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A culturally-tailored diabetes self-management support programme

Healthy Eating and Active Lifestyles for Diabetes (HEAL-D), is a culturally tailored diabetes self-management education and support programme for African and Caribbean communities.

Heal dThe programme aims to improve healthcare access and engagement amongst local communities and is delivered in partnership with people living with type 2 diabetes, healthcare practitioners and community leads. In 2019, HEAL-D won the Quality in Care Award for Diabetes Education Programmes.

We spoke with Dr Louise Goff, [pictured right], Chief Investigator at HEAL-D, to learn more about the programme.

Dr Louise Goff, please tell us about yourself and role within  King’s Health Partners?

I’m a Reader in Nutritional Sciences, based in the School of Life Course Sciences at King’s College London. I have a keen interest in the role of nutrition in the development, prevention and management of type 2 diabetes.

Since joining King’s College London 11 years ago, my research has focused on tackling inequalities in type 2 diabetes. I work with the London African and Caribbean communities across a broad range of research, from understanding ethnic differences in the physiological mechanisms by which diabetes develops, through to improving cultural competency of healthcare professionals and promoting equitable access to healthcare for people living with diabetes.

I am also the Chief Investigator for HEAL-D. I co-designed HEAL-D and evaluated the programme in a feasibility trial in south east London.

Please could you describe HEAL-D and its important role in helping people living with type 2 diabetes from African and Caribbean communities?

HEAL-D was developed because there is an urgent need to address ethnic inequalities in type 2 diabetes. We know that type 2 diabetes is approximately three times more prevalent and develops around 10 years earlier in Black African-Caribbean compared to White-British communities. In addition, approximately 25% of African-Caribbean people who have diabetes are under the age of 40.

We also see poorer glycaemic control at the point of diagnosis and the need for greater medical management to achieve good glycaemic control. We also know that there are major cultural barriers to healthcare access and engagement within our Black communities, including distrust and lack of culturally sensitive self-management advice. Providing culturally-tailored care has been identified as a priority by patient groups and is recognised to be highly effective in improving healthcare access and self-management. However, in the UK, there is an absence of relevant programmes.

HEAL-D is specifically tailored to promote and support self-management of type 2 diabetes in African and Caribbean communities and was developed in partnership with people from these communities living with diabetes, healthcare practitioners, commissioners and community leaders, including faith leaders and volunteer health advocates.

Sessions are delivered in community venues, such as church halls and community centres, by a diabetes specialist dietitian and a trained lay educator from the African/Caribbean community.

The programme delivers group-based education, behaviour change support and participatory physical activity classes to people living with type 2 diabetes to help improve their knowledge of diabetes and motivate and support the development of self-management skills. We provide participants with a large range of culturally tailored resources, for example booklets and videos advising on appropriate portion sizes of cultural foods and healthy cooking practices.

We also deliver group-based exercise classes, which enable people to understand the right intensity and types of exercise that they should be doing to help manage their diabetes.

What impact has HEAL-D had on improving health for UK African and Caribbean communities?

In our trial we evaluated attendees’ experiences. Overwhelmingly, people found attending HEAL-D a positive experience, with lots citing improved knowledge, motivation, support and behaviour change.

Below are some quotes from participants:

I didn't have the support until I came to this group. Half the things that I learned here, well, all of the things that I learned here I wouldn't have known before. So, it's really taken me positively to the next level and next journey of my life, living with diabetes.
What I really like about the session is about the exercise and the food that they teach us to be eating and about the small portions.
What I really liked about coming to this class was the amount of information we had access to, the practical tips and guidance that was given.
Meeting the people, everybody's in the same boat and how we all can learn and be together on this. It was the support we got from each other as well.

We are currently applying for funding to conduct a full trial of HEAL-D to assess its clinical and cost effectiveness.

How was HEAL-D informed about research to support people with diabetes?

HEAL-D is a programme of research funded by a National Institute for Health Research (NIHR) Advanced Fellowship. 

Throughout the research process, as Chief Investigator for the programme, I worked with Health Innovation Network (HIN) and commissioners for south east and south west London to ensure HEAL-D was sensitive to the needs of NHS services and had potential for adoption.

In 2019, on completion of the research study, commissioners in south London expressed a desire to fund a pilot implementation of HEAL-D. As part of this, I worked with Guy’s and St Thomas’ NHS Foundation Trust’s Dietetic Department and the HIN to embed HEAL-D within clinical service provision, enabling patients from four south London Clinical Commissioning Groups to receive HEAL-D as part of their healthcare.

What do you value most about being part of King’s Health Partners?

Being part of King’s Health Partners has been key to me being able to translate HEAL-D from a research intervention into a clinical service. I have been able to develop a partnership with clinical service managers to go through the commissioning process and to understand how to embed HEAL-D within service provision, thinking through key processes such as referral pathways. It’s this partnership and sharing of expertise that has been critical to the success of HEAL-D.

Visit the HEAL-D website to learn more about the programme.

Read recent publication on the programme.