Exploring the Religious Practice of Langar as a Route to Health Promotion in the Sikh Community in Northern England: A Qualitative Study.

Cardiovascular disease and type 2 diabetes are prevalent among UK South Asians. Langar is a Sikh religious food practice that could be important in dietary health promotion. This study explored perceptions of langar, its role in health, readiness and strategies for change and whether Gurdwaras (Sikh place of worship) are able to support change. Using an exploratory qualitative design, we conducted eight focus groups and one single interview with 28 Gurdwara attendees (12 males, 16 females), analysing transcripts using thematic analysis. Four themes were developed that described the meaning of langar, the understanding of health among Sikhs, the evolution of langar and implications for health and changing langar to protect health. It can be concluded that any change to langar needs to be gradual, respectful and widely supported. This research has scope to continue in light of the potential impact on health for the Sikh community.

Feasibility and acceptability of an education and training e-resource to support the sexuality, intimacy and relationship needs of older care home residents: a mixed methods study.

BACKGROUND: sexuality, intimacy and relationship needs are often a neglected aspect of the care of older adults in residential care facilities. Improving awareness, knowledge and improving attitudes about these needs among care staff could enhance quality of care and lead to better outcomes for residents. OBJECTIVE: to evaluate the feasibility and acceptability of a co-designed education and training e-resource to help care staff support their residents' sexuality, intimacy and relationship needs. METHODS: we delivered the education and training e-resource to five UK care homes over a 6-month period in a pre-post mixed methods study using surveys, focus groups and individual interviews. RESULTS: fifty-nine members of staff from participating care homes undertook the education and training e-resource. 18/59 (31%) of participants completed all six modules and the pre-post surveys. Eleven participants participated in focus groups/interviews to explore experiences of using the e-resource. The e-resource was successfully implemented in the study homes and found to be acceptable. We found preliminary evidence of positive changes in staff attitudes. Factors that facilitated implementation included support from the care home manager. Barriers identified included IT infrastructure and technology. CONCLUSIONS: the findings provide initial evidence that a co-designed education and training e-resource raised awareness of, and improved attitudes towards, older adults' sexuality and intimacy needs. This work provides the foundation for a next phase to establish the effectiveness of the e-resource on staff practice and resident outcomes.

A scoping review of education and training resources supporting care home staff in facilitating residents' sexuality, intimacy and relational needs.

BACKGROUND: Having positive intimate, sexual and relational experiences is an important issue for older adults in care settings, yet little is known on the extent to which nursing staff and care workers have received education or training in addressing and meeting these needs among older residents. This scoping review aimed to identify and examine what education and training resources exist to assist nursing staff and care workers to meet their residents' needs in this area. METHODS AND ANALYSIS: Using the Arksey and O'Malley framework, we systematically searched papers and grey literature to identify education interventions and resources that aimed to facilitate care home staff to meet their residents' sexuality, intimacy and relational needs. RESULTS: Eleven studies (one dissertation) and three education resources met the inclusion criteria; most were conducted in the USA and Australia. Across the studies and resources identified, the education content was mixed and the methodology, presentation, design and duration varied widely. The focus of the education interventions and resources was to increase knowledge and improve and/or change attitudes towards the: (i) sexual expression of older people living in residential aged care, (ii) sexuality and ageing and (iii) expression of sexuality in people with dementia. CONCLUSION: Few education interventions and training resources were identified. The findings suggest that education interventions can improve knowledge and/or change care staff attitudes, in the short-term, towards older people's sexuality, intimacy and relational needs in care home settings, which can lead to facilitating staff to enhance person-centred care in this area of need.

Barrett's oesophagus: A qualitative study of patient burden, care delivery experience and follow-up needs.

BACKGROUND: Barrett's oesophagus (BO), a precursor to oesophageal adenocarcinoma, requires long-term endoscopic surveillance. The rising incidence of this chronic disease has implications for service provision and patient burden. Few studies have explored BO patients' personal burden, care delivery experience and participation in health-care delivery decisions. OBJECTIVE: To identify and explore factors impacting BO patients' health-related quality of life, follow-up needs and views on new models of follow-up care. DESIGN: An exploratory qualitative approach was adopted using semi-structured, in-depth, one-to-one interviews, audio-recorded and transcribed verbatim. Patients undergoing BO surveillance, at a single NHS hospital, were recruited using purposive sampling with the aim of achieving maximum variation. Data were analysed using framework analysis approach, supported by NVivo Pro 11. RESULTS: Data saturation occurred after 20 participant interviews. Ten subthemes and three main themes emerged from the analysis: (a) burden of disease-symptom control, worry of oesophageal cancer and surveillance endoscopy; (b) follow-up experiences-follow-up care, at this NHS hospital, was found to be inconsistent and often inadequate to meet patients' needs, in particular a lack of disease-specific information; and (c) follow-up needs-participants sought enhanced communication, organization and structure of care. They highly valued face-to-face interaction with a specialist, and the concept of direct secondary care access in-between endoscopies was reassuring to participants. CONCLUSIONS: This qualitative research provides an in-depth account of the patients' perspective of BO, the effectiveness of follow-up care and patient opinion on new follow-up systems.

Ethnic differences in sedentary behaviour in 6-8-year-old children during school terms and school holidays: a mixed methods study.

BACKGROUND: Sedentary behaviour (SB) in childhood is a major public health concern. Little is known about ethnic differences in SB during school and holiday weeks among White British (WB) and South Asian (SA) children, which this study aims to address through investigating inclinometer measured SB and exploring reasons for child engagement in SB. METHODS: A mixed methods study, comprising of a quantitative investigation with 160, 6-8 years old children and a qualitative study with a subsample of 18 children, six parents and eight teachers was undertaken. Children of WB and SA ethnicity in three schools were invited to wear inclinometers for seven school terms (summer/winter/spring) and seven holidays (winter/spring) days during July 2016-May 2017. Total SB, SB accumulated in bouts > 30 min and breaks in SB were explored using multivariate linear mixed effects models which adjusted for wear time, sex, deprivation, overweight status, season, term, weekday and school. Nine focus groups and two interviews were carried out using the Theoretical Domains Framework to explore SB perceptions among parents, teachers and children. Data were analysed using the Framework Approach. RESULTS: 104/160 children provided 836 valid days of data. Children spent on average eight hours of SB/day during term time and holidays, equating to 60% of their awake time, and had on average 111 SB breaks /day. SA children had 25 fewer SB breaks/ day when compared to WB (p < 0.001). Perceived reasons for engagement in SB included: boredom, enjoyment of screen activities (by children), parenting practices, curriculum pressures (by teachers), the need to sit down and learn, and child's preference for screen activities (by parents). CONCLUSIONS: Children spent 60% of their awake time being sedentary, regardless of ethnicity or school term. There were no significant ethnic differences for any of the SB outcomes except for breaks in SB. Interventions aimed at reducing SB should consider involving parents and teachers and should focus on increasing breaks in SB, especially for SA children, who are at a higher risk of cardio metabolic ill health.

Multiple influences on participating in physical activity in older age: Developing a social ecological approach.

BACKGROUND: Evidence of the benefits of engaging in physical activity (PA) is strong, yet the number of older adults meeting the recommended 150 min/wk is low. Policy to increase uptake and adherence has focussed on the health benefits of PA, but may not be the most successful approach. OBJECTIVE: This qualitative study sought to ask older adults what the components of a successful intervention to promote PA would be, by asking active older adults what motivated them to be active and asking inactive older adults what might encourage them to change. DESIGN, SETTING AND PARTICIPANTS: Focus groups and semi-structured interviews were held with 60 community-dwelling older adults, aged 50-87 years. Framework analysis was used to analyse the data, and themes congruent with a social ecological model of behaviour change were developed. FINDINGS: Five themes emerged that influenced PA engagement at multiple levels: individual; interpersonal; perceived environment; community or organizational; and policy. PA engagement was determined by attitude or health status for some participants, but for the majority, PA being enjoyable, sociable, affordable, accessible, flexible and seasonal were more important than the health benefits. DISCUSSION AND CONCLUSIONS: A social ecological model is presented, highlighting the fact that both motivated and unmotivated older adults need to have a range of appropriately labelled, appealing and accessible activities to choose from when thinking about engaging in PA. Policymakers and practitioners need to ensure that their offers of activity sessions are easy to access and easy to remain involved in.

Openness, inclusion and transparency in the practice of public involvement in research: A reflective exercise to develop best practice recommendations.

CONTEXT: Reflective accounts of public involvement in research (PI) are important for helping researchers plan and deliver more effective PI activities. In particular, there is a need to address power differentials between team members that can prohibit effective and meaningful involvement. OBJECTIVE: To critically reflect on the PI practices that underpinned our research project on intimacy and sexuality in care homes, to develop a series of recommendations for improving future PI activities. SETTING: The research team comprised five academics from nursing, public health, sociology and psychology, and two members of the public with experience of sex education, and lesbian, gay, bisexual and trans issues in older populations. In order to address power differentials within the group, we developed an approach to PI practice that was grounded in values of openness, inclusion and transparency. METHOD: Reflective commentaries on the strengths and weaknesses of the team's approach to PI were gathered through interviews and open-ended questionnaires with research team members. These views were collated and discussed at a workshop comprising research team members and an additional member of the public to generate recommendations for future PI practice. RESULTS: A number of strengths and limitations of our approach to PI were identified. Clear recommendations for improving PI practice were developed for three broad areas of identified difficulty: (i) communication within and between meetings; (ii) the roles and responsibilities of team members; and (iii) PI resources and productivity. DISCUSSION AND CONCLUSION: These recommendations add to the developing body of guidance for conducting effective PI.

Exercise and physical activity in asylum seekers in Northern England; using the theoretical domains framework to identify barriers and facilitators.

BACKGROUND: Many asylum seekers have complex mental health needs which can be exacerbated by the challenging circumstances in which they live and difficulties accessing health services. Regular moderate physical activity can improve mental health and would be a useful strategy to achieve this. Evidence suggests there are barriers to engaging black and minority ethnic groups in physical activity, but there is little research around asylum seekers to address the key barriers and facilitators in this group. METHODS: A two stage qualitative study used semi-structured interviews underpinned by the Theoretical Domains Framework. The interviews were conducted in voluntary sector groups in four towns/ cities in Northern England. Purposive sampling recruited 36 asylum seekers from 18 different countries. Interviews were audio recorded, transcribed verbatim and subject to framework analysis. Stage two involved a nominal group technique with five key stakeholders including asylum seekers and those that work with them. They followed a four stage process to rank and reach consensus on the key barrier to undertaking physical activity/ exercise that could be addressed locally through a future intervention. RESULTS: A number of barriers and facilitators were identified including a lack of understanding of the term physical activity and recommended levels but knowledge of the health benefits of physical activity/ exercise and the motivation to increase levels having engaged with activities back home. Living as an asylum seeker was considered a barrier due to the stress, poverty and temporary nature of living in an unfamiliar place. The outcome of the nominal group technique was that a lack of knowledge of facilities in the local area was the prevailing barrier that could be addressed. CONCLUSIONS: Public health practitioners could develop interventions which capitalise on the motivation and knowledge of asylum seekers to encourage an increase in physical activity which may in turn reduce the breadth and depth of mental health needs of this group.

The challenges and opportunities in researching intimacy and sexuality in care homes accommodating older people: a feasibility study.

AIM: To explore the challenges of conducting research on sexuality and intimacy among older care home residents. BACKGROUND: Sexuality and intimacy are neglected in care policies and practices. DESIGN: Qualitative analytical study drawing on poststructuralist theorizing. METHODS: Semi-structured interviews were conducted with residents and spouses (n = 6) and care staff (n = 16) in two care homes in Northwest England in 2014. The sample was obtained through a network of 'research-ready' care homes. Thematic analysis was used to make sense of narratives with the aid of NVivo10. RESULTS: Participant responses highlight the workings of ageist erotophobic discourse that undergirds the assumption of residents (and old people generally) as postsexual. This materialized in reservations about the research ranging from opposition on moral grounds to doubts about its feasibility given the age-group concerned. However, residents and care home staff can also draw on counter-discourses that resist/challenge ageist erotophobic thinking, which materialized in methodological and ethical recommendations. CONCLUSION: Participants generally agreed with the principle of the research and made recommendations that could counter/resist ageist erotophobic governance and guide researchers on sampling, style of questioning and communicating with (prospective) study participants on a sensitive subject.

A comparison of job descriptions for nurse practitioners working in out-of-hours primary care services: implications for workforce planning, patients and nursing.

AIMS AND OBJECTIVES: To compare and contrast job descriptions for nursing roles in out-of-hours services to obtain a general understanding of what is required for a nurse working in this job. BACKGROUND: Out-of-hours services provide nursing services to patients either through telephone or face-to-face contact in care centres. Many of these services are newly created giving job opportunities to nurses working in this area. It is vital that nurses know what their role entails but also that patients and other professionals know how out-of-hours nurses function in terms of competence and clinical role. DESIGN: Content analysis of out-of-hours job descriptions. METHOD: Content analysis of a convenience sample of 16 job descriptions of out-of-hours nurses from five out-of-hours care providers across England was undertaken. The findings were narratively synthesised, supported by tabulation. RESULTS: Key role descriptors were examined in terms of job titles, managerial skills, clinical skills, professional qualifications and previous experience. Content analysis of each out-of-hours job description revealed a lack of consensus in clinical competence and skills required related to job title although there were many similarities in skills across all the roles. CONCLUSION: This study highlights key differences and some similarities between roles and job titles in out-of-hours nursing but requires a larger study to inform workforce planning. RELEVANCE TO CLINICAL PRACTICE: Out-of-hours nursing is a developing area of practice which requires clarity to ensure patient safety and quality care.

Development and feasibility testing of an oral hygiene intervention for stroke unit care.

OBJECTIVE: To develop an oral hygiene complex intervention and evaluate its feasibility in a single UK stroke centre. BACKGROUND: Oral hygiene interventions might improve clinical outcomes after stroke but evidence-based practice is lacking. MATERIALS AND METHODS: We used a sequential mixed methods approach and developed an oral hygiene complex intervention comprising: (i) web-based education and 'hands-on' practical training for stroke unit nursing staff, (ii) a pragmatic oral hygiene protocol consisting of twice-daily powered (or manual if preferred) brushing with chlorhexidine gel (or non-foaming toothpaste) ± denture care. We evaluated feasibility of (i) the staff education and training and (ii) the oral hygiene protocol in consenting inpatients with confirmed stroke, requiring assistance with at least one aspect of personal care. RESULTS: The staff education and training were feasible, acceptable and raised knowledge and awareness. Several barriers to completing the education and training were identified. The oral hygiene protocol was feasible and well-tolerated. 22% of eligible patients screened declined participation in the study. Twenty-nine patients (median age = 78 year; National Institutes of Health Stroke Scale score = 8.5; 73% dentate) were recruited at a median of 7 days from stroke onset. 97% of participants chose the default chlorhexidine-based protocol; the remainder chose the non-foaming toothpaste-based protocol. The mouth hygiene protocol was administered as prescribed on 95% of occasions, over a median duration of 28 days. There were no adverse events attributed to the oral hygiene protocol. CONCLUSION: Our oral hygiene complex intervention was feasible in a single UK stroke centre. Further studies to optimise patient selection, model health economics and explore efficacy are now required.

Older Adults' Uptake and Adherence to Exercise Classes: Instructors' Perspectives.

Exercise classes provide a range of benefits for older adults, but adherence levels are poor. We know little of instructors' experiences of delivering exercise classes to older adults. Semistructured interviews, informed by the Theory of Planned Behavior (TPB), were conducted with instructors (n = 19) delivering multicomponent exercise classes to establish their perspectives on older adults' uptake and adherence to exercise classes. Analysis revealed 'barriers' to uptake related to identity, choice/control, cost, and venue, and 'solutions' included providing choice/control, relating exercise to identity, a personal touch, and social support. Barriers to adherence included unrealistic expectations and social influences, and solutions identified were encouraging commitment, creating social cohesion, and an emphasis on achieving outcomes. Older adults' attitudes were an underlying theme, which related to all barriers and solutions. The instructor plays an important, but not isolated, role in older adults' uptake and adherence to classes. Instructors' perspectives help us to further understand how we can design successful exercise classes.

Sexuality and intimacy among care home residents.

Discussing sexuality and intimacy with older people can be problematic, so it is not uncommon that their needs go unrecognised. This article identifies barriers to addressing sexuality and intimacy needs, and outlines some simple strategies to raise awareness of them among older care home residents and staff, thereby facilitating a discussion to enable such needs to be met.

Development of a patient-centred, patient-reported outcome measure (PROM) for post-stroke cognitive rehabilitation: qualitative interviews with stroke survivors to inform design and content.

BACKGROUND: Improving cognition is service users' top research priority for life after stroke, and future research should include outcomes that they deem important. Patient perspectives on outcomes are collected using patient-reported outcome measures (PROMs). There is currently no patient-centred PROM specific for cognitive rehabilitation trials. OBJECTIVE: Inform PROM development by exploring stroke survivor perspectives on the important, measurable impacts of persisting post-stroke cognitive problems. DESIGN: Qualitative semi-structured interviews in participants' homes. PARTICIPANTS: Purposive sample of 16 cognitively impaired stroke survivors at least six months post-stroke. METHODS: Interviews used a schedule and communication aids developed through patient consultation. Interviews were transcribed verbatim with non-verbal communication recorded using field notes. Data were analysed using a framework approach to find commonalities to shape the focus and content of an outcome measure. RESULTS: Participants identified important impacts of their 'invisible' cognitive problems, outside of other stroke-related impairments. Cognitive problems exacerbated emotional issues and vice versa. Changes in self-identity and social participation were prominent. Impact was not spoken about in terms of frequency but rather in terms of the negative affect associated with problems; terms like 'bothered' and 'frustration' were often used. CONCLUSIONS: The results support the development of a PROM specifically designed to address the impact of cognitive problems. It should: include items addressing a comprehensive range of cognitive skills; ask questions about mood, self-identity and social participation; use accessible wording that respondents understand and endorse; measure impact rather than frequency; and explore perceived impact on carers.

Organisation, practice and experiences of mouth hygiene in stroke unit care: a mixed-methods study.

AIMS AND OBJECTIVES: To (1) investigate the organisation, provision and practice of oral care in typical UK stroke units; (2) explore stroke survivors', carers' and healthcare professionals' experiences and perceptions about the barriers and facilitators to receiving and undertaking oral care in stroke units. BACKGROUND: Cerebrovascular disease and oral health are major global health concerns. Little is known about the provision, challenges and practice of oral care in the stroke unit setting, and there are currently no evidence-based practice guidelines. DESIGN: Cross-sectional survey of 11 stroke units across Greater Manchester and descriptive qualitative study using focus groups and semi-structured interviews. METHODS: A self-report questionnaire was used to survey 11 stroke units in Greater Manchester. Data were then collected through two focus groups (n = 10) with healthcare professionals and five semi-structured interviews with stroke survivors and carers. Focus group and interview data were recorded, transcribed verbatim and analysed using framework approach. RESULTS: Eleven stroke units in Greater Manchester responded to the survey. Stroke survivors and carers identified a lack of oral care practice and enablement by healthcare professionals. Healthcare professionals identified a lack of formal training to conduct oral care for stroke patients, inconsistency in the delivery of oral care and no set protocols or use of formal oral assessment tools. CONCLUSION: Oral care post-stroke could be improved by increasing healthcare professionals' awareness, understanding and knowledge of the potential health benefits of oral care post-stroke. Further research is required to develop and evaluate the provision of oral care in stroke care to inform evidence-based education and practice. RELEVANCE TO CLINICAL PRACTICE: Development of staff training and education, and evidence-based oral care protocols may potentially benefit patient care and outcomes and be implemented widely across stroke care.

The study protocol of: 'Initiating end of life care in stroke: clinical decision-making around prognosis'.

BACKGROUND: The initiation of end of life care in an acute stroke context should be focused on those patients and families with greatest need. This requires clinicians to synthesise information on prognosis, patterns (trajectories) of dying and patient and family preferences. Within acute stroke, prognostic models are available to identify risks of dying, but variability in dying trajectories makes it difficult for clinicians to know when to commence palliative interventions. This study aims to investigate clinicians' use of different types of evidence in decisions to initiate end of life care within trajectories typical of the acute stroke population. METHODS/DESIGN: This two-phase, mixed methods study comprises investigation of dying trajectories in acute stroke (Phase 1), and the use of clinical scenarios to investigate clinical decision-making in the initiation of palliative care (Phase 2). It will be conducted in four acute stroke services in North Wales and North West England. Patient and public involvement is integral to this research, with service users involved at each stage. DISCUSSION: This study will be the first to examine whether patterns of dying reported in other diagnostic groups are transferable to acute stroke care. The strengths and limitations of the study will be considered. This research will produce comprehensive understanding of the nature of clinical decision-making around end of life care in an acute stroke context, which in turn will inform the development of interventions to further build staff knowledge, skills and confidence in this challenging aspect of acute stroke care.

Perceived barriers to initiating and maintaining physical activity among South Asian and White British adults in their 60s living in the United Kingdom: a qualitative study.

OBJECTIVE: To explore the barriers to initiating and maintaining regular physical activity (PA) among UK Indian, Pakistani and White British adults in their 60s. DESIGN: An exploratory qualitative approach was utilised using 15 focus groups and 40 in-depth interviews. Purposive sampling was used to recruit participants with different experiences of participation or non-participation in PA. RESULTS: Misunderstandings about the value of exercise in later life, particularly for those with ongoing healthcare problems, were identified in UK South Asian and White British older adults' accounts of their experience of the barriers to initiating and maintaining regular PA. Both groups and genders said that PA could exacerbate pre-existing health problems and result in physical harm. Although most beliefs were similar to those of the White British, ethnic-specific factors, such as language barriers, religious beliefs and cultural practices could act as additional barriers to undertaking and maintaining PA among UK South Asian older adults. CONCLUSIONS AND IMPLICATIONS: Understanding the multiple levels of influence on older adults' PA behaviour can provide the basis for developing comprehensive approaches to health promotion initiatives aimed at increasing PA levels. Healthcare providers need to understand the characteristics and specific barriers faced by these groups of older adults; work with older people from these groups to develop culturally appropriate PA programmes and address the misunderstandings and misconceptions about the value of exercise in later-life, particularly in those with ongoing health problems.

What are the barriers and facilitators to exercise and physical activity uptake and adherence among South Asian older adults: a systematic review of qualitative studies.

OBJECTIVE: The objective of this study is to synthesise views and experiences of South Asian (SA) older adults in relation to exercise and physical activity (PA). It was anticipated that this work would identify barriers and facilitators that could inform interventions aimed at promoting PA among this population. METHOD: A systematic review of qualitative research was conducted. Six electronic databases were searched for relevant papers published from January 2000 to October 2011. Studies were appraised and data extracted by two reviewers. A synthesis was undertaken using framework analysis. Of 26 papers read in full, 11 were included in the review. RESULTS: An overriding concept derived from the synthesis was the influence of empowering and disempowering contexts on PA levels of SA participants. It was supported by the following themes: communication (e.g. relying on relatives for translation of information, lack of understanding); relationships (e.g. social support from family, friends, community), beliefs (e.g. not culturally appropriate to exercise, fatalism) and environment (e.g. lack of accessible recreational areas/facilities). CONCLUSIONS: Drawing on community resources to generate group norms appears to be important when trying to increase exercise and PA among SA older adults. Implications of the results for PA promotion and provision are discussed.

Using Personalized Avatars as an Adjunct to an Adult Weight Loss Management Program: Randomized Controlled Feasibility Study.

BACKGROUND: Obesity is a global public health concern. Interventions rely predominantly on managing dietary intake and increasing physical activity; however, sustained adherence to behavioral regimens is often poor. The lack of sustained motivation, self-efficacy, and poor adherence to behavioral regimens are recognized barriers to successful weight loss. Avatar-based interventions achieve better patient outcomes in the management of chronic conditions by promoting more active engagement. Virtual representations of self can affect real-world behavior, acting as a catalyst for sustained weight loss behavior. OBJECTIVE: We evaluated whether a personalized avatar, offered as an adjunct to an established weight loss program, can increase participant motivation, sustain engagement, optimize service delivery, and improve participant health outcomes. METHODS: A feasibility randomized design was used to determine the case for future development and evaluation of avatar-based technology in a randomized controlled trial. Participants were recruited from general practitioner referrals to a 12-week National Health Service weight improvement program. The main outcome measure was weight loss. Secondary outcome measures were quality-of-life and self-efficacy. Quantitative data were subjected to descriptive statistical tests and exploratory comparison between intervention and control arms. Feasibility and acceptability were assessed through interviews and analyzed using framework approach. Health Research Authority ethics approval was granted. RESULTS: Overall, 10 men (n=7, 70% for routine care and avatar and n=3, 30% for routine care) and 33 women (n=23, 70% for intervention and n=10, 30% for routine care) were recruited. Participants' initial mean weight was greater in the intervention arm than in the routine care arm (126.3 kg vs 122.9 kg); pattern of weight loss was similar across both arms of the study in T0 to T1 period but accelerated in T1 to T2 period for intervention participants, suggesting that access to the self-resembling avatar may promote greater engagement with weight loss initiatives in the short-to-medium term. Mean change in participants' weight from T0 to T2 was 4.5 kg (95% CI 2.7-6.3) in the routine care arm and 5.3 kg (95% CI 3.9-6.8) in the intervention arm. Quality-of-life and self-efficacy measures demonstrated greater improvement in the intervention arm at both T1 (105.5 for routine care arm and 99.7 for intervention arm) and T2 (100.1 for routine care arm and 81.2 for intervention arm). Overall, 13 participants (n=11, 85% women and n=2, 15% men) and two health care professionals were interviewed about their experience of using the avatar program. CONCLUSIONS: Participants found using the personalized avatar acceptable, and feedback reiterated that seeing a future self helped to reinforce motivation to change behavior. This feasibility study demonstrated that avatar-based technology may successfully promote engagement and motivation in weight loss programs, enabling participants to achieve greater weight loss gains and build self-confidence. TRIAL REGISTRATION: ISRCTN Registry 17953876; https://doi.org/10.1186/ISRCTN17953876.