Summary
Good2Go is a structured education course for people with Type 2 diabetes. It has been running in person since 2010. The aspiration was to offer Good2Go in different formats, to make it more accessible, as working age participants represented a large proportion of non-attendees. The pandemic pushed the move to a virtual platform. However, the goal was to offer a portfolio of structured education options for different needs and preferences. Two solutions are now provided: a virtual webinar, delivered daytime or evening, or a workbook with one-to-one Q&A for those without internet access. Video clips are also available.
Innovation
Good2Go was traditionally a six-hour, face-to-face course with visual props and different teaching styles. Slides were adapted and more animations used to maintain the flow of sessions and participant engagement. Upskilling in the technological aspects of delivering an online course was needed. The Trust had to approve the hosting platform for the presentations, upskill staff in using this software and also ensure participants felt comfortable and competent. A dietetic assistant supported participants who were not confident with technology. A workbook of course content was created for those without access to technology or who preferred not to use it. It was activity based to encourage participant involvement, with a three-week follow up phone call with either a diabetes nurse or dietitian, to field questions and check understanding. The workbook was so popular it was printed professionally and distributed at the end of webinars. It will be given to participants once face-to-face sessions resume. Videos were available for participants to watch after the course, or to accompany the workbook if they did not wish to attend virtual courses. Quality assurance and evaluation were paramount. Evaluation forms had a poor return rate via email. Participant feedback was complimentary and supportive of the format and content. Evaluation of clinical data was also captured, including pre-course HbA1c and cholesterol, and six months post course HbA1c and cholesterol. The aim was to recreate this for all of the QISMET accredited structured education programmes (BITES - Brief Intervention in Type 1 Diabetes Education and Self Efficacy, Insulin Skills, Insulin Pump Therapy Initiation Course). Each programme would have a face-to-face option, a virtual webinar (likely to be held predominately in the evenings), a written workbook and videos.
Results
Demographic data and HbA1c and cholesterol pre- and post-course were collected. Comparison was made between different course formats (webinar versus workbook) using the data from July -November 2020 and compared with data from July 2019-November 2019 when it was delivered face to face. In addition, workbook data were split into patients who accepted the three-week follow up phone call and those who did not answer the phone or who reported that they did not complete the workbook. Those seen face to face July-November 2019: 138 participants; those seen via webinar: 51 participants; those who received a workbook: 144 participants. Figures for July-November 2020: 195 participants. For the face-to-face course, pre-course HbA1c average was 62.2mmol/mol, and six months post course, HbA1c was 55.1mmol/mol. Pre-course cholesterol averaged 4.8mmol/L, and six months post course 4.4mmol/L. For the webinar, the pre-course HbA1c average was 62.4mmol/mol, and six months post course, HbA1c was 54.4mmol/mol. Pre-course cholesterol average was 4.5mmol/L, and six months post course 4.3mmol/L. For those who did the workbook (119 who responded to follow-up call), pre-course HbA1c average was 57.8mmol/mol, and six months post course HbA1c was 55.0mmol/mol. Pre-course cholesterol average was 4.5mmol/L, and six months post course, 4.4mmol/L. Results for the workbook from those who did not respond to the follow up call (29 participants) were: pre-course HbA1c average 58.2mmol/ mol, and six months post course HbA1c was 58.7mmol/mol. Pre-course cholesterol averaged 4.8mmol/L, and six months post course, 4.9mmol/L. The webinar and face-to-face course had similar results. The workbook did not see such a decrease in HbA1c or cholesterol, but those who engaged with it and said they filled it in did better in outcomes than those who did not. The average age for webinars was 59.5 years, compared to 61.3 years for the workbook. The adaptation of Good2Go meant people could still receive timely advice about their diagnosis, despite constraints. There were also cost savings. Encouraging uptake of the webinar over the workbook offers maximum benefit on clinical outcomes. Once face-to-face classes resume a lot of those who opt for the workbook may prefer classes in person.
User Feedback
The return rate for the post-course emailed evaluation form was poor so something like SurveyMonkey could be used for feedback before participants finish the course. To date, feedback has been overwhelmingly positive. Participant feedback has always been the main driver for course and session updates. The NHS Trust is consulting on the format for real-time evaluation forms.
Dissemination and Sustainability
The project has been delivered in York Hospital for the Vale of York CCG population. Prior to the pandemic the resources were shared with other CCGs and the team was approached about selling the package. There is a ‘train the trainer’ package for all the QISMET-accredited programmes and the lesson plans for Good2Go have been adapted to support delivery of the webinars, so it could be easily shared with interested Trusts.
QISMET has provided full support, in terms of accreditation and quality assurance, since 2012, so this course is sustainable. This is developed and improved continually to ensure the best and latest information is provided. Participants receive the information that they need soon after diagnosis in a way that suits them.
