Assessing healthcare professionals' experiences of delivering opportunistic, weight-related conversations in a mental health setting: a mixed methods study

Background: Making Every Contact Count (MECC) is a person-centred approach to health behaviour change, utilising behavioural science to promote healthy lifestyle choices. Weight-related conversations in mental health settings are particularly important, with users noting gaps in information on medication-related weight gain and support needs. MECC training can address these gaps by improving staff confidence and service delivery, enhancing weight management for individuals with serious mental illness. This study explores staff experiences of weight-related MECC conversations in a mental health setting. Methods: This mixed-methods study involved healthcare staff from a National Health Service (NHS) mental health inpatient setting in Northeast England. A quantitative online survey administered pre-MECC training, post-MECC training, and 8-10 weeks later captured staff perspectives. Qualitative interviews were conducted with trained and non-trained staff to explore MECC implementation. Quantitative data were analysed using independent and paired-samples t-tests, while qualitative data underwent thematic analysis, using the COM-B framework that examines Capability, Opportunity, and Motivation as key drivers of behaviour. Results: Thirty-six staff completed the pre-training survey, 20 completed the post-training survey, and 25 participated in interviews (15 trained, 10 non-trained staff). Quantitative analysis showed that training improved staff perceptions of confidence and motivation to deliver MECC, though most changes were not statistically significant. Perceptions around opportunity (time, resources, social support) declined at follow-up. Perceived importance and usefulness of MECC also declined over time (p < .05). Qualitative analysis identified barriers and facilitators, mapped to the COM-B model. Trained staff highlighted organisational resources, training structure, and wider determinants of health in supporting MECC delivery, alongside skills in rapport-building. Non-trained staff noted gaps in MECC awareness, recording systems, and training but recognised MECC importance and impact. Both groups identified time constraints, confidence, and the integration of MECC within their professional roles as key factors influencing delivery of weight-related conversations. Conclusion: MECC training positively impacted healthcare professionals' perceptions and confidence in delivering weight-related MECC conversations in mental health settings. While only confidence changes were evident in surveys, qualitative findings showed multifaceted influences on MECC implementation, emphasising the need for sustained support and system-level changes to overcome structural barriers and ensure long-term MECC delivery.