The Role of Digital Education Programmes for People with Diabetes
Dr Sean Wheatley, MSc, PhD. Science and Research Lead
Sean.Wheatley@xperthealth.org.uk
In a recent blog we took a look at NHS Healthy Living, an online education programme for people with diabetes, and why it is unlikely to help people achieve their health goals. This raises a broader question about the role of digital education programmes – is it just NHS Healthy Living that is limited, or is there a fundamental issue with digital diabetes education programmes?
What is a digital education programme?
In the context of this blog, this includes any programme that an individual would be able to access on an electronic device and that they would engage with independently*. This includes programmes accessible as a web page via an internet browser and programmes accessed through an App on a mobile phone or tablet.
What are the benefits of digital programmes?
Firstly, there is clear and growing evidence that they can help people to improve their health. See here, here and here, for example. This is probably the most significant benefit!
Secondly, digital programmes are often more accessible for people who cannot attend a group programme. They provide a flexibility in terms of when and where people use the programme, removing the need to be in a certain place at a certain time. This can have benefits for a wide range of people, including those with certain disabilities, people with limited access to suitable transport, and/or people who have other commitments (e.g., work or childcare) that do not align with the times that group sessions are available.
There can also sometimes be reduced costs compared to attending group programmes. This can be, for example, through removing the need for transport or childcare.
Next, the provision of digital programmes can improve engagement with people who will not attend a group programme. For some individuals a group programme is simply not an option they are interested in. Providing an alternative that they can access independently might be more acceptable though. Digital programmes can therefore enable them to receive help and support that they would otherwise be missing out on.
The use of digital programmes can also help to reduce waiting times. The number of places available on group programmes is limited by the availability of staff, and of physical spaces from which to deliver programmes. Even where places are available, there is no guarantee these will be at a time or place that is suitable for any given individual. These limitations are not true of digital programmes.
This is not an exhaustive list of the potential benefits, but it is clear that there are some advantages to offering education programmes digitally.
What are the limitations of digital programmes?
Despite the possible strengths, there are also some potential limitations if digital education programmes were the only option made available to people with diabetes.
Firstly, in the same way that some people will not engage with group-based programmes, some will not engage with digital ones! As with lifestyle choices, one size does not fit all. It is therefore important to offer a menu of options to maximise the number of people who see an option that they are happy to try.
Importantly, only offering digital programmes may even be discriminatory. This is because some people cannot use the technology that is required to access these programmes. This might be due to a lack of access to appropriate equipment, not possessing the skills required to use it fully, and/or disabilities which limit or remove the ability to do so. Only offering digital programmes may therefore increase existing health inequalities.
Next, there is also a risk of worse outcomes for patients. This is in part due to the issues noted above which may reduce engagement and access. There are also elements of group programmes which can be valuable for some people that a digital programme simply cannot replicate. These include the provision of peer support, and the increased opportunity to discuss important concepts, personal experiences and individualised options with others. It is also worth noting that, although there is evidence that digital programmes can be effective, the evidence supporting the use of group-based diabetes education programmes is much more established.
Again, this is not a complete list of all potential limitations, but it is apparent that digital programmes are not likely to meet the needs of everyone on their own.
So, what’s the bottom line?
There are clear benefits to offering digital education programmes to people with diabetes.
There are also clear limitations to only offering digital education programmes to people with diabetes.
The bottom line is therefore that, ideally, digital and group-based programmes should be offered to patients, to allow them to select the option that is most appropriate (and acceptable) for them. Doing this will help to increase engagement with diabetes education, which will likely lead to improved patient outcomes as a result.
* Some of these programmes – including X-PERT Diabetes Digital – include additional support options (e.g., access to a health coach). These are not part of the main educational content though, so they still qualify as programmes that participants access and work through independently.
