More than 75% of people with diabetes (PwD) live in low- and middle-income countries and recent global trends show an alarming increase in vision loss from diabetic retinopathy (DR), highlighting the need to build capacity and strengthen diabetic eye health services at national level. Diabetic eye health services within the NHS provide a unique insight into a health systems approach for the prevention of vision loss. This initiative aimed to share evidence and good practice for the prevention of visual loss from diabetic eye diseases globally via the open online course, ‘Diabetic Eye Disease’ (DED), for health professionals around the world working in local diabetic services.
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Efforts to improve population health require both health-system and patient-level approaches. Inequality in the access, availability and delivery of care for PwD, particularly in low- and middle-income settings, remains a widespread concern. Health professionals are further challenged by the lack of availability of, and limited access to, appropriate training resources and the high cost of training. The plan was to assist diabetic eye care services through an open, online course. Central to the approach was collaboration between diverse groups: the funder, The Queen Elizabeth Diamond Jubilee Trust, clinical and public health experts (NHS and globally), education leads (London School of Hygiene and Tropical Medicine [LSHTM], FutureLearn) and educational technology experts. A steering group was established to identify best practice in health systems and relevant global guidance in public health for diabetic eyediseases, to develop an appropriate learning design and content and deliver the open content online. Focus was placed on the learner experience and the quality of the content. An open copyright licence was applied in order to deliver a ‘cascadable’ learning and teaching opportunity for participants to use, reuse and adapt for a local level. In order to engage a wide range of target learners, the training was delivered online and was free to access for all. This offered a unique learning space for a diverse range of participants, from eye health professionals to PwD. The learning was designed to be relevant and applicable to the whole team involved in the delivery of care for PwD, as part of the Massive Open Online Course (MOOC). The principles of universal design were applied, with multiple means of engagement, representations and expression provided. Learning tools included videos, animations, articles, infographics, quizzes and a hypothetical case study.
The four-week course was developed with experts from NHS DR screening services and global advisers, to ensure it was relevant, high quality and had shared ownership.It was based on the NHS DR screening model at a national level, as best practice, along with global guidelines from the World Health Organisation and International Council of Ophthalmology.Each week of the course was assigned an external consultant who worked with the lead educator and learning technologist. The course is accessed via the FutureLearn platform and covers: classification, natural history, epidemiology and complications of diabetes mellitus and diabetic eye disease, in particular DR; the impact of diabetic eye disease on the individual, society and health services; public health and screening for diabetic eye disease; partnerships and a team approach to prevent blindness from DR; DR screening and grading services; treatment protocols and guidelines for DR in high- and low-resourced healthsystems, plus monitoring and evaluation approaches for DR screening.Maximising opportunities for learning among diverse learners was achieved through: a globally-accessible online platform; offering multiple means of engagement, representation and expression; content designed for applicability across multiple countries and settings, such as use of plain English and non-culturally-specific graphics, captions and clear audio; encouraging learners to develop their thinking through note taking, reflection and dialogue; targeted digital marketing to engage intended audiences; extended dialogue on the course through facilitation by subject experts, local practitioners and LSHTM alumni, as well as offering freely-downloadable content for areas with restricted internet access and further teaching and learning access offline. Learners can navigate the content as needed, at their own pace.
A total of 74 learning steps was created and delivered through a variety of formats. Direct social/conversational learning was supported at the end of each step through the comments section, which allowed peer-to-peer interaction facilitated by course mentors and the lead educators. A hypothetical planning case study enabled participants to relate their practical experiences to the needs of the health system and to apply their learning. A total of 3,401 participants from 153 countries enrolled on the course in Oct 2018 and January 2019. Of these, 56.3% were from low- or middle-income countries. Flexible enrolment and participation enabled a wide range of learners to use the course. They could complete all 74 learning steps, self-select steps, learn as a team, or download content for local training. Users included PwD, allied eye health providers, health system managers and ophthalmic specialists.
Sustainability and Spread
The course has been disseminated by the Commonwealth Eye Health Consortium. It is also a direct resource for the DRNET VISION 2020 Links Programme. The plan is to run the course at least twice a year. Regular content updates will be implemented as required, following annual review with experts in the steering group. To support educators in the practice of open education there is a webinar series link available, along with articles in the Community Eye health Journal. The courses are supported with a multi-pronged marketing strategy and social media coverage. The long-term impact of the course will be assessed at the end of 2019 using a value creation framework tool.
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