Exposure to behaviour change techniques and self-management tasks in a nationally-implemented digital intervention for type 2 diabetes self-management: Analysis of usage data

Background: ‘Healthy Living’ is an online self-management intervention for people living with type 2 diabetes rolled out across England from 2019. It was based on the ‘HeLP-Diabetes’ intervention which demonstrated effectiveness in a randomised controlled trial. However, it is unclear how much people are exposed to intervention content outside of a trial setting.

Purpose: To analyse exposure to behaviour change techniques and self-management content in routine usage.

Methods: Anonymous usage data was obtained for all registered Healthy Living users between May 2020 and September 2023, and linked with previously coded behaviour change technique and self-management content of 895 Healthy Living webpages.

Results: N=42,689 users registered for a Healthy Living account, of whom n=27,422 activated it, and n=19,137 (69.8%) accessed some intervention content. The median number of times users (n=19,137) were exposed to self-regulatory behaviour change techniques across the intervention was 0 (IQR: 0,0), apart from ‘Self-monitoring of outcome(s) of behaviour’ (median: 1, IQR: 0,1). Fewer than 30% of users were exposed to behaviour change techniques present after the first section of the curriculum. The median frequency of user (n=19,137) exposure to medical self-management tasks was 11 (IQR: 4,32), emotional self-management tasks was 4 (IQR: 1,7), and role self-management tasks was 0 (IQR: 0,1).

Conclusions: This is the first analysis to quantify engagement with behaviour change techniques and self-management tasks in a ‘real-world’ digital type 2 diabetes self-management programme. Future work needs to identify how to encourage usage of key material in online interventions, for example, by allowing users greater flexibility to access content they wish to engage with.