Developing HeLP-Diabetes: An internet
self-management intervention for people
with Type 2 Diabetes
Dack, C., Ross, J., Pal, K., Stevenson, F., Michie, S. & Murray, E.
Dr Charlotte Dack, University of Bath
Email: c.n.dack@bath.ac.uk
This project was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number
RP-PG-0609-10135). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Aims for today’s talk
• Why?
• How?
– Emphasis on:
• Theoretical underpinning
• User participation
• Next steps …
Why? Policy
Current Policy
More Efficient
Care
Use Of ICT
Improved Quality
of Care
Improved Health
Outcomes
SelfManagement
for LTCs
Decreased
Health Cost
Why?: Diabetes & Self-management
• Structured education programmes can
improve health outcomes and quality of life
• <10% patients report access to structured
education (2011)
• UK DM education mostly group-based
• Not suitable for everyone
Internet Interventions
Why?
• Convenience, accessibility, anonymity
• “Just in time” information
• Interactivity, enabling:
–
–
–
–
Behaviour change support
Decision support
Emotional support
Peer support
BUT ….
• Evidence of internet interventions efficacy is weak
– Interventions may not work
– Poor implementation track record
– High attrition rates/Problems with engagement
– Digital divide / health inequalities
How?:Developing HeLP-Diabetes
Theory/
Framework
Evidence
HeLP-Diabetes
User
Participation
Commercial
Input
What did patients & HP’s say?
Features
Patients (n = 20)
Health Professionals (n = 17)
Info, Hyperlinks, Tools for selfmonitoring, Quizzes, Ask the
Expert, Videos, Personal Stories
Info, Tools for self-monitoring,
Emotional Support
Presentation Consistent, Colourful, Easy to
navigate, Interactive & Visual,
Accessible language
Interactive and visual
Simplicity is key
Tone
Positive, Supportive, Humorous
Positive, Motivating
Engagement
Referral, Text & Emails, Peer
Support, Tailored
Save time, Fit in with QOF,
Endorsed, Positive trial data
Dislikes
Crowded text, Medical jargon,
Adverts, Broken links,
Americanised
More work
Integrating Theory
1. Corbin & Strauss tasks for self-management
2. Individual behaviour change
3. Implementation and Normalization Process Theory
What do patients need?
• Behavioural Management
• Emotional Management
E
B
• Role Management
Corbin and Strauss: Unending Work and Care. 1988
R
Individual Behaviour Change
For each BC module we used the following
BCT’s:
• Information provision
• Self-assessment tools
• Personalised goal setting, action planning,
review, self-monitoring/feedback
• Additional behaviour change techniques from
Michie’s taxonomy as appropriate
Why goal setting, action planning &
feedback?
• Self-monitoring/Feedback effective across
behaviours
• Psychological theory to predict combinations
of techniques that might be more effective
• Self-regulation (Control) Theory* suggests
how feedback may interact with other
techniques to change behaviour
*Carver & Scheier, 1982
Normalization Process Theory
Organizing structures and social norms
Impact on
consultations and
relationships
Does it make
sense?
(Coherence)
Do I want to take
part?
(Cognitive
Participation
Impact on work
(Collective Action)
Fit with existing skill set
and organisational goals
and resource
Group processes and conventions
May & Finch; Sociology 2009
Is it worth it?
(Reflexive Monitoring)
What?: Components of HeLP-Diabetes
R
Forum & Help
Living and Working
E
R
Treating Diabetes
B
Health Record
B
Understanding
Diabetes
B
Managing My
Feelings
E
Staying Healthy
•
•
•
•
•
•
B
Healthy Eating
Physical activity
Smoking cessation
Alcohol
Taking medicines
Working with health professionals
Each module contains:
• self-assessment tools,
• goal setting,
• action plans,
• self-monitoring,
• Review
• Feedback
RCT in Primary Care
Intervention
Vs.
Control
Implementing HeLP-Diabetes
Uptake & Use
Barriers &
Facilitators
Resource
needed
Ross, J., Stevenson, F., Dack, C., Pal, K., May., C., Michie, S., Parrott, S., & Murray, E. (2014). Evaluating the implementation of HeLP-Diabetes
within NHS services: study . BMC Health Services Research.
Thank you!
Dr Charlotte Dack, University of Bath
Email: c.n.dack@bath.ac.uk
This project was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number
RP-PG-0609-10135). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.