Engagement with the Healthier You: NHS Digital Diabetes Prevention Programme: A mixed methods study exploring design and early use of a nationally implemented digital health service (Preprint)

BACKGROUND The NHS Digital Diabetes Prevention Programme (NHS-digital-DPP) is a 9-month digital behaviour change intervention, delivered by 4 independent providers, which is implemented nationally across England. No studies have explored the design features included by service providers of digital DPPs to promote engagement and little is known about how participants of nationally implemented digital DPPs like this make use of them. OBJECTIVE This study aims to understand engagement with the NHS-digital-DPP. Specific objectives were to describe how engagement with the NHS-digital-DPP is promoted via design features and strategies, and b) describe participants’ early engagement with the NHS-digital-DPP apps. METHODS Mixed methods were used. Qualitative study: A secondary analysis of documents detailing the NHS-digital-DPP intervention design, and interviews with program developers (n=6). Data were deductively coded according to an established framework of engagement with digital health interventions. Quantitative study: Anonymous usage data, collected over 9 months for each provider, representing participants’ first 30 days of use of the apps, was obtained for participants enrolled to the NHS-digital-DPP. Usage data fields were categorised into four intervention features (Track, Learn, Coach Interactions and Peer Support). Amount of engagement with intervention features were calculated for the whole cohort and differences between providers were explored statistically. RESULTS Data were available for 12,857 participants who enrolled on the NHS-digital-DPP during the data collection phase. Overall, 94% of those enrolled (12,133/12,857), engaged with the apps in the first 30 days. The median number of days of use was 11 (IQR 23). Track features were engaged with most (median number of tracking events 46.0 (IQR 119)), and Peer Support features were the least engaged with (0.0 (IQR 0)). Significant differences in engagement with features were observed across providers. Qualitative findings offer explanations for the variations including suggesting the importance of health coaches, reminders and regular content updates to facilitate early engagement. CONCLUSIONS Almost all participants of the NHS-digital-DPP started using the apps. Differences across providers identified by the mixed methods analysis provide the opportunity to identify features that are important for engagement with digital health interventions and could inform the designs of other digital behaviour change interventions.