Background Readiness for practice (RFP) is a critical outcome for medical education, reflecting a graduate's ability to transition from student to clinician. Objective Structured Clinical Examinations (OSCEs) play a pivotal role in evaluating RFP. This study aimed to investigate the conceptualisation and operationalisation of RFP within the OSCE context and evaluate the contribution of a newly developed RFP-focused rating tool compared to traditional OSCE scoring. Methods Utilising a sequential explanatory mixed-methods approach, this study was conducted across five Australian medical schools. Quantitative data from final-year medical students' OSCE results were analysed to examine correlations between RFP scores and components of a 5-item Process of Decision-Making (PDM) checklist: safety, reliability, trustworthiness, insight, and an organised/logical approach. In the qualitative phase, semi-structured interviews with OSCE examiners were analysed using inductive thematic analysis to explore their perceptions of RFP and decision-making processes. Results Quantitative analyses of 550 medical students' OSCE performance datasets revealed that global rating had the strongest correlation with RFP scores, followed by safety and reliability components of the PDM checklist, whereas trustworthiness showed a weaker association. Failing students consistently scored poorly across all checklist components and RFP, with approximately half or fewer meeting individual checklist requirements. Qualitative analysis of nine examiners' interviews produced a schema of What, How, and Why: What assessors viewed as RFP was the integration of clinical competence, safety, scope awareness, reasoning, and team readiness; How RFP was judged was through behaviours such as supervision-seeking, recognising unwell patients, attitudinal maturity, and structured consultations; Why RFP judgments were used included: to assess socio-relational skills, address workplace limitations, and make decisions, particularly on borderline performances. Conclusions Readiness for practice is a complex, multi-dimensional construct that includes application of knowledge, technical skills, reliability, professional identity, safety and trustworthiness. While this study does not directly evaluate examiner training, understanding how examiners apply RFP frameworks may inform future efforts to enhance training consistency, fairness, and assessment utility.

BACKGROUND:Despite available screening tools for eating disorders (EDs), the accuracy and suitability of these in identifying binge eating disorder (BED) and bulimia nervosa (BN) in a primary care setting are undetermined, despite BED and BN being the most common EDs. AIM:To evaluate the accuracy and suitability of ED screening tools for BED and BN in a primary care setting. DESIGN & SETTING:A systematic review with narrative synthesis in a primary care setting. METHOD:Six databases were searched, including MEDLINE, PsycInfo, and Embase. Two independent reviewers screened studies for inclusion. Studies were included that assessed the accuracy and/or suitability of screening tools for BED and BN in primary care. Quality was assessed using the Mixed Methods Appraisal Tool. A narrative summary was created after integrating the data using a convergent segregated approach. RESULTS:Four studies met inclusion criteria. The included studies reported on Binge Eating Disorder Screener-7 (BEDS-7), Eating Disorder Examination Questionnaire (EDE-Q), and SCOFF (sick, control, one stone, fat, food) screening tools. No studies reported on the accuracy of screening tools for BED and suitability for BN. BEDS-7 and EDE-Q screening tools reported variations in their suitability in primary care. The main barriers to implementation in primary care were time constraints and a lack of trust in screening. SCOFF showed high sensitivity (97.88%-100%) for BN but had lower specificity (89.6%-94.4%), increasing false positives. CONCLUSION:ED screening tools face feasibility and accuracy concerns for BED and BN. Further research is needed to validate screening tools' accuracy and suitability in a primary care setting for BED and BN in the general population.

Background: Relational continuity of care (RCC), which is characterised by an ongoing therapeutic relationship between patients and their primary care providers, is critical for ensuring high-quality care in general practice. Despite its importance, challenges, such as staffing shortages, policy shifts, and evolving patient needs, often impede its consistent delivery. With the new GP contract in England highlighting the need for primary care providers to monitor and deliver relational continuity, it is more crucial than ever to understand how best to achieve it. Aim: To explore how, why, and under what conditions interventions to improve relational continuity are successfully implemented in general practice. Design & setting: The realist review will be supported by an expert stakeholder panel and a patient advisory group to consider the diverse and dynamic settings of general practice, and generate contexts, mechanisms, and outcomes configurations exploring how interventions to enhance RCC in general practice work. Method: Through the synthesis of diverse international evidence sources, including qualitative, quantitative, and mixed-methods studies, as well as grey literature, the review will develop an understanding of the mechanisms that produce relational continuity, the contexts in which these mechanisms operate, and the outcomes they produce for the health system, practices, practitioners, and patients. Conclusion: The findings will provide data to inform future research and refine strategies and policies that support the effective delivery of relational continuity, which in turn may lead to improved patient outcomes and enhanced care experiences.

BackgroundAttention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder resulting in negative long-term outcomes if untreated. Pathways to healthcare in the United Kingdom are complex, especially for those aged 16-25 transitioning between child and adult mental health services. We aimed to co-produce evidence-informed resources to improve accessibility of primary care for young people with ADHD.MethodsWe utilised co-production principles from the National Institute for Health and Care Research and findings from recent research to create evidence-informed resources which collate experiences of multiple stakeholders. Lived experience advisors (young people aged 16-25 with ADHD and their supporters) and healthcare professionals were recruited through previous research engagement and local collaborations. Research partners engaged in workshops or individual meetings to agree priorities, content, and language/visual appearance for outputs.ResultsLived experience advisors (7), healthcare professionals (5), and researchers (3) co-produced a downloadable resource for young people and their supporters. The resource identifies key stages on ADHD healthcare pathways, common barriers, and top tips recommended by people with lived experience, and verified by healthcare professionals. Key messages for primary care professionals were co-produced.ConclusionCo-produced resources can help address barriers to accessing ADHD treatment and support via stretched NHS services. Collaborative working also highlighted the need for national policy change to alleviate pressures faced by healthcare professionals and patients.Patient and Public ContributionTwo research advisory groups (RAGs) of healthcare professionals and lived experience advisors informed research methods and presentation of results. RAG members participated in co-production workshops, contributed to authorship, and disseminated outputs.

Background: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder which can have poor long-term outcomes when unmanaged. Young people aged 16-25 with ADHD are often unable to access specialist healthcare as recommended by UK guidelines, due to gaps in services, poor transitional support between child and adult services, and long waiting lists. Healthcare information, which is important for condition management, may help mitigate service gaps and support thriving in people with ADHD, however little is known about provision via primary care. Aim: To investigate experiences of information provision supporting management of young people with ADHD in general practice and explore the potential of digital resources. Design and Setting: This qualitative research comprised interviews with young people with ADHD, their supporters, and primary healthcare professionals from sites across England. Method: Participants were recruited from five purposively sampled general practices, varying by local area characteristics. Semi-structured interviews included questions about information provision, healthcare information needs, and digital resources. Themes were generated using reflexive thematic analysis, within a critical realist framework. Results: 20 participants were recruited (11 healthcare professionals and nine people with lived experience). Four themes were generated: lack of ADHD-specific resources, supporting patients with condition management, dedicated resources for clinicians, and digital resources enhancing care. Conclusion: People with lived experience and healthcare professionals want better healthcare information about ADHD in general practice, including co-produced resources to support understanding and self-management. Digital resources represent a potentially cost-effective and accessible solution that is currently under-utilised.

INTRODUCTION:An estimated 262 million people lived with asthma globally in 2019. Similarly, in 2021, chronic obstructive pulmonary disease (COPD) was responsible for 3.5% million global deaths. They are usually distinct disorders, but the Global Initiative Chronic Obstructive Lung Disease (GOLD) 2024 strategy document asserts that asthma and COPD are conditions that may coexist in an individual and may require specific personalised approaches and treatments. It is acknowledged that they may share some common treatable traits and clinical features There are many challenges to manage asthma and COPD in the older population, including poor adherence to prescribed medications and poor inhaler techniques. The overall aim of this systematic review is to identify, appraise and synthesise available evidence around digital health interventions used to improve medication adherence in older people with asthma or COPD. METHODS AND ANALYSIS:This systematic review will examine studies that evaluated digital health interventions for asthma or COPD in any setting (eg, primary or secondary care). To be included, studies must be reported in English, Arabic or French and published from the year 2000 onwards. A literature search will be performed in MEDLINE via Ovid, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, EMBASE and PsycINFO via Ovid to identify relevant articles published since 2000 and up to December 2024. No language restrictions will be applied.The Cochrane risk-of-bias tool for randomised trials will be used to assess the quality of retrieved randomised controlled trials and quasi-experimental studies. The quality of cross-sectional, cohort and case-control studies will be assessed using the Newcastle Ottawa Scale. Mixed-methods studies will be assessed using the Mixed Methods Appraisal Tool (MMAT). The quality of qualitative studies will be assessed using the Critical Appraisal Skills Programme (CASP) qualitative checklist.Data will be synthesised using a convergent segregated approach, which involves an independent synthesis of quantitative and qualitative data leading to the generation of quantitative and qualitative evidence, which will then be integrated. ETHICS AND DISSEMINATION:Ethics approval is not applicable for this study since no original data will be collected. The results will be disseminated through a peer-reviewed publication and conference presentations. Findings will be used in a bigger project aimed to answer the question on how to embed a pharmacist-led digital health service to support older people with asthma or COPD into the NHS (National Health Service) usual care. PROSPERO REGISTRATION NUMBER:CRD42024575924.

BACKGROUND:Hypertension is the leading modifiable cause of cardiovascular disease. Primary care management is predominantly individual and remains suboptimal. Interventions delivered to groups incorporate peer support and potentially offer efficient use of limited resources. Evidence for the benefits of group-delivered interventions in hypertension is unclear. AIM:To determine whether group-delivered hypertension interventions improve blood pressure (BP) outcomes compared to usual care (UC). DESIGN AND SETTING:Systematic review, meta-analyses, and meta-regression of randomised controlled trials in community, primary, or outpatient care settings. METHOD:MEDLINE, Embase, Cochrane CENTRAL, and CINAHL were searched from inception to 20 March 2024 for randomised controlled trials comparing group-delivered interventions to UC for adults with hypertension. Primary outcomes were changes in systolic and diastolic BP, achievement of study BP targets and medication adherence; quality was assessed using the Cochrane Risk of Bias 2 tool. Data were pooled according to intervention type using random effects meta-analyses; predictors of BP lowering were modelled with meta-regression. RESULTS:Overall, 5326 citations were retrieved; 59 intervention groups (IGs) from 54 studies (13 976 participants) were included. Compared to UC, systolic BP reduced by 7.2 mmHg (95% confidence interval [CI] = 4.7 to 9.6; 23 IGs) following exercise, 4.8 mmHg (95% CI = 3.2 to 6.4; 26 IGs) following lifestyle education, and 3.6 mmHg (95% CI = 0.3 to 6.9; seven IGs) following psychotherapeutic interventions. Corresponding reductions in diastolic BP were 3.9 mmHg (95% CI = 2.6 to 5.2; 21 IGs), 2.9 mmHg (95% CI = 1.8 to 3.9; 24 IGs), and 1.2 mmHg (95% CI = -1.9 to 4.3; seven IGs). Achievement of target BP and medication adherence were infrequently reported, with equivocal findings (relative risks 1.1, 95% CI = 1.0 to 1.2, P = 0.02, 11 IGs and 1.0, 95% CI = 1.0 to 1.1, P = 0.60, seven IGs, respectively). In multivariable models, higher baseline BP and pre-existing cardiovascular morbidity were associated with greater BP reductions. CONCLUSION:Group-delivered interventions were effective at lowering BP for people with hypertension compared with UC; their feasibility and cost-effectiveness in primary care require further study.

BACKGROUND:Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that can have poor long-term outcomes when unmanaged. Young people aged 16-25 years with ADHD are often unable to access specialist health care as recommended by UK guidelines because of gaps in services, poor transitional support between child and adult services, and long waiting lists. Healthcare information, which is important for condition management, may help mitigate service gaps and support thriving in people with ADHD; however, little is known about provision via primary care. AIM:To investigate experiences of information provision supporting management of young people with ADHD in general practice and explore the potential of digital resources. DESIGN AND SETTING:This qualitative study comprised interviews with young people with ADHD, their supporters, and primary healthcare professionals from sites across England. METHOD:Participants were recruited from five purposively sampled general practices, varying by local area characteristics. Semi-structured interviews included questions about information provision, healthcare information needs, and digital resources. Themes were generated using reflexive thematic analysis, within a critical realist framework. RESULTS:In total, 20 participants were recruited (11 healthcare professionals and nine people with lived experience). Four themes were generated: lack of ADHD-specific resources, supporting patients with condition management, dedicated resources for clinicians, and digital resources enhancing care. CONCLUSION: People with lived experience and healthcare professionals want better healthcare information about ADHD in general practice, including co-produced resources to support understanding and self-management. Digital resources represent a potentially cost-effective and accessible solution that is currently underutilised.

BACKGROUND:Frailty increases vulnerability to major health changes because of seemingly small health problems. It affects around 10% of people aged >65 years. Older adults with frailty frequently have multiple long-term conditions, personal challenges, and social problems. Personalised care planning (PCP) based on 'goal setting' and 'action planning' is a promising way to address the needs of older adults living with frailty. AIM:To identify and explore factors that influence the implementation of PCP-style interventions for older adults. DESIGN & SETTING:We conducted a scoping review and identified a small number of interventions that explicitly employed goal setting and action planning. METHOD:We used a range of sources to identify relevant material. We included all interventions inclusive of patients aged ≥65 years and reported in English. We excluded end-of-life care interventions, group education, and/or those that did not involve one-to-one engagement. We explored all related articles that described, examined, or discussed implementation. We constructed a thematic framework in NVivo (version 11). Findings were narratively synthesised. RESULTS:We identified 18 potentially relevant PCP-style interventions and 13 of these met the inclusion criteria. Within these, were seven main categories of potentially modifiable influences relevant to older adults with frailty related to the following: primary care engagement; delivery staff characteristics; training; patient engagement; collaborative working; organisation and management; and systems. CONCLUSION:Many modifiable factors can influence the implementation of PCP. We identified several influences that have informed the development and implementation of a novel intervention PeRsOnaliSed care Planning for oldER people with frailty (PROSPER).

Aim: Type 1 diabetes (T1D) is one of the most common chronic conditions in children and adolescents. Approximately 1.5 million young people are currently living with T1D throughout the world. Despite recent improvement in overall indices of metabolic control in children and adolescents with T1D, control remains suboptimal and additional approaches are needed. The aim of the study was to conduct a systematic review and meta-analysis of educational and psychoeducational self-management interventions, to help optimize future interventions including physical activity support. Methods: A systematic review and meta-analysis were conducted according to our registered protocol (PROSPERO CRD42022295932) and are reported in line with the PRISMA 2020 guidance. We searched five databases (MEDLINE, EMBASE, PsycINFO [via Ovid], CINAHL [via EBSCO], Cochrane Library) from 1994 up to May 2024. We included randomized controlled trials assessing the effectiveness of self-management interventions. Outcomes of interest included HbA1c and quality of life (QoL) as well as self-care behaviors, diabetes knowledge, and self-efficacy. Meta-analyses were conducted using a random effects model. Results: In total, 46 papers were included, reporting on 30 interventions. Meta-analyses showed small short-term improvements in HbA1c (MD = -2.58 mmol/L, 95% CI -4.44 to -0.71, p=0.007) and QoL (mean difference [MD] = 1.37, 95% CI 0.19-2.54, p=0.02). Prespecified subgroup analyses suggested no significant difference in effectiveness of psychoeducational and education-only interventions. Quality of included studies was low with 27 having a high risk of bias. Conclusion: There is a lack of robust evidence that current self-management interventions result in clinically meaningful improvements in HbA1c and QoL. Future research should focus on redefining approaches to supporting and encouraging self-management.

BACKGROUND:Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, for which there are effective pharmacological treatments that improve symptoms and reduce complications. Guidelines published by the National Institute for Health and Care Excellence recommend that primary care practitioners prescribe medication for adult ADHD under shared-care agreements with Adult Mental Health Services (AMHS). However, provision remains uneven, with some practitioners reporting a lack of support. AIM:This study aimed to describe elements of support, and their availability/use, in primary care prescribing for adult ADHD medication in England to improve access for this underserved population and inform service improvement. DESIGN AND SETTING:Cross-sectional surveys were used to elicit data from commissioners, health professionals (HPs), and people with lived experience of ADHD (LE) across England about elements supporting pharmacological treatment of ADHD in primary care. METHOD:Three interlinked cross-sectional surveys were used to ask every integrated care board in England (commissioners), along with convenience samples of HPs and LEs, about prescribing rates, AMHS availability, wait times, and shared-care agreement protocols/policies for the pharmacological treatment of ADHD in primary care. Descriptive analyses, percentages, and confidence intervals were used to summarise responses by stakeholder group. Variations in reported provision and practice were explored and displayed visually using mapping software. RESULTS:Data from 782 responders (42 commissioners, 331 HPs, 409 LEs) revealed differences in reported provision by stakeholder group, including for prescribing (95% of HPs versus 64% of LEs). In all, >40% of responders reported extended AMHS wait times of ≥2 years. There was some variability by NHS region - for example, London had the lowest reported extended wait time (25%), while East of England had the highest (55%). CONCLUSION:Elements supporting appropriate shared-care prescribing of ADHD medication via primary care are not universally available in England. Coordinated approaches are needed to address these gaps.

BACKGROUND:Asthma is a common long-term condition that affects people of all ages. Evidence suggests that a significant proportion of asthma patients in the Gulf Cooperation Council (GCC) do not receive appropriate diagnosis, monitoring and/or treatment. When inadequately treated, asthma can negatively affect quality of life and may lead to hospitalisation and death. Although pharmacists play a role in asthma care globally, there appears to be no defined role for pharmacists in providing care to patients with asthma in the GCC countries. AIM:This scoping review aims to review and summarise studies conducted in the GCC countries involving pharmacists in the management of adults with asthma or evaluating pharmacists' asthma care knowledge and/or skills. METHOD:A systematic scoping review was undertaken. Seven databases were searched using relevant search terms for articles published up to May 2023. Studies that evaluated pharmacists roles, knowledge and skills in providing asthma care to adults in the United Arab Emirates (UAE), Qatar, Kuwait, Oman, Saudi Arabia, and Bahrain were considered eligible for inclusion. Extracted data were collated using tables and used to produce narrative descriptive summaries. RESULTS:Out of the 1588 search results, only seven studies met the inclusion criteria. Of those, only one developed and tested a pharmacist-led inhaler technique educational intervention in the UAE within community pharmacy setting for asthma patients. The remaining six studies assessed community pharmacists knowledge in providing asthma management and patient education in UAE, Saudi Arabia and Qatar. The quality of the included studies varied with four relying on simulated patients to assess pharmacists knowledge. The study that tested the intervention suggested improvement in inhaler technique and asthma symptoms control after receiving the intervention. The findings suggest a need to improve pharmacists knowledge of inhaler technique demonstration (mainly Metered Dose Inhalers), asthma management advice and assessment of asthma control and medication use. CONCLUSION:This review highlights a lack of research on pharmacist-led asthma interventions and identifies training needs to enable pharmacists to be involved in asthma care in the GCC countries. Future research could develop approaches involving pharmacists to improve asthma care and outcomes in the region.

OBJECTIVEInvestigate associations between quantity, content and specificity of action-plans and weight loss in a diabetes prevention study.DESIGNProspective cohort study nested within a randomised controlled trial. Participants completed action-planning worksheets during intervention sessions.MAIN OUTCOME MEASURESAction-plans were coded in terms of: number of plans set, their content, and specificity. Multivariate regression analyses assessed associations with weight loss at four-months.RESULTS890 planning-worksheets from 106 participants were analysed. Participants wrote a mean of 2.12 (SD = 1.20) action-plans per worksheet, using a mean of 2.20 (SD = 0.68) specificity components per action-plan. Quantity of action-plans per worksheet decreased over time (r = -0.137, p < 0.001) and increased quantity was associated with reduced specificity [r = -.215, p < 0.001]. Walking (34.9% of action-plans) and reducing high fat/sugar snacks (26.1%) were the most commonly planned lifestyle actions. In multivariate modelling, increased quantity of action-plans was associated with greater weight loss (R2 = 0.135, Unstandardised Beta = 0.144, p = 0.002). Specificity was not significantly associated with weight-loss (p = 0.096).CONCLUSIONProducing more action-plans was associated with greater weight loss. Further research should directly compare more versus less specific action-plans and explore ways to sustain engagement in action-planning. Our findings imply that participants should freely set numerous action-plans, rather than being encouraged to focus on specificity.Supplemental data for this article is available online at https://doi.org/10.1080/08870446.2022.2055026 .

BACKGROUND:Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder. UK guidance states that primary care has a vital role in effective ADHD management, including referral, medication prescribing and monitoring, and providing broader mental health and wellbeing support. However, many GPs feel unsupported to provide health care for young people with ADHD. Inadequate health care is associated with rising costs for patients and society. AIM:To investigate the experiences of young people with ADHD accessing primary care in England, from the perspectives of people with lived experience of ADHD and healthcare professionals (HCPs). DESIGN AND SETTING:A qualitative study. Interviews were conducted with HCPs (GPs, practice managers, and a wellbeing worker) and people with lived experience of ADHD (young people aged 16-25 years and their supporters) located in integrated care systems across England. METHOD:Semi-structured interviews were conducted with participants at five purposively selected general practices (varying by deprivation, ethnicity, and setting). Questions focused on experiences of accessing/providing health care for ADHD. Reflexive thematic analysis was undertaken within a critical realist framework to understand how provision works in practice and to explore potential improvements. RESULTS:In total, 20 interviews were completed with 11 HCPs and nine people with lived experience. Three themes were generated: a system under stress, incompatibility between ADHD and the healthcare system, and strategies for change in ADHD primary care provision. CONCLUSION:Standardisation of ADHD management in primary care, providing better information and support for HCPs, and advising on reasonable adjustments for people with lived experience could help improve access to effective treatments for young people living with ADHD.

Abstract Background Current research suggests that people with attention deficit hyperactivity disorder (ADHD) are at higher risk of physical and mental health disorders. This study aimed to explore these health risks in ADHD from the perspectives of multiple stakeholders. Methods This study forms part of the ‘Managing young people with ADHD in Primary care (MAP) study’. A survey developed by the study team was distributed to over 16 year olds with ADHD, their supporters, primary healthcare professionals and health commissioners across England, via social media and through patient/clinical networks (September—October 2022). This survey contained two questions on health risks. Question one asked about views on health risks in ADHD (free text). Question two asked about advice given (options list and free text). Descriptive statistics summarised responses to questions one and two, and qualitative analysis (reflexive thematic analysis) was used to explore free text responses from question one. Results 782 participants responded to the MAP survey. Of these, 206 healthcare professionals, 157 people with ADHD and 88 supporters answered question one. The most mentioned perceived risks were substance misuse, sleep disorders, weight management and smoking. More people with ADHD reported disordered eating as a health risk (n = 32) than healthcare professionals (n = 5). Generated themes included perceived health risks, impact of living with ADHD, lack of adequate healthcare, and need for ADHD awareness. In respect to advice given (question two), based on responses from 258 professionals, 162 people with ADHD and 100 supporters, the most common advice discussed in consultation was mental health (n = 149, n = 50 and n = 17 respectively). High numbers of respondents reported not giving/receiving advice on wider health (n = 38, n = 88 and n = 61 respectively). Conclusions Findings demonstrate that respondents perceived a range of physical and mental health risks posed by ADHD. These related to difficulties with activities of daily living, as well as healthcare interactions and the impact of core features of ADHD (e.g. impulsivity, emotional dysregulation). These risks are not currently explicitly addressed in United Kingdom national guidance on ADHD. More work is needed to examine and address the broader health outcomes of people with ADHD.

Background Empirical research indicates that impulsive processes that operate below conscious monitoring can undermine peoples’ attempts to change behaviour patterns, especially those that have become habitual. This may, therefore, be a serious challenge for those trying to lose weight. A novel smartphone app-based intervention (ImpulsePal) offers practical strategies to manage impulsive urges to facilitate reductions in the consumption of energy-dense processed food and overeating. Aim This process evaluation of ImpulsePal aimed to explore what was delivered/received and used, mechanisms of action, and potential contextual factors impacting intervention engagement and outcomes. Methods A mixed-methods process evaluation, with composite analysis of the quantitative (app usage statistics) and qualitative data (semi-structured interviews), was conducted alongside a feasibility randomised controlled trial with individuals with a body mass index of at least 25 kg/m 2 who wanted to lose weight. Results Of 58 participants receiving ImpulsePal, 56 had successfully shared app usage statistics, and 36 (62%) were interviewed. Although usage statistics indicated reductions in the use of some features, interviews indicated that participants were still using app-recommended strategies without requiring them to open ImpulsPal. Overall, interviews highlighted that participants valued having access to in-the-moment support, felt more aware of their own eating behaviour and influences on it, and felt an increased ability to avoid and reconceptualise, in-the-moment temptations. Conclusion This process evaluation offers support for a logic model suggesting that impulse management, using ImpulsePal, can promote healthier eating among those motivated to lose weight. It also highlights the necessity of using multimodal methods to explore the delivery and use of digital interventions.