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Objectives: To elicit and value patient preferences for the processes and outcomes of surgical management of stress urinary incontinence in women., Design: A discrete choice experiment survey to elicit preferences for type of anaesthesia, postoperative recovery time, treatment success, adverse events, impact on daily activities and cost. An experimental design generated 40 choice tasks, and each respondent completed 1 block of 10 and 2 validity tests. Analysis was by multinomial logistical regression., Setting: N=21 UK hospitals., Participants: N=325 adult women who were a subsample of those randomised to the single-incision mini-slings clinical trial., Outcomes: Patient preferences; valuation obtained using willingness to pay., Results: N=227 of 325 (70%) returned a questionnaire, and 94% of those completed all choice tasks. Respondents preferred general anaesthesia, shorter recovery times, improved stress urinary incontinence symptoms and avoidance of adverse events. Women were willing to pay (mean (95% CI)) £76 (£33 to £119) per day of reduction in recovery time following surgery. They valued increases in Patient Global Impression of Improvement, ranging from £8173 (£5459 to £10 887) for 'improved' to £11 706 (£8267 to £15 144) for 'very much improved' symptoms, compared with no symptom improvement. This was offset by negative values attached to the avoidance of complications ranging between £-8022 (£-10 661 to £-5383) and £-10 632 (£-14 077 to £-7187) compared to no complications. Women valued treatments that reduced the need to avoid daily activities, with willingness to pay ranging from £-967 (£-2199 to £266) for rarely avoiding activities to £-5338 (£-7258 to £-3417) for frequently avoiding daily activities compared with no avoidance., Conclusion: This discrete choice experiment demonstrates that patients place considerable value on improvement in stress urinary incontinence symptoms and avoidance of treatment complications. Trade-offs between symptom improvement and adverse event risk should be considered within shared decision-making. The willingness to pay values from this study can be used in future cost-benefit analyses., Trial Registration Number: ISRCTN: 93264234; Post-results., Competing Interests: Competing interests: DB reports grants from UK NIHR during the conduct of the study. KB has been a speaker and trainer for the following companies in the past: Astellas, Pfizer, AMS, Contura, Allergan and others, where he received honoraria and sponsorship towards attending scientific conferences. JN'D reports HTA General Committee 2016–2018. GM reports grants from UK NIHR during the conduct of the study. JN reports grants from University of Edinburgh, outside the submitted work; and past and present member of the following: HTA Commissioning Sub-Board (EOI), NIHR CTU Standing Advisory Committee, NIHR HTA & EME Editorial Board, Pre-Exposure Prophylaxis Impact Review Panel, EME Strategy Advisory Committee, EME-Funding Committee Members, EME Funding Committee Sub-Group Remit & Comp Check, HTA General Committee, HTA Funding Committee Policy Group (formerly CSG), HTA Commissioning Committee, HTA Post-funding committee teleconference 2016–2019 and COVID-19 reviewing 2020. MA-F reports none in the last 5 years. Before 2015, he has been a speaker, consultant and/or surgical trainer for a number of industrial companies (Astellas, Ethicon, Bard, Pfizer, AMS, Coloplast and others); has reimbursed his travel expenses and on occasions received personal honoraria, proctorship fees and sponsorship towards attending scientific conferences; received research grant from Coloplast managed by University of Aberdeen. Moreover, his limited number of trainees attended pharmaceutical sponsored educational/leadership workshops and/or received assistance towards presenting their research work in scientific conferences. He was also Chairman of the Scottish Pelvic Floor Network (SPFN), which at the time, received financial sponsorship from various industrial companies (including all those mentioned above) and non-profit organisations for its annual meetings and surgical workshops. The SPFN provided an educational grant funding the PI at the highest recruiting site to attend the International Continence Society annual scientific conference in Brazil in 2014. At present, he receives travel sponsorship and occasionally speaker’s fees from numerous national and international conferences and non-profit organisations when invited as guest speaker and/or expert surgeon. In 2019, and at the request from NHS Grampian, he attended two educational meetings for setting up sacral nerve stimulation service partially funded by Medtronic. He is the Chief Investigator for four NIHR-HTA-funded studies. He does not hold (and never held) any shares (or similar) in any of the industrial companies (medical or non-medical). To the best of his knowledge, none of the above have influenced his research or clinical practice. No other authors declared any potential conflict of interest., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To investigate what weight management interventions work for men, with which men, and under what circumstances., Design: Realist synthesis of qualitative studies., Data Sources: Sensitive searches of 11 electronic databases from 1990 to 2012 supplemented by grey literature searches., Study Selection: Studies published between 1990 and 2012 reporting qualitative research with obese men, or obese men in contrast to obese women and lifestyle or drug weight management were included. The studies included men aged 16 years or over, with no upper age limit, with a mean or median body mass index of 30 kg/m(2) in all settings., Results: 22 studies were identified, including 5 qualitative studies linked to randomised controlled trials of weight maintenance interventions and 8 qualitative studies linked to non-randomised intervention studies, and 9 relevant UK-based qualitative studies not linked to any intervention. Health concerns and the perception that certain programmes had 'worked' for other men were the key factors that motivated men to engage with weight management programmes. Barriers to engagement and adherence with programmes included: men not problematising their weight until labelled 'obese'; a lack of support for new food choices by friends and family, and reluctance to undertake extreme dieting. Retaining some autonomy over what is eaten; flexibility about treats and alcohol, and a focus on physical activity were attractive features of programmes. Group interventions, humour and social support facilitated attendance and adherence. Men were motivated to attend programmes in settings that were convenient, non-threatening and congruent with their masculine identities, but men were seldom involved in programme design., Conclusions: Men's perspectives and preferences within the wider context of family, work and pleasure should be sought when designing weight management services. Qualitative research is needed with men to inform all aspects of intervention design, including the setting, optimal recruitment processes and strategies to minimise attrition., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective: To assess the feasibility, acceptability and fidelity of a feeding team intervention with an embedded randomised controlled trial of team-initiated (proactive) and woman-initiated (reactive) telephone support after hospital discharge., Design: Participatory approach to the design and implementation of a pilot trial embedded within a before-and-after study, with mixed-method process evaluation., Setting: A postnatal ward in Scotland., Sample: Women initiating breast feeding and living in disadvantaged areas., Methods: Quantitative data: telephone call log and workload diaries. Qualitative data: interviews with women (n=40) with follow-up (n=11) and staff (n=17); ward observations 2 weeks before and after the intervention; recorded telephone calls (n=16) and steering group meetings (n=9); trial case notes (n=69); open question in a telephone interview (n=372). The Framework approach to analysis was applied to mixed-method data., Main Outcome Measures: Quantitative: telephone call characteristics (number, frequency, duration); workload activity. Qualitative: experiences and perspectives of women and staff., Results: A median of eight proactive calls per woman (n=35) with a median duration of 5 min occurred in the 14 days following hospital discharge. Only one of 34 control women initiated a call to the feeding team, with women undervaluing their own needs compared to others, and breast feeding as a reason to call. Proactive calls providing continuity of care increased women's confidence and were highly valued. Data demonstrated intervention fidelity for woman-centred care; however, observing an entire breast feed was not well implemented due to short hospital stays, ward routines and staff-team-woman communication issues. Staff pragmatically recognised that dedicated feeding teams help meet women's breastfeeding support needs in the context of overstretched and variable postnatal services., Conclusions: Implementing and integrating the FEeding Support Team (FEST) trial within routine postnatal care was feasible and acceptable to women and staff from a research and practice perspective and shows promise for addressing health inequalities., Trial Registration: ISRCTN27207603. The study protocol and final report is available on request.

Objective: To assess the feasibility of implementing a dedicated feeding support team on a postnatal ward and pilot the potential effectiveness and cost-effectiveness of team (proactive) and woman-initiated (reactive) telephone support after discharge., Design: Randomised controlled trial embedded within a before-and-after study. Participatory approach and mixed-method process evaluation., Setting: A postnatal ward in Scotland., Sample: Women living in disadvantaged areas initiating breast feeding., Methods: Eligible women were recruited to a before-and-after intervention study, a proportion of whom were independently randomised after hospital discharge to intervention: daily proactive and reactive telephone calls for ≤14 days or control: reactive telephone calls ≤ day 14. Intention-to-treat analysis compared the randomised groups on cases with complete outcomes at follow-up., Primary Outcome: any breast feeding at 6-8 weeks assessed by a telephone call from a researcher blind to group allocation., Secondary Outcomes: exclusive breast feeding, satisfaction with care, NHS costs and cost per additional woman breast feeding., Results: There was no difference in feeding outcomes for women initiating breast feeding before the intervention (n=413) and after (n=388). 69 women were randomised to telephone support: 35 intervention (32 complete cases) and 34 control (26 complete cases). 22 intervention women compared with 12 control women were giving their baby some breast milk (RR 1.49, 95% CI 0.92 to 2.40) and 17 intervention women compared with eight control women were exclusively breast feeding (RR 1.73, 95% CI 0.88 to 3.37) at 6-8 weeks after birth. The incremental cost of providing proactive calls was £87 per additional woman breast feeding and £91 per additional woman exclusively breast feeding at 6-8 weeks; costs were sensitive to service organisation., Conclusions: Proactive telephone care delivered by a dedicated feeding team shows promise as a cost-effective intervention for improving breastfeeding outcomes. Integrating the FEeding Support Team (FEST) intervention into routine postnatal care was feasible., Trial Registration Number: ISRCTN27207603. The study protocol and final report are available on request.