Health Innovation Network South London, London, UK.
Implementation and Involvement Team, National Institute for Health and Care Research Applied Research Collaboration South London, London, UK.
J Hum Nutr Diet. 2025 Feb;38(1):e13396. doi: 10.1111/jhn.13396.
People of African and Caribbean heritage in the UK have a higher prevalence of Type 2 Diabetes (T2D) and poorer health outcomes than white Europeans. Healthy Eating and Active Lifestyles for Diabetes Online (HEAL-D Online) is a co-designed, culturally tailored T2D self-management programme for black African and Caribbean adults, which, due to online delivery, is well positioned for spread. This qualitative evaluation uses the Exploration-Preparation-Implementation-Sustainment (EPIS) framework to explore factors affecting scale-up from delivery and commissioning perspectives.
Semi-structured interviews were conducted with nine commissioners and providers of T2D services from three English areas with varying population characteristics to explore scale-up. Focus groups were held with 15 people of African and Caribbean heritage with T2D lived experience to explore the impact of a digital model of participation. Data were analysed using thematic analysis, with themes mapped onto the EPIS framework exploration phase constructs to consider the outer and inner contextual factors for planning implementation.
Six EPIS constructs were identified by commissioners and providers as key in scaling HEAL-D Online. People with T2D lived experience explored the online mode of delivery, using the patient advocacy construct as the analytical lens. In delivering an online T2D programme, two themes were identified: (1) aligning course content with people's preferences; (2) practicalities to ensure online delivery was acceptable and accessible to the community.
HEAL-D Online was acceptable with the potential to help address health inequalities. The EPIS framework provided a structure to understand factors in planning scale-up for an intervention targeting underserved communities.
在英国，非洲裔和加勒比裔人群患 2 型糖尿病（T2D）的比例较高，健康状况也较差。“糖尿病在线健康饮食和积极生活（HEAL-D Online）”是一个共同设计、文化适配的 2 型糖尿病自我管理项目，针对的是非洲裔和加勒比裔成年人。由于是在线提供的，因此非常适合推广。本定性评估使用探索-准备-实施-维持（EPIS）框架，从交付和委托的角度探讨影响推广的因素。
在具有不同人口特征的三个英国地区，对 9 名 T2D 服务的委托人和提供者进行了半结构化访谈，以探索推广。与 15 名有 T2D 患病经历的非洲裔和加勒比裔人群举行了焦点小组会议，以探讨参与数字模式的影响。使用主题分析对数据进行分析，将主题映射到 EPIS 框架探索阶段的构建中，以考虑规划实施的外部和内部环境因素。
委托人和提供者确定了六个 EPIS 构建，认为这些是推广 HEAL-D Online 的关键。有 T2D 患病经历的人使用患者倡导构建作为分析视角，探讨了在线交付模式。在提供在线 T2D 项目时，确定了两个主题：（1）使课程内容与人们的偏好保持一致；（2）确保在线交付为社区所接受和可及的实际问题。
HEAL-D Online 是可以接受的，有可能有助于解决健康不平等问题。EPIS 框架为规划针对服务不足社区的干预措施的推广提供了一个结构。
