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

Abstract

Background The NHS Diabetes Prevention Programme (NHS-DPP) is a nine-month, group-based behavioural intervention for adults in England at risk of developing Type 2 diabetes. Four independent providers were commissioned to deliver versions of the NHS-DPP, in line with NHS England specifications. This observational study maps NHS-DPP delivery in routine practice against the NHS specification, and compares service delivery with observed patient experiences. Methods Researchers observed service delivery across eight complete NHS-DPP courses (118 sessions, median 14 sessions per course), consenting 455 participants (36 staff, 398 patients, 21 accompanying persons). Key features of NHS-DPP delivery were described using the Template for Intervention Description and Replication (TIDieR) framework. Researchers wrote detailed field notes during each session, including observations of patient experience. Field notes were content analysed; instances of positive and negative experiences were labelled and grouped into categories. Researchers used a novel method of comparing observed patient experiences to variations in programme delivery. Results Delivery broadly followed NHS England’s specification and the plans set out by providers. Deviations included the scheduling and larger group sizes in some sessions. There was variation in the type and format of activities delivered by providers. Positive patient experiences included engagement, satisfaction with the programme, good within-group relationships and reported behavioural changes. Negative experiences included poor scheduling, large groups, and dissatisfaction with the venue. Where more interactive and visual activities were delivered in smaller groups of 10–15 people with good rapport, there were generally more instances of positive patient experiences, and where there were structural issues such as problems with the scheduling of sessions, poor venues and inadequate resources, there tended to be more negative patient experiences. Conclusions Addressing issues that we have identified as being linked to negative experiences with the NHS-DPP could increase uptake, reduce patient drop-out and increase the overall effectiveness of the programme. In particular, modifying structural aspects of the NHS-DPP (e.g. reliable session scheduling, reducing group sizes, enough session resources) and increasing interaction appear particularly promising for improving these outcomes.

‘Going the distance’: an independent cohort study of engagement and dropout among the first 100 000 referrals into a large-scale diabetes prevention program

“…One possible interpretation of this is that the DPP has been most successful at engaging and retaining majority groups from among those referred, although efforts were made in some cases to tailor DPP provision to fit the cultural needs of local communities. 28 Another interpretation is that those referred tend to represent those who participate best, and both of these may be true simultaneously.…”

“…Considerable variation in achievement of all three participation milestones was found between providers and across sites after adjustment for all available factors, suggesting that there may be scope for learning by providers and sites with low participation from those with better levels. Some flexibility in local provision was encouraged in the English DPP and may be desirable to tailor the content to local circumstances or to different populations, 28 but variation in participation may be an unintended consequence. Higher levels of retention and completion were seen where some out-of-hours provision was offered, suggesting that extending out-of-hours provision may improve participation in the DPP.…”

The theoretical basis of a nationally implemented type 2 diabetes prevention programme: how is the programme expected to produce changes in behaviour?

“…Of the first 100,000 referrals in the NHS-DPP in 2016-2017, 56% took up a place on the programme and 34% went on to attend the recommended proportion of sessions [18]. See Hawkes et al [19] for a description of NHS-DPP programme delivery.…”

The best possible self‐intervention as a viable public health tool for the prevention of type 2 diabetes: A reflexive thematic analysis of public experience and engagement

“…In this context, we are reporting on the psychological and affective determinants of individual health behaviours, which we suggest are often missed from inclusion in the rollout of public health interventions, such as prevention for T2D intervention, which focuses purely on promoting behaviour change 78 . Individual variation in the needs and determinants of behaviours fluctuate.…”

“…In this context, we are reporting on the psychological and affective determinants of individual health behaviours, which we suggest are often missed from inclusion in the rollout of public health interventions, such as prevention for T2D intervention, which focuses purely on promoting behaviour change. 78 Individual variation in the needs and determinants of behaviours fluctuate. Therefore, any public health interventions that aim to target large population groups must be flexibly aligned to individual determinants and support the behavioural and underpinning psychological and affective changes.…”