Service user experiences of a nationwide digital type 2 diabetes self-management intervention (‘Healthy Living’): A qualitative interview study

Background:
Diabetes Self-Management Education and Support (DSMES) programmes for people living with type 2 diabetes mellitus (T2DM) can increase glycaemic control and reduce the risk of developing T2DM-related complications. However, recorded uptake to these programmes is low. Digital self-management interventions have the potential to overcome barriers associated with attendance at face-to-face sessions.
‘Healthy Living’ is an evidence-based digital self-management intervention for people living with T2DM, based on the ‘HeLP-Diabetes’ intervention which demonstrated effectiveness in a randomised controlled trial. NHS England has commissioned Healthy Living for national rollout into routine care. Healthy Living consists of online structured education and ‘Tools’ components to help service users self-manage their condition, including setting goals. However, there were key changes implemented during national rollout that contrasted with the trial, including a lack of facilitated access from a healthcare professional, and the omission of a moderated online support forum.

Objective:
The present qualitative research aimed to explore service users’ experiences of using Healthy Living early in the national rollout.

Methods:
Nineteen participants were interviewed via telephone or a video conferencing platform. Topics included peoples’ experiences and views of website components, their understanding of the intervention content, and overall acceptability of Healthy Living. Transcripts were analysed thematically, using a framework approach.

Results:
Participants valued having trustworthy information that was easily accessible. The emotional management content resonated with participants, prompting some to book an appointment with their GP to discuss low mood. After completion of the structured education, participants may have been encouraged to continue using the website if there was more interactivity (a) between the website and other resources/devices they were using for self-management, (b) with health professionals and services, and (c) with other people living with T2DM. There was consensus that the website was particularly useful for people who had been newly diagnosed with T2DM.

Conclusions:
Digital DSMES programmes offering emotional aspects of self-management are addressing an unmet need. Primary care practices could consider offering Healthy Living to people as soon as they are diagnosed with T2DM. Participants suggested ways in which Healthy Living could increase interaction to promote continued use with the website longer-term.