Project: (HED-LINE) Healthy Living Diabetes – Long-term Independent National Evaluation 

Why was the research conducted? 

Type 2 diabetes is a serious health condition which can increase the risk of further health complications, such as cardiovascular problems and nerve damage (NICE, 2015). Effective self-management of type 2 diabetes is important to reduce these risks, for example through exercise, healthy eating and taking medication (Shrivastava et al., 2013).  

The NHS Healthy Living programme is an online service which provides content designed to support people with type 2 diabetes to better self-manage their condition (NHS England, 2024). Healthy Living is based on the ‘HeLP-Diabetes’ intervention which demonstrated effectiveness in a trial (Murray et al., 2017). In 2019, it was commissioned by NHS England for national rollout into routine care in England. The HED-LINE project set out to evaluate Healthy Living to understand how well the programme works when rolled out on a national scale. 

How was the research conducted?

The independent evaluation of the Healthy Living programme commenced in 2020, and has used a variety of methods including; interviews with patients and NHS managers, content analysis of the Healthy Living programme and analysis of primary care data on people with type 2 diabetes. 

What were the findings? 

Rollout

NHS local leads, responsible for rolling out Healthy Living across their area, were generally positive about including Healthy Living as an addition to their type 2 diabetes structured education offers. Most were undertaking ‘light touch’ implementation, which mainly involved one-way communications to general practices to inform them about Healthy Living. However, they reported wanting to receive data on uptake, so they could better target the rollout to those who might benefit the most from the service, and they were unsure where Healthy Living fitted within existing type 2 diabetes services (Brunton et al., 2024). 

Intervention content

The content of the Healthy Living programme was generally in line with what the original ‘HeLP-Diabetes’ programme intended (Benton et al., 2022). This meant the programme included key content designed to help people change their health behaviours and self-manage type 2 diabetes. Interviews with programme leads who were responsible for rolling out the online service highlighted it was not possible to include support from healthcare professionals without adding pressure to existing NHS services. The service was therefore rolled out as a self-led programme. 

Usage

The overall usage of Healthy Living was in line with usage of other digital health interventions. Two-thirds of users who created a Healthy Living account accessed some of the website content, however, few people spent time progressing through the programme. Females were more likely to spend more time on the programme than males, and those from the least deprived areas were more likely to spend time on the programme compared to those from the most deprived areas.

User experience

Service users of Healthy Living valued having trustworthy information and learning about how diabetes can impact their low mood (Hawkes et al., 2024). However, they suggested the programme could include more interactive features to encourage further engagement, such as interactivity with other programme users, healthcare professionals, and an app. 

What next? 

HED-LINE have also conducted research looking into the uptake and effectiveness of Healthy Living which will be available in the upcoming months. Watch this space! 

HED-LINE are also working with NHS England to feedback the findings from this independent evaluation. So far, they have advised on how to improve some of the behaviour change content in the programme and NHS England are working on improving navigation to some of the self-management content on the website. The Healthy Living programme is being continually improved based on findings from this programme of work, which will inform key decisions on the procurement of future structured education programmes for type 2 diabetes. 

For further information about the HED-LINE project

• Visit the website
• Email hawkes@manchester.ac.uk

About the researchers  

The HED-LINE research team included: Dr Sarah Cotterill, Dr Jack Benton, Dr Lisa Brunton, Prof Rachel Elliott, Prof David French, Dr Rhiannon Hawkes, Prof Evan Kontpantelis, Eric Lowndes, Dr Antonia Marsden, Dr Luke Paterson, Prof Caroline Sanders, Prof Paul Wilson & Dr Salwa Zghebi. 

Members of a Patient and Public Involvement and Engagement group were key members of the evaluation team throughout the design, data collection and analysis of these findings. 

Please note: This blog reports independent research funded by the National Institute for Health and Care Research (Policy Research Programme, Healthy Living Diabetes – Long-term Independent National Evaluation (HED-LINE), NIHR200933). The views expressed in this blog are those of the authors and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care. 

Writers 

Co-written by Lauren Moore (MSc Health Psychology student) and Dr Rhiannon Hawkes (Researcher at the University of Manchester). 

References

• Benton, J. S., Cotterill, S., Hawkes, R. E., Miles, L. M., & French, D. P. (2022). Changes in a Digital Type 2 Diabetes Self-management Intervention During National Rollout: Mixed Methods Study of Fidelity. Journal of Medical Internet Research,  24(12), e39483. https://doi.org/10.2196/39483  
• Brunton, L., Cotterill, S., & Wilson, P. (2024). Evaluating the national roll out of a type 2 diabetes self-management intervention: a qualitative interview study with local NHS leads responsible for implementation. Journal of Medical Internet Research, 26, e55546. https://doi.org/10.2196/55546
• Hawkes, R.E., Benton, J.S., Cotterill, S., Sanders, C. & French, D.P. (2024). Service users’ experiences of a nationwide digital type 2 diabetes self-management intervention (‘Healthy Living’): A qualitative interview study. JMIR Diabetes, 9, e56276.   https://doi.org/10.2196/56276
• Murray, E., Sweeting, M., Dack, C., Pal, K., Modrow, K., Hudda, M., … & Patterson, D. (2017). Web-based self-management support for people with type 2 diabetes (HeLP-Diabetes): randomised controlled trial in English primary care. BMJ Open, 7(9), e016009. https://doi.org/10.1136/bmjopen-2017-016009
• National Health Service. (n.d.). Healthy Living for people with type 2 diabetes.
• National institute for Health and Care Research (NICE). (2015). Type 2 diabetes in adults: management. [NICE guideline NG28].
• Shrivastava, S. R., Shrivastava, P. S., & Ramasamy, J. (2013). Role of self-care in management of diabetes mellitus. Journal of Diabetes & Metabolic Disorders, 12(1), 1-5. https://doi.org/10.1186%2F2251-6581-12-14

Infographic summary

View an infographic summarising the above findings (PDF).

Illustration by @Sketchify on Canva.

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