The Bournemouth structured education programme (BERTIE) has been running for over 10 years and has proven outcomes in terms of reduction in HbA1c and improvement in diabetes distress scores and reduction in hypoglycaemia. In order to increase access to structured education across the UK an online version of BERTIE was introduced in 2006. Over the past nine years we have had over 36,000 users and demonstrated accessibility, acceptability and positive outcomes.
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We are not aware of any other platform offering online structured education to people with type 1 diabetes. From the user feedback on the original BERTIE site we knew that there was a need for an alternative method of providing structured education. People all learn in different ways and have different lifestyles to accommodate: 97% of users reported the site is useful (46% extremely useful, 32% very useful). Rather than use scarce resources to reinvent existing material, we also made use throughout of many other excellent sources available by signposting to other sites (eg Diabetes UK and JDRF), videos, blogs, tweetchats etc. In order to capture the important aspect of peer support during face-to-face learning we have integrated a ‘shared experiences’ theme throughout to allow people to share both the frustrations and their tips for living with type 1 diabetes.
We worked very closely with a web design company specialising in delivering online education using educational theory to redesign, expand and redevelop the platform. Our aim was to make education available as a programme which sits within a web application provided in a cloud-based solution. We aimed to make education accessible offline and on all digital modalities - PC, laptop and mobile, via all servers. This has been achieveable by using an innovative technique of a fully responsive version of the course which adapts to fit the screen size of the hardware in use. In order to tailor the service to meet the needs we approached our local population with type 1 diabetes and the diabetes online community to ascertain what would be useful and necessary to them using focus groups. We upgraded the educational content of the original BERTIE curriculum introducing each of the concepts of diabetes management with examples, graphics, videos and self-assessment tools in a modern format. We introduced user questionnaires to assess hypoglycaemia risk and diabetes distress. We are able to assess whether utilisation of the platform leads to a reduction in diabetes distress by asking the user to complete the questionnaires at the beginning and end of the modules.
Results at six months after launch of the platform have shown a reduction in diabetes distress from mean 32.2 (SD 15) to mean 24.2 (SD 16.2) (p<0.005). This does however only represent a small cohort of 33 people. In addition we utilised a carbohydrate counting examination tool developed at Royal Bournemouth Hospital as a model for an assessment at the end of each module. In the first six months of launch we had 1,824 register for the site with a mean dwell time of 45 minutes on each module which represents an average of over two hours of structured education from the basic modules. We have demonstrated that over 80 % completed the assessments and we have used data from incorrect answers to adjust the specific wording of some of the information and questions to make it more user-friendly.
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