Implications for future policy implementation: a qualitative evaluation of the national rollout of a diabetes prevention programme in England.

Abstract Background The National Health Service Diabetes Prevention Programme (NHS DPP) was commissioned by NHS England in 2016 and rolled out in three ‘waves’ across the whole of England. It aims to help people with raised blood glucose levels reduce their risk of developing type 2 diabetes through behaviour change techniques (e.g. weight loss, dietary changes and exercise). We report findings from interviews with designated local leads, responsible for the local commissioning and implementation of the programme, to explore how local implementation processes were enacted and adapted over time. Methods We conducted a telephone interview study across two time-points. We conducted 24 semi-structured interviews with local leads across 19 sampled case sites between October 2019 and January 2020. We conducted 13 interviews with local leads across 13 sampled case sites between July 2020 and August 2020. Interviews aimed to reflect on the experience of implementation and explore how things changed over time; this included how implementation plans changed in the light of the COVID-19 pandemic. Results We identified five overarching themes to show how implementation was locally enacted and adapted across the sampled case sites: 1. Adapting to provider change; 2. Identification and referral; 3. Enhancing uptake in underserved populations; 4. Digital and remote service options and 5. Impact of COVID-19 pandemic on implementation. Conclusion This paper reports how designated local leads, responsible for local implementation of the NHS DPP, adapted implementation efforts over the course of a changing national diabetes prevention programme, including how implementation and delivery of the programme was impacted during the COVID-19 pandemic. This paper highlights three main factors that influence implementation: the importance of facilitation, the ability (or not) to tailor interventions to local needs and the role of context in implementation.