UCL Research Department of Primary Care and Population Health

Introduction: Diabetes is one of the commonest long-term conditions in the UK, affecting about 2 million adults.  It causes substantial morbidity and premature mortality and costs the NHS about £9 million per annum.  Structured education reduces the incidence of complications and NICE advises that all people with T2DM should have structured education at diagnosis with annual reinforcement.  In 2006 only 11% of people with T2DM reported being offered such education, suggesting considerable ummet need.  This programme aims to address this need through the development, evaluation and implementation of a computer-based self-management programme (SMP) for people with type 2 Diabetes.

Methods: Following MRC guidance, our research applies a rigourous theoretical framework for developing and evaluating this complex intervention.  In years 1-2 we will explore user perspectives of essential and desirable features of a computer-based SMP.  We will use participatory design to develop a theoretically informed SMP which is linked with the patient electronic record but can also be accessed independently.  The SMP will address recognised patient needs and will facilitate communication between patients and health professionals.  We will then run two parallel evaluations of the intervention in primary care: a phase-3 randomised controlled trial (RCT) and a phase-4 implementation study.  The RCT will determine effectiveness and cost-effectiveness of the SMP, using HbA1c and health related quality of life as primary outcomes.  The implementation study will explore what happens when the SMP is used in routine NHS practice, and what resources are needed for implementation.

Results: Early del;iverables include an understanding of essential and desirable characteristics of a computer-based SMP to inform the development of similar programmes for other long-term conditions.  By year 2 we will have an innovative, theoretically-informed SMP of proven acceptability to users through a process of participatory design.  By year 5 we will have data on its effectiveness, cost-effectiveness, resources needed for implementation, and impact on health when used in routine clinical practice.

Conclusions: We hope the combination of innovative methodology, strong theoretical undepinning and a highly prevalent chronic condition will be of interest to everyone in the department, especially those with an interest in or experience of using complex interventions.