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Publication Detail
Developing and evaluating a plan to implement an online self-management programme for people with type 2 diabetes within routine healthcare
Background Internet interventions have the potential to provide self-management support to patients with type 2 diabetes. However, little is known about the adoption and use of internet interventions within routine healthcare by services and patients. Available data on the reach and use of such interventions has been collected in the context of research which may not generalise to routine practice. Implementation of e-health into healthcare settings is frequently described as challenging, and concerns about a digital divide are reported. Aim To employ implementation science methods to investigate the implementation of HeLP-Diabetes, an internet based self-management intervention for people with type 2 diabetes into routine healthcare. Methods A theoretically informed implementation plan was developed and applied to the implementation of HeLP-Diabetes within routine healthcare. A mixed methods case study in one National Health Service (NHS) Clinical Commissioning Group evaluated the implementation. Data were collected to describe: the adoption and implementation by NHS services, uptake and use by patients, and barriers and facilitators to implementation and use. Results Adoption was high but relatively few NHS services actually implemented HeLP-Diabetes. Barriers included the current NHS context with limited time and resources to undertake the work of implementation and the prioritisation of incentivised tasks over HeLP-Diabetes. A wide range of patients registered to use HeLP-Diabetes including those with basic computer skills and no education. Over half of registered patients made some use of HeLP-Diabetes. Staff facilitation of access and the accessibility of HeLP-Diabetes promoted uptake and use. Conclusion In the context of diabetes self-management there seems to be good potential for internet based interventions. Staff facilitation of access has the potential to provide access to patients with lower education and basic computer skills. However, to become part of routine practice resources need to be allocated and the work has to be prioritised by staff.
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