Objectives Evaluation of the demonstrator phase and first wave roll-out of the National Health Service (NHS) Diabetes Prevention Programme (DPP) in England. To examine: (1) intervention design, provision and fidelity assessment procedures; (2) risk assessment and recruitment pathways and (3) data collection for monitoring and evaluation. To provide recommendations informing decision makers on programme quality, improvements and future evaluation.
Design We reviewed programme documents, mapping against the NHS DPP specification and National Institute for Health and Care Excellence (NICE) public health guideline: Type 2 diabetes (T2D) prevention in people at high risk (PH38), conducted qualitative research using individual interviews and focus group discussions with stakeholders and examined recruitment, fidelity and data collection procedures.
Setting Seven NHS DPP demonstrator sites and, subsequently, 27 first wave areas across England.
Interventions Intensive behavioural intervention with weight loss, diet and physical activity goals. The national programme specifies at least 13 sessions over 9 months, delivered face to face to groups of 15–20 adults with non-diabetic hyperglycaemia, mainly recruited from primary care and NHS Health Checks.
Participants Participants for qualitative research were purposively sampled to provide a spread of stakeholder experience. Documents for review were provided via the NHS DPP Management Group.
Findings The NHS DPP specification reflected current evidence with a clear framework for service provision. Providers, with national capacity to deliver, supplied intervention plans compliant with this framework. Stakeholders highlighted limitations in fidelity assessment and recruitment and retention challenges, especially in reach and equity, that could adversely impact on implementation. Risk assessment for first wave eligibility differed from NICE guidance.
Conclusions The NHS DPP provides an evidence-based behavioural intervention for prevention of T2D in adults at high risk, with capacity to deliver nationally. Framework specification allows for balance between consistency and contextual variation in intervention delivery, with session details devolved to providers. Limitations in fidelity assurance, data collection procedures and recruitment issues could adversely impact on intervention effectiveness and restrict evaluation.
- health policy
- organisational development
- public health
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Statistics from Altmetric.com
Contributors FFS, AJA, MW, CS, EG, AB, RB and LP designed the evaluation and secured funding for the study. AH, AR, MMM, KB, FFS, ABA and LP conducted fieldwork, and KS and VA-S assisted with data analysis. All authors contributed to interpretation of analyses, study reports and drafts of this summary paper. All co-authors have reviewed and agreed this final draft of the paper that is submitted for publication.
Funding The ‘NHS Diabetes Prevention Programme: process evaluation of the demonstrator phase and consensus building for a common evaluation framework and data-set for programme implementation’ and the ‘Formative evaluation of the First Wave of the national implementation of the NHS Diabetes Prevention Programme’ research studies were funded via the NIHR School for Public Health Research (SPHR). The work was undertaken by Fuse: a UKCRC public health research centre of excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council and the National Institute for health Research is gratefully acknowledged. This paper presents a summary of these two independent but linked research studies. The study sponsors had no influence on the content of this manuscript.
Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Competing interests All authors have completed the Unified Competing Interest form and declare: no support from any organisation for the submitted work other than that the fact that NIHR SPHR funded the research studies. MW and RB hold honorary consultant in public health posts with PHE. MW is programme director for the PHR programme at NIHR. Otherwise there are no financial relationships with any organisations that might have an interest in the submitted work in the previous three years and no other relationships or activities that could appear to have influenced the submitted work. The NHS Diabetes Prevention Programme, on which these independent research studies were conducted, was funded by a partnership of NHS England, Public Health England and Diabetes UK. Research governance procedures were agreed and implemented before the studies reported here commenced, to ensure the independence of our research. During the research period, we regularly reported to the NIHR SPHR and provided executive summaries, with recommendations resulting from these formative evaluations that were made available to the NHS Diabetes Prevention Programme Management Group.
Patient consent Not required.
Ethics approval We obtained NHS ethical approval and Health Research Authority research governance agreements for stakeholder interviews (IRAS number 190418) and ethical approval from Newcastle University Faculty of Medical Sciences ethics committee for stakeholder workshops (FMS number 3475/2016).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are available for further analysis from the corresponding author.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.