Implementing Functional Imagery Training (FIT) into healthcare settings

I have really enjoyed working on my PhD. PenARC have been so supportive throughout, particularly during the pandemic. Having to move my research online brought about a lot of changes to my project, but this led to lots of great opportunities to develop my skills.

Functional Imagery Training (FIT) is an intervention that draws upon motivational interviewing techniques combined with multi-sensory imagery. This is with the aim of increasing intrinsic motivation and further strengthening behaviour change by practicing working towards goals through imagery. The imagery supports individuals to focus on the positive feelings that success can bring and how they would feel if they made the changes they want to make.

Functional Imagery Training (FIT) is an intervention that draws upon motivational interviewing techniques combined with multi-sensory imagery

FIT has been developed through many years of research and has now been used in several different contexts. My PhD is focused on the use of FIT to support people to lose weight. Previous research has shown that FIT is beneficial for weight loss when delivered one to one and in person. This PhD is seeking to evaluate the use of group-based, remote-accessed FIT and how best to implement it. Many of the weight management services use group work as part of their service and therefore gaining some understanding on whether FIT works in a group would be beneficial for understanding where and how FIT would work in practice. The study began just as covid hit and so we needed to rely upon remote delivery of the intervention. Remote accessed healthcare is now a key part of the NHS system plus there are other benefits to online services such as flexibility, reduced pressure on clinic time and it can increase access for those in rural areas.

Remote accessed healthcare is now a key part of the NHS system

As part of this project a feasibility study has been conducted and a randomised control trial is currently underway. The trial involves people who have a BMI over 30 being allocated to either group FIT sessions or the NHS 12-week weight loss plan. The sessions are focused on training the individuals to use FIT in their daily lives to build confidence and motivation by developing plans and goals that are meaningful to them as individuals. Each person within the group has the same goal, to lose some weight, however they will all have their own individual reasons for wanting to do this. Reasons for wanting to lose weight can vary from health and fitness through to confidence and self-acceptance. This randomised control trial will be running until June 2023 with data being collected on BMI, waist measurement and aspects such as quality of life and self-perceived health. We are interested in exploring whether group FIT demonstrates changes in these areas independently and compared to the NHS 12-week programme over 12 months.

One of the reasons for developing the scientific evidence base for FIT is to be able to implement the intervention into healthcare settings. Therefore, alongside this trial the PhD is also looking at the barriers and facilitators to implementing FIT. This process began with a mixed-methods study looking at public and private healthcare practitioners who have been trained in FIT and asking them their experiences on using the intervention in practice. This provided us with data on what aspects seem to work well and where hurdles can arise in certain organisations when using a new intervention. The use of theory and frameworks from within the implementation science literature supported this study, specifically, the normalisation process theory. This is a theory that looks at the embedding process and the normalised use of an intervention, particularly within healthcare organisations. The data from this study and the guidance from the normalisation process theory has led to the development of a programme theory that we hope will guide the next steps of implementing FIT. The use of a realist approach in implementation research is beneficial as it supports understanding on what works for who and under what circumstances. This allows an implementation plan to be developed that assumes successful embedding of the intervention under certain circumstance. For example, if the practitioners feel that the intervention will be beneficial to their clients then they will be more willing to take the time to develop their FIT skills and subsequently use the intervention in their day-to-day practice. This aspect of a programme theory allows the development of these if-then statements to explore the mechanisms for reaching certain outcomes.

“Having to move my research online brought about a lot of changes to my project, but this led to lots of great opportunities to develop my skills.”

The next steps of implementing FIT into healthcare settings is drawing upon the progress made in the delivery of FIT and the programme theory for implementation. This involves an upcoming study implementing FIT into Devon Mind. The organisation will be using the group FIT sessions developed throughout the PhD and the study will involve evaluating the implementation process. This will allow further refinement of the programme theory and clarity into the best way to successfully implement the FIT intervention. This study is due to begin in September 2022 and will involve input from the Devon Mind practitioners, stakeholders, and Devon Mind clients to allow a triangulation of experiences of FIT in practice.

I’m looking forward to the next stage of my research and tying the narrative of my PhD together by implementing FIT into Devon Mind.

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