How is the NHS Diabetes Prevention Programme being implemented?
Dr Judith Gellatly, Research Fellow, Division of Population Health, Health Services Research & Primary Care
The DIPLOMA study is now underway. Our team at the University of Manchester has embarked upon a four-year evaluation of Healthier You: the NHS Diabetes Prevention Programme (NHS DPP). The NHS DPP aims to identify people at risk of developing Type II diabetes and provide them with the opportunity to take part in a 9-month behaviour change intervention. Those referred to the service get tailored, personalised help to reduce their risk including education on healthy eating and lifestyle, physical activity and weight loss. The intervention is being delivered by four providers and there are ambitious plans to roll out the service to all areas of England.
Our study, like the intervention, is both ambitious and complex. It involves a long term evaluation of all aspects of the programme to understand whether it really works to prevent diabetes and whether doing it in this way is a good use of NHS resources. As part of the work, we are exploring how the NHS DPP is being implemented.
Understanding why interventions can be successfully implemented in some settings but not others is a key issue for wider uptake and spread of programmes of this type. Our work package will explore the local context surrounding wider implementation of the NHS DPP and will do so through three sequential phases of work.
The first phase has involved scoping all of the participating areas to gain an understanding of the local contexts and characteristics. We did this to help select a sample of 16 areas that would be used to explore implementation in-depth and for use in some of the other aspects of the planned work. We aimed to ensure that the areas selected would provide us with a broad picture of implementation nationally focusing on variations in NHS DPP provider, rural vs urban locations, geographical region, socio –economic characteristics, and differences in recruitment and incentive strategies.
The second phase has involved interviewing the key leads in each of the 16 selected areas about their experiences of implementing the NHS DPP. We intend to interview these individuals twice. The first interviews commenced in November 2017. We have spoken to commissioners, NHS DPP project managers and individuals involved in public health roles within the areas sampled. Initial discussions have explored issues such as local processes such as organisation of the programme, funding and incentives, clinical pathways and expectations and attitudes. Follow-up interviews will be conducted with the same individuals commencing in April and will allow them to reflect further on the successes and challenges of organising, implementing and delivering the programme over time.
To complement this area-level analysis, we also plan to explore in-depth the development and implementation of the NHS DPP at the level of the individual general practice. Our interviews in this phase will explore perceptions and attitudes towards the NHS DPP scheme, the local practice approaches and procedures that have been implemented, identify any recruitment challenges and any other unintended consequences from implementing NHS DPP itself. (A separate work stream is exploring health care professionals’ attitudes towards implementation of the NHS DPP. More information can be found in a previous blog)
To help us understand the implementation processes emerging from the data collected, we are using a theoretical approach known as Normalisation Process Theory (NPT). For our purposes we will use NPT to understand:
- how NHS DPP is understood and compared with existing practices
- how NHS DPP is developed and delivered in practice locally
- the extent to which NHS DPP becomes part of the routine
- the extent to which NHS DPP is sustained as part of normal practice
The investment in NHS DPP is significant and on-going. For our research to be of maximum value we will make sure that emerging insights are fed back to those running the NHS DPP to inform both the current and future commissioning and delivery arrangements for the programme.
About the author: Dr Judith Gellatly is an investigator on the DIPLOMA research team which is funded by the National Institute for Health Research Health (NIHR) Services and Delivery Research.
Disclaimer: The views expressed in this article are those of the author and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.