# Getting back on track: Development of a blended-care intervention for weight recurrence after metabolic bariatric surgery using intervention mapping

## TL;DR

This paper describes the development of a blended-care intervention to address weight recurrence after metabolic bariatric surgery, using a structured approach involving patients and healthcare professionals.

## Contribution

The novel application of the Intervention Mapping protocol to co-develop a blended-care intervention for post-surgery weight recurrence.

## Key findings

- The intervention integrates stakeholder input and addresses key determinants like stress and lack of social support.
- Personalized modules and goal-setting tools were developed using a blended-care approach.
- The process emphasized self-direction and skill-building as crucial elements for success.

## Abstract

To systematically re-develop a blended-care intervention addressing weight recurrence after metabolic bariatric surgery (MBS). Weight recurrence poses a significant longterm challenge for around 20–30 % of MBS patients. The intervention aims to improve weight outcomes and enhance patient well-being. This study describes the novel application of the Intervention Mapping (IM) protocol, integrating scientific evidence and stakeholder input.

The six-step IM protocol guided the development process, ensuring the active involvement of patients and healthcare professionals. A comprehensive needs assessment using quantitative, qualitative, and literature-based approaches informed the creation of a logic model of the problem (Step 1) and a logic model of change (Step 2). Program outcomes and objectives were formulated through collaborative brainstorming and design-thinking sessions, leading to intervention design (Step 3). The intervention was co-produced with patients, implementers, and an app developer (Step 4). Detailed implementation (Step 5) and evaluation (Step 6) plans were subsequently developed.

The IM process yielded a blended-care intervention grounded in theoretical frameworks and evidence-based methods. The intervention actively involved the target population and implementers, addressing key determinants of weight recurrence.

The IM protocol demonstrated utility in designing a tailored, theory-based intervention post-MBS. The process emphasized the value of integrating stakeholder perspectives and highlighted the feasibility of co-creating an evidence-informed intervention.

This intervention incorporates newly developed elements in a novel blended-care structure. Future evaluation is necessary to determine its effectiveness in achieving the desired outcomes.

•Intervention Mapping facilitated the active involvement of both patients and implementers.•Patients attribute weight recurrence to life events and stressors, or a lack of social support.•The intervention focuses on stress management, healthy eating, planning, and strategies for relapse prevention.•Personalized modules and goal-setting tools were integrated into the intervention using a blended-care approach.•Professionals emphasized self-direction, autonomy and skill-building as crucial elements.

Intervention Mapping facilitated the active involvement of both patients and implementers.

Patients attribute weight recurrence to life events and stressors, or a lack of social support.

The intervention focuses on stress management, healthy eating, planning, and strategies for relapse prevention.

Personalized modules and goal-setting tools were integrated into the intervention using a blended-care approach.

Professionals emphasized self-direction, autonomy and skill-building as crucial elements.