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Design programmes to maximise participant engagement: a predictive study of programme and participant characteristics
James Nobles1, Claire Griffiths2, Andy Pringle2
1Institute of Sport, Physical Activity and Leisure, Centre of Active Lifestyles, Carnegie Faculty, Leeds Beckett University, Headingley Campus, Leeds, UK. j.d.nobles@leedsbeckett.ac.uk.
Insights
Programme characteristics, not participant traits, significantly influence engagement in paediatric weight management programmes. Smaller groups and earlier delivery periods enhance participation, suggesting a need to focus on program design over individual factors for better weight management outcomes.
Area of Science:
- Public Health
- Paediatric Obesity
- Health Services Research
Background:
- High attrition rates (approx. 50%) in paediatric weight management (WM) programmes impact effectiveness and cost-efficiency.
- Previous research on predictors of non-completion often used small, non-representative samples.
- The influence of programme characteristics on participant engagement remains underexplored.
Purpose of the Study:
- To investigate participant and programme characteristics associated with engagement in a large-scale paediatric WM programme.
- To identify factors influencing different levels of participant engagement, from initiation to completion.
Main Methods:
- Secondary data analysis of 2948 participants (aged 10.4 ± 2.8 years, BMI SDS 2.48 ± 0.87) from a nationwide WM provider (2009-2014).
- Participants categorized into five engagement groups: Initiators, Late Dropouts, Low/High Sporadic Attenders, Completers (≥70% attendance).
- Multivariable logistic regression models used to identify 11 participant and 6 programme characteristics linked to engagement groups.
Main Results:
- Programme characteristics (e.g., small group size, winter/autumn delivery, earlier programme years) were stronger predictors of engagement than participant characteristics.
- Participant characteristics showed weak and inconsistent associations with engagement across different groups.
- Programme completion rate was 47.1% (mean attendance 59.4%), with 21% not attending any sessions.
Conclusions:
- Programme design elements, such as group size (≤20 participants), appear crucial for enhancing engagement in paediatric WM.
- Baseline participant characteristics are poor predictors of engagement, necessitating research into participant motivations and barriers.
- Standardized recording of session-by-session attendance is recommended to improve research transparency and validity.
Background:
Approximately 50% of paediatric weight management (WM) programme attendees do not complete their respective programmes. High attrition rates compromise both programme effectiveness and cost-efficiency. Past research has examined pre-intervention participant characteristics associated with programme (non-)completion, however study samples are often small and not representative of multiple demographics. Moreover, the association between programme characteristics and participant engagement is not well known. This study examined participant and programme characteristics associated with engagement in a large, government funded, paediatric WM programme. Engagement was defined as the family's level of participation in the WM programme.
Methods:
Secondary data analysis of 2948 participants (Age: 10.44 ± 2.80 years, BMI: 25.99 ± 5.79 kg/m(2), Standardised BMI [BMI SDS]: 2.48 ± 0.87 units, White Ethnicity: 70.52%) was undertaken. Participants attended a MoreLife programme (nationwide WM provider) between 2009 and 2014. Participants were classified into one of five engagement groups: Initiators, Late Dropouts, Low- or High- Sporadic Attenders, or Completers. Five binary multivariable logistic regression models were performed to identify participant (n = 11) and programmatic (n = 6) characteristics associated with an engagement group. Programme completion was classified as ≥70% attendance.
Results:
Programme characteristics were stronger predictors of programme engagement than participant characteristics; particularly small group size, winter/autumn delivery periods and earlier programme years (proxy for scalability). Conversely, participant characteristics were weak predictors of programme engagement. Predictors varied between engagement groups (e.g. Completers, Initiators, Sporadic Attenders). 47.1% of participants completed the MoreLife programme (mean attendance: 59.4 ± 26.7%, mean BMI SDS change: -0.15 ± 0.22 units), and 21% of those who signed onto the programme did not attend a session.
Conclusions:
As WM services scale up, the efficacy and fidelity of programmes may be reduced due to increased demand and lower financial resource. Further, limiting WM programme groups to no more than 20 participants could result in greater engagement. Baseline participant characteristics are poor and inconsistent predictors of programme engagement. Thus, future research should evaluate participant motives, expectations, and barriers to attending a WM programme to enhance our understanding of participant WM engagement. Finally, we suggest that session-by-session attendance is recorded as a minimum requirement to improve reporting transparency and enhance external validity of study findings.
