Integrating theory and data to create a new online self-management programme for adults with type 2 diabetes: HeLP-Diabetes

Problem

Long-term conditions account for half of all GP appointments and 70 percent of the total health and care spend in England. Diabetes is one of the most common long-term conditions and 10 percent of the NHS budget is spent on treating diabetes and related complications like heart attacks, strokes and blindness. Improving self-management in people living with type 2 diabetes is crucial in reducing the morbidity and mortality associated with this disease. However, uptake of group-based self-management training is low and programmes are often poorly described and lack an appropriate theoretical basis. There is an urgent need for evidence based and effective alternatives and computer-based interventions have the potential to provide cost-effective self-management training and improve outcomes for people with type 2 diabetes. This talk will describe an interdisciplinary protocol for combining theory and empirical data to inform an online self-management programme for adults with type 2 diabetes (‘HeLP-Diabetes’).

Approach

Literature was searched and experts consulted in the areas of psychology, clinical medicine and medical sociology to identify relevant clinical outcome data, theory and evidence of efficacy of behaviour change techniques (BCTs). A qualitative study explored views and experiences of patients and health professionals. Different sources were relevant to different aspects of the intervention design with weight given to the strength of the evidence supporting a particular approach. Expert consensus and theory were used to guide development where there were conflicting sources or insufficient data.

Findings

Two broad frameworks were identified for defining the scope and implementation of the intervention:

• Corbin & Strauss’ model of learning to live with a long-term condition

• Normalisation Process Theory to understand why complex interventions do, or do not become implemented and embedded into routine practice.

The COM-B model was used to understand the core behaviours relevant to diabetes self-management i.e. relating to diet, activity, and taking medication. Alcohol intake, depression and smoking cessation were tackled by more specialist interventions imported into the programme. The Behaviour Change Wheel was used as a post-hoc framework to summarise the process by which the data were synthesised and used to create the intervention and the intervention was described in terms of BCTs. The active ingredients of the intervention have been explicitly described in terms of 14 BCTs delivered through 8 sections of the website. Three theories underpin the behaviour change elements of the intervention: i) Operant learning theory; ii) Control theory; and iii) Social cognitive theory.

Consequences

This study demonstrates a multi-disciplinary approach to combining theory and evidence from multiple sources to create ’HeLP-Diabetes’: a new online self-management intervention for adults with type 2 diabetes.