Developing implementation strategies for a community-based digital weight management program: a hybrid deductive–inductive thematic analysis grounded onto implementation theory

Community-based digital weight management programs have shown potential to address the public health concern of obesity, but often face implementation barriers. Hence, we aimed to identify and evaluate current implementation barriers, facilitators, and further develop strategies. A prospective qualitative study was conducted via workshops of stakeholders from community-based weight loss management services across Singapore, alongside a separate series of interviews for adopters. A hybrid deductive-inductive approach to thematic analysis was then adopted, informed by the Consolidated Framework for Implementation Research (CFIR), the Theoretical Domains Framework (TDF), and the Expert Recommendations for Implementing Change framework (ERIC). Interview transcripts were qualitatively coded based on relevant CFIR and TDF domains using a coding template. Subsequently, identified barriers and domains were mapped to ERIC strategies. 48 and 145 barriers were identified based on adopter and implementer transcripts, spanning across 26 and 35 subdomains of the TDF and CFIR, respectively. Several barriers were consistently identified by both adopters and implementers, with the main consistency being a mismatch of expectations. These include differing expectations of public awareness on obesity as a disease, expectations on the flexibility of implementations, and expectations on support for personal motivation. Furthermore, 43 adopter and 57 implementer facilitators were identified, spanning across 25 and 28 distinct subdomains of the TDF and CFIR framework, with the provision of incentives, societal and doctor endorsements as common facilitators. 53 distinct ERIC implementation strategies subthemes were also identified. The study identified underlying themes linking barriers and facilitators across implementers and adopters of community-based weight management services. These were mapped to ERIC strategies and contextualized using the AACTT framework to specify actors and actions. Many of these strategies could be operationalized by policymakers and nurses, highlighting their central role in facilitating program adoption and delivery.