Is the NHS Diabetes Prevention Programme intervention delivered as planned? An observational study of fidelity of intervention delivery

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Abstract

Background
The NHS Diabetes Prevention Programme (NHS-DPP) has been delivered by four commercial organisations across England, to prevent people with impaired glucose tolerance developing Type 2 diabetes. Evidence reviews underpinning the NHS-DPP design specification identified 19 Behaviour Change Techniques (BCTs) that are the intervention “active ingredients”. It is important to understand discrepancies between BCTs specified in design and BCTs actually delivered. Purpose
To compare observed fidelity of delivery of BCTs that were delivered to (a) the NHS-DPP design specification, and (b) the programme manuals of four provider organisations.
Methods
Audio-recordings were made of complete delivery of NHS-DPP courses at eight diverse sites (two courses per provider organisation). The eight courses consisted of 111 group sessions, with 409 patients and 35 facilitators. BCT Taxonomy v1 was used to reliably code the contents of NHS-DPP design specification documents, programme manuals for each provider organisation, and observed NHS-DPP group sessions.
Results
The NHS-DPP design specification indicated 19 BCTs that should be delivered, whereas only 7 (37%) were delivered during the programme in all eight courses. By contrast, between 70% and 89% of BCTs specified in programme manuals were delivered. There was substantial under-delivery of BCTs that were designed to improve self-regulation of behaviour, e.g. those involving problem solving and self-monitoring of behaviour.
Conclusions
A lack of fidelity in delivery to the underlying evidence base was apparent, due to poor translation of design specification to programme manuals. By contrast, the fidelity of delivery to the programme manuals was relatively good. Future commissioning should focus on ensuring the evidence base is more accurately translated into the programme manual contents.
Original languageEnglish
JournalAnnals of Behavioral Medicine
Publication statusAccepted/In press - 18 Oct 2020

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