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Citation

Macaulay L, O’Dolan C, Swingler J, Torrens C, MacLean A, Turner K, Avenell A, Cotton S, Dombrowski SU, Gray CM, MacLennan G, Hunt K, Kee F, McKinley MC & Hoddinott P (2024) Men with long-term conditions in the Game of Stones text messaging and financial incentives trial: an explortory mixed methods study. https://www.medrxiv.org/. https://www.medrxiv.org/content/10.1101/2024.12.13.24318555v1; https://doi.org/10.1101/2024.12.13.24318555

Abstract
Abstract: Men living with multiple long-term conditions and obesity are under-represented in behavioural weight management trials. Within an effective text messaging and financial incentives trial, our aim was to explore retention, secondary mental health and wellbeing outcomes, and experiences of men with multiple long-term conditions. Methods: Mixed methods process evaluation within a 3-group randomised controlled trial: behavioural text messages with financial incentives, texts alone and waiting-list control, for 583 of 585 men with obesity. Trial retention, mental health and wellbeing outcomes, and experiences were compared for 235 (40%) participants with multiple long-term conditions, 181 (31%) with single conditions, 167(29%) with no conditions, and for 165 (29%) with disability. Semi-structured interviews, analysed using the Framework method, explored experiences with weight trajectories. Concurrent descriptive and qualitative analyses were undertaken. Results: Of the 235 (40%) trial participants with multiple long-term conditions, 99 were disabled and 93 were living in deprived areas. Participants with multiple long-term conditions and/or disability were older, fewer had a degree level qualification, and fewer were in full time work. Retention at 12 months was higher for men with disability (76%) or no long-term conditions (75%), and lower for men with diabetes (65%). Self-reported weight stigma, wellbeing and quality of life scores improved or stayed the same for men living with multiple long-term conditions in the intervention groups, however, results for anxiety and depression screening scores were inconsistent. Participant experiences indicated complex dynamic health, social and life situations which could provide motivation to lose weight for some but not others. Hospitalisation and poor mobility, with inability to exercise, was de-motivating for making changes to reach weight loss targets. Conclusion: Men with multiple long-term conditions varied from very successful weight loss and improved health, to not prioritising or feeling helped by the programme or disengagement due to immobility or diabetes.

Keywords
Obesity; financial incentives; multiple long-term conditions; MLTC;