Natalie An Qi Tham, Fredrik Kjell Bodell, Helen M Parretti, Helena Jopling, Zarnie Khadjesari
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Abstract
Background: Obesity is a leading cause of ill health in England and places a substantial burden on health systems and the economy. Behavioral weight management services (WMS) are central to reducing obesity-related risk, but their reach remains limited. Electronic signposting (eSignposting), which uses electronic health records and digital communication to connect patients with appropriate services, may improve access to behavioral WMS. Effective and equitable implementation of eSignposting requires a comprehensive understanding of the behavioral WMS ecosystem, including its key components and interdependencies.
Objective: This study aimed to characterize the behavioral WMS ecosystem in the East of England (Norfolk, Suffolk, and North-East Essex) to identify opportunities and considerations for implementing eSignposting.
Methods: A qualitative study was conducted using semi-structured interviews with professional stakeholders (n = 11) involved in the commissioning, referral, and delivery of behavioral WMS. Directed content analysis was used to develop ecosystem maps and a comprehensive inventory of services across the region.
Results: The findings revealed a complex behavioral WMS landscape spanning the local authority, national, commercial, and voluntary sectors. Self-referral and primary care referral emerged as the predominant routes to accessing behavioral WMS. Ecosystem maps identified key entry points where eSignposting could maximize reach and impact. Analysis of inter-stakeholder relationships also highlighted potential unintended consequences of eSignposting, including increased pressure on local services, preferential uptake of digitally accessible commercial programmes, and the risk of digital exclusion among underserved populations, enabling these issues to be proactively addressed in the future design and implementation of eSignposting.
Conclusion: The behavioral WMS ecosystem in East England is multifaceted and interconnected. Ecosystem mapping provides valuable insight into referral pathways and stakeholder relationships, supporting the development of effective and equitable eSignposting strategies to improve access to behavioral WMS while minimizing risks to service equity and sustainability.
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