Usage and Exposure to Content of the NHS Healthy Living Program for People With Type 2 Diabetes: Retrospective Observational Cohort Study

Background Diabetes self-management education and support (DSMES) programs can improve health outcomes, but engagement is often low. “Healthy Living” is a web-based self-management program for people with type 2 diabetes, based on the “HeLP-Diabetes” intervention, which demonstrated effectiveness in a randomized controlled trial. Healthy Living was commissioned by the National Health Service in England and rolled out nationally into routine care in 2020. The program comprises web-based structured learning, unstructured articles (which users could access at any time), and tracking tools such as goal setting. It is important to assess not only the uptake of digital interventions but also the amount of time spent using the intervention and the content they engage with. There is currently limited research on the extent to which people engage with digital DSMES program content outside of a trial setting. Objective This study aimed to investigate the overall usage and exposure to content of Healthy Living, including differences in usage/exposure by user characteristics. Methods This study used a retrospective observational cohort study design to conduct a service evaluation of Healthy Living. Pseudonymous usage data from all people with type 2 diabetes (N=27,422) who activated a Healthy Living account between May 2020 and September 2023 were available, including (1) which program activities were accessed, (2) when activities were accessed, and (3) how long users spent on each activity. User demographic and usage information was summarized using means and SDs, medians and IQRs, or frequencies and percentages. Logistic regression evaluated the association between user demographics and usage. Results Of the 27,422 users who activated a Healthy Living account, the mean age was 58.6 (SD 12.0) years, and the percentage of females was 56.8% (15,385/27,422). There was an even spread across deprivation quintiles. The median length of time spent on the program in total was 7.6 (IQR 0.6-27.6) minutes; 12,066 (44%) users spent 27,000 users. Given that higher usage of DSMES programs is associated with improved health outcomes in people with type 2 diabetes, further work needs to identify how to encourage increased engagement with the program.