JMIR Publications

ABSTRACT

Background:

Community-based, face-to-face programmes may be particularly valuable for underserved populations because they provide trusted relational support, peer learning, and accessible local delivery. However, these programmes often provide limited support between sessions or after completion. Hybrid interventions, which combine in-person support with digital components may help extend support while preserving the relational mechanisms of in-person delivery. However, there is limited published evidence exploring hybrid interventions in more deprived communities.

Objective:

This study undertook formative research to inform the design of a digital augmentation to an existing community-based weight management intervention delivered in an area of deprivation in South Bristol, United Kingdom. Specifically, this work aimed to (1) undertake multi-method primary qualitative research into participants’ experience of the existing intervention, (2) develop programme theory of the existing intervention, (3) co-develop opportunities to improve the intervention, and (4) develop specific design objectives and intervention features for the digital augment (guiding principles).

Methods:

We conducted a multi-method qualitative and participatory research study guided by the Person-Based Approach. The study was conducted alongside the Robins Foundation, who deliver group-based weight management programmes in areas of deprivation. Programme attendees participated in longitudinal ecological data collection using a conversational WhatsApp-based research tool, post-programme semi-structured interviews, and participatory research workshops. Delivery team members participated in workshops to develop programme theory and identify improvement opportunities. Interview and longitudinal chat-log data were analysed using framework analysis, providing empirical evidence to refine programme theory. Finally, qualitative findings were synthesised alongside workshop outputs, to derive guiding principles for digital augmentation.

Results:

Nine programme attendees participated in interviews, longitudinal WhatsApp-based data collection, and participatory research workshops. Delivery team members participated in planning workshops. Participants described the in-person programme as working primarily through trusted and credible delivery of health information, an inclusive group environment, peer learning, and support to develop personally relevant behaviour-change strategies. Social opportunity was the most prominent facilitator. Persistent challenges included missed-session learning gaps, limited recall of content, limited between-session support, variable support in home environments, and concern about sustaining change after programme completion. Synthesising these findings with findings from participatory workshops, we derived guiding principles proposing that a digital component should support familiarity and engagement before the programme begins, reinforce learning and personalised behaviour-change support between sessions, extend support after programme completion, and provide appropriate monitoring that benefits both participants and the delivery team.

Conclusions:

This study provides formative evidence, synthesised into guiding principles for the design of a digital augment to a community-based weight management programme for underserved populations. Findings suggest that this digital augmentation should extend, rather than replace, the key relational and behavioural mechanisms of the face-to-face programme. Future work should focus on prototyping and evaluating the feasibility, acceptability, and usability of the proposed hybrid intervention.