Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 16, 2025
Open Peer Review Period: Dec 16, 2025 - Feb 10, 2026
Date Accepted: Apr 3, 2026
(closed for review but you can still tweet)
Usage and exposure to content of the NHS Healthy Living programme for people with type 2 diabetes: a retrospective observational cohort study
ABSTRACT
Background:
Diabetes self-management and education services can improve health outcomes, but engagement is often low. ‘Healthy Living’ is an online self-management programme for people with type 2 diabetes, based on the ‘HeLP-Diabetes’ intervention which demonstrated effectiveness in a randomised controlled trial. Healthy Living was commissioned by NHS England and rolled out nationally into routine care. The website comprises structured learning, unstructured articles (which users could access at any time), and tracking tools such as goal setting.
Objective:
To investigate overall usage and exposure to content of Healthy Living, including differences in usage/ exposure by user characteristics.
Methods:
Anonymous usage data from all people (n=27,422) who activated an account between May 2020 and September 2023 were available, including (1) which website activities were accessed, (2) when activities were accessed and (3) how long users spent on each activity. User demographic and usage information was summarised. Logistic regression evaluated the association between user demographics and usage.
Results:
The median length of time spent on the website in total was 7·6 minutes (IQR 0·6-27·6 minutes); 12,066 (44·0%) users spent less than five minutes on the website and 3,022 (11·0%) spent one hour or more. Of those who activated an account, 69·8% accessed some website content, 40·7% completed the first section of structured education, and 4·7% completed 60% of the structured education. Usage of the unstructured aspects of the programme was low. Female gender, lower deprivation, White ethnicity, and a shorter time since diagnosis were associated with increased usage.
Conclusions:
This study is one of the first to provide detailed analysis of user engagement with a national digital self-management programme for type 2 diabetes. Usage of with Healthy Living was generally low, in line with other digital self-management programmes. However, encouraging increased usage with the programme has the potential to lead to better health outcomes in people with type 2 diabetes.
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Copyright
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