Commissioners and Providers

Why is HEAL-D needed?

Diabetes disproportionately impacts people from Black, Asian and Minority Ethnic communities. Addressing health inequalities among high-risk groups in combatting preventable causes of disease is a key priority for the NHS. In the UK, type 2 diabetes is 2-4 times more common in Black African and African-Caribbean ethnicity compared to people of white ethnicity and it occurs 10 years earlier, requires more intensive medical management and poorer outcomes are evident.

Structured education courses which teach self-management principles are an important foundation for type 2 diabetes management support in the UK. Courses need to be responsive to an individual’s lifestyle and culture to be most effective. These courses tend to provide generic advice not designed to be sensitive to minority or multicultural groups. Evidence demonstrates that these courses are less successful in minority ethnic groups, with worse outcomes, lower participation, and higher attrition rates among these groups (Winkley et al, 2015¹).

Culturally tailored education has resulted in greater improvements in diabetes control and knowledge than usual care, and the benefits are maintained long-term (Creamer et al, 2016²; Goff et al, 2021³). However, to date, culturally tailored interventions for communities of African and Caribbean heritage have largely been based in the US and not in the UK. The provision of bespoke diabetes education tailored to meet socio-cultural needs of patient groups point to a more cost-effective approach to improving long-term diabetes outcomes and tackle health inequalities.

Developed as a face-to-face programme, HEAL-D pivoted to HEAL-D online in October 2020. Digital or remote diabetes education has been shown as a credible supplement or alternative to face-to-face options (Edwards, 2021⁴).

1.  Winkley K, Evwierhoma C, Amiel SA, Lempp HK, Ismail K, Forbes A. Patient explanations for non-attendance at structured diabetes education sessions for newly diagnosed Type 2 diabetes: a qualitative study. Diabet Med. 2015 Jan;32(1):120-8. doi: 10.1111/dme.12556. Epub 2014 Aug 26. PMID: 25081181.

2.  Creamer J, Attridge M, Ramsden M, Cannings-John R, Hawthorne K. Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: an updated Cochrane Review of randomized controlled trials. Diabet Med. 2016 Feb;33(2):169-83. doi: 10.1111/dme.12865. Epub 2015 Sep 7. PMID: 26202820.

3.  Goff, L.M., Rivas, C., Moore, A., Beckley-Hoelscher, N., Reid, F. and Harding, S., 2021. Healthy Eating and Active Lifestyles for Diabetes (HEAL-D), a culturally tailored self-management education and support program for type 2 diabetes in black-British adults: a randomized controlled feasibility trial. BMJ Open Diabetes Research and Care, 9(1), p.e002438.

4.  Edwards, J., Waite-Jones, J., Schwarz, T. and Swallow, V., 2021. Digital technologies for children and parents sharing self-management in childhood chronic or long-term conditions: a scoping review. Children, 8(12), p.1203.[SI1]