Stakeholders’ perceptions and experiences of the National Health Service diabetes prevention programme in England: qualitative study with service users, intervention providers and deliverers, commissioners and referrers

Abstract

Background: The National Health Service diabetes prevention programme in England, (NHS DPP) aims to identify people at high risk of type 2 diabetes (T2D) and offer them a face-to-face, group-based, behaviour change intervention for at least 9 months. The NHS DPP was rolled out in phases. We aimed to elicit stakeholders' perceptions and experiences of the factors influencing implementation of, and participation in, the programme during the development phase. Methods: Individual, semi-structured telephone interviews were conducted with 50 purposively sampled stakeholders: service users (n = 20); programme commissioners (n = 7); referrers (n = 8); and intervention deliverers (n = 15). Topic guides were structured using a pragmatic, theory-informed approach. Analysis employed the framework method. (Continued on next page)Results: We identified factors that influenced participation: Risk communication at referralstakeholders identified point of referral as a window of opportunity to offer brief advice, to provide an understanding of T2D risk and information about the programme; Perceived impact of the NHS DPP -service users highlighted the positive perceived impact on their behaviour change, the peer support provided by participating in the programme, the option to involve a relative, and the 'knock on' effect on others. Service users also voiced disappointment when blood test results still identified them at high risk after the programme; and Behavioural maintenance -participants highlighted the challenges linked to behavioural maintenance (e.g. discontinuation of active support). Factors influencing implementations were also identified: Case findingstakeholders suggested that using community involvement to identify service users could increase reach and ensure that the workload was not solely on GP practices; Adaptability: intervention deliverers acknowledged the need to tailor advice to service users' preferences and needs; Accountabilitythe need to acknowledge who was responsible for what at different stages of the NHS DPP pathway; and Fidelitystakeholders described procedures involved in monitoring service users' satisfaction, outcome data collection and quality assurance assessments. Conclusions:The NHS DPP offers an evidence-informed behavioural intervention for T2D prevention. Better risk communication specification could ensure consistency at the referral stage and improve participation in the NHS DPP intervention. Cultural adaptations and outreach strategies could ensure the NHS DPP contributes to reducing health inequalities.

The NHS Diabetes Prevention Programme: an observational study of service delivery and patient experience

“…The only previous research to explore patients’ experiences of the NHS-DPP was during the pilot phase [ 16 ]. However, this interview study was conducted before the NHS-DPP was implemented nationally, patient data were analysed alongside data from other NHS-DPP stakeholders, and the comparison of patient experiences across sites and providers was not within the previous evaluation’s scope.…”

“…Further, researchers could only observe and interact with patients who continued attendance at the NHS-DPP. Consequently, this study cannot provide insights into barriers of attendance; a limitation also present in previous research on patient experience of the NHS-DPP [16]. Despite not having any formal estimation of observation reliability, researchers discussed what should be included in the observational notes beforehand, and both researchers documented similar types of observations in their notes (see Additional files 2 and 3).…”

“…The best information currently available on NHS-DPP delivery is from an evaluation of the pilot NHS-DPP; a smaller-scale NHS-DPP intervention in 2015, before the programme began phased roll-out in 2016 [ 15 , 16 ]. This evaluation [ 16 ] is currently the only study to report on patient experience of the programme which used qualitative telephone interviews, but the description is brief alongside data from other stakeholders such as commissioners. Nonetheless, key themes relating specifically to patient experience reported patients to benefit from the group support of sessions and positive behavioural changes made [ 16 ].…”

“…This evaluation [ 16 ] is currently the only study to report on patient experience of the programme which used qualitative telephone interviews, but the description is brief alongside data from other stakeholders such as commissioners. Nonetheless, key themes relating specifically to patient experience reported patients to benefit from the group support of sessions and positive behavioural changes made [ 16 ]. In the 2016 evaluation, providers spoke about tailoring the programme to local context [ 15 , 16 ].…”

“…Nonetheless, key themes relating specifically to patient experience reported patients to benefit from the group support of sessions and positive behavioural changes made [ 16 ]. In the 2016 evaluation, providers spoke about tailoring the programme to local context [ 15 , 16 ]. However, there is yet to be an evaluation of how this adaptation impacts on actual delivery of the NHS-DPP and whether the NHS-DPP can deliver comparable benefits to published trials in reducing the onset of Type 2 diabetes.…”