Table 1 Service parameters outlined in the programme specification in comparison to each digital provider’s design documentation
| Â | NICE PH38 | NHS Service Specification | Provider 1 | Provider 2 | Provider 3 | Provider 4 |
|---|---|---|---|---|---|---|
Initial assessment | - | Adequate information on benefits and risks of service to allow informed decision to participate, confirm eligibility, baseline data, brief intervention for smoking | Telephone call, confirm baseline data, questions answered, brief interventions (including for smoking cessation where appropriate), technology explained, commitment to behaviour change, Healthbox sent in post | After mini assessment to take weight and HbA1c 60-minute onboarding F2F video call to establish relationship, commitment to behaviour change, set initial goals | Pre-assessment surveys3, email, SMS or telephone call (45-minutes3) to confirm eligibility, brief interventions including for smoking, deliver motivational interviewing, discuss weight measurement options | Targets set for weight loss, 30-minute onboarding call with coach, access to educational content, motivational interviewing. Smoking cessation advice available. |
Duration | 9–18 months with follow-up sessions for two years | Minimum of 9 months | 9-month programme divided into 2 phases | 9-month programme | 9-month programme, divided into 3 phases3 | 13 curriculum topics over 9-month programme |
Frequency | Tapered and delivered in a logical progression | Allow sufficient time between sessions to make gradual behaviour changes, engagement activity each month | Core phase (weeks 1–12): new content unlocked daily. On demand coaching with average 2-hours dedicated coach time per week via messages. Sustain phase (weeks 13–40): new content unlocked weekly. On demand coaching with average 30–60 min of coaching time per week. Frequency and intensity of coach support reduces over time. | 2 personal coaching sessions per month over 9-months (but can be front-loaded to support initial motivation), 16 2-minute bite-sized videos and written modules delivered to enhance coaching support | Modular curriculum unlocked each 30 day period, frequency of HC prompts and guided feedback gradually reduced from weekly to monthly 3Start/Core phase: intensive weekly app coaching for 6 weeks (3 times per week), or fortnightly phone calls. 3Sustain phase: monthly calls from HC for 6 months | Prompted to engage with tools and curriculum > fortnightly 2Behaviour change techniques delivered weekly |
Mode of delivery | Individual or group sessions | 13 sessions must be provided in a format appropriate to a range of diverse groups | Access to app/ web-application, notifications via email, text and ‘push’ messages | Content of sessions include messages, videos, pdf’s, links, education offered in both written and video content | Delivered by smartphone app, online, or as a phone-based service. Articles, videos, podcasts material online, or available offline in pdf/printed. | Access to app/ web-application, audio, video and interactive content, structured education via email, programme prompts through emails and texts, materials can be in print or electronic |
Materials | The programme should offer practical learning opportunities, particularly for those who have difficulties with communication and literacy | The programme material designed to allow service users with different levels of knowledge and different approaches to learning to progress at different paces, promoting self-directed learning | Wireless scales, handbook, activity tracker, recipe book, articles, action plans, tracking tools on app, articles, online exercise videos | Tracking and goal setting tools, structured education videos/ pdf’s | Online learning portal, optional Guidebook/DVD if no online access. Includes meal plans, recipe book, articles, videos, podcasts, quizzes, tracking tools | Weekly videos and email content, workbook, > 1,000 recipes, barcode scanner, tracking tools, content from Headspace and Aaptivea, nutritional data for branded foods, behaviour-based rewards, articles detailing ‘success stories’ |
Support offered | Support from sensitive, well-trained and dedicated people; encourage support from family members | Consider social and psychological support needed to support people to implement behaviour changes, provide individual 1:1 support | Personalised health coaching through 1:1 messaging, participant peer support groups of approximately 10 people, average total coach time via messenger is 36 + hours per service user | 60-minute onboarding video call, 18 personal coaching sessions, algorithmic messaging support, access to online community groups (grouping based on interests, etc.), same HC throughout programme | Initial call with HC to set action plan for diet, physical activity and weight loss, meal plan designed, at least 10 1:1 support sessions from HC via telephone and messaging/ video calls, peer groups support of 10 service users, option for carer/ relative to join 1:1 calls, same HC throughout programme | Telephone support at initial assessment, access to social community groups (connect), 24/7 1:1 chat |
Tailoring | Sensitive and flexible to the needs, abilities, and cultural or religious norms of local people | Tailored to personal circumstances and culture of service users, sensitive to different culinary traditions, maximise flexibility of offering | Tailored coach advice for setting diet and activity goals, nutritional advice specifically for different cultural backgrounds, and individualised support1. | Individualised adaptable goal setting, mode of educational resources personalised to user (e.g. videos, pdf’s) | Physical activity advice graded and structured within personalised timeframe, learning materials personalised to level of knowledge and approach to learning, multi-lingual dieticians/HCs for over 15 languages, personalised meal plans for cultural and culinary traditions, varying appointment times offered (8am-8pm Monday-Saturday) 3Health Action Process Approach tool completed after the first 2 weeks of coaching to help determine whether coaching or self-led approach. | Range of different channels to support different learning styles/ abilities/ cultural needs, support materials in > 10 languages, private online groups for like-minded people, recipes to suit all culinary traditions, personalised goals, booked calls with translators |
Measurements (weight, HbA1c) | - | Regular weigh-ins (self-monitoring); baseline, 3-month, 6-month and 9-month weigh-ins taken via calibrated mechanisms. Blood test at first and final session | Provided with wireless scales to record weights at IA, and months 3, 6 and 9, at weeks 37–40 blood test is taken by F2F provider | Service users initially invited to blood and weight testing mini-assessment at a F2F session or pharmacy | Weekly self-monitoring of weight encouraged. Weight measurements and HbA1c taken at F2F measurement clinics, or local weight machines, validated weight at days 30, 90, 180 and 270 | Weight measurements at F2F groups or pharmacy |