The influence of referral, initial assessment, and logistical factors on dropout at an adult weight management service: A semi structured interview study

Background: Patient retention is crucial to the effectiveness of weight management services; however, high dropout rates are a significant limitation. This study aimed to explore the influence of referral, initial assessment and logistical factors on dropout and retention within an NHS weight management service. Methods: This qualitative study employed semi-structured interviews with 37 patients from an NHS weight management service. Interviews were conducted either face-to-face or via telephone, focusing on the impact of referral processes, initial consultations, intervention selection, and logistical factors on early-stage retention. Interviews were recorded, transcribed verbatim, and analysed thematically. Results: Referrers to the weight management service reportedly had limited knowledge of the service and what it involved, and several participants expressed a desire for more detailed information at referral, which might better shape patient expectations and provide an opportunity for an informed and considered decision about engaging. Initial assessment was perceived as a critical opportunity to influence motivation, though experiences were mixed, and some viewed the appointment as perfunctory and system-focused, as opposed to person centred. Participants reported a desire for explorative discussions to align treatment options with individual needs and preferences. While most participants were satisfied with appointment scheduling and locations, travel-related issues and competing commitments emerged as barriers for a minority. Conclusion: Early engagement stages, particularly referral and initial assessment, are pivotal in shaping patient expectations and a key opportunity to positively influence patient motivation. Participant feedback offers valuable insights for refining service delivery, which could improve retention outcomes in weight management services.