Diabetes self-management education and support programmes, provided routinely within NHS care, aim to support people living with type 2 diabetes (T2D) to adopt healthful self-management practices. However, they are considerably less successful in minority ethnic groups, with lower participation and limited benefit to HbA1c (the test of blood sugar levels over a period of time used to assess the risk of developing diabetes-related complications).
Culturally tailored support programmes are shown to result in greater improvements in HbA1c, knowledge and quality of life than standard programmes but to date there have been no programmes in the UK for people of Black ethnicity.
Healthy Eating & Active Lifestyles for Diabetes (‘HEAL-D’) is a culturally tailored diabetes self-management education and support programme for Black African and Caribbean adults living with T2D, recently developed with NIHR funding and evaluated in a feasibility trial.
In the UK, people of Black African and African-Caribbean ethnicity are more likely to develop T2D than White people, it occurs around 10 years earlier, requires more intensive medical management, and poorer outcomes are evident. HEAL-D was co-developed between 2016 and 2018 in collaboration with people living with T2D and community leaders from African and Caribbean community organisations in order to tackle ethnic inequalities in type 2 diabetes healthcare access.
The project has two strands with different aims:
1. Evaluation: to evaluate the feasibility and acceptability of the virtually delivered HEAL-D online service across south London and assess scalability requirements. This will provide crucial evidence to support further local commissioning of the service and inform research studies to examine the clinical impact of face-to-face and remote HEAL-D delivery.
2. Prepare for scale: to prepare HEAL-D for delivered nationally by preparing key resources for spread (e.g. “train the trainer” resources), examining likely commissioning and operating models and providing recommendations for systems planning to adopt HEAL-D, and seeding pilots in areas with large African and Caribbean communities. The project will examine how remote HEAL-D may be an effective solution for areas of low population density.
The evaluation will have two strands (1) a mixed methods prospective evaluation of HEAL-D online in south London and (2) a prospective qualitative study of the scale-up of HEAL-D online beyond south London. Both strands will utilise well-established implementation frameworks to structure the approach and will utilise a post-course questionnaire / interviews with stakeholders (service users, service delivery staff) as well as quantiative data available via the service provider.
The scale-up strand will trial delivery of HEAL-D online at two or three pilot sites in England. The approach for this is to be determined based on local resources, but may include: remote delivery to a cohort of service users and/or testing of online training material.
Co-design has been integral to development of HEAL-D, and the original intervention was designed in collaboration with members of local African and Caribbean communities in south London.
Patient and public involvement (PPI) will continue to be key throughout the course of this project and a group of people with African and Caribbean heritage will be recruited to support the study. These individuals will be previous HEAL-D service users who have completed the HEAL-D online programme and lay partners who have offered to support future development of the programme.
These individuals will form a reference group, and a series of workshops will be held with them at key stages – including to inform the development of study materials and to inform the analysis and reporting of the findings.
As part of the evaluation 20 service users who have taken part in the remote version of HEAL-D will be interviewed. This will assess their experience of participating in the programme and also take their views on the feasibility of the digital delivery of HEAL-D.
A number of individuals from outside of south London will also take part in interviews / focus groups to understand their perspective about the provision of online learning (e.g. accessibility, acceptability, benefits, risks and limitations).
The study will examine the remotely delivered version of HEAL-D which also brings in the potential for digital health inequalities to be experienced. Through examining the experience of people involved in participating in remote and digitally delivered education this project will help identify causes of digital exclusion within this novel method of delivery, which will enable these to be addressed as HEAL-D is scaled further. This research will provide evidence for further commissioning of the service, both locally and wider.
This research is funded by the NHS England, National Insights Prioritisation Programme. It was adopted by ARC South London in July 2022 and will be completed by March 2023.
