Designing and testing whether an e‑signposting platform can be effectively implemented at scale to increase access to weight‑management support, reduce obesity‑related cancer risk, and help prevent cancer and cancer disparities across the region.
Why is the research needed?
Cancer causes one in six deaths worldwide. Changing health behaviours, such as dietary intake, alcohol consumption, tobacco, use and physical activity can prevent almost 40% of cancers. However, there are barriers to implementing effective interventions that support behaviour change.
Obesity is the second leading preventable cause of cancer in England. Behavioural weight management services can reduce obesity-related cancer risk, yet only about 3% of eligible patients are referred. Electronic signposting (e-signposting) offers a low-cost way to identify patients through electronic health records and uses digital communication to signpost individuals to weight-management support services.
The eSign study will use text-messages to signpost people to weight-management services across the East of England. People who may benefit from weight-management services will be identified through hospital and GP electronic health records. By raising awareness of behaviour change support in more effective ways, e-signposting could improve the reach of services and ultimately prevent cancer and cancer disparities.
What are we doing?
We will design, test and implement the widespread use of text messages to signpost people to weight‑management services across the East of England. To achieve this, we will review the literature to understand what types of electronic signposting work, for whom, in what circumstances, and how. We will then co‑design the content and timing of the text messages with people interested in weight‑management support, health professionals who refer patients, and data scientists who manage electronic health records, allowing us to develop and refine the e‑signposting approach. Through this process, we will identify the most effective text‑message content and delivery mechanisms for directing people to weight‑management support. We will also map the regional weight‑management system to explore different ways of implementing e‑signposting in healthcare settings and work with staff to embed it within the existing system to maximise its spread and adoption. Finally, we will develop a toolkit to support healthcare organisations to implement and evaluate e‑signposting.
How are we working with communities, services and organisations?
We work in collaboration with a range of communities, services and organisations to ensure that we are developing an approach that meets the needs of a diverse population. Our Patient, Public Involvement and Engagement (PPIE) group includes of experts by experience from diverse communities, our project management group includes clinical and academic experts, and our stakeholder group consists of representatives from Health Innovation East, Norfolk and Suffolk County Council Public Health teams, Norfolk and Waveney ICB, West Suffolk NHS Foundation, and the East Suffolk and North Essex NHS Foundation Trust. Each group meets quarterly as members of our wider project team.
What will the impact and benefits of this research be?
We envision that the eSign project will generate a range of positive impacts across academic, patient, service and population levels. Academically, the project’s outputs will form a blueprint for e‑signposting that can be applied in different contexts and regions across the UK. Patients will benefit from improved access to weight‑management support and the associated health gains. For NHS services, e‑signposting offers a simple, scalable way to increase uptake of weight‑management programmes while improving the integration of existing services and reducing variation in access and provision. At a broader level, the learning from eSign can be applied to other health behaviours and settings, contributing to the prevention of cancer, reducing cancer disparities, and ultimately lowering cancer‑related deaths.
What do we have planned for knowledge mobilisation and implementation?
This implementation study aims to promote the uptake of weight‑management services across the region. Using an implementation‑science approach, we apply methods and strategies that help practitioners and policymakers embed evidence‑based interventions into routine practice. Our focus is on supporting the real‑world integration of e‑signposting into NHS referral pathways and everyday clinical processes. We will develop a toolkit to help healthcare organisations implement and evaluate e‑signposting, and we will use ongoing feedback to refine materials so they are practical, acceptable and ready for future regional scale‑up and national rollout. We work closely with key stakeholders and communities, who are integral members of our wider research team. Insights and learning from the study will be communicated clearly and appropriately for different audiences, including patients and the public, healthcare professionals, commissioners, charities and academics. Lay summaries of the findings will be shared with study participants, full results will be published in leading scientific journals, and we will present our work at conferences and through UEA social media channels.
Related papers, outputs and resources
Visit the OSF page for this project
Participant summary findings of weight management needs (available via our OSF page)
Who is involved?
- Principal Investigator: Dr Zarnie Khadjesari, University of East Anglia
- Dr Adam P Wagner, University of East Anglia
- Ella Malloy, University of East Anglia
- Tracey Brown, University of East Anglia
- Prof Felix Naughton, University of East Anglia
- Dr Helen Parretti, University of East Anglia
- Prof Lee Shepstone, University of East Anglia
- Dr Lucy Clark, University of East Anglia
- Anna Varley, University of East Anglia
Get in contact
Email Dr Zarnie Khadjesari at z.khadjesari@uea.ac.uk.
The eSign project is funded by Cancer Research UK. It started in June 2024 and will last 6 years.
