Usage and Exposure to Content of the NHS Healthy Living Program for People With Type 2 Diabetes: Retrospective...

Diabetes self-management education and support (DSMES) programs can improve health outcomes, but engagement is often low. "Healthy Living" is a web-based self-management program for people with type 2 diabetes, based on the "HeLP-Diabetes" intervention, which demonstrated effectiveness in a randomized controlled trial. Healthy Living was commissioned by the National Health Service in England and rolled out nationally into routine care in 2020. The program comprises web-based structured learning, unstructured articles (which users could access at any time), and tracking tools such as goal setting. It is important to assess not only the uptake of digital interventions but also the amount of time spent using the intervention and the content they engage with. There is currently limited research on the extent to which people engage with digital DSMES program content outside of a trial setting.

This study aimed to investigate the overall usage and exposure to content of Healthy Living, including differences in usage/exposure by user characteristics.

This study used a retrospective observational cohort study design to conduct a service evaluation of Healthy Living. Pseudonymous usage data from all people with type 2 diabetes (N=27,422) who activated a Healthy Living account between May 2020 and September 2023 were available, including (1) which program activities were accessed, (2) when activities were accessed, and (3) how long users spent on each activity. User demographic and usage information was summarized using means and SDs, medians and IQRs, or frequencies and percentages. Logistic regression evaluated the association between user demographics and usage.

Of the 27,422 users who activated a Healthy Living account, the mean age was 58.6 (SD 12.0) years, and the percentage of females was 56.8% (15,385/27,422). There was an even spread across deprivation quintiles. The median length of time spent on the program in total was 7.6 (IQR 0.6-27.6) minutes; 12,066 (44%) users spent <5 minutes on the program, and 3022 (11%) spent ≥1 hour. Of those who activated an account, 69.8% (19,137/27,422) accessed some program content, 40.7% (11,149/27,422) completed the first section of structured education, and 4.7% (1219/27,422) completed 60% of the structured education. Usage of the unstructured aspects of the program was low. Female gender, lower deprivation, White ethnicity, and a shorter time since diagnosis were associated with increased usage.

This study is one of the first to provide detailed analysis of user engagement with a national digital self-management program for type 2 diabetes. Unlike previous evaluations conducted on smaller sample sizes, this study highlights the low usage of Healthy Living across >27,000 users. Given that higher usage of DSMES programs is associated with improved health outcomes in people with type 2 diabetes, further work needs to identify how to encourage increased engagement with the program.