title: Cluster randomised trial of a tailored intervention to improve the management of overweight and obesity in primary care in England.
abstract: Tailoring is a frequent component of approaches for implementing clinical practice guidelines, although evidence on how to maximise the effectiveness of tailoring is limited. In England, overweight and obesity are common, and national guidelines have been produced by the National Institute for Health and Care Excellence. However, the guidelines are not routinely followed in primary care.
  
  
  
  A tailored implementation intervention was developed following an analysis of the determinants of practice influencing the implementation of the guidelines on obesity and the selection of strategies to address the determinants. General practices in the East Midlands of England were invited to take part in a cluster randomised controlled trial of the intervention. The primary outcome measure was the proportion of overweight or obese patients offered a weight loss intervention. Secondary outcomes were the proportions of patients with (1) a BMI or waist circumference recorded, (2) record of lifestyle assessment, (3) referred to weight loss services, and (4) any change in weight during the study period. We also assessed the mean weight change over the study period. Follow-up was for 9 months after the intervention. A process evaluation was undertaken, involving interviews of samples of participating health professionals.
  
  
  
  There were 16 general practices in the control group, and 12 in the intervention group. At follow-up, 15.08 % in the control group and 13.19 % in the intervention group had been offered a weight loss intervention, odds ratio (OR) 1.16, 95 % confidence interval (CI) (0.72, 1.89). BMI/waist circumference measurement 42.71 % control, 39.56 % intervention, OR 1.15 (CI 0.89, 1.48), referral to weight loss services 5.10 % control, 3.67 % intervention, OR 1.45 (CI 0.81, 2.63), weight management in the practice 9.59 % control, 8.73 % intervention, OR 1.09 (CI 0.55, 2.15), lifestyle assessment 23.05 % control, 23.86 % intervention, OR 0.98 (CI 0.76, 1.26), weight loss of at least 1 kg 42.22 % control, 41.65 % intervention, OR 0.98 (CI 0.87, 1.09). Health professionals reported the interventions as increasing their confidence in managing obesity and providing them with practical resources.
  
  
  
  The tailored intervention did not improve the implementation of the guidelines on obesity, despite systematic approaches to the identification of the determinants of practice. The methods of tailoring require further development to ensure that interventions target those determinants that most influence implementation.
  
  
  
  ISRCTN07457585.
authors.affiliation: Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, LE1 6TP, UK.|Faculty of Health and Life Sciences, Coventry University, Richard Crossman Building, Priory Street, Coventry, CV1 5FB, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Goodfellow
authors.affiliation: Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, LE1 6TP, UK.
authors.forename: Shona
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, LE1 6TP, UK.
authors.forename: Fawn
authors.initials: F
authors.lastname: Harrad
authors.affiliation: Saffron Group Practice, 509 Saffron Lane, Leicester, Leicester, UK.
authors.forename: David
authors.initials: D
authors.lastname: Shepherd
authors.affiliation: Leicester Clinical Trials Unit, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Morris
authors.affiliation: Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, LE1 6TP, UK.|Department of Mathematical Statistics and Actuarial Science, University of the Free State, Bloemfontein, 9300, South Africa.
authors.forename: Arne
authors.initials: A
authors.lastname: Ring
authors.affiliation: Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, LE1 6TP, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Walker
authors.affiliation: Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, LE1 6TP, UK.|Clinical Lead for Applied Health Research Northamptonshire Healthcare Foundation Trust, Berrywood Hospital, Northampton, NN5 6UD, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Rogers
authors.affiliation: Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, LE1 6TP, UK. rb14@leicester.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Baker
mesh_terms: D001294:Attitude to Health; D015992:Body Mass Index; D016000:Cluster Analysis; D003695:Delivery of Health Care / Q000592:standards; D004739:England; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D019983:Guideline Adherence; D000070497:Healthy Lifestyle; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009765:Obesity / Q000628:therapy; D050177:Overweight / Q000628:therapy*; D010174:Pamphlets; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care; D058996:Quality Improvement; D016896:Treatment Outcome; D055105:Waist Circumference; D061217:Weight Reduction Programs