Influences on Patient Uptake of and Engagement With the National Health Service Digital Diabetes Prevention Programme: Qualitative Interview Study

Abstract

Background Digital diabetes prevention programs (digital-DPPs) are being implemented as population-based approaches to type 2 diabetes mellitus prevention in several countries to address problems with the uptake of traditional face-to-face diabetes prevention programs. However, assessments of digital-DPPs have largely focused on clinical outcomes and usability among those who have taken them up, whereas crucial information on decision-making about uptake (eg, whether a user downloads and registers on an app) and engagement (eg, the extent of use of an app or its components over time) is limited. Greater understanding of factors that influence uptake and engagement decisions may support large-scale deployments of digital-DPPs in real-world settings. Objective This study aimed to explore the key influences on uptake and engagement decisions of individuals who were offered the National Health Service Healthier You: Digital Diabetes Prevention Programme (NHS-digital-DPP). Methods A qualitative interview study was conducted using semistructured interviews. Participants were adults, aged ≥18 years, diagnosed with nondiabetic hyperglycemia, and those who had been offered the NHS-digital-DPP. Recruitment was conducted via 4 providers of the NHS-digital-DPP and 3 primary care practices in England. Interviews were conducted remotely and were guided by a theoretically informed topic guide. Analysis of interviews was conducted using an inductive thematic analysis approach. Results Interviews were conducted with 32 participants who had either accepted or declined the NHS-digital-DPP. In total, 7 overarching themes were identified as important factors in both decisions to take up and to engage with the NHS-digital-DPP. These were knowledge and understanding, referral process, self-efficacy, self-identity, motivation and support, advantages of digital service, and reflexive monitoring. Perceptions of accessibility and convenience of the NHS-digital-DPP were particularly important for uptake, and barriers in terms of the referral process and health care professionals’ engagement were reported. Specific digital features including health coaches and monitoring tools were important for engagement. Conclusions This study adds to the literature on factors that influence the uptake of and engagement with digital-DPPs and suggests that digital-DPPs can overcome many barriers to the uptake of face-to-face diabetes prevention programs in supporting lifestyle changes aimed at diabetes prevention.

Engagement with a nationally-implemented digital behaviour change intervention: Usage patterns over the 9-month duration of the National Health Service Digital Diabetes Prevention Programme

“…Additionally, access to peer support was associated with a significantly greater weight reduction at 12 months in a recent evaluation of the pilot NHS-DDPP ( Ross et al, 2022 ). On the other hand, people on the NHS-DDPP report to opt for digital programmes because they do not like the group aspect ( Ross et al, 2023 ), and these larger online networks (akin to social media) may lack the ‘critical mass’ to deliver sufficient personalised support ( Elaheebocus et al, 2018 ). This may explain why users on the provider programme who offered closed peer group support moderated by a health coach showed higher engagement with this intervention feature in the current analysis.…”

Diabetes prevention at scale: Narrative review of findings and lessons from the DIPLOMA evaluation of the NHS Diabetes Prevention Programme in England

“…[39][40][41] We also explored decisions about taking up the digital offer and found that these were based on similar issues to the conventional format (such as self-efficacy) as well as unique features of the digital interventions such as enhanced accessibility. 42 We also found that professional support remained important even with digital delivery. 41…”

“…IMPROVING UPTAKE 1. Communication with patients 24,25,42 Around 50% of those referred take up a place on the NHS DPP. Around 30% of patients do not recall being invited.…”

Experiences of online group support for engaging and supporting participants in the National Health Service Digital Diabetes Prevention Programme: A qualitative interview study

“…This finding accords with previous research. 28 Some participants also attributed this level of disengagement to not being able to relate to the other users posting on the forums, a similar barrier to some participants’ engagement with the group chats offered by Provider 1. Notably, some participants supported the principle of discussion forums, acknowledging their role in facilitating idea sharing and supporting behavioural changes, but chose not to engage as it did not align with participants’ own perceptions of how they preferred to communicate with others: I just don’t do social media.…”