JMIR Publications

ABSTRACT

Background:

Digital diabetes prevention programmes (digital-DPP) are being implemented as population based approaches to type 2 diabetes prevention in several countries in order to address problems with uptake of traditional face-to-face diabetes prevention programmes (f2f-DPP). However, assessments of digital-DPPs have largely focused on clinical outcomes and usability among those who have taken them up, while crucial information on decision-making about uptake (e.g. whether a user downloads and registers on the application) and engagement (e.g. the extent of usage of the application or its components over time) is limited. A greater understanding of factors that influence uptake and engagement decisions may support large-scale deployments of digital-DPPs in real world settings.

Objective:

This study aims to explore key influences on uptake and engagement decisions of those offered the National Health Service ‘Healthier You’: Digital Diabetes Prevention Programme (NHS-digital-DPP).

Methods:

A qualitative interview study using semi structured interviews. Participants were adults, aged 18 or over, diagnosed with non-diabetic hyperglycaemia, who had been offered the NHS-digital-DPP. Recruitment was via four providers of the NHS-digital-DPP and three primary care practices in England. Interviews were conducted remotely and were guided by a theoretically informed topic guide.

Results:

Interviews were conducted with thirty two participants who had either accepted or declined the NHS-digital-DPP. Seven overarching themes were identified as important factors in both decisions to take-up and engage with the NHS-digital-DPP. These were: (1) Knowledge and understanding (2) Referral process (3) Self-efficacy (4) Self-identity (5) Motivation and support (6) Advantages of digital and (7) Reflexive monitoring. Perceptions of accessibility and convenience of the NHS-digital-DPP were particularly important for uptake and barriers in terms of the referral process and healthcare professional engagement were reported. Specific digital features including health coaches and monitoring tools were important for engagement.

Conclusions:

This study adds to the literature on factors that influence uptake and engagement of digital-DPPs and suggests that digital-DPPs can overcome many of the barriers to uptake of f2f-DPPs in supporting lifestyle changes aimed at diabetes prevention.