Implementing an Internet Self-Management Intervention for Type 2 Diabetes
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Abstract
Background
The internet is increasingly utilised to deliver healthcare. Implementation of internet interventions into routine clinical practice has however, proved inconsistent. With an increasing number of interventions being developed, understanding the process of successful implementation is ever more important in order for their full potential to be realised.
Although the internet offers huge promise as a mode of delivery of public health interventions, data on the actual reach in ‘real world’ settings is scarce. Most data on uptake, use and reach is provided by trials of purposively sampled participants, whose online behaviour may not reflect how people use these interventions in reality.
HeLP-Diabetes is an evidenced based, theoretically informed self-management website for people with type 2 diabetes. In this study HeLP-Diabetes is offered to a range of diabetes services within the National Health Service (NHS) in order to examine the implementation and reach of the intervention in the ‘real world’.
Objectives
To implement HeLP-Diabetes in the NHS and determine the: uptake, use and effects of the intervention in an unselected population in routine care; determine factors that inhibit or facilitate a) integration into existing services and b) use by patients; and determine the resources needed for effective widespread implementation.
Methods
A longitudinal adaptive implementation study using mixed methods was used to implement HeLP-Diabetes into existing health services. A two stage implementation process was taken whereby batches of General Practice surgeries and Diabetes Clinics were firstly offered the use of HeLP-Diabetes and were then subsequently asked to participate in evaluating the implementation. Data was collected to describe the number and type of services and patients who signed up to HeLP-Diabetes, and the implementation costs. Semi-structured interviews were conducted with patients and health professionals, and cohorts of patient participants were asked to complete self-report measures (Problem Areas in Diabetes and Diabetes Management Self-Efficacy Scale) at baseline, 3 months, and 12 months from registration.
Results
The following early findings will be presented: Data on the uptake of HeLP-Diabetes by NHS services and patients and descriptions of the strategies that are successful in facilitating implementation into routine practice and promoting patient adoption; data from qualitative interviews with key NHS stakeholders (including commissioners, GPs and diabetes nurses) which explore the barriers and facilitators to, and the resources needed for, successful implementation; and data from patient interviews which address HeLP-Diabetes adoption and use. Effects of HeLP-Diabetes use on patient psychological distress and self-efficacy for self-management at baseline and 3 month follow up will also be presented.
Conclusions
This study provides data on what happens when an internet intervention for patients with type 2 diabetes is made available to health services and patients in a ‘real world’ setting. Implementation studies such as this (which is being conducted in parallel to an RCT of the HeLP-Diabetes intervention) are essential for commissioners of healthcare, researchers and developers as they provide valuable data on what happens to interventions in routine practice, and what actions and resources are needed for successful implementation and realisation of potential benefits.
The internet is increasingly utilised to deliver healthcare. Implementation of internet interventions into routine clinical practice has however, proved inconsistent. With an increasing number of interventions being developed, understanding the process of successful implementation is ever more important in order for their full potential to be realised.
Although the internet offers huge promise as a mode of delivery of public health interventions, data on the actual reach in ‘real world’ settings is scarce. Most data on uptake, use and reach is provided by trials of purposively sampled participants, whose online behaviour may not reflect how people use these interventions in reality.
HeLP-Diabetes is an evidenced based, theoretically informed self-management website for people with type 2 diabetes. In this study HeLP-Diabetes is offered to a range of diabetes services within the National Health Service (NHS) in order to examine the implementation and reach of the intervention in the ‘real world’.
Objectives
To implement HeLP-Diabetes in the NHS and determine the: uptake, use and effects of the intervention in an unselected population in routine care; determine factors that inhibit or facilitate a) integration into existing services and b) use by patients; and determine the resources needed for effective widespread implementation.
Methods
A longitudinal adaptive implementation study using mixed methods was used to implement HeLP-Diabetes into existing health services. A two stage implementation process was taken whereby batches of General Practice surgeries and Diabetes Clinics were firstly offered the use of HeLP-Diabetes and were then subsequently asked to participate in evaluating the implementation. Data was collected to describe the number and type of services and patients who signed up to HeLP-Diabetes, and the implementation costs. Semi-structured interviews were conducted with patients and health professionals, and cohorts of patient participants were asked to complete self-report measures (Problem Areas in Diabetes and Diabetes Management Self-Efficacy Scale) at baseline, 3 months, and 12 months from registration.
Results
The following early findings will be presented: Data on the uptake of HeLP-Diabetes by NHS services and patients and descriptions of the strategies that are successful in facilitating implementation into routine practice and promoting patient adoption; data from qualitative interviews with key NHS stakeholders (including commissioners, GPs and diabetes nurses) which explore the barriers and facilitators to, and the resources needed for, successful implementation; and data from patient interviews which address HeLP-Diabetes adoption and use. Effects of HeLP-Diabetes use on patient psychological distress and self-efficacy for self-management at baseline and 3 month follow up will also be presented.
Conclusions
This study provides data on what happens when an internet intervention for patients with type 2 diabetes is made available to health services and patients in a ‘real world’ setting. Implementation studies such as this (which is being conducted in parallel to an RCT of the HeLP-Diabetes intervention) are essential for commissioners of healthcare, researchers and developers as they provide valuable data on what happens to interventions in routine practice, and what actions and resources are needed for successful implementation and realisation of potential benefits.
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