An Evaluation of the Reach and Effectiveness of a Diabetes Prevention Behaviour Change Program Situated in a Community Site

Abstract Background The National Health Service Diabetes Prevention Programme (NHS-DPP) is a behavioural intervention for people identified as high risk for developing type 2 diabetes that has been rolled out across England. The present study evaluates whether the four commercial providers of the NHS-DPP train staff to deliver behaviour change technique (BCT) content with fidelity to intervention plans. Method One set of mandatory training courses across the four NHS-DPP providers (seven courses across 13 days) was audio-recorded, and all additional training materials used were collected. Recordings and training materials were coded for BCT content using the BCT Taxonomy v1. BCTs and depth of training (e.g. instruction, demonstration, practice) of BCT content was checked against providers’ intervention plans. Results Ten trainers and 78 trainees were observed, and 12 documents examined. The number of unique BCTs in audio recordings and associated training materials ranged from 19 to 44 across providers, and staff were trained in 53 unique BCTs across the whole NHS-DPP. Staff were trained in 66% of BCTs that were in intervention plans, though two providers trained staff in approximately half of BCTs to be delivered. The most common way that staff were trained in BCT delivery was through instruction. Training delivery style (e.g. experiential versus educational) varied between providers. Conclusion Observed training evidences dilution from providers’ intervention plans. NHS-DPP providers should review their training to ensure staff are trained in all key intervention components, ensuring thorough training of BCTs (e.g. demonstrating and practicing how to deliver) to enhance BCT delivery.

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The theoretical basis of a nationally implemented type 2 diabetes prevention programme: how is the programme expected to produce changes in behaviour?

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-021-01134-7 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Rhiannon E. Hawkes ◽

Lisa M. Miles ◽

David P. French

Keyword(s):

Type 2 Diabetes ◽

Behaviour Change ◽

Staff Training ◽

Diabetes Prevention ◽

Logic Model ◽

Prevention Programme ◽

Behaviour Change Techniques ◽

Behavioural Changes ◽

Diabetes Prevention Programme

Abstract Background It is considered best practice to provide clear theoretical descriptions of how behaviour change interventions should produce changes in behaviour. Commissioners of the National Health Service Diabetes Prevention Programme (NHS-DPP) specified that the four independent provider organisations must explicitly describe the behaviour change theory underpinning their interventions. The nationally implemented programme, launched in 2016, aims to prevent progression to Type 2 diabetes in high-risk adults through changing diet and physical activity behaviours. This study aimed to: (a) develop a logic model describing how the NHS-DPP is expected to work, and (b) document the behaviour change theories underpinning providers’ NHS-DPP interventions. Methods A logic model detailing how the programme should work in changing diet and activity behaviours was extracted from information in three specification documents underpinning the NHS-DPP. To establish how each of the four providers expected their interventions to produce behavioural changes, information was extracted from their programme plans, staff training materials, and audio-recorded observations of mandatory staff training courses attended in 2018. All materials were coded using Michie and Prestwich’s Theory Coding Scheme. Results The NHS-DPP logic model included information provision to lead to behaviour change intentions, followed by a self-regulatory cycle including action planning and monitoring behaviour. None of the providers described an explicit logic model of how their programme will produce behavioural changes. Two providers stated their programmes were informed by the COM-B (Capability Opportunity Motivation – Behaviour) framework, the other two described targeting factors from multiple theories such as Self-Regulation Theory and Self-Determination Theory. All providers cited examples of proposed links between some theoretical constructs and behaviour change techniques (BCTs), but none linked all BCTs to specified constructs. Some discrepancies were noted between the theory described in providers’ programme plans and theory described in staff training. Conclusions A variety of behaviour change theories were used by each provider. This may explain the variation between providers in BCTs selected in intervention design, and the mismatch between theory described in providers’ programme plans and staff training. Without a logic model describing how they expect their interventions to work, justification for intervention contents in providers’ programmes is not clear.

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A systematic review of the behaviour change techniques and digital features in technology-driven type 2 diabetes prevention interventions

Digital Health ◽

10.1177/2055207620914427 ◽

2020 ◽

Vol 6 ◽

pp. 205520762091442 ◽

Cited By ~ 5

Author(s):

Luke Van Rhoon ◽

Molly Byrne ◽

Eimear Morrissey ◽

Jane Murphy ◽

Jenny McSharry

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Behaviour Change ◽

Diabetes Prevention ◽

Behaviour Change Techniques ◽

Significant Weight Loss ◽

Effective Interventions ◽

Prevention Interventions ◽

Clinically Significant

Objectives Our aim was to conduct a systematic review to determine which technology-driven diabetes prevention interventions were effective in producing clinically significant weight loss, and to identify the behaviour change techniques and digital features frequently used in effective interventions. Methods We searched five databases (CINAHL, EMBASE, MEDLINE, PsychINFO, and Pubmed) from inception to September 2018 and reviewed 19 experimental and non-experimental studies of 21 technology-driven diet plus physical activity interventions for adults (≥18 years) at risk of developing type 2 diabetes. Behaviour change techniques were coded using the BCT taxonomy v1, and digital features were identified via thematic analysis of intervention descriptions. Results Sixty-three per cent of interventions were effective in the short term (achieving ≥3% weight loss at ≤6 months), using an average of 5.6 more behaviour change techniques than non-effective interventions, and 33% were effective in the long term (achieving ≥5% weight loss at ≥12 months), using 3.7 more behaviour change techniques than non-effective interventions. The techniques of social support (unspecified), goal setting (outcome/behaviour), feedback on behaviour, and self-monitoring of outcome(s) of behaviour were identified in over 90% of effective interventions. Interventions containing digital features that facilitated health and lifestyle education, behaviour/outcome tracking, and/or online health coaching were most effective. Conclusion The integration of specific behaviour change techniques and digital features may optimise digital diabetes prevention interventions to achieve clinically significant weight loss. Additional research is needed to identify the mechanisms in which behaviour change techniques and digital features directly influence physical activity, dietary behaviours, and intervention engagement.

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A systematic review of recruitment strategies and behaviour change techniques in group-based diabetes prevention programmes focusing on uptake and retention

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2020.108273 ◽

2020 ◽

Vol 166 ◽

pp. 108273

Author(s):

Sonia Begum ◽

Rachel Povey ◽

Naomi Ellis ◽

Christopher Gidlow

Keyword(s):

Systematic Review ◽

Behaviour Change ◽

Diabetes Prevention ◽

Behaviour Change Techniques ◽

Recruitment Strategies ◽

Prevention Programmes

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Evaluation and Refinement of a Bank of Text Messages to Promote Behaviour Change Adherence Following a Diabetes Prevention Program (Preprint)

JMIR Formative Research ◽

10.2196/28163 ◽

2021 ◽

Author(s):

Megan MacPherson ◽

Kaela Cranston ◽

Cara Johnston ◽

Sean Locke ◽

Mary Jung

Keyword(s):

Behaviour Change ◽

Prevention Program ◽

Diabetes Prevention ◽

Diabetes Prevention Program ◽

Text Messages

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Protocol for a qualitative study exploring the perception of need, importance and acceptability of a digital diabetes prevention intervention for women with gestational diabetes mellitus during and after pregnancy in Malaysia (Explore-MYGODDESS)

BMJ Open ◽

10.1136/bmjopen-2020-044878 ◽

2021 ◽

Vol 11 (8) ◽

pp. e044878

Author(s):

Nur Hafizah Mahamad Sobri ◽

Irmi Zarina Ismail ◽

Faezah Hassan ◽

Iliatha Papachristou Nadal ◽

Angus Forbes ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Behaviour Change ◽

Diabetes Prevention ◽

Mobile App ◽

Expert Committee ◽

Prevention Intervention ◽

Behaviour Changes ◽

Healthy Behaviour

IntroductionWomen who develop gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes, and to reduce this risk the women have to adopt healthy behaviour changes. Although previous studies have explored the challenges and facilitators to initiate behaviour change among women with GDM, there is limited data from Malaysian women. Thus, this study will explore the factors affecting the uptake of healthy behaviour changes and the use of digital technology among women and their healthcare providers (HCPs) to support healthy behaviour changes in women with GDM.Methods and analysisThe study will be modelled according to the Capability, Opportunity, Motivation and Behaviour and Behaviour Change Wheel techniques, and use the DoTTI framework to identify needs, solutions and testing of a preliminary mobile app, respectively. In phase 1 (design and development), a focus group discussion (FGDs) of 5–8 individuals will be conducted with an estimated 60 women with GDM and 40 HCPs (doctors, dietitians and nurses). Synthesised data from the FGDs will then be combined with content from an expert committee to inform the development of the mobile app. In phase 2 (testing of early iterations), a preview of the mobile app will undergo alpha testing among the team members and the app developers, and beta testing among 30 women with GDM or with a history of GDM, and 15 HCPs using semi-structured interviews. The outcome will enable us to optimise an intervention using the mobile app as a diabetes prevention intervention which will then be evaluated in a randomised controlled trial.Ethics and disseminationThe project has been approved by the Malaysia Research Ethics Committee. Informed consent will be obtained from all participants. Outcomes will be presented at both local and international conferences and submitted for publications in peer-reviewed journals.

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Evaluation and Refinement of a Bank of Text Messages to Promote Behaviour Change Adherence Following a Diabetes Prevention Program (Preprint)

10.2196/preprints.28163 ◽

2021 ◽

Author(s):

Megan MacPherson ◽

Kaela Cranston ◽

Cara Johnston ◽

Sean Locke ◽

Mary Jung

Keyword(s):

Behaviour Change ◽

Prevention Program ◽

Text Messaging ◽

Diabetes Prevention ◽

Diabetes Prevention Program ◽

Evidence Base ◽

Text Messages ◽

Message Content ◽

Behaviour Change Wheel ◽

Diet And Exercise

BACKGROUND Text messaging presents a low-cost and far-reaching modality which can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behaviour change adherence. To date, little research has been published regarding the process of text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base, and to guide implementation of effective and scalable mHealth interventions in public health initiatives and in future research. OBJECTIVE This paper describes the development and refinement of a bank of text messages targeting diet and exercise behaviour change to be implemented following a diabetes prevention program. METHODS A bank of 124 theory-based text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behaviour change techniques OR BCTs). The Behaviour Change Wheel is a theory-based framework which provides structure to intervention development, and can guide the use of evidence-based practices in behaviour change interventions. Once messages were written, 18 individuals who either took part in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance using a 5-point Likert scale. Messages were refined according to participant feedback and re-coded to have an accurate representation of BCTs in the final bank. RESULTS Seventy-six messages (61%) were edited, four were added, and 8 were removed based on participant scores and feedback. Of the 76 messages edited, 43 received minor word choice and grammar alterations while retaining their original BCT code; the remaining 33 (plus the four newly written messages) were re-coded by a reviewer trained in BCT identification. CONCLUSIONS This study outlines the process used to develop and refine a bank of text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed text messages which were overall deemed clear, useful, and relevant by both individuals who will be receiving and delivering them. This formative development process can be used as a blueprint in future text messaging development to ensure that message content is representative of the evidence base and is also grounded in theory and evaluated by key knowledge users.

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