Launched in south-east London, the Healthy Eating & Active Lifestyles for Diabetes (HEAL-D) programme helps participants to manage their diabetes better, improving their health and quality of life. A recent service evaluation of the online version of HEAL-D showed:
78% of people who completed the progamme reported weight loss
98% strongly agreed or agreed that HEAL-D Online has helped them to manage their diabetes
The proportion of patients experiencing ‘diabetes-related distress’ (a wellbeing measure for diabetes patients) reduced from 49% to 23% after attending
HEAL-D Online is now available across south London and is being piloted in other parts of the country. Read on to find out more about the development of HEAL-D and its impact.
Type 2 diabetes is a common, chronic condition that causes the level of sugar (glucose) in your blood to become too high. If type 2 diabetes is not managed effectively, it can cause disabling and life-threatening complications, including heart disease and stroke, problems with eyesight, painful foot sores, and poor kidney health.
In the UK, African and Caribbean communities are 2-4 times more likely to develop type 2 diabetes than White Europeans. They also develop the condition, on average, 10 years earlier. In south-east London, an area with a large African and Caribbean population, 40% of people with newly diagnosed type 2 diabetes are of Black-British ethnicity.
People living with type 2 diabetes can manage the symptoms themselves – and even sometimes reverse the condition – through a combination of medication, a healthy diet and keeping active. But to do this effectively, evidence shows it is important for people to understand type 2 diabetes and the principles that underpin self-management. That’s why the NHS routinely provides programmes to help people learn about and manage their diabetes. However, these programmes are considerably less successful in minority ethnic groups, with lower levels of participation and little improvement in diabetes control after completing the programme.
Louise Goff, professor of nutrition sciences, Leicester Diabetes Centre (formally at King’s College London), who led the ARC’s work in this area, says:
Because type 2 diabetes often develops in adults with African and Caribbean heritage at a younger age, they are more likely to be working and juggling other responsibilities, such as looking after children. This can make attending programmes more difficult. Also, African and Caribbean people who take part in some of the existing self-management programmes say that the advice given, for example around diet, does not always translate easily to the food they eat at home
Using NIHR funding, Louise and her team set out to develop a new diabetes education and self-management programme that was engaging and meaningful for African and Caribbean adults. The aim was to develop a programme that addressed inequalities in structured education attendance and outcomes, and that met the needs of both participants and the NHS.
Known as Healthy Eating & Active Lifestyles for Diabetes (HEAL-D), the new programme was co-developed between 2016-2018 working in partnership with people from African and Caribbean communities in south-east London (see some of the team, below).
The HEAL-D programme includes culturally sensitive diet and lifestyle information, goal setting and physical activity classes. Delivered in small groups by a dietitian, physiotherapist and a community facilitator, it gives participants an opportunity to share experiences, learn together and support each other.
The next step for the researchers was to evaluate the HEAL-D programme to check that it was acceptable to patients and health professionals. A group of 27 patients with newly diagnosed type 2 diabetes in Lambeth and Southwark were invited to join the 7 two-hour sessions, delivered once a week in small groups, through their local GP practice.
This feasibility trial showed that the participants found HEAL-D acceptable, with high levels of people attending and completing the programme. Furthermore, the 14 hours of education and behaviour change support delivered through HEAL-D was highly effective at improving diabetes control.
Following these positive results, local health service commissioners committed to make the programme more widely available across south-east London, shortly before the Covid-19 pandemic hit and restrictions on in-person social contact came into force. In response, Louise, supported by the Health Innovation Network, set about developing an online version of HEAL-D that could be accessed at home. This meant producing new resources, including educational videos, and learning how to optimise online training.
The development of HEAL-D Online ensured that the programme continued to be provided at a time when accessible, culturally sensitive diabetes education was even more of a priority. HEAL-D Online was piloted in south-east London before being made available across south London via the Diabetes Book and Learn Platform. More than 19 courses have been delivered between January 2022 and March 2023, with more than 170 people accessing the programme since it began.
A recent service evaluation of HEAL-D Online, as part of the NHS Insights Prioritisation Programme (NIPP) showed that:
These positive results have led to the programme being recognised nationally with HEAL-D Online shortlisted in the HSJ Digital Awards 2023 for ‘Reducing health inequalities through digital’. Louise was also invited to present HEAL-D at the prestigious Harry Keen Rank Nutrition award lecture at the Diabetes UK Conference earlier in 2023.
Loved the course content and learnt a lot about carbohydrates I did not know before
I’m glad the doctors sent me to you, I was down and depressed. It helped lift me up
The exercise sessions were great
Liked that it targeted at Black ethnic groups, especially with traditional food examples
Evidence shows that HEAL-D Online has the potential to improve quality of life and diabetes self-management for Black African and Caribbean people living with diabetes. In 2021, ARC South London and the Health Innovation Network received funding from the NHS Insights Prioritisation Programme (NIPP), which was set up to accelerate the evaluation and implementation of promising innovations developed during the pandemic. The team worked with a pilot site in Manchester and spoke to commissioners and service providers outside London to understand how to support the implementation of HEAL-D in other areas. Further funding from the NIHR is being used to support a randomised controlled trial with sites in Manchester, Birmingham and London to explore clinical and cost effectiveness.
At the heart of the HEAL-D programme is close collaboration with members of African and Caribbean communities. The programme was co-designed with people from the community in south London, and patient and public involvement has continued to be vital in developing HEAL-D. For the NIPP project, for example, a group of people who have completed the HEAL-D Online programme, have also supported the development of new resources and shaped the service evaluation.
Read about Matilda's experiences of participating in the programme how she is supporting its scale up to other parts of the country.
Adapting HEAL-D from a face-to-face programme to an online programme involved close collaboration between the research team and several stakeholders, including: