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Introduction: Although behavioural interventions have been found to help control type 2 diabetes (T2D), it is important to understand how the delivery context can influence implementation and outcomes. The NHS committed to testing a low‐calorie diet (LCD) programme designed to support people living with excess weight and T2D to lose weight and improve diabetes outcomes. Understanding what influenced implementation during the programme pilot is important in optimising rollout. This study explored the transferability of the NHS LCD Programme prior to wider adoption. Methods: Twenty‐five interviews were undertaken with stakeholders involved in implementing the LCD programme in pilot sites (health service leads, referring health professionals and programme deliverers). Interviews with programme participants (people living with T2D) were undertaken within a larger programme of work, exploring what worked, for whom and why, which is reported separately. The conceptual Population–Intervention–Environment–Transfer Model of Transferability (PIET‐T) guided study design and data collection. Constructs of the model were also used as a deductive coding frame during data analysis. Key themes were identified which informed recommendations to optimise programme transfer. Results: Population: Referral strategies in some areas lacked consideration of population characteristics. Many believed that offering a choice of delivery model would promote acceptability and accessibility of the eligible population. Intervention: Overall, stakeholders had confidence in the LCD programme due to the robust evidence base along with anecdotal evidence, but some felt the complex referral process hindered engagement from GP practices. Environment: Stakeholders described barriers to accessing the programme, including language and learning difficulties. Transferability: Multidisciplinary working and effective communication supported successful implementation. Conclusion: Referral strategies to reach underrepresented groups should be considered during programme transfer, along with timely data from service providers on access and programme benefits. A choice of delivery models may optimise uptake. Knowledge sharing between sites on good working practices is encouraged, including increasing engagement with key stakeholders. [ABSTRACT FROM AUTHOR]

Objective: The study objective was to assess participant weight change for the English National Health Service (NHS) Digital Weight Management Programme, the first such digital intervention to achieve population coverage. Methods: A service evaluation was used to assess intervention effectiveness for adults with obesity and a diagnosis of hypertension and/or diabetes, between April 2021 and March 2022, using prospectively collected, national service–level data in England. Results: Of the 63,937 referrals made from general practices, within the time period, 31,861 (50%) chose to take up the 12‐week Programme. There were 31,718 participants who had time to finish the Programme; of those, 14,268 completed the Programme (defined as attending ≥60%), a 45% completion rate. The mean weight change for those who had time to finish the Programme was −2.2 kg (95% CI: −2.25 to −2.16), for those who completed it was −3.9 kg (95% CI: −3.99 to −3.84), and for those who had time to finish the Programme but did not complete it was −0.74 kg (95% CI: −0.79 to −0.70). Conclusions: The NHS Digital Weight Management Programme is effective at achieving clinically meaningful weight loss. The outcomes compare favorably to web‐based weight management interventions tested in randomized trials and those delivered as face‐to‐face interventions, and results suggest that the approach may, with increased participation, bring population‐level benefits. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of multiple longterm conditions (MLTC) at whole English population level, stratifying by age, sex, socioeconomic status and ethnicity. Design: A whole population study. Setting: Individuals registered with a general practice in England and alive on 31 March 2020. Participants: 60,004,883 individuals. Main outcome measures: MLTC prevalence, defined as two or more of 35 conditions derived from a number of national patient-level datasets. Multivariable logistic regression was used to assess the independent associations of age, sex, ethnicity and deprivation decile with odds of MLTC. Results: The overall prevalence of MLTC was 14.8% (8,878,231), varying from 0.9% (125,159) in those aged 0– 19 years to 68.2% (1,905,979) in those aged 80 years and over. In multivariable regression analyses, compared with the 50–59 reference group, the odds ratio was 0.04 (95% confidence interval (CI): 0.04–0.04; p < 0.001) for those aged 0–19 years and 10.21 (10.18–10.24; p < 0.001) for those aged 80 years and over. Odds were higher for men compared with women, 1.02 (1.02–1.02; p < 0.001), for the most deprived decile compared with the least deprived, 2.26 (2.25–2.27; p < 0.001), and for Asian ethnicity compared with those of white ethnicity, 1.05 (1.04–1.05; p < 0.001). Odds were lower for black, mixed and other ethnicities (0.94 (0.94–0.95) p < 0.001, 0.87 (0.87–0.88) p < 0.001 and 0.57 (0.56–0.57) p < 0.001, respectively). MLTC for persons aged 0–19 years were dominated by asthma, autism and epilepsy, for persons aged 20–49 years by depression and asthma, for persons aged 50–59 years by hypertension and depression and for those aged 60 years and older, by cardiometabolic factors and osteoarthritis. There were large numbers of combinations of conditions in each age group ranging from 5936 in those aged 0–19 years to 205,534 in those aged 80 years and over. Conclusions: While this study provides useful insight into the burden across the English population to assist health service delivery planning, the heterogeneity of MLTC presents challenges for delivery optimisation. [ABSTRACT FROM AUTHOR]