Evaluation of a community group weight management scheme: Are outcomes influenced by who delivers it?

Abstract

This dissertation aimed to investigate if clinical outcomes, attendance rates and the demographics of patients vary according to the type of health worker who delivered a primary care group weight management scheme. An observational, retrospective evaluation: a before and after analysis of twelve week group weight management programmes. A dataset containing 974 suitable entries was examined according to three cohorts of primary care health workers; administrative assistants (AA), health care assistants (HCA) and nurses. Comparisons between these worker groups included: differences in worker outcomes for weight, waist circumference, body mass index (BMI), and blood pressure after 12 weeks; percentage attendance at week 12; gender, age, ethnicity and the registered general practice (GP) indices of multiple deprivation score (IMD) of patients who enrolled. Patients seen by personnel in health assistant roles lost more weight (-1kg, p=0.008) lowered their BMI (- 0.3 kg/m², p=0.008) and decreased their waist circumference (-2cm, p<0.001) significantly more than those seen by nurses. Poor data entry for blood pressure recordings hampered analysis of this outcome. Attendance was 38% and not significantly different between any workers (p=0.444). Those who completed the programme were predominantly white (99.5%) women (82%), significantly older (median age 61years compared to 57 years, p<0.001) and from GP practices with significantly lower IMD scores (27.3 compared to 31.5, p<0.001). Patient characteristics were generally similar, irrespective of the deliverer. Health care workers in supporting clinical roles were able to help patients achieve greater weight loss outcomes than nurses. High levels of erroneous and missing clinical data were problematic for less qualified deliverers and indicative of a lack of more advanced clinical abilities. High attrition and limited appeal were difficulties for all three health worker groups and jeopardised the overall efficacy of the scheme.