NHS Diabetes Prevention Programme

Digital Stream

Diane Powell (National Prevention Lead - Digital)

What are we doing with Digital to support Improvements in Diabetes Outcomes?

Implementing digital behaviour change interventions aimed at

preventing Type 2 diabetes in those already identified to be at

high risk and evaluate their effectiveness;

Improving the provision of information to support self-

management and care of people living with Type 1 diabetes;

Scaling digital flexible learning resources to support

management and self-care for people living with diabetes.

Background – Digital Pilot Partnerships with 8 Local

Health Economies (LHEs)

North East London STP Digital only

Humber Coast & Vale STP Digital only

Somerset STP Digital only

Salford CCG Digital only

Bristol, North Somerset, South

Gloucester STP

Choice

Lancashire & South Cumbria STP Choice

Buckinghamshire, Oxfordshire,

Berkshire STP

Choice

Central London, West London,

Hammersmith & Fulham, Hounslow &

Ealing

Refused face to

face

5,000 places on Digital Behaviour Change Interventions (DBCI)

• Tender exercise led to contract with

Our Mobile Health to undertake App

assessment.

• 87 EOIS, 30 digital interventions

reviewed against the NHS Digital

Assessment Framework.

• 14 digital interventions longlisted for

consideration for pilot, 5 chosen to use

for in-service evaluation.

• Open tender exercise led to contract

with RSM the Delivery and Evaluation

Partner to work alongside LHE’s.

• MoUs with LHEs.

• RSM - sub-contracts with 5 final DBCI

providers.

• RSM - sub-contract with Lloyds

pharmacy.

High Level Timeline

Activity Date

Contract in place with a delivery and evaluation

partner

19 June 2017

• Mobilisation and implementation plans

• DBCIs identified to be used in pilot

End of August 2017

Contracts with digital service providers in place 30 October 2017

Referrals to digital services commence By 30 November 2017

Data collection and activity reporting commence Jan/Feb 2018

Interim findings report October 2018

Final output report(s) assured and published September 2019

Site Provider

North East London STP

• Liva

Central London, West London,

Hammersmith & Fulham, Hounslow &

Ealing

• Oviva

London Region Pilot Sites

North East London Area 3 CCGs

15 GP practices

Total population – 750,000

Cohort Total - 1,100 uptake

• NDH – 625

• Overweight/obese - 495

Providers Digital only

• Liva Healthcare (1,100)

Mobilisation • Mobilising GP practices to make referrals

• Operational work with Liva – health coaches

• Communications & marketing

• Go live Jan 18

CWHHE Area 5 CCGs

Total population – 1.4m

Cohort Total - 500 uptake

• NDH – 500

Providers Refusal

• Oviva (500)

Mobilisation • Operational work with Oviva – health coaches

& ICS

• Communications & marketing

• Referrals via ICS commenced 9 Dec

• First Clinic 18 Dec

Liva Healthcare (1 year programme)

Recruitment

Referral from GP or PR, brochures

or other recruitment

Meeting

One-on-one introductory meeting (or digital meeting)

Goal setting/plan

Goals/plans are set and a relationship is established

Customisation

Platform is customised to the individual

Tracking

Daily tracking and registrations

Personal interaction: coaching/social interaction

Healthcare professional Other patients

Z

Y

X

Lifestyle change: Diabetes prevention

1 2 3

4 5 6

Digital Provider - Oviva

Frequent support and coaching offered by a dietitian for up to 6 months

Support offered via: phone calls, text-message chat, smartphone app

and online learning.

Personalised nutrition and activity plan designed by dietitian.

Goal Setting, Nutrition, Activity and Weight Tracked.

Digital Diabetes In-Service Evaluation

• Objectives: Provide DBCIs to reduce the risk of people developing type 2 diabetes.

• Aims: To test the effectiveness of DBCIs in reducing the risk of the user group

developing type 2 diabetes, through encouraging behaviour change (dietary change,

increased physical activity and weight loss).

• Target population: People (18+) identified at risk of developing type 2 diabetes

where they meet any of the eligibility criteria:

– Present with non-diabetic hyperglycaemia (NDH) HbA1c of 42 – 47 mmol/mol

(6.0 – 6.4%) or an FPG of 5.5 – 6.9 mmol/l

– Overweight BMI is equal to or over 25.

Primary Objectives of the In-Service Evaluation

• Are digital interventions effective in supporting behaviour change in those with non-diabetic hyperglycaemia

(measured by reduction in weight and/or lowering of blood glucose as a minimum at 6 months and 12 months)?

• Are those same digital interventions effective in supporting behaviour change in overweight and or obese

individuals who have not been diagnosed with NDH (measured by reduction in weight as a minimum at 6 months

and 12 months)?

• What potential effect do these DBCI’s have on health inequalities though:

a) Access to the interventions and;

b) Outcomes achieved as a result of receiving the interventions and;

• Can any conclusions be drawn about which groups would most benefit from the introduction of DBCI’s?

• What are the potential costs of implementation and delivery of digital interventions and to where do costs accrue?

• What lessons can be learnt (positive and negative) about how the interventions have been implemented?

Secondary Objectives of the In-Service Evaluation

• What are the characteristics of digital interventions which appear to be the most

effective/ have the most potential? And are any characteristics more or less effective

for particular groups?

• How do the costs of different characteristics relate to the outcomes achieved?

The following areas are not in scope of this project:

- Comparisons of DBCIs to face to face interventions or comparisons of

specific products

- A comprehensive health economics assessment of the interventions.

Qualitative data

In-depth explanatory data

from a small sample

Understanding human behaviour

Data will be coded and analysed by

themes

Illustrative explanations

Face to face interviews with

incentivisation for participants

50 participant interviews on qualitative research questions, such as understanding

personal experiences, key barriers, issues experienced, enablers etc.

Finally…. Three areas have commenced referrals:

• CWHHE into Oviva

• Humber coast and Vale into LIVA & OurPath

• Bristol OurPath

Remaining areas looking to start referrals asap for individuals to commence

services in January.

Thank You

diane.powell@nhs.net

Memuna.adam1@nhs.net