The Embedding Study

Increasing uptake of effective self-management education programmes for type 2 diabetes in multi-ethnic primary care settings


Funder: National Institute for Health Research, Programme Grants for Applied Health Research

Timescale: Jan 2016 – Jan 2021


Key Points

  • The project involves developing and testing an ‘embedding package’ of practical advice and solutions to facilitate an increase in uptake to structured education for self-management of Type 2 Diabetes by addressing barriers and enablers to uptake at patient, healthcare professional and organisational levels.
  • Key components of the package developed for testing at feasibility stage include: advice on developing a marketing strategy; improving referral processes and data collection; developing the role of an ‘embedder’ to champion and support those using the package; and provision of a tool kit of practical advice and resources.



Type 2 diabetes is a disease with serious consequences, including heart attack and stroke, if not well controlled. People’s lifestyle choices, especially around diet and exercise, can affect diabetes. A substantial body of evidence demonstrates the benefits of self-management education in Type 2 Diabetes. NHS guidelines recommend that everyone with diabetes should have the opportunity to gain knowledge and skills to support them to live healthy lives through structured education programmes. However national surveys conducted from 2006 onwards show low referral and low update and while many GPs provide some opportunities for structured education to people with Type 2 diabetes, this isn’t always the case throughout the UK. There are also many reasons why people don’t go to education sessions when these are offered.

The aim of the study is to trial an ‘embedding education package’ (a tool kit of resources and support for Clinical Commissioning Groups and practices to use) to increase the number of people with type 2 diabetes accessing structured education programmes.

This project will develop and test an embedding package to increase uptake to structured self-management education by people with type 2 diabetes in primary care by addressing barriers and enablers to uptake at patient, healthcare professional and organisational levels through four workstreams.


The research project

For the first 12 months the team has designed an embedding package with input from people with type 2 diabetes, staff and commissioners. This process involved synthesising evidence and identifying best practice and then developing and tailoring the embedding package. The embedding package is now being piloted in six GP practices across the East Midlands to assess its feasibility and suitability. It will then be rolled out more widely in England in a stepped wedge wait-list Randomised Control Trial (RCT) to compare impact of the embedding package with usual care on uptake to structured education. The cost-effectiveness and sustainability of the embedding package will then be assessed.

SAPPHIRE researchers led the development phase; they are now conducting an ethnographic study throughout the feasibility study and will do this throughout the RCT to evaluate the embedding package and provide contextual data on the implementation process, the sustainability of the change, and the ‘fit’ of the embedding package within routine practice. The package will then be refined in response to the findings of the evaluation.


Project team

Qualitative research team: Dr Helen Eborall, Lisa Huddlestone, Prof Graham Martin and Liz Shaw (SAPPHIRE) and Dr Nicky Hudson and Jess Turner (De Montfort University).

Wider programme team: Prof Melanie Davies (PI), Dr Marian Carey, Dr Laura Gray, Kyla Harrington (programme manager), Prof Kamlesh Khunti, Alison Northern, Sally Schreder and Mrs Bernie Stribling (Leicester Diabetes Centre); Prof Jane Speight (Deakin University); Prof Simon Dixon and Prof Alan Brennan (University of Sheffield); Prof Jackie Sturt (King’s College London) and Mr Mike Patterson (PPI).


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