Manchester Centre of Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK.
NIHR School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK.
Ann Behav Med. 2021 Oct 27;55(11):1104-1115. doi: 10.1093/abm/kaaa108.
The NHS Diabetes Prevention Programme (NHS-DPP) has been delivered by four commercial organizations across England, to prevent people with impaired glucose tolerance developing Type 2 diabetes. Evidence reviews underpinning the NHS-DPP design specification identified 19 Behavior Change Techniques (BCTs) that are the intervention "active ingredients." It is important to understand the discrepancies between BCTs specified in design and BCTs actually delivered.
To compare observed fidelity of delivery of BCTs that were delivered to (a) the NHS-DPP design specification, and (b) the programme manuals of four provider organizations.
Audio-recordings were made of complete delivery of NHS-DPP courses at eight diverse sites (two courses per provider organization). The eight courses consisted of 111 group sessions, with 409 patients and 35 facilitators. BCT Taxonomy v1 was used to reliably code the contents of NHS-DPP design specification documents, programme manuals for each provider organization, and observed NHS-DPP group sessions.
The NHS-DPP design specification indicated 19 BCTs that should be delivered, whereas only seven (37%) were delivered during the programme in all eight courses. By contrast, between 70% and 89% of BCTs specified in programme manuals were delivered. There was substantial under-delivery of BCTs that were designed to improve self-regulation of behavior, for example, those involving problem solving and self-monitoring of behavior.
A lack of fidelity in delivery to the underlying evidence base was apparent, due to poor translation of design specification to programme manuals. By contrast, the fidelity of delivery to the programme manuals was relatively good. Future commissioning should focus on ensuring the evidence base is more accurately translated into the programme manual contents.
国民保健制度糖尿病预防计划（NHS-DPP）已由英格兰的四个商业组织提供，以防止糖耐量受损的人患上 2 型糖尿病。支持 NHS-DPP 设计规范的证据审查确定了 19 种行为改变技术（BCT），这些技术是干预的“有效成分”。了解设计中指定的 BCT 与实际提供的 BCT 之间的差异很重要。
比较实际提供的 BCT 的观察到的保真度，这些 BCT 被提供给（a）NHS-DPP 设计规范，和（b）四个提供组织的方案手册。
在八个不同地点（每个提供组织两个课程）对 NHS-DPP 课程的完整交付进行了音频录制。这八门课程包括 111 个小组会议，共有 409 名患者和 35 名辅导员。使用 BCT 分类学 v1 可靠地对 NHS-DPP 设计规范文件、每个提供组织的方案手册以及观察到的 NHS-DPP 小组会议的内容进行编码。
NHS-DPP 设计规范表明应该提供 19 种 BCT，但在所有八门课程的项目中，只有七种（37%）得到了提供。相比之下，方案手册中指定的 BCT 有 70%至 89%得到了提供。旨在改善行为自我调节的 BCT 提供不足，例如那些涉及解决问题和行为自我监测的 BCT。
由于将设计规范转化为方案手册的效果不佳，因此在提供方面明显缺乏对基础证据的保真度。相比之下，向方案手册提供的保真度相对较好。未来的委托应侧重于确保证据基础更准确地转化为方案手册的内容。
