What is the most effective method of delivering Making Every Contact Count training? A rapid review
Authors: Batten Leona , Hammond Greg , England Clare , Jarrom David , Gillen Elizabeth , Davies Jacob Rees , Edwards Rhiannon Tudor , Edwards Adrian , Cooper Alison , Lewis Ruth 
Published: October 2024

The Making Every Contact Count MECC programme encourages staff to have opportunistic brief behaviour change conversations with service users. It uses the day-to-day interactions that healthcare professionals, or those within other organisations, including the not-for-profit sector have with people, to support them in making positive changes to their physical and mental health, and wellbeing. The aim of this review is to assess which elements or types of MECC training, or comparable interventions, are most effective and preferred by those who would implement MECC in practice.

The review included evidence available up until June 2024. 11 studies were included. These all focused on healthcare organisations and included health care or public health professionals, with two also including trainees who worked in a local authority.

There was consistent evidence that training increased both trainee confidence and use of MECC-related techniques immediately following training. There was some evidence that despite a slight reduction, these improvements were at least maintained up to one year later. There was no evidence on the longer-term effect, other than an indication that refresher training would be appreciated. There was also no evidence assessing whether improvements in trainee confidence and competence had any impact on service user behaviour change and outcomes. There was an indication that face-to-face training was preferred to online training.

Barriers to MECC training attendance included a feeling that there was not enough time, and a lack of managerial support. Barriers to MECC utilisation included a feeling that there was not enough time, a lack of organisational and managerial support, a fear of upsetting patients, and a lack of awareness of downstream support services to refer service users to following healthy behaviour conversations. The evidence indicated that barriers to MECC training and utilisation could be overcome via provision of information about downstream support services, and improved organisational and managerial support for both attendance at MECC training and its use in practice. Further research is needed. This should include research into the impact from MECC on patient behaviour and eventual outcomes, and how these change following training.

Funding statement

The authors and their Institutions were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government

EXECUTIVE SUMMARY

What is a Rapid Review?

Our Rapid Reviews (RR) use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias.

Who is this Rapid Review for?

The review question was suggested by Cwm Taf Morgannwg University Health Board Public Health Team. The review is intended to inform those responsible for commissioning and leading Making Every Contact Count (MECC) training.

Background / Aim of Rapid Review

The MECC programme encourages staff to have opportunistic brief behaviour change conversations with service users. It uses the day-to-day interactions that healthcare professionals, or those within other organisations, including the not-for-profit sector have with people, to support them in making positive changes to their physical and mental health, and wellbeing. The aim of this review is to assess which elements or types of MECC training, or comparable interventions, are most effective and preferred by those who would implement MECC in practice. Findings may be used to inform creation of future training, or to update current offerings, and improve consistency across health boards.

Results of the Rapid Review

Recency of the evidence base

The review included evidence available up until June 2024. Publication dates of included evidence ranged from 2013 to 2023.

Extent of the evidence base

11 studies were identified for inclusion in this review; all focused on healthcare organisations.

10 studies took place in the UK (eight of which were in England, and none in Wales), and one was undertaken in Australia. All studies included health care or public health professionals, with two also including trainees who worked in a local authority.

Study designs included pre-test/ post-test, post-test only, qualitative study designs (e.g. interviews, surveys), and mixed methods studies. No study included a separate control group.

Five of the included studies used surveys or questionnaires only, three used interviews only (either with individuals or focus groups), two used a combination of surveys and interviews, and one undertook surveys, interviews and performed observations of participants.

Key findings and certainty of the evidence

There wasconsistent evidence that training increased both trainee confidence and use of MECC-related techniquesimmediately following training. There was some evidence that despite a slight reduction, theseimprovements were at least maintained up to one year later. There was no evidence on the longer-term effect, other than an indication thatrefresher training would be appreciated. There was also no evidence assessing whether improvements in trainee confidence and competence had any impact on service user behaviour change and outcomes.

There was anindication that face-to-face training was preferred to online training. However, some trainees did seem to prefer online training due to its increased flexibility.

Barriers to MECC training attendanceincluded a feeling that there wasnot enough time, and a lack of managerial support.

Barriers to MECC utilisationincluded a feeling that there wasnot enough time, a lack of organisational and managerial support, a fear of upsetting patients, and a lack of awareness of downstream support servicesto refer service users to following healthy behaviour conversations.

Theevidence indicatedthatbarriers to MECC training and utilisation could be overcomevia provision of information about downstream support services, and improved organisational and managerial support for both attendance at MECC training and its use in practice.

Policy and Practice Implications

MECC training can be beneficial in improving trainee confidence and competence in using MECC. However, there are consistently reported barriers both to undertaking training and using MECC in practice, as summarised above. Although this review identified some potential ways of overcoming barriers both for attending training and utilising MECC in practice, the best and most effective ways of overcoming them remain unclear, and many require a widespread culture change.

The lack of evidence around whether changes to MECC training have an impact on service user behaviour and eventual outcomes, may impact how effective attempted changes to MECC training and workplace culture could be.

This review indicates that there appears to be a preference for standardised training with some capacity for tailoring to local needs. This should be taken into account when considering any updates to the Welsh MECC training modules.

Research Implications and Evidence Gaps

There needs to be further research into the impact from MECC on patient behaviour and eventual outcomes, and how these change following training in both the short and long term.

Research specifically into the MECC training being implemented across Wales, how people interact with and use this, and what they find useful and relevant would also be worthwhile.

Identification of methods to overcome the specific barriers and enhance the enablers-particularly around encouraging organisational and managerial support for MECC training and utilisation.

Economic considerations

The Public Health England MECC evaluation guidance 2020 recommends producing a business case for MECC programmes that includes the costs of delivery and considers the value for money of its implementation.

Most policy documents discussing the cost-effectiveness of MECC programmes cite the National Institute for Health and Care Excellence (NICE) public health guidance 2014 (PH49). This guidance however, does not directly refer to MECC programmes, but rather brief behaviour change and signposting interventions.