmes are well documented, there is a lack of proven strategies in the literature addressing these. This paper details the development of a participant engagement intervention aimed at promoting enrolment and attendance to a community-based pre-school obesity prevention programme delivered in UK children’s centres; HENRY (Health, Exercise, Nutrition for the Really Young). The Behaviour Change Wheel framework was used to guide the development of the intervention. The findings of a coinciding focused ethnography study identified barriers and levers to engagement with HENRY that informed which behaviours should be targeted within the intervention to promote engagement. A COM-B behavioural analysis was undertaken to identify whether capability, opportunity or motivation would need to be influenced for the target behaviours to occur. APEASE criteria were used to agree on appropriate intervention functions and behaviour change techniques. A multi-level participant engagement intervention was developed to promote adoption of target behaviours that were proposed to promote engagement with HENRY, e.g. ensuring the programme is accurately portrayed when approaching individuals to attend and providing ‘taster’ sessions prior to each programme. At the local authority level, the intervention aimed to increase buy-in with HENRY to increase the level of resource dedicated to engagement efforts. At the centre level, managers were encouraged to widen promotion of the programme and ensure that staff promoted the programme accurately. HENRY facilitators received training to increase engagement during sessions, and parents that had attended HENRY were encouraged to recruit their peers. This paper describes one of the first attempts to develop a theory-based multi-level participant engagement intervention specifically designed to promote recruitment and retention to a community-based obesity prevention programme. Given the challenges to implementing public health programmes with sufficient reach, the process used to develop the intervention serves as an example of how programmes that are already widely commissioned could be optimised to enable greater impact.
Highlights
Local authorities in England are responsible for improving the health and well-being of people living in their communities
None of the intervention types was consistently effective at promoting all stages of engagement, but monetary incentives were largely successful at promoting enrolment (Diaz and Perez 2009; Dumas et al 2010; Heinrichs 2006; Hennrikus et al 2002) and text message reminders were effective at promoting completion rates (Murray et al 2015)
The study revealed that engagement with HENRY was influenced by implementation factors that were present across multiple operational levels within the children’s centre/local authority context
Summary
Local authorities in England are responsible for improving the health and well-being of people living in their communities. This includes providing equitable access to public health programmes that promote positive lifestyle behaviours. Community-based public health programmes that are adopted and implemented as planned by local authorities have the potential to promote health and reduce heath inequalities. A major barrier which hinders their effective implementation is poor participant engagement (enrolment and completion). Poor engagement reduces potential impact of public health programmes, with greater uptake and reach being associated with better outcomes for participants (Bamberger et al 2014).
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