Summary
How to Manage a Mammoth is a children's book from the Talking Type 1 range, written by a diabetes psychologist in order to help children and families talk about and manage some of the difficult emotional experiences that come alongside living with type 1 diabetes. During Diabetes Week in June 2024, the book was read on the CBeebies Bedtime Story by actor James Norton, who also lives with type 1 diabetes. The broadcast was watched by children and families across the UK, attracting national coverage, and has continued to support children as an educational and destigmatising resource.
Innovation/Novel approach to an existing problem
The Talking Type 1 books were developed in NHS Wales to increase accessibility to diabetes-specific psychological knowledge and techniques, first in adult settings, and later in paediatrics. How to Manage a Mammoth was the first children's book published in the Talking Type 1 range. It uses an Acceptance and Commitment Therapy approach to tell the story of eight-year-old Jake, who lives with Mel the Diabetes Mammoth, who grows and shrinks depending on how much of a problem Jake's diabetes is being. Normalisation and positive representation of coping with diabetes stress are key in reducing stigma and increasing psychological well-being. The team had an idea to ask actor A-list British actor James Norton, who lives with type 1 diabetes, to read the book on the Cbeebies Bedtime Story show. The project lead found herself in a festival ticket queue with some of the Bedtime Story show crew in August 2023 and was able to secure an introduction to the show’s executive producer. Following several months of follow-up emails, it was agreed that the book could be featured. James Norton is well known for speaking about his experiences of living with type 1 diabetes and had previously participated in Talk About Diabetes (TAD) and Breakthrough T1D events. Through Hilary Nathan at Breakthrough T1D the team made the request and James immediately agreed. In February 2024, James met the project lead and the CBeebies team to record the story in London. In addition, he worked with the project lead to develop and discuss his own diabetes creature (Bruce the shaggy dog) and recorded additional advice for parents of children with diabetes. During the recording James discussed his own experiences of living with diabetes and demonstrated his own continuous glucose monitor (CGM).
Equality, Diversity and Variation
CBeebies is the UK’s most watched TV channel for those under the age of six and includes the Bedtime Story show. In recent years, the Bedtime Story show has attracted a significant additional adult audience by featuring stories being read by high-profile celebrities. Combining the CBeebies platform with the ‘star-power’ of James ensured that this reading would have significant reach beyond traditional diabetes channels. The broadcast is available free to UK TV licence payers to watch on BBC iPlayer, and internationally on YouTube, so anyone with an internet connection can access it. The ability to 'share' links online meant that people could publicise the broadcast across their social networks. BBC iPlayer allows the broadcast to be accessed with audio description, sign language interpretation and subtitles in a range of languages. The book illustrations purposefully include characters from a range of ethnicities and in non-traditional gender roles to promote positive role modelling and reduce stigma. The book also has a character called Annesha, a young girl of South Asian heritage who lives with Sid the diabetes hedgehog. It was important to incorporate this character so that children from minority ethnic communities could see themselves and their diabetes represented positively. Aneesha also features in the sequel to Mammoth, How to Hold a Hedgehog, and is illustrated wearing a CGM to reduce feelings of stigma. Tens of thousands of copies of the Mammoth book had already been distributed for free across NHS paediatric diabetes units in England and Wales, allowing children from deprived backgrounds to access the resource.
Impact to Patient Care
Although this project was designed to reduce distress and stigma and increase well-being at a population level, paediatric diabetes services have used the broadcast in their diabetes well-being groups and paediatric services held their own 'viewing parties' of the broadcasts, creating destigmatising group supports. Primary schools used the recording and the accompanying BBC Bitesize information as part of a lesson about type 1 diabetes. It is hoped that this will help to destigmatise the condition and increase levels of understanding and empathy in peers of children with type 1 diabetes. The positive effects of having a celebrity role model talking about their own struggles and coping strategies cannot be understated.
Results
The Bedtime Story was broadcast on 14 June 2024 as the 'grand finale' to the BBC's coverage of Diabetes Awareness Week 2024 and is still available on BBC iPlayer and YouTube. There was significant media coverage before and after the event from several BBC radio outlets, Virgin Radio, Lorraine Kelly, magazines, newspapers, BBC news and local media. James also posted on his Instagram page, as did CBeebies, amassing more than 18,000 likes. The project lead was interviewed on BBC Wales and BBC Points of View. She also helped BBC Bitesize to update their free online information about diabetes with information about supporting emotional well-being. James recorded additional messages for Bitesize. Breakthrough T1D, Digibete and Diabetes UK Cymru publicised the event and held fundraising events. Breakthrough T1D developed 'design your own diabetes creature' sheets and held an Instagram 'live' discussion with James, Hilary Nathan and the project lead straight after the broadcast with more than 1,000 viewers watching live. Diabetes UK Cymru held a pyjama viewing party at their head office, where children with diabetes and their families watch the broadcast and had games and activities. Digibete also publicised it and hosted an online gallery of children's diabetes creatures. The broadcast brought significant additional publicity to the book, with royalties from sales going to the NHS Wales diabetes service, securing funding for reprints and further books.
User Feedback
Diabetes organisations and the public were hugely positive about the story and the broader awareness-raising achieved through the Bedtime Story broadcast and associated events and activities.
