title: Acceptability of delivery modes for lifestyle advice in a large scale randomised controlled obesity prevention trial.
abstract: BACKGROUND
  Preventing obesity is an international health priority and women living in rural communities are at an increased risk of weight gain. Lifestyle programs are needed as part of a comprehensive approach to prevent obesity. Evaluation provides a unique opportunity to investigate and inform improvements in lifestyle program implementation strategies. The Healthy Lifestyle Program for rural women (HeLP-her Rural) is a large scale, cluster randomized control trial, targeting the prevention of weight gain. This program utilises multiple delivery modes for simple lifestyle advice (group sessions, phone coaching, text messages, and an interactive program manual). Here, we describe the acceptability of these various delivery modes.
  
  
  METHODS
  A mixed-method process evaluation was undertaken measuring program fidelity, recruitment strategies, dose delivered, program acceptability and contextual factors influencing program implementation. Data collection methodologies included qualitative semi-structured interviews for a sub-group of intervention participants [n = 28] via thematic analysis and quantitative methods (program checklists and questionnaires [n = 190]) analysed via chi square and t-tests.
  
  
  RESULTS
  We recruited 649 women from 41 rural townships into the HeLP-her Rural program with high levels of program fidelity, dose delivered and acceptability. Participants were from low socioeconomic townships and no differences were detected between socioeconomic characteristics and the number of participants recruited across the towns (p = 0.15). A face-to-face group session was the most commonly reported preferred delivery mode for receiving lifestyle advice, followed by text messages and phone coaching. Multiple sub-themes emerged to support the value of group sessions which included: promoting of a sense of belonging, mutual support and a forum to share ideas. The value of various delivery modes was influenced by participant's various needs and learning styles.
  
  
  CONCLUSIONS
  This comprehensive evaluation reveals strong implementation fidelity and high levels of dose delivery. We demonstrate reach to women from relatively low income rural townships and highlight the acceptability of low intensity healthy lifestyle programs with mixed face-to-face and remote delivery modes in this population. Group education sessions were the most highly valued component of the intervention, with at least one face-to-face session critical to successful program implementation. However, lifestyle advice via multiple delivery modes is recommended to optimise program acceptability and ultimately effectiveness.
  
  
  BACKGROUND
  Australia & New Zealand Clinical Trial Registry. Trial number ACTRN12612000115831, date of registration 24/01/2012.
authors.affiliation: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Locked Bag 29, Monash Medical Centre, Clayton, VIC, 3168, Australia. samantha.kozica@monash.edu.
authors.forename: S L
authors.initials: SL
authors.lastname: Kozica
authors.affiliation: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Locked Bag 29, Monash Medical Centre, Clayton, VIC, 3168, Australia. catherine.lombard@monash.edu.
authors.forename: C B
authors.initials: CB
authors.lastname: Lombard
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Victoria, Australia. cheryce.harrison@monash.edu.
authors.forename: D
authors.initials: D
authors.lastname: Ilic
authors.affiliation: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Locked Bag 29, Monash Medical Centre, Clayton, VIC, 3168, Australia. nicole.ng@monash.edu.
authors.forename: S
authors.initials: S
authors.lastname: Ng
authors.affiliation: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Locked Bag 29, Monash Medical Centre, Clayton, VIC, 3168, Australia. dragan.ilic@monash.edu.au.
authors.forename: C L
authors.initials: CL
authors.lastname: Harrison
authors.affiliation: Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Locked Bag 29, Monash Medical Centre, Clayton, VIC, 3168, Australia. helena.teede@monash.edu.|Diabetes and Vascular Medicine Unit, Monash Health, Victoria, Australia. helena.teede@monash.edu.
authors.forename: H J
authors.initials: HJ
authors.lastname: Teede
mesh_terms: D000328:Adult; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009765:Obesity / Q000517:prevention & control*; D015397:Program Evaluation; D012107:Research Design; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D060145:Text Messaging; D014739:Victoria; D015430:Weight Gain