Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 15, 2023
Date Accepted: Jul 29, 2024
Evaluating the national roll out of a type 2 diabetes self-management intervention: a qualitative interview study with local NHS leads responsible for implementation.
ABSTRACT
Background:
Approximately 4.5 million people now live with type 2 diabetes mellitus (T2DM) in the UK. Evidence shows that structured education programmes can improve glycaemic control and reduce the risk of complications from T2DM, but these have low rates of attendance. To widen access to T2DM structured education, NHS England commissioned a national roll out of Healthy Living, a digital self-management programme.
Objective:
The aim of this research was to understand the barriers and enablers to adopting, implementing and integrating Healthy Living into existing care pathways across England.
Methods:
We recruited 17 local NHS leads responsible for (potentially) implementing Healthy Living across their locality and conducted 16 one-time, semi-structured telephone or online interviews across 16 case sites (one interview was conducted with two local leads from the same case site). Interview data were analysed using a thematic approach.
Results:
We generated three overarching themes from the data: Implementation activities; Where does Healthy Living fit within existing pathway? and Contextual factors affecting implementation. Fourteen out of the 16 sites were implementing Healthy Living with most sites undertaking ‘light touch’ implementation activities, such as adding Healthy Living to their communication strategies. Local leads were generally positive about Healthy Living as an additional offer to their T2DM structured education programmes, but some felt it was more suited to specific patient cohorts. Lack of mandated implementation and data on uptake was the main barrier to undertaking prolonged, targeted implementation activities.
Conclusions:
A passive process of disseminating information about Healthy Living to general practices occurred across most sites sampled, rather than the active process of implementation. This can be attributed to factors such as local leads’ perceptions of the programme and understanding where it fits within their existing T2DM pathways, and contextual factors including receiving no data on uptake at the time that interviews took place, and the timing of the Healthy Living national roll out. Raising awareness of Healthy Living within general practice is necessary, but this alone is unlikely to drive uptake to, and engagement with, the programme. Clinical Trial: N/A
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