Abstract
AimsTo assess fidelity of the Healthier You: NHS Diabetes Prevention Programme (NHS‐DPP), a behavioural intervention for people in England at high risk of developing type 2 diabetes, to the specified programme features.MethodsDocument analysis of the NHS‐DPP programme specification, including National Institute for Health and Care Excellence (NICE) PH38 diabetes prevention guidance. This was compared with the intervention design (framework response documents and programme manuals) from all four independent providers delivering the NHS‐DPP. Documents were coded using the Template for Intervention Description and Replication framework (describing service parameters) and the Behaviour Change Technique Taxonomy v1.ResultsProviders demonstrated good fidelity to service parameters of the NHS‐DPP. The NHS‐DPP specification indicated 19 unique behaviour change techniques. Framework responses for the four providers contained between 24 and 32 distinct behaviour change techniques, and programme manuals contained between 23 and 45 distinct behaviour change techniques, indicating variation in behaviour change content between providers’ intervention documents. Thus, each provider planned to deliver 74% of the unique behaviour change techniques specified, and a large amount of behaviour change content not mandated.ConclusionsThere is good fidelity to the specified service parameters of the NHS‐DPP; however, the four providers planned to deliver approximately three‐quarters of behaviour change techniques specified by the NHS‐DPP. Given that behaviour change techniques are the ‘active ingredients’ of interventions, and some of these techniques in the programme manuals may be missed in practice, this highlights possible limitations with fidelity to the NHS‐DPP programme specification at the intervention design stage.
Highlights
The Healthier You: National Health Service (NHS) Diabetes Prevention Programme (NHS-DPP) is a behavioural intervention focused on encouraging lifestyle behaviour change for adults in England with elevated blood glucose levels [1]
Given that behaviour change techniques are the ‘active ingredients’ of interventions, and some of these techniques in the programme manuals may be missed in practice, this highlights possible limitations with fidelity to the NHS Diabetes Prevention Programme (NHS-DPP) programme specification at the intervention design stage
The service parameters specified by NHS England [2] and National Institute for Health and Care Excellence (NICE) PH38 guidance [3] in comparison with each provider intervention design are shown in Table 1 [12]
Summary
The Healthier You: NHS Diabetes Prevention Programme (NHS-DPP) is a behavioural intervention focused on encouraging lifestyle behaviour change for adults in England with elevated blood glucose levels [1]. The required NHS-DPP intervention content is outlined within a published Service Specification [2], a framework describing the intervention features which should be present within the NHS-DPP, informed by reviews of the evidence for lifestyle interventions in the prevention of type 2 diabetes [3,4]. Based on this evidence, the Service Specification requires the NHS-DPP to be delivered face-to-face in groups of no more than 15–20 adults with non-diabetic hyperglycaemia, over at least 13 sessions (each session lasting 1–2 h, totalling at least 16 h) with a minimum duration of 9 months, in line with existing National Institute for Health and Care Excellence (NICE) guidance on type 2 diabetes prevention [3]. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK
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