Abstract
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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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