Table 2 The structural features of four provider programmes delivering the NHS-DDPP, including modifications identified
Provider 1 | Modifications | Provider 2 | Modifications | Provider 3 | Modifications | Provider 4 | Modifications | ||
|---|---|---|---|---|---|---|---|---|---|
Materials | Virtual materials | App including tracking, chat, toolbox and activity functions; 12 weeks of Core Learn educational materials; Option to sign up to 7 Sustain course modules | App including tracking, personal profile, ‘agreement’, messages and group functions; 41 pdfs and 13 videos of educational material | HC dashboard of available pdfs/videos is growing | App including goal setting ‘to dos’, tracking weight & behaviours and graphs of progress; chat with coach/peers; access to online learning platform; and profile functions. | App including tracking, barcode scanner, food information and recipes; Access to educational materials (weekly techniques) via app; pdf of editable DPP workbook; pdfs on success planning and maintenance/signposting | |||
Physical materials | Handbook (Introduction, Nutrition advice, Meal planning, Q&A); Tracker; Scales | Printed guidebook available if no online access | |||||||
Procedures | Educational material | Core Learn articles for weeks 1–12; links to exercise videos, recipes; Option to sign up to 7 Sustain course modules | Content of articles continually reviewed | Series of pdfs and videos sent to participant by HC | Structured Learn platform comprising 42 lessons, gradually unlocked over 9 mo. | Content of modules is continually reviewed and updated | 1 pdf editable workbook sent to participants at start of programme; 1 pdf workbook to ‘plan success’; 1 pdf sent to participants at end of programme with focus on signposting; Weekly articles available via the app | ||
App | App includes procedures to plan meals, set habits, participate in steps leaderboard, track weight, steps and sleep (device can be paired with app), enter reflections (food diary and journal) | App includes procedures to set and track progress against goals, track multiple behaviours and outcomes, and view agreement between HC and participant | App includes procedures to set and track goals ‘to do’s, track diet, physical activity and steps (fitness tracker devices can be synced with app), weight and other outcomes | App includes procedures to track activity, sleep, water and food; assess nutrition information of foods, plan meals and access workout videos and audio coaching for mindset. Series of emails sent to participants to encourage use of app functions | Changes to points system for monitoring progress and personalised food plans identified Nov 2021. Introduction of workout videos and mindset coaching (based on new research and user feedback in 2020) | ||||
Support | First 12 weeks: 1–1 messaging with HC and closed group chat. After week 12 Community Groups discussion forums available (choice of 17 topics) (post, like and comment); Sustain chat group -participants in each 4 week course added to the relevant module ‘chat’ group. Closed group chat (peer-peer) avail all 9 Mo, but only moderated by HC up til week 24. HC available to respond to private 1–1 messages for 24 weeks | Initial consultation by live video call, followed by series of asynchronous video messages (with text), and pdfs/videos sent from HC to participant. HC use signposting to other resources and recipes. Group support (optional): group forum for peer support (post, like, comment, not actively moderated by HC) | Initial consultation telephone call, followed by app or phone coaching (scheduled), then monthly telephone calls. Discharge telephone call at end of programme | Choice of 3 pathways introduced in July 2021: Group coaching pathway (20 members moderated by HC); App coaching pathway; Phone coaching pathway | 1–1 messaging available with access to online HCs 24/7. Group support forum (post, like, comment, HC present) | ||||
Format of delivery (per procedure) | Core Learn articles | Pdfs | Learn platform | Workbook and pdfs | |||||
Mode of delivery | Remote | Remote | Remote | Remote | |||||
Delivery method | Individual | Individual | Individual | Individual | |||||
Delivery channel | App/website (Passive) | App, chat (Passive, potential for prompted interaction). | App/website (Passive) | Website/email (Passive) | |||||
Delivery route | Text, audio, video | Text, picture | Audio, text, picture, video | Text, picture | |||||
Sustain modules | Videos | Weekly articles (techniques) via app | |||||||
Mode of delivery | Remote | Remote | Remote | ||||||
Delivery method | Individual | Individual | Individual | ||||||
Delivery channel | App, email (Passive) | App, chat (Passive, potential for prompted interaction). | App, email (Passive) | ||||||
Delivery route | Text | Audio, video | Text, picture, video | ||||||
App | App | App | App | ||||||
Mode of delivery | Remote | Remote | Remote | Remote | |||||
Delivery method | Individual | Individual | Individual | Individual | |||||
Delivery channel | App (Interactive) | App (Interactive) | App (Interactive) | App (Interactive) | |||||
Delivery route | Experiential | Experiential | Experiential | Experiential | |||||
Support (group chat and community groups) | Support (group forum) | Support (group chat) introduced in July 2021 | Support (group forum) | ||||||
Mode of delivery | Remote | Remote | Remote | Remote | |||||
Delivery method | Group (group chat up to 20 people) | Group | Group | Group | |||||
Delivery channel | Chat (Interactive) | App, chat (interactive) | App, chat (interactive)1 | App, chat (interactive) | |||||
Delivery route | Text, picture | Text, picture | Text, picture1 | Text, picture, video | |||||
Support (health coaching) | Support (health coaching) | Support (health coaching) | Revised July 2021 | Support (health coaching) | |||||
Mode of delivery | Remote | Remote, remote and face-face | Remote (remote face-face option available) | Remote (remote face-face option available) | Remote | ||||
Delivery method | Group, individual | Individual | Individual | Individual/group | Individual | ||||
Delivery channel | Chat (Interactive) | Video call, chat, video messaging (interactive) | Telephone, chat (interactive) | Telephone, chat (interactive) | Chat, (occasionally telephone) (interactive) | ||||
Delivery route | Text, pictures | Text, audio, video, picture | Text, audio | Text, audio | Text, audio | ||||
Physical materials | |||||||||
Mode of delivery | remote | ||||||||
Delivery method | Individual | ||||||||
Delivery channel | Physical booklet and tracker (passive) | ||||||||
Delivery route | Text, images (handbook); unclear (tracker) | ||||||||
Deliverers2 | Undergraduate/postgraduate degree in Psychology/Nutrition; further training in coaching, safeguarding; CBT | Undergraduate/postgraduate degrees in Sports Science and Clinical Exercise Physiology; further training including motivation, behaviour change; Hospitality/nutrition adviser background; Clinical medicine background; further training including motivational interviewing, behaviour change | Undergraduate/postgraduate degree in nutrition; further training including motivational interviewing, behaviour change, patient trauma, medical conditions, diabetes, information governance | Previous members of programme, further training in behaviour change, diabetes | |||||
Dose and scheduling | Sessions/educational material | Core Learn material unlocked in weeks 1–12. After 12 weeks: Sustain modules take place over 4 weeks, with 3 articles per week sent Mon/Wed/Fri | Pdfs and videos sent to participants by HC according to need over 9 mo (approx 2 resources sent per interaction) | 42 weekly lessons, gradually unlocked over 9 mo. | Series of emails sent weeks 1–4 (4 per week) to encourage use of all programme procedures e.g. tracking, meal planning | ||||
Health coaching | Group chat: HC makes contact proactively daily for first 12 weeks, proactively weekly for next 12 weeks, then leaves group. Community groups: HC makes contact proactively weekly. Private chat: Proactive check-in by HC 3 x in first 12 weeks, then reactive to Qs up to week 24. | Initial consultation with HC by live video call (45–50 min) at start of programme; subsequent asynchronous HC video messages (3 min) / interventions (lasting 9-10 min) weekly for first 3 months, bi-weekly for next 3 months and monthly for final 3 months. | Initial consultation with HC by telephone (30 min) in week 1; followed by six weeks of app coaching (HC proactive 3 times/week, 5 min each time) or three bi-weekly phone calls (20-30 min). Remainder of programme to 9 months phone coaching from HC at pre-agreed time points (monthly telephone calls of 20-30 min each) | Group coaching pathway: 45 min initial consultation with HC, followed by monthly 15 min group app interaction with HC 1–1 App coaching pathway: 45 min initial consultation with HC, followed by monthly 15 min 1–1 app interaction with HC 1–1 Phone coaching pathway: 45 min initial consultation with HC, followed by monthly telephone calls with HC (30 min each) Telephone coaching sessions reduced from 30 to 20 min in July 2021 | HC support is provided reactively to participant questions (not scheduled) | ||||
Support (peer-peer) | Group chat remains open for peer-peer chat for 9 mo | Group forum available for 9 mo | Group forum available for 9 mo | ||||||
Tailoring | Automated | Series of scheduled ‘Support’ emails sent to participants who do not engage with programme | Messages of encouragement sent to participants when they log their weight; automated tailoring of goal setting on app and feedback on tracked information | ||||||
Tailored by whom? | HC can tailor app experience (e.g. Leaderboard on/off, feedback on food diary) and support according to lifestyle factors e.g. working patterns, caring responsibilities, disabilities. | HC tracked information, barriers to change, lifestyle | HC tailors advice and support according to individual assessment questionnaire which is completed prior to first appointment, tracked information and progress | HC can tailor advice when responding to questions e.g. setting of goals | |||||