Final report
November 2017
Innovating for Improvement
Integrated structured education programme for paediatric newly
diagnosed type 1 patients to empower them in self management
(DEAPP)
University Hospitals of Leicester and the Children and Young People with Diabetes East Midlands
Network.
About the project
Project title:
Integrated structured education programme for Paediatric newly diagnosed type 1
diabetes patients to empower them in self-management (DEAPP)
Lead organisation:
University Hospitals of Leicester NHS Trust.
Partner organisation(s):
The Children and Young People’s East Midlands Diabetes Network (CYPEMDN).
The Design Unit, School of Design, De Montfort University
Chesterfield Royal Hospital NHS Trust
Derby Hospital NHS Trust
Nottingham University Hospitals NHS Trust
Sherwood Forest Hospitals NHS Trust
Project lead(s):
Dr James Greening, Clinical Lead and Mrs Marie Atkins, Project Manager.
Contents
About the project ............................................................................................................... 2
Part 1: Abstract .................................................................................................................. 3
Part 2: Progress and outcomes ......................................................................................... 3
Part 3: Cost impact .......................................................................................................... 11
Part 4: Learning from your project ................................................................................... 13
Part 5: Sustainability and spread ..................................................................................... 16
Appendix 1: Resources and appendices .......................................................................... 18
Part 1: Abstract
Our project delivered the full diabetes curriculum for children and young people
newly diagnosed with Type 1 Diabetes using a “flipped” learning approach and an
app (Deapp – Diabetes education app). There are over 26,000 children in England
and Wales with Type 1 Diabetes: 3000 are based in the East Midlands region, our
setting for piloting this innovative approach to promote self-management in Type 1
Diabetes.
Flipped learning involves the patient learning the theory via a virtual learning
environment, combining visual, auditory, kinaesthetic and emotional learning and
that knowledge is then tested via face to face learning.
We originally wanted to design a website that was a moodle based platform of
learning. However following initial discussions around the practicalities of this and its
design, it would have looked very unappealing for children to use. We decided to
design an app with high-quality animation and face to face resources to run
alongside because it is more visual for children and is better suited to how children
already learn and engage, whilst making it fun and interactive, yet still giving them
the knowledge that they need to learn about diabetes.
Our innovation has already been embedded amongst 4 of the teams across the East
Midlands diabetes network. We were ambitious in our original plan of piloting this
across 5 sites in the East Midlands. Feedback from staff has been positive and
indicates that this innovative approach is effective and takes less time to deliver than
the previous model.
Part 2: Progress and outcomes
It was originally intended that the educational content for Deapp would be stored on
and delivered through a virtual learning environment (VLE) such as Moodle.
However, despite the structural and graphical flexibility within Moodle, it did not offer
the standard needed for Deapp. We found it was:
• Simply not ‘fun and engaging enough for the range of ages (particularly the
younger ones) that would be using it.
• Better suited to older students in higher education groups.
• Needed to be more visually interesting.
Developing a dedicated app had a number of potential advantages over a VLE such
as Moodle:
• Greater freedom to organise and present content in a way that was
appropriate for younger users.
• A higher professional standard of the animation.
• Made it easier to navigate whilst building in visual interest.
Below is what the app looks like on the ipads at the beginning and each line shows
the progression until all 12 learning modules have been completed.
This shows one of the sessions that the children undertake. As they watch the
videos they then get a tick to show it has been completed. We also have online
games developed into the app. For example, video 7 is a game where you guess if
the food has carbohydrates or not.
The key to this project is being able to assess a patient’s knowledge and below is a
picture which is the backend of the app which is what the HCP’s see when assessing
a patient’s knowledge.
We have produced visuals of all 12 sessions and these are included in the
appendices. The 12 modules are:
• What is diabetes?
• Practical Skills
• Food
• Highs and lows
• During illness
• DKA (Diabetic Keto-Acidosis)
• Correction doses
• Carbohydrate counting
• School
• Exercise
• Future complications
• Travel and lifestyle
With a project of this size involving multi organisations there were many things that
went less smoothly than we would have liked, these include:
• The amount of time and resources required to complete the project was
underestimated without a full-time dedicated Project Manager.
• The issues concerning the use of the app in hospital environments regarding
wifi networks/ security within each individual trust despite seeking assurances
and by supplying them with Ipads. This proved more time consuming than
anticipated.
• Trying to work with patients who did not have access to IT or did not have
phones that were compatible.
• Dealing with a national cyber attack right in the middle of producing the app.
• Agreement and finalisation of the teaching materials with a medical team of
20 HCPs across 5 pilot sites.
Challenge of delivering training (we have included the agenda in the appendices) to
each of the 5 pilot sites, comprising 50 HCPs. This training was essential in
delivering this flipped learning model to patients. This proved to be invaluable as this
quote explains:
“Training facilitators were fantastic really engaged the group and the understanding
and knowledge of the project, it moved at a fast pace but not too fast, very interactive
and hands on, plenty of opportunity for discussion, contribution. Good explanation of
flipped learning and app. Excellent teaching linking to theory and practice, Very well
prepared and delivered, activities kept participants engaged. Excellent day thank you
(one of the most useful study days I have attended),
We have qualitative data from staff indicating that this model reduces their workload,
and we will be gathering statistical data to confirm this. Below is another quote.
“I feel that patients get a better experience at diagnosis having gone through the app
and being assessed on their knowledge reinforces the information given and also
gives the PDSN a better understanding of how well the family have understood and
retained the information. The resources used to assess knowledge have helped to
focus and have helped to engage them regardless of age. Having the app also
enables the family to go back and recap on knowledge as they need”. Following the
introduction of the app with patients we designed an evaluation form for parents and
patients to complete after they were diagnosed and before they left the hospital. We
had already involved children and parents in the development of this app and they
had trialled the modules for us and gave feedback on information before it went live.
Below is one of the stand-out quotes from one of the parents.
“It was very useful to be left alone with the app/or to watch it with XX. It gave me
chance to listen to it at my own pace, to look at sections again if I wanted to. It was
also useful at raising questions for me to ask the team when I wasn’t always sure
what questions to ask!”
This was our originally evaluation plan.
We set up a database recording all activity and a summary is below (also refer to
appendices):
• 54 patients diagnosed out of our predicted numbers of 100 patients.
• 7 of these 54 patients have completely finished using the app
• 20 patients were not able to partake in the app due to various issues including
IT issues and for some of these English being their first language.
• Nottingham had 21 patients that were unable to partake in the project due to
problems with IT.
In regards to the statistics from the app usage we can see that:
• Number of patients: 485, of which 366 have never completed a step
• Active patients: 119. (Some will be tests – it is not easy to pick them out)
• Number of self registrations: 54 (again some are tests)
• Non patients (hospital admins etc): 54
• Number of steps completed: 2,562
• Sessions completed: 614
In terms of app installs, according to the stores:
• Android = 37
• iOS = 87
We have completed statistical analysis on the patient’s quality of life and knowledge
via a survey monkey, 11 patients have completed the survey which is lower than we
wanted despite various ways of trying to engage them to complete this. The analysis
looks at 3 areas: (We have been able to use Nottingham patients as a surrogate
control as they have not yet started using DEAPP and have continued education in
the standard manner).
• A Kauffman Competency and measure of diabetes self – management, it is
based on a numerical scale from 1-8.
• A measure of hypoglycaemia awareness via the Clarke score. Any score >4
defines hypoglycaemia unawareness and indirect maker of poor control.
• The PAID (problem areas in diabetes) and psychological assessment of
diabetes wellbeing.
Measure Site Average Range
Kauffman competency
Other 4 pilot sites 4.1 range 2-6
Nottingham 4 range 3-5
Paid “problem areas in diabetes”
Other 4 pilot sites 10.29 range 5-14
Nottingham 10 range 7-13
hypo scores
Other 4 pilot sites <4 range 0-3
Nottingham <4 range 0-2
The primary conclusion from this limited data is that there appears to be no
difference in outcome between the 2 groups. However 11 patients aren’t enough for
a reliable analysis. We will continue data collection beyond the project term to allow
our statistician to do more robust analysis that we will share with others and we
intend to apply for an RCT to provide the evidence to an academic standard.
We also took a baseline analysis of HbA1c at 3 and 6 months. It is medically proven
the lower the HbA1c and the longer the numbers remain low, the risk of further
complications are reduced. We are still aiming to complete the 9 and 12 months
analysis.
Interpretation: although number are small at this stage DeAPP demonstrated at least parity
with traditional education.(By default 1 centre Nottingham wasn’t able to enrol patient so has
worked as a de-facto control group)
HbA1c outcomes measures (mmol/mmol)
Centre At Diagnosis 3 months 6 months
Leicester (n=29) 93.5 61.75 52
Derby (n=7) 100 62.5 N/A
Chesterfield (n=14) 107.76 51.13 45
Sherwood forest
(n=10)
113.77 52.33 N/A
Average (n= 60) 101 55.31 50.61
Queen Medical
Centre
(control n= 21)
103.61 50.42 46.52
Below is a summary of just one of the pilot sites data (the full data report is included
in the appendices).
Trust
Username
Used by Patient or Staff?
Date of Diagnosis
Age of Child
Progress as of 24/08/17
Progress as of 15/11/17
HbA1c at diagnosis mmol/mol
HbA1c at 3 months mmol/mol
HbA1c at 6 months mmol/mol
Sherwood PZ180-002 staff N/A N/A N/A N/A N/A N/A N/A
Sherwood PZ180-003 staff N/A N/A N/A N/A N/A N/A N/A
Sherwood
PZ180-004
patient
22/04/2017
16
During Illness
No further progress
113
33
Sherwood
PZ180-005
patient
28/04/2017
15
During Illness
No further progress
92
83
Sherwood
PZ180-006
patient
01/05/2017
12
During Illness
No further progress
cant find
52
Sherwood
PZ180-007
patient
08/06/2017
15
During Illness
No further progress
131
37
Sherwood
PZ180-008
carer/patient
09/06/2017
5
During Illness
No further progress
101
DNA clinic
Sherwood
PZ180-009
carer/patient
20/06/2017
5
During Illness
No further progress
88
45
Sherwood
PZ180-010
patient
01/06/2017
11
What is Diabetes and Food Completed only
Completed all of it
136
64
Sherwood PZ180-011 patient/carer 21/08/2017 8 During Illness Exercise 103 awaiting
Sherwood PZ180-012 patient/carer 20/09/2017 6 During illness 141 awaiting
Sherwood
PZ180-013
patient/carer
13/10/2017
10
Completed all of it
119
awaiting
Part 3: Cost impact
Original Budget : £75,000 (awarded by the Health Foundation) Additional Funding: £75,000 (matched by Sanofi Aventis - Medical Education Grant) Total Budget : £150,000 Total Spent: £133,374.00 Remaining budget: £16,626.00
Researched Costs
Actual Costs
Organisation Reasoning
£25,000
£0
£0
£30,000
£0
£0
£900.00
£120,000 (inc Vat)
£3094.85
£765.00
£0
£2987.90
£3782.00
£0
De Montfort Uni
External Professional Facilitators
Video/Photography (BCH)
N/A
IT Dept (BCH)
Kegworth House
N/A
Due to designing an app rather than a website, which was a free platform. This also included the cost of the resources at a higher standard, due to the prototypes.
We decided to provide a structured training programme, for the staff, over 3 days.
This was agreed, to act a training tool, when we decide to roll out to other units and also to act as a refresher.
Project Manager/Project Coordinator, we realised that we needed this money, at the beginning to pay for the app services with DMU
2 IPads for each trust were purchased to ensure that the pilot teams were able to deliver the education.
We agreed to hold weekly meetings, at a mutually convenient for all 5 sites. (originally we planned to meet at the Hospital sites, however the time taken to travel would have been significant)
Each team decided not to claim for travel, to help save costs.
The initial quote for DMU to design everything for just the first five sessions
including all of the games and resources was £50,000 excluding VAT. This was over
and above any estimate that we had costed for. Due to us being awarded the grant
from the Health Foundation back in August 2016 and this being a staged payment
system, it became apparent that we really needed additional funding.
Once we secured the additional funding this was fantastic as it meant that we could
finish all 12 sessions of the app. However these obviously had to be paid for and
again we paid DMU another £50,000 excluding VAT. In total out of the £150,000
awarded we have paid DMU (£120,000 including VAT).
In total out of the £150,000 we have been awarded we have spent, £133,374.00. We
have kept aside £6000.00 of the remaining £16,626 budget from Sanofi, (we have
already used all of the money from the Health Foundation) for the statistics and
paying Leicester University for this service. We also wish to buy Ipads and supply
the games and resources for the additional 6 hospitals in the East Midlands Network
which will use up the rest of the £10,000 money for this project. The app has been
built to be future proofed so that changes can be made more easily, however this
will inevitably cost money along with the training of staff etc. If another unit agrees to
adopt Deapp we are going to be incorporating running costs into this cost.
Part 4: Learning from your project
As our project focus changed dramatically at a very early stage of the project by
developing an app and resources rather than a moodle based platform, the project
team had to radically adapt our way of working. In hindsight what we wanted to
achieve with the app was extremely difficult to achieve within the timeframes
especially when we realised that 1 minute’s worth of animation takes a day to draw.
It is down to the dedication of the whole project group that we have been successful
in delivering this project. We have proved that this app works and although we don’t
yet have the detailed statistics to back this up, the initial findings are very
encouraging.
Early on in the project, once we decided to go with an app, we decided that we
would not compromise on the quality of this although it meant our timeframes were
very tight. We are all ecstatic with the finished project and so pleased that we did not
compromise on this aspect of the project.
One of the main challenges was getting a group of healthcare professionals to all
agree (this is something that is not uncommon in any project) and although the
project manager was used to dealing with differing opinions, it required negotiation to
ensure that everybody was happy in the project group and that the information was
clinically correct and the quality did not suffer.
We established weekly meetings for the group to try and ensure that everyone was
happy. This meant that everybody had a voice and felt included which was an
essential learning tool as geographically the teams are spread across the East
Midlands. By ensuring there were weekly, face to face meetings meant things were
not lost in communication.
All of the partners in this project bought into it from the outset 3 years ago and have
all worked hard to get this up and running. The entire project group gave up their
time including weekends and evenings to attend meetings, work on materials and
Marie and Sarah did 12-16 hour days regularly to keep the project to schedule. We
also had parents and patients on board. Technology was the biggest hindrance to
the success of this project.
Also, we had issues with culture due to some patients not being able to understand
sufficient English to engage in the project. Going forward, one of our aims is to
provide this education in different languages.
Whilst we did envisage issues with IT, we seriously underestimated the problem of
trying to engage five different IT trusts using different IT systems. Unfortunately
during this project the NHS was hit by a cyber bug which then made any progress
even more frustrating and long winded. The NHS could be regarded as its own worst
enemy; by trying to protect itself, it makes it impossible to make progress quickly on
new initiatives. Another example of a problem that we did not envisage was that
some patients originally from overseas having moved to the UK, may have
technology that is not compatible with accepting apps and digital information. This
meant that they were unable to participate. Some families also did not have
technology at home to participate.
Through the project it became obvious that our innovation was working effectively
and was fulfilling the brief of helping to identify gaps in patients’ knowledge before
they are discharged from hospital. All of the staff are delighted with this as it
highlighted where they need to spend additional time with patients. For example, one
pilot site had 4 newly diagnosed patients in one week and the app meant that the
team were able to manage their inpatient education workload which previously would
have proved very difficult.
As anticipated we have had to support members of the clinical teams with the
process of change whilst the app was being developed. The initial feedback from
children and their families has been lovely to receive because they love it, which we
hoped for, but is nice to actually know they appreciate it and want to use it and learn.
It also goes to show there was obviously an actual need for this which means that
we have been successful with our innovative ideas and approaches to educating
patients.
Our recommendations for the future projects are to double or even triple whatever
time frame you think you will need, especially if you are working with other
organisations. If you were completing this project in just one trust it would be
achievable, however once you bring in additional trusts and outside organisations
your time frames extend because you are relying on others to achieve things.
In hindsight and moving forward, we will be budgeting for the continuation and
further education sessions a lot better. We now have a greater understanding of how
much things cost and also how much time is involved to enable us to not make the
same mistakes next time.
Due to the nature of the project changing in its primary structure, this changed the
timeframes and the workload. When it was a moodle based resource this would have
been achievable in the timeframes that we stated however once it changed and with
everyone already working full time in their own jobs this was a major factor as we
had to rely on people’s goodwill and desire to finish this project and be successful.
Going forward, we have already started to make changes and will be more realistic
with our own times frames and those of others.
We are planning to roll this project out nationally and will be getting each team to
liaise with their own IT departments before they sign up to the project to avoid issues
that we have had so it does not delay them. Any future teams also need to buy in to
the whole package. It’s not just about the videos and animations, it is about the
flipped learning and teaching patients in a completely different way which is actually
easy. Because patients don’t know any different, it’s about changing the mind-set
and practices of all the HCPs
The flipped learning part of the innovation has proved to work. We now need to
collect data to prove this. This had been our intention, but due to the late completion
of the app (version 6 of the app was launched in August 2017) we have not been
able to achieve this. However, we will be obtaining this pilot data for at least 6
months, and would be happy to produce further report for the Health Foundation on
the findings.
Part 5: Sustainability and spread
Our project is definitely going to be carried on past this report. We have planned the
following:
• January 2018 – Apply for additional funding from the Health Foundation with
their programme.
• Re-launch of the project in February 2018 to the original 5 pilot sites.
• March 2018 – launch the project to the remaining 6 hospitals in the East
Midlands.
• March 2018 – Do a full media launch.
• March 2018 – Complete a statistical analysis to show findings and if
appropriate look into avenues for a RCT.
• April 2018 – Develop a pump section to the app (dependent on if funding is
successful). We have already had interest from relevant industry with regard
to supporting this.
• June 2018 – Present this to the National Network for adoption and approval
from them.
• Summer 2018 – Apply for a Quality in Care Award.
• Autumn 2018 – Apply for abstracts to be submitted to the following
conferences:
• Diabetes UK Conference,
• International Society of Paediatrics and Adolescents (ISPAD),
• British Society of Paediatrics and Endocrinology (BSPED).
• Advanced Technologies and Treatments for Diabetes (ATTD)
• Royal College of Paediatrics and Child Health (RCPCH)
• Association of Children’s Diabetes Clinicians (ACDC)
Type 1 Diabetes nationally have a network that is made up of 11 regions across
England and Wales and we already have a structure in place to share and
disseminate information. The initial feedback that we have had from regional
networks has been very positive. With 176 centres across England and Wales this is
immense and fantastic. There is also no reason why this project can not be rolled out
across adults with Type 1 and actually any English speaking country as information
about type 1 diabetes is the same regardless of age. We have also had interest from
adult services.
We have purposely not done any publications or applied for any awards relating to
this project as it was a pilot and we were trying to limit the people using the app to
only newly diagnosed patients across the 5 pilot sites to ensure validity of data and
statistics. Going forwards we plan to promote the app very strongly and apply for
awards. We are in the process of developing a marketing strategy and have
identified key conferences and national meetings to present at as listed above. We
also have identified peer reviewed journals to publish. Again we would be happy to
write a further report based on all of these outcomes.
This project could be adopted by any healthcare provider. The principles of this
project could be replicated across any disease. The flipped learning can be applied
to any healthcare condition: the resources and videos would have to be adapted.
Appendix 1: Resources and appendices
Appendix 1: Training Day Agenda for HCP’s
DEAPp Training day 28th February 2017/1st March 2017/2nd March 2017
Course aim and objectives for the day:
• To familiarise the pilot teams with the DEAPp project, video materials and
curriculum booklet.
• Establish the ethos of a flipped learning approach.
• Emphasise the need for flexible and varied assessment types and tools
• Develop confident questioning for use in practice, and as a resource bank for
all teams.
HCP’s were taught on the following:
• Theory of flipped learning
• The first 5 sessions of the project.
• Why is the assessor role so important?
• Different ways to assess patients knowledge
• How to make questions to assess knowledge
• Functions of the app and how to use it practically
• Discussion around not all patients are the same how to facilitate differences?
Appendix 2: Evaluation comments from the training days for HCPS
Bespoke One Day Training Course for DEAPp Healthcare Professionals
Diabetes Online Education Application:
Date of training. Red is Tuesday 10 forms Blue Wed x 19 12 x
Thursday
Training Evaluation
Course aims for the day:
• To familiarise the pilot teams with the DEAPp video materials and curriculum
booklet.
• Establish the ethos of a flipped learning approach.
• To emphasise the need for flexible and varied assessment types and tools.
• To develop confident questioning for use in own practice, and as a resource
bank for all teams.
1. Please tick the appropriate box: Strongly
Agree
Agree
Neutral
Disagree Strongly
Disagree
The aims of the course were largely achieved 5, 7, 9 5,
12,3
The course has up skilled my approach to assessing
and to becoming a more effective educator
5, 7, 8
4, 12,4 1
The course: 6, 11, 7 4, 8, 5
• Was relevant to my area of teaching
practice
6, 8, 7 4, 10, 1, 1
• Has raised my awareness on how to assess
children and young people of varying ages • Has helped me to link the theory of good
4
6, 5, 6 4, 14,
teaching and assessment practice to improving the delivery of health education
6
via the online DEAPp materials
2. The major strengths of the day were:
Great interactive session, group work, well thought course (x2), like whole idea, pace and
variety to see and experiment with, working with different people throughout day, skilled
facilitators and educators (x2), my understanding was good, resources very good, variety of
practical sessions covering a range of influencing educational factors such as age of child
topic covered and educational level, food section, putting ideas into practice, ideas on
alternative ways to teach (to be an educator!), fast pace, relevant, I really learnt a lot,
thanks so so much/actually inspiring/looking forward to using the app to help our CYP and
families. Utilising resources and looking at ways to assess learning, opportunity to give
feedback.
Time to critique the videos, meeting new people, good venue, good underpinning of
educational theory, learning how to educate using Blooms taxonomy and pedagogical learning,
quality of teachers, a good explanation of this new way of educating, and really getting me
to think more about assessing rather than teaching, a chance to look at the resources (x5),
getting view videos and familiarise resources, thinking about each can be used, moving around
short burst which helped to keep attention throughout, good to view the app. Good mixture
of taught stuff, viewing videos and group activities, Liked the way we looked at different
age groups, very informative and interactive sessions, course delivery and great interactive
and practical session, delivery of the session was very informal which encouraged
involvement, learned about flipped learning, availability of resources for DEAPp, good
educators and enthusiasm for deapp, facilitators, structure, venue, clearer picture on how to
use deapp and how to use resources, good link between watching clips and assessing
knowledge, assessment information, HCP settings in App itself. Learning how to assess CYP
etc, video app flipped learning understood the concept, interactive and enthusiastic team,
Training facilitators were fantastic really engaged the group and the understanding and
knowledge of the project, it moved at a fast pace but not too fast, good interactive sessions
(x3), a chance to experience all aspects of the app, very interactive and hands on , very
visual, plenty of opportunity for discussion (x2) and to contribute, facilitators very receptive
to contributions and valuing, Good explanation of flipped learning and app, sessions done at
varying times, Excellent teaching linking to theory and practice, good structure to the day,
Very well prepared and delivered, activities kept participants engaged. Excellent day thank
you (one of the most useful study days I have attended), good balance between theory and
practical sessions, opportunity to view app and provide feedback, videos very
useful/resources realistic, Good venue, variety of presentations and activities, safe
environment, friendly, very well organised course
3. The course would have been improved if…
Need more tips on non-verbal questioning, techniques to approach mute
teenagers/disinterested group, really young group visual aids and adjuncts, information given
as to how to role out APP and outcomes and info given to families, not such a tight time
limit, small room (x2), look at more at start so familiar with layout, read up on course
before hand, prevue videos and course content, run through contents of the box with list of
contents in box.
Preferred theory of teaching AM. And app info PM (I found it a bit distracting flicking from
one to the other), written info on using the app. Shorter day, more ipad to share with the
group when sharing the use of the app, we had a short session at the beginning to look
through resources box (x2), tables to work around, more space for work shops, more of an
introduction to the resources, the start date of the 13th is too soon,
Nothing to improve (x2), could have had agenda before, more time to use the ipad for those
who are not well versed with technology given the short time the pilot starts, pre-course
info, maybe in videos “3D” structure to explain cell and key model (insulin),
4. Aspect of the course Excellent Good Satisfactory Poor Unacceptable
Delivery of material… 6, 14, 10 4, 5, 2
The learning activities…. 6, 6, 9 4, 13, 3
The management of activities… 6, 13, 8 4, 6, 4
My learning achievement… 5, 6, 7 5, 13, 5
Content of course… 7, 11, 9 3, 8, 2 (1
missing)
Accommodation… 1, 13, 8 2, 6 (Chilly
x1), 3
(chilly x1)
3 4xn/a
N/A x1
Catering…. 2, 14, 10 4, 5, 2 1
Overall the course was… 6, 12, 9 4, 7, 2 (1
missing)
5. Course
organisation/content
Was there sufficient pre course information and instructions? Yes 11, 5/No 7, 6
If no what else would have been useful?
Did not receive any (x2), would have like pre-course reading as I am a slow learner, I did not
attend network so only knew date and time, more about pilot aims and objectives, outcome
measures and study design,
Would be good to send out more info before training day (x2), course outline not clear, more
access to app. It was difficult to supply more info than you did, unaware of course info except
direction, time and venue, some info on days structure would have been helpful,
Aims/objectives of the day/plan for day as only had venue info pre course
Brief presentation of the curriculum of deapp, could include list of resources, came with open
mind, enjoyed thoroughly, did not have precourse instructions (x2), curriculum could be given out
before hand so know what to expect during the day, timetable for day,
Is 1 day the right length? Yes 10, 18, 11 /No
If no please give suggestions.
Could be shorter finish at 4pm, a lot but not sure 2 days needed
Can be made shorter, could have been a half day perhaps,
Good structure with plenty of breaks to keep hydrated
Is the course information and teaching practice something you would use again back in your work
place?
Yes 10 19, 12/No
Please comment
Learn very useful approaches to teaching patients, transferable and adaptable, absolutely I am
keen to do new reading/practice on being an educator, I have found this session really useful and
interesting and it will definitely shape my future practice.
As a team we need to look at the materials and decide how we can use it for patients and carers,
assessment of understanding, tip to defer question from patients until relevant, rather than
feeling forced as they are raised, yes definitely!! It has given me ideas and made me think about
new ways of approaching education to the benefit of the patients, I have a bit more info to
underpin the project, good to have refresher on teaching skills, motivating to revamp my teaching
style, especially how to flip learn
Absolutely really helpful information, excited to start using it, It was really useful to have some
training on how to train/deliver the education, I have been able to think about my practice and
have ideas on how to improve my standard of education delivery, learnt “use different styles of
questioning” for various age groups, It made me reflect on my approach in consultation/teaching
not only in diabetes but in other areas of my practice too, Yes I feel this will enhance my practice
and am looking forward to outing it into use,
Are you interested in becoming more involved with the development of further online DEAPp
materials and supporting curriculum documentation? Yes /No
Do not work enough hours to develop deapp
If so, please give your name here Zainab, Nicki (but not tues), Marion, Rachel swindle, Julie Smith
Pooja, Aan mayes, Anne Rogers, Amy Ball, Rachel Williams, sarah Hodgkinson, Data manager
(?Nicki), Dawn Kitchen only if for ages 16-19years, Vaya Tziaferi, Prem Sundoram, sonal Kapoor,
Emma Green Marianne W, Rachel Cummings Sue Roach
Please add any comments to develop/support the answers you have given
Excellent boxed resources of good quality, thank you, I am keen that the food and CHO counting
session is current and evidence based so important to have latest info/would like to discuss
(Marion) thank you soo much, Sorry did not add positive comments
Enthusiastic facilitators, better understanding of an educator, resources will have to be looked at
not entirely accurate, excellent looking forward to putting into practice!! Thank you! Anne and
Julie were excellent facilitators thank you, just need more time/practice using /navigating the
ipad for app as not computer savvy
Excellent day and has made me realise what a lot of work it has been.
Maybe add a section where staff put comments on sessions or assessments on the app (but would
not be accessed by patients as password protected), really good bad feel as a professional, as we
get used to the app, it is going to be great especially as technology is the way forward this can
only equip us, over all a good day, I can see everyone has worked very hard on this project and this
is something that will enhance my practice and the app and prop box has been on my wish list for a
while thank you. Having training today has been helpful to deliver this education effectively –
thank you. Fantastic resources too, handouts of learning of theory - probing questions. Thanks to
all the facilitators it was a very useful introduction to deapp.
Thank you
Appendix 3: Evaluation form that parents fill in
1, On a scale of 0-5, Overall how useful did you find using the App?
0 1 2 3 4 5 (0=Not at all,5= Very useful)
2, On a scale of 0-5, Did you find the App easy to use?
0 1 2 3 4 5 (0=Not at all,5= Very useful)
3, On a scale of 0-5, How likely are you to use the App once discharged home?
0 1 2 3 4 5 (0=Not likely,5= Very likely)
4, On a scale of 0-5, How would you rate the contents of the videos
0 1 2 3 4 5 (0=Not at all,5= Very useful)
5, How did you feel about being given the App and using it without a member of the team
being present?
6, would you change anything about the App?
Appendix 4: Progress data of patients
Trust
Username
Used by Patient or Staff?
Date of Diagnosis
Age of Child
Progress as of 24/08/17
Progress as of 15/11/17
HbA1c at diagnosis mmol/mol
HbA1c at 3 months mmol/mol
HbA1c at 6 months mmol/mol
Chesterfield
PZ064- 001
Staff
N/A
N/A
School
N/A
N/A
N/A
N/A
Chesterfield
PZ064- 002
Staff
N/A
N/A
During Illness
N/A
N/A
N/A
N/A
Chesterfield
PZ064- 003
patient
20/03/2017
9
Highs and Lows
No further progress
132
42
48
Chesterfield
PZ064- 004
patient
19/04/2017
11
Highs and Lows
No further progress
142
51
42
Chesterfield
PZ064- 005
patient
26/04/2017
16
During Illness
No further progress
68
60
N/A
Chesterfield
PZ064- 006
patient
06/06/2017
14
Food
No further progress
125
46
N/A
Chesterfield
PZ064- 007
patient
09/06/2017
15
Not used
173
54
N/A
Chesterfield
PZ064- 008
patient
16/06/2017
13
During Illness
No further progress
102
58
N/A
Chesterfield
PZ064- 009
patient
31/06/2017
9
Practical Skills
No further progress
77
54
N/A
Chesterfield
PZ064- 010
patient
07/08/2017
11
Completed all of it
149
44
N/A
Chesterfield
PZ064- 011
patient
30/08/2017
3
Practical Skills
70
N/A
N/A
Chesterfield
PZ064- 012
patient
12/09/2017
1
What is diabetes
66
N/A
N/A
Chesterfield
PZ064- 013
patient
15/09/2017
9
During illness
97
N/A
N/A
Chesterfield PZ064- patient 07/11/2017 6 Practical Skills 83 N/A N/A
014
Chesterfield
PZ064- 015
patient
16/11/2017
10
N/A
N/A
117
N/A
N/A
Derby
PZ005- 001
Staff
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Derby
PZ005- 002
Staff
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Derby
PZ005- 003
Patient but moved areas straight after diagnosis
N/A
N/A
What is Diabetes
No further progress
N/A
N/A
N/A
Derby
PZ005- 004
Staff
N/A
N/A
Not used
N/A
N/A
N/A
Derby
PZ005- 005
Staff
N/A
N/A
Practical Skills
No further progress
N/A
N/A
N/A
Derby
PZ005- 006
Staff
N/A
N/A
What is Diabetes
Practical Skills
N/A
N/A
N/A
Derby
PZ005- 007
Staff
N/A
N/A
What is Diabetes
No further progress
N/A
N/A
N/A
Derby
PZ005- 008
Patient
13/07/2017
15
Future complications
No further progress
119
49
N/A
Derby
PZ005- 009
Patient
21/08/2017
2
Adjusting insulin
No further progress
87
76
N/A
Derby
PZ005- 010
Patient
11/09/2017
13
using at home due to connection issues
99
N/A
N/A
Derby
PZ005- 011
Patient
12/09/2017
7
using at home due to connection issues
87
N/A
N/A
Derby
PZ005- 013
Patient
02/10/2017
10
using at home due to connection issues
109
N/A
N/A
Derby
PZ005- 014
Patient
03/10/2017
10
using at home due to connection issues
162
N/A
N/A
Derby
PZ005- 015
Patient
20/10/2017
15
using at home due to connection issues
Highs and lows
92
N/A
N/A
Derby
PZ005- 016
Patient
29/10/2017
11
using at home due to connection issues
81
N/A
N/A
Derby
PZ005- 017
Patient
06/11/2017
7
What is diabetes
64
N/A
N/A
Derby
PZ005- 018
Used as follow up education
17/10/2016
7
N/A
N/A
N/A
N/A
N/A
Leicester
PZ055- 005
Test
During Illness
Leicester
PZ055- 006
Patient
18/04/2017
13 YRS
During Illness
Adjusting insulin
155mmol
69mmol
36mmol
Leicester
PZ055- 007
Patient
20/04/2017
2YRS
During Illness
No further progress
Leicester
PZ055- 008
Patient
21/04/2017
3 YRS
During Illness
Completed all of it
98mmol
68mmol
38mmol
Leicester
PZ055- 009
Patient
duplicate patient
Food
No further progress
Leicester
PZ055- 010
Patient
24/04/2017
7 yrs
Food
During illness
72mmol
43mmol
39mmol
Leicester
PZ055- 011
Patient
26/04/2017
15 yrs
During Illness
Adjusting insulin
72mmol
46mmol
56mmol
Leicester
PZ055- 012
Staff
Not used
Leicester
PZ055- 013
Patient
02/05/2017
7 yrs
Not used
Leicester
PZ055- 014
Patient
05/05/2017
2 yrs
Practical Skills
During illness
87mmol
68mmol
72mmol
Leicester
PZ055- 015
Patient
05/05/2017
8 months
Practical Skills
No further progress
Leicester
PZ055- 016
Staff
Extreme Highs and Lows
No further progress
Leicester
PZ055- 017
Staff
Food
Leicester
PZ055- 018
Patient
12/05/2017
12 yrs
During Illness
No further progress
98mmol
56mmol
38mmol
Leicester
PZ055- 019
Patient
15/05/2017
10 YRS
Not used
During illness
75mmol
50mmol
Leicester
PZ055- 020
Staff
Food
Leicester
PZ055- 021
Patient
07/06/2017
10 yrs
During Illness
No further progress
Leicester
PZ055- 022
Patient
As above but Dad
As above
but Dad
Highs and Lows and During Illness only completed
No further progress
Leicester
PZ055- 023
Test
Practical Skills
Leicester PZ055- 024
Staff
Practical Skills
Leicester
PZ055- 025
Staff
What is Diabetes
Leicester
PZ055- 026
Patient
01/07/2017
2 yrs
Practical Skills
No further progress
86mmol
62mmol
56mmol
Leicester
PZ055- 027
Patient
02/07/2017
11 yrs
During Illness
No further progress
89mmol
58mmol
50mmol
Leicester
PZ055- 028
Adjusting insulin
Leicester
PZ055- 029
Patient
29/07/2017
10 yrs
What is diabetes
106mm0l
62mmol
55mmol
Leicester
PZ055- 030
wouldn’t work
What is diabetes
Leicester
PZ055- 031
wouldn’t work
Not used
Leicester
PZ055- 032
Patient
25/08/2017
8 yrs
Completed all of it
100mmol
85mmol
74mmol
Leicester
PZ055- 033
Patient
15/09/2017
12 yrs
Practical Skills
Leicester
PZ055- 034
Not used
Leicester
PZ055- 035
Patient
20/04/2017
2 yrs
Completed all of it
84mmol
51mmol
54mmol
Leicester
PZ055- 036
staff
Not used
Leicester
PZ055- 037
Carb counting
Leicester
PZ055- 038
Patient
18/10/2017
12 yrs
Practical Skills
98mmol
Leicester
PZ055- 039
Patient
19/10/2017
14 yrs
Completed all of it
Leicester PZ055- 040
staff
Not used
what is diabetes
Leicester
PZ055- 041
patient
22/10/2017
7 yrs
Not used
what is diabetes
Leicester
PZ055- 042
Patient
22/10/2017
9 yrs
Not used
what is diabetes
Sherwood
PZ180- 002
staff
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Sherwood
PZ180- 003
staff
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Sherwood
PZ180- 004
patient
22/04/2017
16
During Illness
No further progress
113
33
Sherwood
PZ180- 005
patient
28/04/2017
15
During Illness
No further progress
92
83
Sherwood
PZ180- 006
patient
01/05/2017
12
During Illness
No further progress
cant find
52
Sherwood
PZ180- 007
patient
08/06/2017
15
During Illness
No further progress
131
37
Sherwood
PZ180- 008
carer/patient
09/06/2017
5
During Illness
No further progress
101
DNA clinic
Sherwood
PZ180- 009
carer/patient
20/06/2017
5
During Illness
No further progress
88
45
Sherwood
PZ180- 010
patient
01/06/2017
11
What is Diabetes and Food Completed only
Completed all of it
136
64
Sherwood
PZ180- 011
patient/carer
21/08/2017
8
During Illness
Exercise
103
awaiting
Sherwood
PZ180- 012
patient/carer
20/09/2017
6
During illness
141
awaiting
Sherwood
PZ180- 013
patient/carer
13/10/2017
10
Completed all of it
119
awaiting
Appendix 5: Summary of the visuals and the learning resources for all 12 sessions
You can view the actual videos by following these instructions
They are in collections (albums) per session number to try and ensure that they are
watched in the correct order. Each collection is password protected.
The password for all is deapp1
The link below will take you to a list of the collections (they will be formatted in the
correct order):
https://vimeo.com/user63321840/albums/sort:alphabetical/format:thumbnail
If you need to input the address manually just type:
vimeo.com/user63321840/albums
This will show them in a backward order. Click ‘sort: alphabetical’ to put them in a 1 –
12 order if you desire.
Ii
Session one - What is Diabetes
I
I
I
I
.. Glucose • ••
I
I
• • • • • • Ii
Explains what glucose is and what it
does. I Explains what typel diabetes is.
I
I
I
I
I
I
I
· .:: C, •
••
••
••• 0• • ,& I
••. •• •0 o••• • •: W' •• I
$ •• 0 •• . • 0 •• I
I
I
I
I
I
I
I
I
Explains why you have diabetes, lookin g
at your auto immune system.
Talks about Your chances of getting
diabetes.
Explains how a piece of toast is digested
and how it is thenconverted into
energy.
Touches on ketones and how they are
produced and how harmful they can
become.
Explains why the need for a fast (quick)
and slow (long) actinginsulin.
l l
)
.:;;,,
---..-.-- _,... .......
..!.....,. ..!- '
• • ..•..., ,•--
- ..,
• •
.:;;,,
• • •
•
- - ..,
_,, -.., '.,. - ,, .... .,.. · ..
The body map also comes with facial expressions, these can be used to help patients/parent to talk about how they
are feeling after being diagnosed with typel diabetes.
Session one - Learning Tools
The 4 T's thi s reveals the 4 symptoms of diabetes. Tired, thin, thirsty,
toilet. The pat ient/ parent names the symptoms and then peels of a
T to reveal the picture.
The body map can be used in a number of ways. One way is to get the
patient/parent to place the body pieceson the board then talk through the
journey of toast. Explaining how food is broken down and how food containing
carbs are converted into energy.
,
Session Two - Practical Skills
BLOOD GLUCOSE TEST
Explains why it is important to test your
blood glucose levels.
Quality Control Testing
Cr: · 4f,
Explainswhere to give an insulin injection. This video looks at how to prepare an
insulin pen and how it works.
Talksabout Quality control testing and
why its important.
. ·
I I I I II
Looks at how to give an insulin inje ction
Sharps- what is a sharp, what needs to go
in a sharps bin and where to get one from.
Explains the different types of insulin's
that can be used/ prescribed.
Shows how to do a blood glucose test.
Session Two - Learning Tools
Using the equipment your diabetes teamhave demonstrate how to test blood glucose and how to give an
injection.This session also covers how to change an insulin cartridge, lancets and test for ketones.
Injection sites
This is used to ask/show patients
and parents where they can give
an insulin injection.
Sharps or non-sharps
Using the discs ask patient or parent to
throw the correct discs into a demo sharps
bin.
---------
Give the patient or parent the sequence cards and ask them to place them on the board in the
order they feel they should follow if it was them doing a blood glucose test.
I
I
I
I
I
J
Session Three - Food
This video explains that youdon't need a
special diet, it looks at the eat well plate
and its sections.
An insight into what foods contain
carbohydrates.
Explains about good meal times and ideas
on what to have.
This video looks at lactose and fructose.
And long and fast acting foods.
Talks about takeaway's and going out. Explains how to read a food label, and
what to look for.
Session Three- Learning Tools
Using the food cards Patients and parents
can pick out foods that they think contain
carbs.
Patient can also play pairs or snap.
The food plate can be used to get the
patients or parents to choose what they
would like for a meal (using food models)
and talk about what food item would
contain carbs.
You could also use the plate to group the
food models together l:e protein or dairy.
Session Four - Highs & Lows
Explains what a hyper is.
Explains what a hypo is.
This video looks at how to treat a hypo.
· <":, ";
H:. l:i9
I
--"' /4
Session Four - Learning Tools
- •• ,•• H;ghs&lowsd;,csa,eg;,e, ....... _ to the patient or parent to H : lit 1;1:_: 1.1
9 A
l9 . ....• -- 'A9
he lp prompt the start of a
conver sa t ion a bou t t he .; . _ ; . _ ,
sy m ptom s of a high or a low
_l..ivJl
UtN\rM\1'il\M b loo dg lucose r ea d ing. .. ....
•
u••
• ••
••
c ----'e9
W W
S!ood 1 ' 81oud C.lu&..vsc C lc•n e
Tn \ lcSl
QP II QP I , ..._ ......
The time line can be used to look
at when a patient or parent needs
to either give an insulin inject ion
and when to test blood glucose
levels.
t:fttorei,.r.4..'... •ffr.• •
r,.1''
flit'-' J'h rt Sot
Cha r lie's Choice
1. Charlie is going out with nwt es, what sl,ollld h take with him>
Pick items to pack in his , ur• r.2• -
l t,ns ¥•• Keto hi Ml·.1,
Hypol l\" ::,l, ll
l11 L•llfl \n
Wipes or Bot tled Wat,r/ r·ss,·(tn:, finper ),
Mob,(e Pho ne, ldent;f,cat, on.
2. After being out for 2 hours, Charlie start s to fee l thirsty.
What should hedo?
''" rfie•s c'n°' '
Using Charlie and his ruck sack the patient or parent decides
what Charlie needs to take with him when goingfor a walk or
out with his friends.
Readingthroughthe scenarios, the nurse/ educator could
initiate a discussion about what happens next. What would
they do if it was them?
Charlie's Choice I
-
K)
K)
/41mc1.,...-._.. 1
Using the wipe clean board the nurse/educator can ask
the patient or parent to draw where they think a high
blood glucose reading would be.
The nurse/educator can write the expected bloods in the
circles i:e bottom circle 4. Four is the floor
\Q) 7
Using the mat patient or parent can place the hot air balloon
or submarine where they think a high or low blood glucose
reading is. Or what their blood glucose reading is.
/
Session Five - Sick day rules
,v @>&!/
[ Explains about sick day rules,and what to do if they are
ill.
Session Six - DKA
This video looks at DKA, what it is and why it happens.
/'-- -:"K":""e"-ton-es - --
more than1.5 Give a correction of 20'¾ of the total daily dose of Insulin
Session Six - Learning Tools
Traffic light stickers
These can be given to patientsand stuck on the
back of their ketone meter.
Slip in the high blood readingcards .Askthe patient or
parent to roll the dice, if it lands on a high blood glucose
reading and it as ketones ask the patient or parent what to
do.
Session Seven - Correction doses
This video looks at correction doses and how to work
them out.
I Session Seven - Learning Tools
I
I
I
I
I
I
I
I
I
I
I
I The correction ladder will help the patient or parent to be able to work out their own correction dose.
I
I
I
I
I
I
I
I
I
I
I
I
I
I
/l - :7
<Reading @ r - "
/
Target Level
I
I
I Ses. sion Eight- Carb Counting
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
- I
Learm·ng Carb values.
I
Session Eight - Learning Tools I
I
I
I
I
I
I
I
I
I
I
I
I I
I I
I
I
I
I
I
I
The dieticians will visit the patient or parent and help them to understand carb counting. They use a carb n
cals book, and shr,w them how to weigh foods out and calculate the amount of carbs in that portion.
--- -
Coun t your Corb s & Calories wltnO'f' 1200 food & D1lnk thotoi l
Mn.ff
l(lQJI;
.'
COUNTER CARB & CALORIE
CEREAL
Session Nine - Schools
,;fo1-), I/
Nursery, School, and
College
This video looks at diabetes in schools. Care
Session Ten - Exercise
LearningCarb values.
Session Ten - Learning Tools
Patients or parents roll the dice and depending
what it says th ey need to tell you if they are able
to take part in PE. This prompts discussion about
different types of exercise and how they could
affect their blood glucose readings.
You can also use the diabetescards to prompt the
same discussion.
p,£ Session Eleven - Future complications
I
I
I
I
I
COMPLICATIONS I
I
I This video looks at the complications that could happen
due to poor control.
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
- - - - - - - - - - -
Session Eleven - Learning Tools
These glasses help to give the patient or parent an idea of what it would be like to have the start of eye
Nurse or educator will use these photos to
show the deterioration of a minor foot
problem. This is not meant toscare the
patient or parent but to help them
understand how not looking after their
diabetes could affect them later on in life.
complications. Ask the patient to wear them whilst watching one of the videos on the app. Discuss how they would
feel and what t he y can do to avoid this from happening.
Thefol i-t;serieso, pho( s thedetenor,tbioralOIC'Ol'footinp'v,.. t,ctt ppeflbas1 ofPoOrl)Qbttr:sconuulrm• tJrOe.
Session Twelve - Lifestyle and Travel
LI FESTYLE
Explains that you can still live a normal life, making sure
diabetes doesn't stop you doing anything .
This video looks at travel and what you need to take and
where to store your diabetes equipment.
Twelve - Learning Tools
·carry on'bag 'Check in' bag
-·- What would they need to take on
holiday?
And where would they pack it? Cou ld
it go in the hold or would it have to go
in their cabin bag....
Use this time to talk about different
time zones and relevant travel letters
they made need.