Increasing access to digital health technologies for people from under-served communities at risk or diagnosed with Type 2 Diabetes: INACT-T2D

 

Funding

Bristol, North Somerset and South Gloucestershire ICB Research Capability Funding.

What is the problem?

Type 2 diabetes (T2D) is a chronic disease that affects a large number of people and creates a significant burden for patients and the health services that support them. In the United Kingdom, 1 in 10 people over the age of 40 years now has T2D and around a third of adults living in England have pre-diabetes. Pre-diabetes puts individuals at high risk of developing T2D and the associated health complications, including cardiovascular pathologies, kidney disease, eye problems and foot ulcers. In addition to the threat of poor health outcomes, people with T2D often encounter widespread changes to their lives and that of their family. It is argued that becoming chronically ill is a challenge to self-identity, requiring a shift to incorporate the illness into their sense of self.

There is a social gradient to T2D, whereby people with lower Socio-Economic Status (SES) experience both higher incidence and greater severity of chronic illness than those with higher SES. Resource restrictions mean that primary health services are not in a position to offer substantial interventions to prevent and treat T2D. As it stands, the management of diabetes consumes 10 percent of the NHS budget, at around 10 billion pounds a year. Where interventions are provided in primary care, those from lower SES groups often have the least access to this support.

The prevention and early treatment of T2D is central to the NHS Long Term Plan, and increasing the availability of interventions to tackle this goal are seen as key to address health inequalities. Therefore, this research is needed now to ensure that these interventions reach all groups, and not just those from with higher SES who generally have better access to health services and interventions.

What is the aim of the research?

This project aims to develop and evaluate an intervention that acts like a social resource to reduce barriers accessing DHTs for people with lower SES, with pre-diabetes and with T2D.

How will this be achieved?

RCF would make it possible to conduct primary research that will be essential for the development of the intervention. It will also allow for the continued engaging with stakeholders, and to develop further collaborations with target users and people involved in the delivery of the intervention.

The primary research would include a scoping search of DHTs that have demonstrated evidence of effectiveness for improving outcomes for those at risk of and with a diagnosis of T2D. It would also fund a qualitative study investigating whether COVID has had an impact on how and why people with pre-diabetes and T2D engage in DHTs. I have previously conducted interviews with people diagnosed with T2D from a range of different social groups to understand how and why they access and use DHTs. However, this work needs to be updated to include any new barriers or facilitators to access to DHTs have emerged as a result of the pandemic. In addition to exploring whether people with pre-diabetes experience different barriers and facilitators to accessing DHTs compared to those with a diagnosis of T2D. This is essential to understand if people with pre-diabetes need different support from the intervention. The evidence will be used in the intervention to provide examples of how people at risk of T2D use DHTs, and how they overcome barriers to accessing them.

I will develop further collaborations with stakeholders, through engagement with community groups, social prescribers, digital health hubs and members of the CCG. I have had PPI input from people from under-served groups in early iterations of this project. However, I will be seeking to recruit PPI members who have pre-diabetes and have a diagnosis of T2D. I will also be recruiting advisory representatives from each of the professions that will support the intervention, including primary care-based health care assistants and nurses, and social prescribers.

Who is leading the research?

Dr Sophie Turnbull, Research Fellow, University of Bristol.

Further information

For more information or to get involved with this project, please contact bnssg.research@nhs.net