This document discusses a study exploring the use of tailored text message interventions for postpartum weight loss and management. The study aims to develop and pilot test a multi-component SMS-delivered intervention to support weight loss and maintenance in new mothers. If shown to be acceptable and feasible in the pilot, a larger randomized controlled trial will evaluate effectiveness. Key challenges of postpartum weight loss include balancing demands of motherhood with self-care. The text message approach could offer a flexible format to support women anytime and anywhere over an extended period. The pilot will provide evidence to inform a potential future effectiveness trial of the SMS intervention.

1. Working together for better health and
wellbeing:
Understanding what works
Healthy eating – challenges facing families
Dr Michelle McKinley
Centre for Public Health & NI UKCRC Centre of
Excellence for Public Health Research,
Queen’s University Belfast
m.mckinley@qub.ac.uk

3. Key elements of the design and
evaluation process

4. MRC developing and evaluating
complex interventions
www.mrc.ac.uk/complexinterventionsguidance

6. Evaluations are often undermined by problems of acceptability,
compliance, delivery of the intervention, recruitment and retention,
and smaller than expected effect sizes that could have been
predicted by thorough piloting

7. Healthy eating – challenges facing
families
Mums as agents of change…….

8. Supporting MumS study
QUB, University of Stirling, London School of Hygiene and Tropical
Medicine, University of Dundee, University of Glasgow

9. • NIHR Call: 14/67 Weight management after
pregnancy
• Research Question(s)
– What are the effective and cost-effective interventions for
weight management after pregnancy?

10. Opportune time

11. Supporting PP weight loss: some challenges

12. The challenges of postpartum weight loss
• Women struggle to balance the demands of postpartum life
with weight management
– Time issues
– Motivation issues
– Support (partner, family, health professionals, friends, other mums) – both
+ve and -ve
– Complicating factors – postnatal depression, sleep (or lack of it)
Montgomery et al; Matern Child Health J 2011; 15:1176-84

13. The challenges of postpartum weight
loss
Montgomery et al; Matern Child Health J 2011; 15:1176-84
It’s hard to juggle everything you need to do when
you work, take care of the house, take care of
everyone else’s needs. As a mother, I think it is
typical to say that a mother’s needs always come last
because you put everybody else before you. So that
could be another factor in taking care of yourself
physically, eating, and exercising. It’s hard to find the
time to, because everything else is so demanding.

14. The challenges of postpartum weight
loss
Montgomery et al; Matern Child Health J 2011; 15:1176-84
While I have many obstacles now, once I get past
some of these I am hoping I can work on being the
person I want to be.

15. Opportune time BUT Challenging time

16. How to deliver the intervention?
• Commissioning brief: …..Consideration should be given to
intervention timing, duration, delivery format, engagement and
sustainability.
• Need for:
– A flexible and individualised approach to WL at this life stage
– Home-based or more adaptable anytime, anyplace approach
– Key components – diet, physical activity, key behaviour change
techniques
– Pay attention to maintenance of weight loss

17. Supporting MumS Study
(SMS Study)
A tailored, SMS-delivered, multi-component
intervention for weight loss and maintenance of
weight loss in the postpartum period: intervention
adaptation and pilot RCT
http://www.nets.nihr.ac.uk/projects/phr/146720

18. The approach – SMS – text message
• Simple mode of communication - uses basic mobile technology
• Intervention can be proactive as well as reactive - does not necessarily rely on
initiation by the participant
• Instant, delivered in a timely manner - anyplace, anytime
• Allow flexible content and scheduling – tailoring
• Sustained contact women over medium-long term - extended contact following
WL – considered best practice for WLM
• Ability to re-engage with women after life events that may disrupt weight
management progress (illness, stress)
• Low-cost – potential for roll-out and scalability
• Has been used successfully to change various health behaviours

19. Two stages:

20. Intervention adaptation
1. Systematic review of systematic
reviews
2. Message development, testing,
refinement
3. Add functionality to SMS platform
to allow provision of feedback

22. Population
n=100; 50 per group
Inclusion
had a baby in previous two years; aged over 18; BMI over 25kg/m2
, primiparous
or multiparous
Exclusion
no access to phone, insufficient English, pregnancy, on specialist diet,
psychiatric disorders, eating disorder, previous/planned bariatric surgery, T1DM

23. Intervention & Active control
(12 month intervention period)
Diet & activity
Cluster BCTs
(supported by evidence base –
embedded within SMS)
Tailored
(WL, WLM, eating triggers,
infant feeding)
n=50
General childcare &
development – emotional,
social, cognitive, physical
development; health; safety;
parenting
n=50

24. Outcome
To provide the basis for deciding whether to proceed to
a multi-centre RCT to fully test effectiveness of the
intervention.
• Acceptability of intervention and active control
• Feasibility of recruitment
• Retention rate
• Evidence of positive indicative effects

25. Spill over effects….

28. What about dads?

29. - Fathers notably absent from research exploring parental
influences on child physical activity and nutrition
- To improve the quality of childhood obesity prevention
programs, a deliberate and sustained effort is needed
from researchers to greatly increase the meaningful
engagement of fathers
- Relatively little is known about how best to engage fathers
in obesity prevention

30. Conclusion
• Systematic approach to intervention development
and testing, e.g. MRC framework for
development and evaluation of complex
interventions – include a process evaluation
• Report what doesn’t work as well as what does
work
• Trans-disciplinary approach – multiple
perspectives
• Academia and PH practitioners – partnership
• PPI

31. Social determinants of health - the
Dahlgren-Whitehead rainbow model