How the Behavior Change Content of a Nationally Implemented Digital Diabetes Prevention Program Is Understood and Used by Participants: Qualitative Study of Fidelity of Receipt and Enactment

• Published in: Journal of medical Internet research 2023-01, Vol.25 (1), p.e41214-e41214
• Main Authors: Miles, Lisa M, Hawkes, Rhiannon E, French, David P
• Format: Article
• Language: English
• Subjects: Adult; Behavior change; Behavior modification; Behavior Therapy - methods; Coaching; Design; Diabetes; Diabetes Mellitus, Type 2 - prevention & control; Diet; Emotional support; Enactment; Exercise; Fidelity; Frustration; Goal setting; Handbooks; Health Promotion; Health services; Humans; Intervention; Original Paper; Physical activity; Prevention; Prevention programs; Problem solving; Qualitative research; Self regulation; Selfmonitoring; Specification; State Medicine; Type 2 diabetes mellitus; Understanding
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/41214

The National Health Service Digital Diabetes Prevention Programme (NHS-DDPP) is a program for adults in England at risk of developing type 2 diabetes mellitus (T2DM). It is based on NHS England specifications that stipulate specific behavior change techniques (BCTs), that is, active ingredients to produce behavior change to target diet and physical activity. Now rolled out nationally, the NHS-DDPP is being delivered by 4 independent providers as a 9-month intervention via apps, educational material, and remote health coaching. To optimize effectiveness, participants need to be able to understand and use behavior change content (eg, goal setting and problem solving) of an intervention delivered to them digitally. Previous research has shown that people benefit from support to aid the understanding and use of BCTs. The objectives of this qualitative study were to evaluate how participants in the NHS-DDPP understand and use BCT content, investigate how participants describe the role of health coaches in supporting their behavior change, and examine how the understanding and use of behavior change content of the NHS-DDPP varies across providers. In total, 45 service users were interviewed twice by telephone at 2 to 4 months into, and at the end of, the program. Topics included participants' understanding and use of key BCTs to support self-regulation (eg, goal setting) and the support they received via the program. Transcripts were analyzed thematically, informed by the framework method. Participants described their understanding and use of some behavior change content of the program as straightforward: use of BCTs (eg, self-monitoring of behavior) delivered digitally via provider apps. Participants valued the role of health coaches in supporting their behavior change through the emotional support they offered and their direct role in delivery and application of some BCTs (eg, problem solving) to their specific circumstances. Participants expressed frustration over the lack of monitoring or feedback regarding their T2DM risk within the program. Variations in the understanding and use of behavior change content of the NHS-DDPP were present across provider programs. Health coaches' support in delivery of key components of the program seems to be pivotal. To improve the understanding and use of BCTs in digital interventions, it is important to consider routes of delivery that offer additional interactive human support. Understanding of some self-regulatory BCTs m