An evaluation of Total Wellbeing Luton: an integrated health care pathway for physical and mental health

Abstract

Background: In the UK, there is a strong policy priority to the redesign of health services toward integrated physical and mental health care. Models of integrated physical and mental health have been shown to improve service users' health outcomes, reduce hospital admissions, and enhance patient satisfaction in comparison to usual care. The number of individuals with complex care needs is increasing, because of the concurrent chronic health conditions, mental health, and social challenges. Obesity and mental health are two of the public health priorities in the UK. 'Total Wellbeing Luton' is an example of an integrated care service for physical and mental health. Given that obesity and mental health are complex health problems, caused by a variety of influences, and the increasing interest around targeting complexity and applying system thinking to public health, it is a key priority for commissioners and service providers to understand the implementation and practice of an integrated healthcare service, under a Whole Systems Approach. The present study was commissioned to evaluate the effectiveness of 'Total Wellbeing Luton', an integrated care pathway for physical and emotional health, after the first year of the service, and suggest elements that require a change to reach a whole systems integration. Therefore the study was designed to create a framework of knowledge for improving the implementation and practice of 'Total Wellbeing Luton' under a Whole Systems Approach and to identify areas of improvement in the service.Methods: The study uses a mixed-methods design. A review of the available literature on integrated care interventions for obesity and mental health, under a whole-systems approach was conducted. In addition, semi-structured interviews were conducted with service providers, managers, coordinators, and healthcare professionals to understand their experiences and perceptions on the integration of healthy lifestyle and mental health services of 'Total Wellbeing Luton' and to understand how are shared and flow between participating organisations might affect the integration of services. Semi-structured interviews were also conducted with service users to understand the experiences and perceptions on the service they receive from 'Total Wellbeing Luton'. Lastly, routinely collected data was analysed to explore service users' sociodemographic characteristics associated with completion or drop out and to evaluate health and wellbeing outcomes associated with the completion of the "Weight Management" and "Improving Access to Psychological Therapies – IAPT" programmes of the service.Results: The scoping review identified a range of factors that facilitate and/or hinder the implementation, and practice of whole-systems integrated interventions to obesity and mental health. In addition, this study found that the integration of physical and mental health services in 'Total Wellbeing Luton' was affected by the organisational culture, human and financial resources, communication, and capacity building. The present study, also revealed what was the expectation and what is the reality of the integration of the services. The study documented how a single point of access, staff's awareness of the need for quality data, consistency in data collection, the functionality of health information systems, and the use of disconnected systems affect the integration of the services provided by Total Wellbeing Luton. Furthermore, the current study found that the dropout rate from the weight management programme was 77.5%. The strongest predictor of completion of the weight management programme is the area where the people live in. People who live in the least deprived areas were 3 times more likely to complete the WM programme than those who live in the most deprived areas (OR = 3.03, 95% CI: 1.19 – 7.73). The model which investigated whether any sociodemographic characteristics would predict the completion of the IAPT programme was not statistically significant, x2 (8, N= 233) = 3.57, p > .05, indicating that the model was not able to distinguish between those that did and did not complete the IAPT programme. Routinely collected data of 24 service users who have been identified as completers of both weight management and IAPT programme show that weight management and IAPT programme completion resulted significant reductions in weight, BMI, depression, and anxiety scores.Contribution to Knowledge: Findings from this study contribute to the development of an evidence base for integrated care, under a Whole Systems Approach, and can support commissioners, policy-makers, and service providers to improve the implementation and practice of integrated care initiatives in the future. In addition, the identified limitations of this study can suggest directions for future research.

Date of Award	Jun 2023
Original language	English
Awarding Institution	University of Bedfordshire
Supervisor	Yannis Pappas (Supervisor) & Angel Chater (Second supervisor)