Background
Methods
Recruitment and eligibility
Quantitative data collection
Quantitative data analysis
Focus Group | Number attending | Gender | Geographical Area | Extent of Deprivation by Assembly Area | Mean Age (yrs) | Mean BMI | UE n (%) | Retired n (%) | Mean MDS (SD) | Knew about Med diet n (%) | Would consider making changes to diet n (%) |
---|---|---|---|---|---|---|---|---|---|---|---|
1 | 5 | Male | West Belfast | 76 | 53.8 | 35 | 0 (0) | 1(20) | 2.8 (1.48) | 1 (20) | 5 (100) |
2 | 7 | Femalea | West Belfast | 76 | 54.7 | 33c | 4(57) | 0 (0) | 1.6 (1.81) | 2 (29) | 6 (86) |
3 | 5 | Malea | West Belfast | 76 | 64.6 | 31 | 0 (0) | 4 (80) | 0.6 (0.55) | 0 (0) | 5 (100) |
4 | 6 | Female | Urban mix | – | 72 | 26 | 1 (17) | 5 (83) | 4 (1.41) | 4 (67) | 6 (100) |
5 | 2 | Female | West Belfast | 76 | 56 | 29c | 1 (50) | 0 (0) | 3.5 (0.71) | 2 (100) | 2 (100) |
6 | 5 | Femalea | Holywood | 3 | 56.2 | 26 | 1 (20) | 0 (0) | 2.4 (1.14) | 2 (40) | 5 (100) |
7 | 6 | Male | Urban mix | – | 65.8 | 28c | 0 (0) | 5 (83) | 2.7 (0.52) | 5 (83) | 6 (100) |
8 | 6 | Female | Whiteabbey | 59 | 62.5 | 30 | 0 (0) | 4 (67) | 2.3 (1.97) | 4 (67) | 5 (83) |
9 | 3 | Female | Randalstownb | 5 | 70.3 | 28c | 1 (33) | 2 (67) | 1.3 (1.16) | 1 (33) | 3 (100) |
10 | 4 | Male | Randalstownb | 5 | 59.3 | 27 | 2 (50) | 2 (50) | 1 (0.82) | 0 (0) | 4 (100) |
11 | 11 | Femalea | Kilcoob | 7 | 75.1 | 25c | 5 (46) | 5 (46) | 2.3c (1.42) | 1 (10) | 9 (82) |
12 | 7 | Male | Urban mix | – | 64.6 | 29 | 0 (0) | 4 (57) | 2.3c (1.97) | 5 (71) | 7 (100) |
Motivating Factors | De-motivating factors | |
---|---|---|
Personal | Reason to change | Inconvenience |
People would need to be driven to attend those kind of things and if you felt you needed support you’d be more inclined to do it. FG1 (male, less affluent) | Once a week? Some of us are busy men. FG3 (male, less affluent) | |
You see for the likes of us and no transport at night, if things were held in the middle of the day it would be easier for them to get to. .. And then there’s some older people doesn’t like to go out at night. FG9 (female, more affluent) | ||
Measurements | Lack of interest | |
I need to be going face to face or getting on a scale with somebody and somebody saying to me, you know, you haven’t lost weight or you have lost weight to spur me on. FG5 (female, less affluent) And then the other thing that would be interesting would be for somebody to show evidence that by you changing your diet that it actually has helped your health. If you’re doing that for health and you’re really struggling because you really don’t like but if you feel that when you change and you’re feeling better and the results are coming, that your blood pressure’s coming down or your cholesterol and so on, because everybody needs just a little bit of reassurance that you’re succeeding. FG8 (female, less affluent) | I think with discussion groups, they’re okay but they fade out very quickly, especially in bad weather and all the rest of it. Who is going to get up if there’s something on the TV and they’re sitting with a beer or whatever it is, am I going to go into town to this discussion group about Mediterranean food? I think not. FG1 (male, less affluent) | |
If you maybe sort of feel it’s an awful night, I couldn’t be bothered going, that sort of thing, you can talk yourself out of the things quite often. FG4 (female) | ||
And part of the reason for that is distraction, “oh God, it’s a wet night.” “There’s a big match on the box” whatever. So the motivation, keeping the motivation, really your point puts that slightly differently, having the motivation to get started is one thing, sustaining that motivation and seeing the benefit is another thing. FG7 (male) | ||
Interpersonal | Support | Poor relationships |
And the fact that you’ve contacted somebody else who’s going through the same thing as you is good, because if you’ve got the urge to go back or retract then they’re encouraging you on, they’re saying, “stick with it.” FG9 (female, more affluent) | I think I would go for a mixture because a group is okay but if you’re there every week sometimes personality clashes come into play, no matter what group you’re in, should it be a sporting group, any kind of group. FG10 (male, more affluent) | |
Yeah, because there’ll always be things comes up. It happens where you won’t be able to make it 1 week, and then sometimes if you can’t make it 1 week and it happens the next week you can slowly drift away, so if you have a back-up there where you can phone and say “look, I’m not going to be able to get for a few weeks” and just keep in the loop with what’s going on or what’s happening. FG5 (female, less affluent) | It depends on the group too. If you get people who are a bit intrusive or going out and sharing things, but generally speaking I think groups meetings are useful. FG4 (female) | |
Accountability | ||
Yeah definitely. You’re getting help with managing it by discussing it with other people and usually in a group you’d be more inclined to think “I’ll give it a go because I don’t want to let myself down in front of everybody.” FG5 (female, less affluent) | ||
Because you’ve made the arrangement to be there you do go. It’s written in stone. FG8 (female, less affluent) | ||
Competitiveness | ||
It (telephone support) wouldn’t be for me because I’m the type of person who if I decide to do it I’m going to do it, and the only thing that would keep me going would be the group and seeing how well they’re doing, and maybe a wee bit of jealously. FG10 (male, more affluent) | ||
I think if you’re comparing weight and things like that it would motivate you. Say, you lost a pound 1 week and I didn’t, you know that sort of thing. FG4 (female) | ||
Role models/ Peer pressure | ||
Say someone had a good result, that result would help motivate the others to maybe stick to the diet. FG3 (male, less affluent) | ||
In a group situation there tends to be maybe a slight pressure on you to be seen to conform to what is good, simply because if you go each week then you want to be seen to be successful, and it does work. FG10 (male, more affluent) |
Characteristic | Important? n (%) | Males n (%) | Females n (%) |
---|---|---|---|
Similar age to you | 16 (25) | 7 (28) | 9 (23) |
Similar gender to you | 16 (25) | 5 (20) | 11 (28) |
Lives in the same area as you | 15 (23) | 5 (20) | 10 (25) |
Has successfully made the recommended changes to their diet | 54 (83) | 20 (80) | 34 (85) |
Is like you and wants to make similar changes to their diet. | 46 (71) | 18 (72) | 28 (70) |
Has expert dietary knowledge | 47 (72) | 17 (68) | 30 (75) |
Is someone you already know | 7 (11) | 4 (16) | 3 (8) |
Qualitative data collection
Qualitative data analysis
Results
Participant characteristics
Preference scoring questionnaire
Thematic analysis of focus groups
Theme 1: Components of an effective peer support group
Give people ideas and you learn from other people’s ideas. FG8 (female, less affluent).
I think with this sort of approach when you’re getting together with other people you’re able to sort of experience what other people are eating and see then, even swapping dietary advice, cooking tips and things like that there, ways to prepare food, even on a reasonable sort of budget, if you were trying to cook for a family but also for yourself. It would be a lot of knowledge from other people getting together. I always think you learn something which you maybe don’t know. FG5 (male, less affluent).
I think it’s always better to see a person and have that sort of human contact to know that there is someone on your side. An anonymous voice at the end of a telephone is not as reassuring, and if you have a face to that voice behind the phone, that’s fine as an extra support. But when you think you’ve got somebody in your corner and you’re looking at them and you’re talking to them and that’s helpful; an anonymous person at the end of the phone, no. FG8 (female, less affluent).People that need to make dietary changes and don’t see anyone face to face probably lie [laughter], because I would. “Yes, I’ve been really good I’ve been brilliant!” FG5 (male, less affluent).
It seems to me the effectiveness of the group would depend on two things. One of them would be the extent to which people are able to trust each other and be open and honest about what their habits really are, and secondly, if you’re going back and you know that somebody is going to say to you, “well, what changes have you made?” and you are going to be held to account. FG7 (male).
I think groups are good because not only do they convey a message, a collective message, you get a sense of bringing something together. FG10 (male, more affluent).
I’m just trying to imagine it, and I think it’s why I would be more comfortable in a group environment than with this (peer mentor approach), I think in a group environment you’re with a bunch of, if you like, fellow strugglers. FG7 (male).
Theme 2: Catalysing motivation
Theme 3: Stepping stones of change
The one to one is nice but it could be a bit intense after a while. FG8 (female, less affluent).
But I think, getting back to this whole situation, it does boil down to group support, and for some for a period of time maybe one to one just to keep you going. When you’re starting something new you need encouragement and that is when you might need it and then when you get going, if that person who you had as a one to one would always be at the end of the phone line if you needed to contact them to say help. FG8 (female, less affluent).
I think it very much depends on the individual. If you get a real shrinking violet they’ll not want a group session, whereas us four here, we can all talk the best and amongst each other but it’s what an individual’s character, what their makeup is too. FG10 (male, more affluent).
It’s like a personal trainer, I suppose, that type of idea. But I think the group idea is better than the one to one, I would prefer that myself, because if it’s a one to one it’s complete focus on each other and I don’t know, it just wouldn’t … I would prefer the group, I wouldn’t like the one to one basis, I wouldn’t really. FG4 (female).
I think the one to one to start with and then the group and maybe then that site that I can dip in and out of, because if shops ask me for my email and things like that I just couldn’t be bothered receiving all those. But if I knew there was a site there that I could go into and get some bits and pieces then, yes, I would do that. FG6 (female, more affluent).
Yeah, I like being in a group session and looking up a website and seeing different menus, easy steps to follow through. FG12 (male).
The group’s the best. Through the group you can expand all sorts of options, you could have ones meeting up for coffee to see how they’re getting on. If you had to phone Joe Bloggs, you know who Joe Bloggs is and what they look like and you know what they’re talking about, but not a complete anonymous voice. FG8 (female, less affluent).
Surely the lesson of life is that it’s neither one nor the other that might work but it’s usually a combination of things. FG10 (male, more affluent).
I sort of see a combination developing for me, just going through my head listening to the scenarios and different things. Initially you start off in a group. Some people are that wee bit more sort of confident and then can go off and do their own thing, some people aren’t just as confident maybe, they’re new to it and they need to learn skills, give them that extra help. And then the third step being … you were talking about links with computer, email and different things and then sort of stem off for that. So people get what they need out of it; if you need a lot you can get a lot. FG1 (male, less affluent).
Format and content of peer support groups
I would say you probably need more meetings at the start … to change and then less after that. But initially you would need more. FG6 (female, more affluent).
If someone’s very much overweight then there’s a good chance that there’s a greater risk of heart disease. I think that’s well accepted in society. If you’re overweight you’re putting more pressure on your heart, and so I think they already have an indicator. But someone like myself, I’m not skinny and I’m not overweight but I’m somewhere in between, people would be saying to me ‘what do you want to do that for? You’re all right.’ But if I had some kind of indicator that said ‘oh...’ then I might say ‘yeah, definitely, this is a good idea. Go for it.’ FG10 (male, more affluent).
If there was somebody living long term in the house you would want them involved for moral support as much as anything else. FG10 (male, more affluent).
Exploration of peer supporter characteristics
Subject | Theme | Illustrative Quote |
---|---|---|
Qualities | Empathetic |
Non-judgemental. So if you don’t succeed they’re not on your back and you know, “this is really what you should be doing” or you know, but just sort of be gentle. FG2
|
Encouraging |
You find a lot of these groups, WeightWatchers and some of these, the ones that are very popular are with somebody who is very good at taking the group and really is very motivated and motivates everybody else.FG4
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Sense of Humour | Has to be able to take a joke. FG3 | |
Attributes | Personal Experience |
I think you need a role model. You need someone that you can say, “well, if they’ve done it I can do it” and someone who’s been there will understand the pitfalls and give you good support. FG8
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Knowledge |
I think the supporter needs to have a basic understanding of health issues, because there’s no use Glenda and I, me saying to Glenda, “oh you just have to do this and your blood pressure will go down. Mine is down.” There’s obviously something different between your genetic makeup and mine that my blood pressure never goes up, and my husband’s on blood pressure tablets. So there’s no point me trying to support Glenda and saying “do this, do this because it worked for me.” There has to be a basic understanding of health issues and various things. FG4
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They are tuned in to people’s needs money wise and stuff, it’s not somebody coming from Malone [affluent area of Belfast] saying “oh you should have this, this and this” when really that’s not in people’s budgets, it’s not realistic. FG2
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Skills | Communication |
They have to be able to communicate the message in a convincing way. FG10
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Active Listening |
Somebody who listens and would have empathy but he or she doesn’t have to have anything in common, as long as you could have a rapport. FG1
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