Making research and education
WICKED
Aim
Develop and evaluate a model of care to
improve self-management in T1DM
specifically for young people aged 16-21
years
The MRC Framework
• development: (identifying the evidence base,
developing theory, modelling process and
outcome);
• feasibility/piloting: (testing procedures, estimating
recruitment, determining sample size);
• evaluation: (assessing effectiveness, understanding
change process, assessing cost-effectiveness), and
• implementation: (dissemination, surveillance and
monitoring long term follow-up).
Eiser C et al. Using the Medical Research Council framework to develop a complex intervention to
improve delivery of care for young people with type 1 diabetes. Diabet Med. 2013
Jun;30(6):e223-8. doi: 10.1111/dme.12185. Epub 2013 Apr 12.
Development Phase
Semi-structured interviews about the diabetes
service, what young people want from a new
service and concerns about transition with
-Staff (N = 15)
-Parents (N = 18)
-Young people aged 11 – 21 (N = 28)
Brierley, S. Eiser, C. Johnson, B. Young, V. Heller, S. Working with young adults with Type 1
diabetes: Views of a multidisciplinary care team and implications for service delivery. Diabet Med.
2012 May;29(5):677-81
Feasibility and Piloting of a Complex Intervention
Individual
Clinic
Family
Knowledge into Action
Clinic Organisation
Family Support
Care
Planning
DOLFIN
WICKED
Goal
Setting
Self-efficacy
Self-care
Psychological well- being
HbA1c
Uptake of Services
WICKED
Working with Insulin, Carbs, Ketones and
Exercise to manage Diabetes
• In response to requests for age-specific
education
• Allows young adults to be flexible in their care
to fit it around their lifestyle
• Young adults recruited in clinic
Beer et al (in press). WICKED: the development and evaluation of a psycho-education programme
for young people with type 1 diabetes. Journal of diabetes nursing.
The very beginning…
Feedback from
CLAHRC Phase 1
research: need for
structured
education for
young people
FEB ‘11
2 diabetes nurse
specialists and
specialist dietitian
to deliver ageappropriate
DAFNE?
Feedback from pilot groups…
•Too much info, some repetition and irrelevance
•Need more guidance on social activities, alcohol
and drug use.
•Days too long, too few breaks
•Too didactic
•More support needed after course
MAY ’11: REVIEWING THE DELIVERY OF AGE-APPROPRIATE DAFNE:
…in response to feedback
Shorter days more breaks over the 5 days and follow-up at
3, 6, 9 & 12 weeks.
•Age-appropriate alcohol & drugs session.
•Input from Sheffield University Dept of Education
•Learning objectives more relevant to young people
•Include games and activities
•Blood glucose profiles tracked with WICKED graph
•No hospital food plus a meal out
•Customized resources
MAY – AUG ’11 INITIAL DEVELOPMENT OF WICKED
•Better name - WICKED!
What’s different?
• Assessment for Learning
• Flexibility within the Scheme of Work
• Schemes of work – some / most / all
• Recap of day before - Quiz
– Higher / lower
– White-boards
– Choose a napkin
• Tailored, small group working (engineered)
AUG ’11 –WICKED pilot course
• 9 attendees, 16 – 20 years
• Observed by Academic Educationalists
• Individual evaluations & feedback from Educationalists
The most helpful
week of my diabetes
life! Made me think
about my diabetes
more
The whole week
has been a brilliant
experience and I am
so grateful for it!
Cheers!
Really helped my
confidence with
moving out and
going to University
Best course you
can do if you
struggle with
diabetes. It goes
back to basic and
explains things
you never knew.
Now I can control
my diabetes
WICKED is a fun and interesting way to learn more about your diabetes,
how it works, and how certain things affect your blood sugar
AUG ’11 – WICKED feedback
The Scheme of Work includes:
•Assessment for Learning
•Clear aims
•Structured timetable including
meals and breaks
•WICKED shopping list
•Resources including crib sheets,
worksheets, games, quizzes &
postcards
Follow-up:
•Meetings at 3, 6, 9, weeks in a
coffee shop (and 12 weeks in
clinic)
•Texts inbetween + extra if YP
DNAs FU - keyworker
MAY ’12: THE FULL WICKED PROGRAMME DEVELOPED!
WICKED EXPERIENCE
• Individualised and tailored
• Take small steps, set subjects, not set times
• Give a consistent message that any improvement is
positive…….(small steps)
• Talk about support/helping others who are finding
diabetes difficult (and actively engineer it)
• Patients set their own targets ………
• Always enthusiastic and proactive……
Evaluation - Participant Characteristics
47 young people (YP) attended one of 6 courses
• 11 were on pumps
• Five were very newly diagnosed (3 days – 13 weeks)
For the remaining 42:
• 22 female
• 16.05 – 21.39 (M = 18.16, SD = 1.47) years
• Time since diagnosis: 1.22 – 18.83 (M = 8.70, SD = 5.09) years
• Mean HbA1c: 91.0 + 27.9 mmol/mol
• 5 young people reached the clinical target of <58 mmol/mol
WICKED attendance and follow-up
• Attendance
– 87.9% attended all sessions
• Follow-ups
– Well-attended 3–week group sessions often
requested, group session for 6 – week follow-up
– Informal sessions – evidence of contact between
group members since course and partners did attend
these sessions
What happens to HbA1c?
N
Baseline
Follow-Up Sig
3-month 41 91.0+27.9
88.1+26.1
n.s
6-month 31 89.9+27.4
84.1+25.3
n.s
Psychosocial Impact
• Self-efficacy
– Increases significantly after the course
• Positive Outcome Expectancies of Management
e.g. Make me feel good about myself.
– Increase significantly after the course
• Perceived Knowledge
– Increases significantly after the course
Feedback from young people
Before the course
Worried it would be like school and a list of what not to
do
The experience exceeded expectations
“You’re not being told what to do you’re being
advised... but you don’t have to its up to you” (FG5).
“was nice to find out that not everyone else is perfect,
and it is possible to do well”
Feedback from young people
Liked interactive activities
“kind of sunk in easier than it would if it were just
like copying something of a board”
Plotting sugars helped “visualise it better” and “It
were nice to hear other people’s results as well”
Positive about content
“They actually talked about stuff that we would do
like alcohol and drugs and stuff and sex and that.
Acknowledgements
• This research was supported by NIHR CLAHRC for
South Yorkshire
• WICKED Educators - Vanessa Whitehead, Rebekah
Beer, Glynis Feerick, Kay Bottrell
• Psychology Team - Barbara Johnson, Sue Beveridge,
Samantha Brierley, Christine Eiser, Jackie Elliott,
Simon Heller, Kath Price, Adrian Scott, Victoria Young
• Sue Beveridge, Dr Jackie Elliott, Prof Simon Heller, Dr
Kath Price, Dr Adrian Scott
• http://www.clahrc-sy.nihr.ac.uk.