Developing implementation strategies for a community-based digital weight management program: A hybrid deductive-inductive thematic analysis grounded in implementation theory.
Han Shi Jocelyn Chew, Wen Wei Ang, Xuanming Sherman Tan and 3 others
PMID 42266856WHAT IT FOUND
Implementers and patients described a dual expectation gap: patients found counseling either too brief or long-winded, while clinicians expected patients to self-manage.
Nurses were identified as key implementers for coaching and care coordination.
Key findings
01A 'dual expectation gap' exists where patients describe counseling as either too brief or long-winded and unhelpful, while implementers expect patients to take greater initiative in their own care.
02Nurses are proposed as essential implementers for community-based weight management, utilizing their skills in patient education, health coaching, and care coordination to bridge the gap between clinical settings and community adoption.
03Incentive systems (such as vouchers or health credits) and physician endorsement were identified as consistent facilitators for engaging both adopters and implementers in weight management programs.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The small number of adopter interviews (n=3) limits the diversity of patient perspectives, particularly regarding underrepresented groups like men and younger adults. The findings are specific to the Singaporean healthcare context, including its high-throughput care model and cultural norms, and may not generalize to other health systems. The proposed implementation strategies are theoretical mappings from qualitative data and have not been tested for feasibility or effectiveness in practice. The face-to-face workshop format for implementers may have introduced social desirability bias, potentially suppressing critical views.
Declared interests
The authors declared no conflicts of interest. The study was supported by the NUS–NUHS HPHSR Enabling Grant, which had no role in the study design, data collection, analysis, or writing.
The easy way to misread this
Do not interpret the proposed implementation strategies as evidence that nurse-led digital weight management improves patient outcomes. The study maps barriers to theoretical strategies but does not test whether these strategies work or whether they lead to sustainable weight loss.