Sophie Lowry is the Implementation and Involvement Manager at the Health Innovation Network (the Academic Health Science Network for south London) and a member of NIHR Applied Research Collaboration (ARC) South London’s Implementation & Involvement Team.
With a BSc in Medical Science from the University of Exeter, an MSc in Implementation and Improvement Science from King’s College London and a background in operational and project management in both acute and community settings. Sophie’s role focuses on supporting the involvement of people with lived experience at a project and strategic level across both organisations as well as the translation of evidence-based research into practice including evaluations.
Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) is a culturally tailored self-management education programme co-designed with, and for, African and Caribbean adults with Type 2 diabetes. Developed as a face-to-face intervention, it is now delivered virtually as ‘HEAL-D Online’.
This study explores the implementation and adoption of HEAL-D Online in other English regions by understanding the factors affecting scale-up from operational delivery and commissioning perspectives.
We conducted focus groups with 15 members of the public of African and Caribbean heritage, and interviews with 6 commissioners and 3 diabetes service providers in three Integrated Care Systems outside of London.
Data was analysed using thematic analysis. The Exploration-Preparation-Implementation-Sustainment’ (EPIS) framework informed the analysis approach, focusing on the ‘Exploration’ stage to consider how HEAL-D Online can address a clinical need whilst considering the contextual factors supporting or hindering implementation.
Focus group findings identified most participants were accustomed to using online platforms, with individuals requesting education on topics covered by HEAL-D Online, suggesting that scaling HEAL-D Online would be acceptable.
Commissioners and service providers highlighted a lack of existing culturally tailored services, and a clear understanding of the benefits that HEAL-D Online, or a similar virtual, culturally tailored programme could offer. Commissioning processes and service capacity varied, though all wanted to understand more around local demand and the clinical and cost-effectiveness of the intervention.
Using EPIS, ‘Client Advocacy’ (patient needs), ‘Funding’ (cost of the intervention vs. available funding), ‘Interorganisational Networks’ (system priorities and relationships) and ‘Patient/Client Characteristics’ (size of target population) were all identified as areas which could support the spread and adoption of HEAL-D Online.
There is strong interest in further exploring population need and scaling of HEAL-D Online in other areas of England, but a key challenge to any virtual scale-up is digital poverty. Addressing this will be required to ensure successful implementation.