Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom.
J Med Internet Res. 2023 Jan 11;25:e41214. 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 may benefit from this support more than others; thus, identifying the optimal mode of delivery for behavior change content is a priority for future research. The NHS-DDPP could be improved by explicitly setting out the need for health coaches to support understanding of some self-regulatory BCT content such as problem solving in the service specification and amending the discharge process so that knowledge of any change in T2DM risk is available to participants.
英国国民保健署数字糖尿病预防计划（NHS-DDPP）是一项针对有 2 型糖尿病（T2DM）风险的英格兰成年人的计划。它基于英国国民保健署的规范，规定了特定的行为改变技术（BCT），即产生行为改变以针对饮食和身体活动的活性成分。该计划现已在全国范围内推出，由 4 个独立的供应商作为为期 9 个月的干预措施通过应用程序、教育材料和远程健康指导进行提供。为了优化效果，参与者需要能够理解和使用数字方式提供给他们的行为改变内容（例如，设定目标和解决问题）。以前的研究表明，人们受益于支持以帮助理解和使用 BCT。
这项定性研究的目的是评估 NHS-DDPP 的参与者如何理解和使用 BCT 内容，调查参与者如何描述健康教练在支持他们的行为改变中的作用，并研究 NHS-DDPP 的行为改变内容的理解和使用如何在提供者之间有所不同。
共有 45 名服务使用者在计划开始后的 2 至 4 个月以及结束时通过电话接受了两次访谈。主题包括参与者对支持自我调节的关键 BCT（例如设定目标）的理解和使用，以及他们通过该计划获得的支持。分析基于框架方法的主题进行。
参与者描述了他们对一些计划中行为改变内容的理解和使用，认为其简单直接：通过供应商应用程序以数字方式提供 BCT（例如行为自我监测）。参与者重视健康教练在通过提供情感支持以及在特定情况下直接提供和应用一些 BCT（例如解决问题）方面在支持他们的行为改变中的作用。参与者对计划中缺乏关于他们的 T2DM 风险的监测或反馈表示不满。不同的提供者方案在理解和使用 NHS-DDPP 的行为改变内容方面存在差异。
健康教练在提供计划关键组成部分方面的支持似乎至关重要。为了提高数字干预措施中 BCT 的理解和使用，考虑提供额外的互动式人工支持的传递途径非常重要。对一些自我调节 BCT 的理解可能比其他 BCT 更需要这种支持；因此，确定行为改变内容的最佳传递模式是未来研究的重点。通过在服务规范中明确规定健康教练支持理解一些自我调节 BCT 内容（例如解决问题）的需求，并修改出院流程，使参与者能够获得任何 T2DM 风险变化的知识，可以改进 NHS-DDPP。
