The national implementation of ‘Healthy Living’, a web-based type 2 diabetes self-management education and support service: Narrative synthesis of evaluation findings and implications for service delivery and research

Aims NHS England adopted ‘HeLP-Diabetes’, a web-based diabetes self-management and education service, effective in a clinical trial, and implemented it across England as ‘Healthy Living for people with type 2 diabetes’ (Healthy Living). This paper aims to narratively synthesises findings from a programme of mixed-methods evaluations undertaken alongside the national implementation. Methods Interviews with programme users and NHS staff, content analysis of the website, analysis of anonymised large datasets, and calculation of the costs and health benefits. Results Service users and health professionals welcomed Healthy Living and made suggestions for improvement. The web content had fidelity to HeLP-Diabetes and was suitable for supporting self-management. Similar to other online programmes, there was variation in uptake and retention, and many people spent a short time engaging. Despite these challenges, Healthy Living registrants had modestly lower blood glucose at one year (by -1 mmol/mol (95% CI: -2, -1); -0.1% (95% CI: -0.2%; -0.1%)) compared with usual care, results were better in those using the programme more, and it was cost-effective. Conclusions We present the first logic model of a UK diabetes self-management and education programme. The implications for UK diabetes care include a need for clarity on eligibility for different services, the importance of expanding access to people from minority ethnicities and areas of highest deprivation, and the need to improve retention. A future research agenda includes achieving consensus on a roadmap through diabetes services, how and why people choose (or not) to participate in self-management services, and which components of these services are most strongly associated with positive health benefits.