The new research, which was carried out by implementation specialists at the Health Innovation Network South London (HIN) and NIHR ARC South London, assessed the feasibility and acceptability of Healthy Eating & Active Lifestyles for Diabetes (HEAL-D) Online. The seven week culturally tailored programme received positive feedback from both patients and health professionals in south-east London, suggesting it could be used elsewhere in the UK to address health inequalities.
HEAL-D Online features culturally tailored education, including diet and lifestyle information, goal setting and physical activity classes. Originally developed as a face-to-face programme, it was adapted for online delivery due to restrictions in the pandemic. The programme is delivered in small groups by a team which includes a dietitian, physiotherapist and a community facilitator, and it gives participants an opportunity to share experiences, learn together and support each other.
HEAL-D Online was developed to address significant health inequalities. In the UK, people from African and Caribbean backgrounds are 3 times more likely to develop type 2 diabetes than White Europeans, typically developing the condition 10 years earlier and experiencing poorer health outcomes. NHS self-management programmes, which have been shown to help people manage their diabetes, are less successful in people from African and Caribbean communities, with lower levels of participation and leading to little improvement in diabetes control.
To address this problem, public health and multimorbidity researchers at the ARC, led by Louise Goff, professor of nutrition sciences, Leicester Diabetes Centre, worked with the HIN to develop the HEAL-D programme. It was co-designed with people from African and Caribbean communities with lived experience of diabetes to provide culturally tailored advice that was engaging and meaningful for African and Caribbean adults.
The research team used a mixed-methods approach to evaluate HEAL-D Online, including analysing service activity records, service user questionnaires, observational data and interviews. In total, 53 service users completed a questionnaire after completing HEAL-D Online, and 14 service users and 7 service delivery staff were interviewed.
The reason why I will refer other people to it [HEAL-D] is because I learned a lot about my diet, exercises, drinking, and hearing from other people, reassuring me that don't worry. It's gonna be OK. You're not on your own
Joseph Low, evaluation manager at the HIN, said: “Our evaluation showed that people who took part in the course felt more confident in controlling their diet and managing their diabetes after completing the course. HEAL-D Online could provide an opportunity to offer a culturally tailored programme in areas where geography or population density may mean a face-to-face model is not practical or cost-effective.”
While these results are encouraging, the evaluation identified areas for improvement. These include providing post-intervention support and conducting needs assessments for attendees with sensory disabilities to ensure better accessibility during sessions.
Online delivery also requires different skills from staff delivering the service, for example around ensuring that service users are engaged, encouraging interaction, supporting individuals with challenges with the technology and determining the right level of exercise for the group.
This evaluation demonstrates the feasibility of delivering a culturally tailored type 2 diabetes self-management programme using an online platform. Whilst participants were enthusiastic about the programme, it is important to understand more about the people who are unable to take up the offer of HEAL-D Online and why. We are also delighted that a clinical and cost effectiveness trial of HEAL-D online is already underway.
Some of these issues are being taken up by the team in a randomised controlled trial with sites in Manchester, Birmingham and London to explore clinical and cost effectiveness.