3 4 An evaluation of caesarean sections by the American College of Obstetricians and Gynecologists reported that first time mothers with term singleton cephalic pregnancies and women with a previous caesarean section account for the greatest increase in rates of caesarean section and much of the variation between institutions.5 Higher rates of caesarean delivery are associated with increased maternal and neonatal morbidity. 6 Rising rates of caesarean deliveries are assumed to have been driven by obstetricians, reflecting medicolegal concerns about vaginal birth after previous caesarean section (VBAC), vaginal breech delivery, and fetal distress in labour. In contrast, over a similar time period there has been increased emphasis on involvement of patients in making medical decisions.7-9 The traditional paternalistic model of care is based on the premise that the obstetrician knows best and by taking the lead on decisions could reduce anxiety and risk for the mother and her baby. 10 The shared model of medical decision making, in which clinician and patient exchange information, reveal preferences for treatment, and jointly come to a decision, is now promoted in preference to other models. [10][11][12] Decision aids are designed to help people select between various treatment strategies by providing information on the options and outcomes relevant to a person's health. A Cochrane review has reported that decision aids can improve knowledge and realistic expectations, reduce decisional conflict, and increase active participation in decision making. 13 A recent consensus process identified key aspects of quality of patients' decision aids relating to content, development, and effectiveness. 14 Determining the optimal mode of delivery for a woman who has experienced a previous caesarean section requires consideration of the risks and benefits of

ObjectivesBeing obese and drinking more than 14 units of alcohol per week places men at very high risk of developing liver disease. This study assessed the feasibility of a trial to reduce alcohol consumption. It tested the recruitment strategy, engagement with the intervention, retention and study acceptability.MethodsMen aged 35–64 years who drank >21 units of alcohol per week and had a BMI > 30 were recruited by two methods: from GP patient registers and by community outreach. The intervention was delivered by a face to face session followed by a series of text messages. Trained lay people (Study Coordinators) delivered the face to face session. Participants were followed up for 5 months from baseline to measure weekly alcohol consumption and BMI.ResultsThe recruitment target of 60 was exceeded, with 69 men recruited and randomized. At baseline, almost all the participants (95%) exceeded the threshold for a 19-fold increase in the risk of dying from liver disease. The intervention was delivered with high fidelity. A very high follow-up rate was achieved (98%) and the outcomes for the full trial were measured. Process evaluation showed that participants responded as intended to key steps in the behaviour change strategy. The acceptability of the study methods was high: e.g. 80% of men would recommend the study to others.ConclusionsThis feasibility study identified a group at high risk of liver disease. It showed that a full trial could be conducted to test the effectiveness and cost-effectiveness of the intervention.Trial registrationCurrent controlled trials: ISRCTN55309164.Trial fundingNational Institute for Health Research Health Technology Assessment (NIHR HTA).Short summaryThis feasibility study recruited 69 men at high risk of developing liver disease. The novel intervention, to reduce alcohol consumption through the motivation of weight loss, was well received. A very high follow-up rate was achieved. Process evaluation showed that participants engaged with key components of the behaviour change strategy.

A theoretically based text-messaging intervention aimed at reducing binge drinking in disadvantaged men was not found to reduce prevalence of binge drinking at 12-month follow-up.

ObjectivesTo examine the acceptability and feasibility of narrative text messages with or without financial incentives to support weight loss for men.DesignIndividually randomised three-arm feasibility trial with 12 months’ follow-up.SettingTwo sites in Scotland with high levels of disadvantage according to Scottish Index for Multiple Deprivation (SIMD).ParticipantsMen with obesity (n=105) recruited through community outreach and general practitioner registers.InterventionsParticipants randomised to: (A) narrative text messages plus financial incentive for 12 months (short message service (SMS)+I), (B) narrative text messages for 12 months (SMS only), or (C) waiting list control.OutcomesAcceptability and feasibility of recruitment, retention, intervention components and trial procedures assessed by analysing quantitative and qualitative data at 3, 6 and 12 months.Results105 men were recruited, 60% from more disadvantaged areas (SIMD quintiles 1 or 2). Retention at 12 months was 74%. Fewer SMS+I participants (64%) completed 12-month assessments compared with SMS only (79%) and control (83%). Narrative texts were acceptable to many men, but some reported negative reactions. No evidence emerged that level of disadvantage was related to acceptability of narrative texts. Eleven SMS+I participants (31%) successfully met or partially met weight loss targets. The cost of the incentive per participant was £81.94 (95% CI £34.59 to £129.30). Incentives were acceptable, but improving health was reported as the key motivator for weight loss. All groups lost weight (SMS+I: −2.51 kg (SD=4.94); SMS only: −1.29 kg (SD=5.03); control: −0.86 kg (SD=5.64) at 12 months).ConclusionsThis three-arm weight management feasibility trial recruited and retained men from across the socioeconomic spectrum, with the majority from areas of disadvantage, was broadly acceptable to most participants and feasible to deliver.Trial registration numberNCT03040518.