TY - JOUR
T1 - Fidelity to Program Specification of the National Health Service Digital Diabetes Prevention Program Behavior Change Technique Content and Underpinning Theory: Document Analysis
T2 - Document Analysis
AU - Hawkes, Rhiannon E
AU - Miles, Lisa M
AU - French, David P
N1 - Funding Information:
The authors would like to thank the NHS-DPP team and all digital provider program leads for providing all the relevant documentation required for this manuscript. The authors would also like to thank the participants who took part in the interview and the provider program leads and management staff for helping to organize the interviews. The authors would also like to thank the following researchers in the DIPLOMA (Diabetes Prevention–Long Term Multimethod Assessment) team who provided valuable feedback during manuscript preparation: Peter Bower, Sarah Cotterill, and Elizabeth Murray. This work is independent research funded by the National Institute for Health Research (Health Services and Delivery Research, 16/48/07—Evaluating the National Health Service Diabetes Prevention Program: the DIPLOMA research program). The views and opinions expressed in this manuscript are those of the authors and do not necessarily reflect those of the National Institute for Health Research or the Department of Health and Social Care.
Funding Information:
The authors would like to thank the NHS-DPP team and all digital provider program leads for providing all the relevant documentation required for this manuscript. The authors would also like to thank the participants who took part in the interview and the provider program leads and management staff for helping to organize the interviews. The authors would also like to thank the following researchers in the DIPLOMA (Diabetes Prevention-Long Term Multimethod Assessment) team who provided valuable feedback during manuscript preparation: Peter Bower, Sarah Cotterill, and Elizabeth Murray. This work is independent research funded by the National Institute for Health Research (Health Services and Delivery Research, 16/48/07-Evaluating the National Health Service Diabetes Prevention Program: the DIPLOMA research program). The views and opinions expressed in this manuscript are those of the authors and do not necessarily reflect those of the National Institute for Health Research or the Department of Health and Social Care.
Publisher Copyright:
© Rhiannon E Hawkes, Lisa M Miles, David P French.
PY - 2022/4/27
Y1 - 2022/4/27
N2 - Background: The National Health Service (NHS) Diabetes Prevention Program is a behavior change intervention for adults in England who are identified as being at high risk of developing type 2 diabetes. The face-to-face service was launched in 2016, followed by a digital service (NHS Digital Diabetes Prevention Program [NHS-DDPP]) in 2019. A total of 4 service providers were commissioned to deliver the NHS-DDPP and were required to deliver the digital service in line with a program specification detailing the key intervention content. The fidelity of the behavior change content in the digital service (ie, the extent to which the program is delivered as intended) is currently unknown. Digital interventions may allow higher fidelity as staff do not have to be trained to deliver all intervention content. Assessing fidelity of the intervention design is particularly important to establish the planned behavior change content in the NHS-DDPP and the extent to which this adheres to the program specification. This is the first known independent assessment of design fidelity in a large-scale digital behavior change intervention. Objective: This study aims to assess the fidelity of the behavior change content in each of the 4 NHS-DDPP providers' intervention designs to the full program specification. Methods: We conducted a document review of each provider's NHS-DDPP intervention design, along with interviews with program developers employed by the 4 digital providers (n=6). Providers' intervention design documents and interview transcripts were coded for behavior change techniques (BCTs; ie, the active ingredients of the intervention) using the Behavior Change Technique Taxonomy version 1 and underpinning theory using the Theory Coding Scheme framework. The BCTs identified in each digital provider's intervention design were compared with the 19 BCTs included in the program specification. Results: Of the 19 BCTs specified in the program specification, the 4 providers planned to deliver 16 (84%), 17 (89%), 16 (84%), and 16 (84%) BCTs, respectively. An additional 41 unspecified BCTs were included in at least one of the 4 digital providers' intervention designs. By contrast, inconsistent use of the underpinning theory was apparent across providers, and none of the providers had produced a logic model to explain how their programs were expected to work. All providers linked some of their planned BCTs to theoretical constructs; however, justification for the inclusion of other BCTs was not described. Conclusions: The fidelity of BCT content in the NHS-DDPP was higher than that previously documented for the face-to-face service. Thus, if service users engage with the NHS-DDPP, this should increase the effectiveness of the program. However, given that a clear theoretical underpinning supports the translation of BCTs in intervention designs to intervention delivery, the absence of a logic model describing the constructs to be targeted by specific BCTs is potentially problematic.
AB - Background: The National Health Service (NHS) Diabetes Prevention Program is a behavior change intervention for adults in England who are identified as being at high risk of developing type 2 diabetes. The face-to-face service was launched in 2016, followed by a digital service (NHS Digital Diabetes Prevention Program [NHS-DDPP]) in 2019. A total of 4 service providers were commissioned to deliver the NHS-DDPP and were required to deliver the digital service in line with a program specification detailing the key intervention content. The fidelity of the behavior change content in the digital service (ie, the extent to which the program is delivered as intended) is currently unknown. Digital interventions may allow higher fidelity as staff do not have to be trained to deliver all intervention content. Assessing fidelity of the intervention design is particularly important to establish the planned behavior change content in the NHS-DDPP and the extent to which this adheres to the program specification. This is the first known independent assessment of design fidelity in a large-scale digital behavior change intervention. Objective: This study aims to assess the fidelity of the behavior change content in each of the 4 NHS-DDPP providers' intervention designs to the full program specification. Methods: We conducted a document review of each provider's NHS-DDPP intervention design, along with interviews with program developers employed by the 4 digital providers (n=6). Providers' intervention design documents and interview transcripts were coded for behavior change techniques (BCTs; ie, the active ingredients of the intervention) using the Behavior Change Technique Taxonomy version 1 and underpinning theory using the Theory Coding Scheme framework. The BCTs identified in each digital provider's intervention design were compared with the 19 BCTs included in the program specification. Results: Of the 19 BCTs specified in the program specification, the 4 providers planned to deliver 16 (84%), 17 (89%), 16 (84%), and 16 (84%) BCTs, respectively. An additional 41 unspecified BCTs were included in at least one of the 4 digital providers' intervention designs. By contrast, inconsistent use of the underpinning theory was apparent across providers, and none of the providers had produced a logic model to explain how their programs were expected to work. All providers linked some of their planned BCTs to theoretical constructs; however, justification for the inclusion of other BCTs was not described. Conclusions: The fidelity of BCT content in the NHS-DDPP was higher than that previously documented for the face-to-face service. Thus, if service users engage with the NHS-DDPP, this should increase the effectiveness of the program. However, given that a clear theoretical underpinning supports the translation of BCTs in intervention designs to intervention delivery, the absence of a logic model describing the constructs to be targeted by specific BCTs is potentially problematic.
KW - Adult
KW - Behavior Therapy/methods
KW - Diabetes Mellitus, Type 2/prevention & control
KW - England
KW - Humans
KW - State Medicine
U2 - 10.2196/34253
DO - 10.2196/34253
M3 - Article
C2 - 35476035
SN - 1439-4456
VL - 24
JO - JOURNAL OF MEDICAL INTERNET RESEARCH
JF - JOURNAL OF MEDICAL INTERNET RESEARCH
IS - 4
M1 - e34253
ER -
