How is the Behavior Change Technique Content of the NHS Diabetes Prevention Program Understood by Participants? A Qualitative Study of Fidelity, With a Focus on Receipt

Background The National Health Service (NHS) Diabetes Prevention Program (DPP) is a nationally implemented behavioral intervention for adults at high risk of developing Type 2 diabetes in England, based on a program specification that stipulates inclusion of 19 specific behavior change techniques (BCTs). Previous work has identified drift in fidelity from these NHS England specifications through providers' program manuals, training, and delivery, especially in relation to BCTs targeting self-regulatory processes. Purpose This qualitative study investigates intervention receipt, i.e., how the self-regulatory BCT content of the NHS-DPP is understood by participants. Methods Twenty participants from eight NHS-DPP locations were interviewed; topics included participants' understanding of self-monitoring of behavior, goal setting, feedback, problem solving, and action planning. Transcripts were analyzed thematically using the framework method. Results There was a wide variation in understanding among participants for some BCTs, as well as between BCTs. Participants described their understanding of self-monitoring of behaviors with ease and valued BCTs focused on outcomes (weight loss). Some participants learned how to set appropriate behavioral goals. Participants struggled to recall action planning or problem solving or found these techniques challenging to understand, unless additional support was provided (e.g., through group discussion). Conclusions Participants' lack of understanding of some self-regulatory BCTs is consistent with the drift across fidelity domains previously identified from NHS design specifications. Behavioral interventions should build-in necessary support for participants to help them understand some BCTs such as action planning and problem solving. Alternatively, these self-regulatory BCTs may be intrinsically difficult to use for this population.

Automated summary

This qualitative study investigates the understanding of self-regulatory behavior change techniques (BCTs) in the NHS Diabetes Prevention Program (DPP) among participants. The results show that there is a wide variation in understanding for some BCTs, particularly in action planning and problem solving. The study suggests that behavioral interventions should provide necessary support to help participants better understand and apply these techniques.