Summary
With face-to-face patient diabetes education on hold during the COVID-19 pandemic, the Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND) team at Leicester Diabetes Centre took various actions. New materials were added to MyDESMOND relating to COVID-19 and diabetes, resilience and emotional wellbeing, ensuring fair access for all. Virtual Delivery Packages were set up for all DESMOND modules. Guidance for educators was written and made available to all DESMOND teams. The DESMOND Academy was launched with virtual workshop support for existing educators, new educator training was redesigned, and Quality Assurance assessment methods were refi ned for virtual delivery.
Innovation
Alternative means of empowering patients with, or at risk of, type 2 diabetes (T2D) to self-manage had to be sought when in-person education was not possible. As those with T2D and those from ethnic minority backgrounds were at increased risk of adverse outcomes from COVID-19, they needed support. The focus was on increasing the number of providers able to offer MyDESMOND to patients. Modifications were needed so that groups could be delivered virtually. Written guidance for educators was insufficient, so the DESMOND Academy was launched. Additionally, there was a need to continue to train new educators while maintaining quality assurance. The LDC multidisciplinary team examined themes from its patient forums to guide content for the MyDESMOND digital programme. Cultural adaption of MyDESMOND was also carried out. Feedback from patients was used to make refinements. Electronic resources and guidance to support educator delivery and patient learning had to meet the criteria for structured self-management programmes. The 1,000+ educators on the database, from 105 healthcare organisations across the UK and Ireland, local staff and patients, provided feedback in May 2020 via online surveys and virtual group meetings. After revisions, version two was rolled out in August 2020. Ensuring quality assurance processes were fi t for virtual observations was important, being unique to DESMOND.
Results
A ten-fold increase in users on the MyDESMOND platform has been recorded since March 2020. These patients were referred, registered and began using one of the online modules. At the first lockdown there were 21 providers offering MyDESMOND; there are now 90, including nationwide roll-out across Wales.
An online survey in June, sent to all MyDESMOND users, received 2,579 responses. Findings showed: 85 % found the programme easy to navigate; 92% said the information was presented clearly and concisely; 82% stated they would recommend it to others; 82% felt they understood their diabetes and how to manage it better, with 61% reporting being more active and 73% changing their diet as a result. Review of self-reported user data showed weight reduction for 87% of users and HbA1c reduction for 85% of users.
MyDESMOND has had significant impact on reducing diabetes distress and improving self-efficacy.
For virtual group delivery, patient online surveys (began August 2020) show an average rating of 4.7 out of 5 for overall experience, with 94% reporting plans to make lifestyle changes as a result. Despite not meeting in person, 92% said they felt part of a group. Since July 2020, 502 existing and 61 new educators have been trained to deliver virtual groups to patients. Of these, 84% said they felt more confident to deliver virtually as a result of attending, and 95% rated the workshops as useful/very useful.
User Feedback
For development of new content for MyDESMOND user reference groups were formed to assess the materials. In August 2020 and June 2021 an online user feedback survey was carried out with all existing MyDESMOND users, garnering over 3,300 responses. All qualitative feedback was analysed to identify barriers/challenges for future developments to content and functionality. The online patient forums were monitored to ensure current needs were met. Educators shared experiences via DESMOND Academy workshops that shaped developments.
Dissemination and Sustainability
MyDESMOND and its three main modules (Type 2 management, Let’s Prevent Diabetes and Babysteps) can be implemented quickly, with little administrative time required to add and track patients, once the relevant governance documents are in place. Uptake rates and user journeys within each module, plus feedback, will be used to develop MyDESMOND. Virtual patient group delivery was provided within two months of the beginning of the pandemic to 105 healthcare organisations across the UK and Ireland, and over 1,000 existing Educators. These virtual groups helped ensure waiting lists were kept down and commissioning KPIs were met. Virtual delivery will remain alongside face-to-face groups and digital platforms like MyDESMOND, as shown in commissioning requirements. More hybrid styles of delivery will be investigated. Discussions are underway with the DESMOND team in Australia regarding virtual delivery, both as a result of the pandemic, but also because of that country’s wide geographical spread. Virtual delivery could enable national/international provision that crosses existing healthcare geographical boundaries. LDC has been commissioned by a large Integrated Care Service from the North East to provide virtual groups to their ethnic minority populations. New educators are being trained and ongoing support is being provided virtually.
