Table 2 Case study details

Healthy Choices

Target population: Racially minoritised communities.

Background: Local data suggested uptake of universally commissioned services like Slimming World was low among racially minoritised communities. Commissioners were aware of research evidence suggesting “peer support” interventions were effective and may work well for weight management, and wanted to use this approach to increase uptake and engagement in these communities. The plan was to identify a peer mentor to run the service, working with their community to adapt the course content and activities to local needs. However, the public health team were unable to identify, recruit and train a peer mentor to run the service within the time available. Instead, the course ran using local authority health promotion officers, rather than a peer mentor. Time constraints also limited their ability to effectively recruit racially minoritised participants. Participants were therefore recruited from the weight management services waiting list: predominantly white middle-aged women, who did not want to attend more traditional weight management services.

Co-design activities: No specific co-design used in determining the overall service due to time constraints. However, there was a focus on tailoring the weight management service to the needs of the individual group members as the service went on.

Final service: A 12-week service, based on Cancer Research UK’s Ten Top Tips took place at two community settings in central LA1, focusing on an individually-tailored lifestyle approach.

FitnFun

Target population: Adults with mild learning disabilities.

Background: Adults with learning disabilities are more likely than their non-disabled peers to be living with overweight or obesity [3]. Based on the national Change4Life Healthier Families campaign, LA1 had previously created their own adult weight management service, developing an intervention booklet which guided sessions and activities over a series of weeks. With some additional government funding available, the service provider (P14_FnF) suggested they adapt this service for adults with learning disabilities, whom she noted often had poor diets and lacked exercise.

Co-design activities: LA1 partnered with a local learning disability day centre and advocacy group, with whom they had pre-existing relationships, to conduct the co-design activities. Adults with learning disabilities attending a local day centre were asked to participate in a one-off co-design session. Participants were shown the original healthy weight booklet and discussed what they liked/disliked about it and how it could be modified to suit their needs. Support staff from the day centre and a disability advocacy group also gave their views. Changes made included simplifying the language and removing some of the pictures to avoid distraction, but keeping the vibrant colours. Some physical activities were adapted so they were suitable for wheelchair users, while some food suggestions were adapted to use cheaper ingredients. Feedback from participants included an emphasis on making it “fun” and maintaining a positive body image. The overall service was also tailored to the local setting e.g., referencing local services and including a trip to a local supermarket.

Final service: A 12-week weight management intervention using a guidance booklet, based on the original healthy weight service, but adapted for use with adults with a mild learning disability. The original service was 10 weeks long, but FitnFun extended this to 12 weeks to allow more time to cover key concepts. The first six sessions included a theory element (e.g., the importance of healthy eating and exercise) and a physically-active game. Participants were encouraged to set personal goals and suggest ideas for what they wanted to cover in later weeks. The second half of service re-visited previous content to reinforce learning and included visits to local supermarkets and taster physical activity sessions at local clubs.

Active People

Target population: Racially minoritised populations and areas of high deprivation.

Background: Active People is a UK-based weight management healthy lifestyles organisation contracted by LA2 to deliver community-based weight management services to both adults and children. Alongside providing weight-management services, Active People were commissioned by LA2 to gather local “insights” with a view to co-producing locally-relevant weight management services. This included extensive community development with local organisations, key stakeholders and members of the public, to map out existing services and build relationships within particular communities within LA2. Active People also employed community members (like P11_AP) from target communities to talk with local people and gather “insights” into what a successful weight management service would look like, though initial conversations were often framed around the concept of “good health” rather than weight per se. This work was building towards specific events with the community members where weight management services would be co-designed. However, government funding was pulled before Active People had the chance to implement these activities.

Co-design activities: A framework for co-design was created but not fully implemented, due to funding cuts. The planned activities involved four ‘stations’ using the analogy of a kitchen and building a recipe together: 1. What’s in your cupboard? (What’s in the community already? What can be built on?); 2. What’s on your shopping list? (What or who else is needed to create this?); 3. Method (How should we make this happen?); 4. Reflection. (Are we happy with this? Do we need to change anything?)

Final service: Active People offer a range of online or in-person services. Most are 12-week services which are tailored to different audiences including adults, families, people with disabilities and adolescents. No co-design activities took place during this period to modify the service formally, but participants suggested there may have been some minimal changes based on the feedback they were received from their “insights” work.

The Men’s project

Target population: Men

Background: Commissioners at ICB1 had a remit around upstream prevention, focusing on the wider determinants of health and reducing inequalities. Local service data suggested men were not accessing commissioned weight management services like Weight Watchers, which are often perceived by men as not appropriate or accessible [32,33,34]. Commissioners wanted to create something that would address this unmet need but were aware the NHS label could be off-putting. Commissioners were already aware of a well-respected local charity whose goal was to create social connection through sharing food. Wanting to try something different, they approached the charity and asked them to partner with them in co-designing this service.

Co-design activities: Co-design activities occurred in both the planning and implementation stages of the project using what the commissioner (C10_MP) called a “social design” approach and drawing on the Design Council’s paper on co-creating health services [35]. An initial informal survey was circulated via the charity’s local social media to ask men their views on health and wellbeing. This led to a series of focus groups to explore what the men wanted to focus on, as well as practical issues such as time of day or group size. Commissioners and providers used this information to create a framework for the service, which was presented to men at an open evening for further feedback and discussion. The service was run successively with two cohorts of 10–12 men, with further co-design occurring throughout: providers provided a loose framework for the initial meeting, but the content and structure of sessions were largely directed by the men thereafter.

Final service: Six-week peer support group for men (though many participants continued meeting after the service had ended). The service involved men coming together to talk about their mental and physical health, while participating in a group activity often based around the sharing of food. The premise was that increased social connection built resilience and enabled men to talk about their health concerns, which may or may not include weight management. Conversations were loosely structured around principles of health coaching and motivational interviewing, to enable participants to set goals for themselves, but the remit was open and collaborative.