What is the Healthy Living for people with Type 2 Diabetes Programme:

The NHS Long Term Plan, released in January 2019, outlined NHS England’s commitment to expand self-management services for individuals with Type 2 Diabetes Mellitus (T2DM)  through the commissioning of Healthy Living for People with Type 2 Diabetes Programme (Health Living).

Healthy Living is an online self-management support programme and accompanying structured education pathway for adults with T2DM, which NHS England has licensed and is currently redeveloping for release during 2020. Healthy Living was originally developed by a team at University College London (UCL), and provides information about T2DM and its treatments, offers emotional support, and helps with adopting and maintaining healthy behaviours (e.g. diet, exercise).
 

The design of the Healthy Living Programme has been informed both by scientific theory and the needs and preferences of patients, their families and health professionals. It has been developed through a process of participatory design where users (both patients and health professionals) were heavily involved in its creation.
 

 

Why is this important?

T2DM has serious health implications, with poor control resulting in vision loss, nerve pain and (in severe cases) amputation, as well as high risk of other cardiovascular complications. T2DM costs the NHS £10 billion per year, 9% of the NHS budget. Appropriate glycaemic and blood pressure control, and changes in lifestyle to reduce weight can decrease these risks.

 

However, people often find it difficult to make (and maintain) changes. Structured T2DM education programmes are recommended by NICE, and providing accessible group support using proven behaviour change techniques is fully aligned with the NHS Five Year Forward View and 10 year NHS Long Term Plan. However, attending groups is not suitable for everyone. Healthy Living was developed as a digital alternative to face-to-face support.

NHS England’s decision to invest and commit to rolling out the Healthy Living Programme, is based on their view of the evidence. A randomised ontrol trial by a team at UCL, funded by the National Institute of Health Research (NIHR), demonstrated modest but significant improvements in HbA1c levels amongst patients with diabetes who were offered HeLP Diabetes (a forerunner of Healthy Living), compared to patients who were not offered the digital service. The UCL team also demonstrated the feasibility of rolling the digital service out across England.

 

What is currently unknown is how the Healthy Living web-based self-management platform performs when it’s rolled out and used nationally in a real world setting. Hence it is important to have an independent evaluation to assess: 

 

• Who uses the Healthy Living platform and whether engagement varies by patient populations.
• Whether it’s effective in changing health outcomes for people
• What the key barriers and facilitators are to implementing this national programme.
• Whether people are receiving a high quality Healthy Living service.
• If the programme is delivering value for money

 
 

How are we doing it?

HED-LINE is a three and half year (2020 to 2023) funded programme of work comprising five distinct areas of focus, utilising both qualitative and quantitative methods to assess the following:

 

• Uptake - understanding how many people start to, and continue to use the Health Living platform
• Effectiveness - analysing how effective Health Living is in changing clinical outcomes compared to usual care.
• Implementation of Healthy Living - exploring how implementation differs across the country
• Service delivery and fidelity - checking what is being delivered and how it compares to expectations
• Cost effectiveness - assessing whether the Health Living is cost effective compared to usual care.

 

The HED-LINE research team

• Dr. Sarah Cotteril (Principle Investigator)
• Prof. Peter Bower (Co-investigator)
• Mike Spence (Collaborator)
• Paul Wilson (Co-applicant)
• Prof. David French (Co-applicant)
• Prof. Evan Kontpantelis (Co-applicant)
• Prof. Rachel Elliott (Co-applicant)
• Prof. Caroline Sanders (Co-applicant)
• Dr Brain Mcmillan (Co-applicant)
• Prof. Martin Rutter (Co-applicant)
• Dr Sally Giles (Co-applicant)
• Eric Lowndes (Co-applicant)
• Kathryn Grady (Collaborator)

 
 

Who we are working with:

• NIHR Policy Research Programme (PRP)
• NHS England

 

 

Downloadable resources:

 

• Summary
  • Scientific Summary (June 2020)
  • Plain Language Summary (June 2020)
• Protocol
  • HED-LINE Protocol v1.7 (October 2023)
• Publications
  • Brunton L, Cotterill S, Wilson P. (2024) Evaluating the National Rollout of a Type 2 Diabetes Self-Management Intervention: Qualitative Interview Study With Local National Health Service Leads Responsible for Implementation, J Med Internet Res 
  • Benton JS, Cotterill S, Hawkes RE, Miles LM, French DP., (2022). Changes in a Digital Type 2 Diabetes Self-management Intervention During National Rollout: Mixed Methods Study of Fidelity. Journal of Medical Internet Research

 

More information:

For more further information about this work, please contact Dr Sarah Cotterill (Principle Investigator) or Mike Spence (Programme Manager)

 

This study/project is funded by the National Institute for Health Research (NIHR) [Policy Research Programme, NIHR200933/Healthy Living Diabetes - Long-term Independent National Evaluation (HED-LINE) of part of the NIHR]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.