Seventeen of the 24 intervention arm participants were interviewed. Of these, 16 took part in baseline interview, 9 completed both baseline and follow-up interview and one took part in follow-up interview only. Mean interview duration was thirteen minutes (range 5-37 minutes). Despite reservations by some participants about the injections before the study, most of those who completed the trial reported no challenges in timing of or administering the injections. Table 1 shows the responses from baseline qualitative interviews while table 2 shows the expectations and prior experiences of participants coming into the study. Table 3 shows the responses from follow-up qualitative interviews.
Medication Associated Weight gain
Several participants reported considerable weight gain associated with the antipsychotic medications they are taking. For example,
- ‘I went to the gym but there’s no point trying. It’s a waste of time. Then I get less motivated, I’m not very motivated as it is, so it was really hard. Like fighting an uphill battle’ .
- ‘Ever since being diagnosed with mental health, all sorts of medications made me put on weight … I’m not happy with my weight’ 
- ‘I need to lose weight … it was dreadful .. my medication doesn’t help’ 
- ‘I’ve been going [to Slimming World] for 18 months … it worked for a while but the medications I’m on make me hungry’ 
- ‘I’m fat … I’ve had a problem with my weight for 4-5 years, it’s linked to my medication’ 
For some participants, this was associated with reduced motivation and despondency as illustrated by the following verbatim:
- ‘I went to weightwatchers and it didn’t work … so many different diets!’ 
- ‘I’ve tried not eating .. eating healthy … exercise … I just can’t lose it’ 
Impact of Study on Quality of Life
Several participants commented that there had been an improvement in their quality of life, which they attributed to the medication, including a positive impact on family relationships. Some participants reported that their quality of life was improved directly as a result of the weight loss. A participant who dropped two clothes sizes described their experience in the study as “life-changing” as they were feeling both physically and mentally better.
- ‘I can walk properly again with improved mobility … I have better breathing … my mood is improved’ 
- ‘It’s been life-changing, a brilliant experience. Before, I was in crippling pain and couldn’t walk even short distances so was isolated further and further. Now I can walk to the corner shop. I’d do it all again tomorrow’ 
- I felt better when my clothes were getting looser, it kind of put me on a bit of a buzz …. My daughter noticed it, mentioned it quite a bit .. she could put her arms around for a cuddle. When I was bigger, she couldn’t as her hands couldn’t touch but now she can which is nice’ 
- ‘I dropped two clothes sizes, I’m feeling better physically and mentally’ 
In the next two examples, the respondents acknowledge the impact on quality of life and family noticing changes
- ‘My family says I’m nicer to be around … mentally I’m in a better place …. My mum’s stopped nagging about food and acting like the food police’ 
- ‘My family noticed my weight loss … told me I’m looking good again. I’m up and about more, engaging with life more, not drowsy all day, wasn’t sleeping all day, it’s a big big help, it’s lovely’ 
Study information and support from trial was well-received:
A common theme from participants was the trial support. On the whole, participants felt well supported (n=7) by the staff who were described to have explained the information really well.
- ‘I felt supported, I didn’t feel abandoned at all’ 
- ‘Information and advice were brilliant, I knew what to expect… I always had five minutes to ask any questions’ 
Furthermore, participants said that the information sheets were good and they found them useful (n=8).
- ‘The information sheet was quite concise, it was pretty good. No jargon’ 
- ‘It was explained really well .. I felt I got a lot of support, felt very supported’ 
Text messages were a key theme of trial support highlighted by participants (n=6). Three participants reported issues with forgetting to take their injections on occasion, but the text messages were a useful reminder. Although not every participant needed the reminders, they were still useful; for example, the following participants said,
- “ the messages set routine”,
- “the text messages everyday helped because they get unsure if they have taken something or not” .
One participant who did not need the reminders still described them as a “good back up” plan .
Whilst all participants interviewed reported being pleased that they had participated in the study, it is clear that those who did not lose any weight were disappointed. Each of these participants assumed they were in the control group, i.e. receiving the placebo. Despite this disappointment, they did not regret their participation.
Practical Aspects of Clinic Attendance
Despite describing clinic attendance as satisfactory (n=3), two participants found the journey to appointments problematic because of the additional stress of not being in control over timing while waiting for their taxi. One participant suggested booking the taxi 20-30 minutes earlier to reduce this burden.
Three participants were concerned about potential side effects of vomiting and diarrhoea before the study started. On completion of the trial, side effects of constipation, diarrhoea, vomiting and stomach pain were each reported by two participants.
Healthcare Professional Perspective
Two healthcare professionals, who were responsible for delivery of the pilot study, including recruitment, intervention delivery supervision and follow-up, were interviewed. Whilst neither were involved in the protocol development, both were involved from the start of the pilot study. Both reported recruitment to be challenging but believed the intervention was feasible if delivered as part of routine care. A particularly positive and rewarding experience was the dramatic weight loss experienced by some participants and the resulting positive impact on their quality of life. The nature of drug delivery, i.e. injection therapy, was seen as a downside by one healthcare professional who felt this was a factor affecting recruitment and a stressor for some participants. No safety concerns were identified by either healthcare professional, with no concerns regarding timing or doses, impact on daily living or adherence to the treatment regimen.