How is the behaviour change content of a nationally implemented Digital Diabetes Prevention Programme understood and used by participants? A qualitative study of fidelity of receipt and enactment. (Preprint)

Background:

The National Health Service Digital Diabetes Prevention Programme (NHS DDPP) is a programme for adults in England at risk of developing Type 2 diabetes (T2DM). It is based on NHS England specifications which stipulate specific behaviour change techniques (BCTs) i.e. ‘active ingredients’ to produce behaviour change to target diet and physical activity. Now rolled out nationally, the NHS-DDPP is being delivered by four independent providers as a nine month intervention via apps, educational material and remote health coaching. To optimise effectiveness, participants need to be able to understand and use behaviour change content (e.g. goal setting, problem solving) of an intervention delivered to them digitally. Previous research has shown that people benefit from support to aid understanding and use of BCTs.

Objective:

The objectives of this qualitative study were to: 1) evaluate how participants in the NHS-DDPP understand and use BCT content; 2) investigate how participants describe the role of Health Coaches in supporting their behaviour change 3) examine how understanding and use of behaviour change content of the NHS-DDPP varies across providers.

Methods:

Forty-five service users were interviewed twice by telephone, at 2-4 months into, and at the end of the programme (at 9 months). Topics included participants’ understanding and use of key BCTs to support self-regulation e.g. goal setting, and the support they received via the programme. Transcripts were analysed thematically, informed by the framework method.

Results:

Participants described their understanding and use of some behaviour change content of the programme as straight-forward: use of BCTs (e.g. self-monitoring of behaviour) delivered digitally via provider apps. Participants valued the role of Health Coaches in supporting their behaviour change through: 1) the emotional support they offered; 2) their direct role in delivery and application of some BCTs (e.g. problem solving) to their specific circumstances. Participants were frustrated about the lack of monitoring or feedback of their T2DM risk within the programme. Variation in understanding and use of behaviour change content of the NHS-DDPP was present across provider programmes.

Conclusions:

Health Coaches’ support in delivery of key components of the programme appears pivotal. To improve understanding and use of BCTs in digital interventions, it is important to consider routes of delivery that offer additional interactive human support. Understanding of some self-regulatory BCTs may benefit from this support more than others, thus identifying the optimal mode of delivery for behaviour change content is a priority for future research. The NHS-DDPP could be improved by explicitly setting out the need for Health Coaches to support understanding of some self-regulatory BCT content such as ‘problem solving’ in the service specification, and amending the discharge process so knowledge of any change in their T2DM risk is available to service users. Clinical Trial: Not applicable