Equity and local health systems: a qualitative evaluation of the experiences of local health service leads during the first two years of the NHS Low Calorie Diet programme pilot

Authors

  • Kevin Drew Leeds Beckett University https://orcid.org/0000-0003-0149-2521
  • Catherine Homer 2 Sport and Physical Activity Research Centre, Sheffield Hallam University, Olympic Legacy Park, 2 Old Hall Road, Sheffield, S9 3TU.
  • Duncan Radley 3Obesity Institute, Leeds Beckett University, School of Sport, Leeds Beckett University, Headingley Campus, Leeds, LS6 3QW.
  • Charlotte Freeman Public Health Calderdale Metropolitan Borough Council, Halifax, HX1 1TS.
  • Karina Kinsella Obesity Institute, Leeds Beckett University, School of Health, Leeds Beckett University, City Campus, Leeds, LS6 3QW
  • Maria Maynard Obesity Institute, Leeds Beckett University, School of Health, Leeds Beckett University, City Campus, Leeds, LS6 3QW
  • Chirag Bakhai 5Larkside Practice, Churchfield Medical Centre, 322 Crawley Green Road, Luton, Bedfordshire, LU2 9SB
  • Louisa Ells Obesity Institute, Leeds Beckett University, School of Health, Leeds Beckett University, City Campus, Leeds, LS6 3QW

DOI:

https://doi.org/10.15277/bjd.2023.416

Keywords:

T2DM, obesity, Low Calorie Diet, equity, inequalities, proportionate universalism, Re:Mission study

Abstract

Background: Obesity and type 2 diabetes (T2DM) can both profoundly impact health and wellbeing. Their prevalence largely follows a social gradient. The National Health Service Low Calorie Diet programme in England aims to support people to achieve T2DM remission while also reducing health inequalities. We aimed to explore the experiences of local health service leads and identify barriers and facilitators in relation to the equitable mobilisation of the Low Calorie Diet programme.

Methods: Twenty semi-structured interviews were completed with 24 locality leads across the first two years of the Low Calorie Diet programme. Interviewees were purposively sampled from the 10 localities who undertook the Low Calorie Diet programme pilot. Each interview explored a number of topics of interest, including referrals, training, communication, incentivisation, governance and engagement, before being subjected to a thematic analysis.

Results: From the data, seven core themes were identified: COVID-19 and primary care capacity and engagement; methods of communication; approaches to training; approaches to incentivisation; approaches to referrals; barriers to referrals; and the importance of collaboration. COVID-19 presented a specific challenge to the mobilisation and delivery of the Low Calorie Diet programme; however, our findings demonstrate the large variation and differences in the approaches taken when delivering the programme across 10 geographically and demographically distinct pilot sites. We also identified a lack of a recognised approach or strategy to mobilisation and delivery support for the Low Calorie Diet programme, such as proportionate universalism, which is a social policy response to tackling health inequalities by ensuring that service delivery is equitable.

Conclusions: Health inequalities remain a significant challenge, and health service leads have the potential to adopt an equity perspective from the start of programme mobilisation. In doing so, resources at their disposal can be managed equitably and can therefore contribute to efforts to reduce the potential occurrence of intervention-generated inequalities.

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Published

2023-12-18

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