Summary
The COVID-19 pandemic meant Dose Adjustment For Normal Eating (DAFNE) patient courses and healthcare professional training had to move away from face-to-face courses. A Remote DAFNE patient course was created (April-July 2020). It comprised a five-week blend of self-directed online learning and structured virtual group sessions, facilitated by a DAFNE educator. Existing educators were trained via a virtual conversion course (RCC), developed in parallel to the Remote DAFNE course. It has been delivered to 303 educators. The Remote DAFNE Educator Programme (RDEP) and Remote DAFNE Doctor Programme (RDDP) were produced to replace in-person workshops.
Innovation
For the Remote DAFNE course to be piloted and rolled out to people living with diabetes (PWD), DAFNE HCP training programmes needed to be developed for existing educators, new educators and new doctors. These had to be accessible but also of quality. A RCC that could be delivered virtually was required, highlighting the differences between it and the the face-to face DAFNE course, along with training on how to facilitate the virtual group sessions. An educator training manual/curriculum, course timetable and lesson plans for each of the five structured weekly virtual group support calls in the Remote DAFNE courses were created. The RCC (piloted July 2020) involved self-directed review of the educator manual/ lesson plans and completion of a 3.5 hour virtual workshop facilitated by a national DAFNE trainer. Educators completed an anonymous SurveyMonkey feedback questionnaire after each week of the Remote DAFNE pilot course. The RCC was not suitable for training new DAFNE educators. Units were adapted as necessary, including facilitation of virtual group sessions and tricky participant behaviours. Scripted scenarios were created, role played and videoed. A trainee course observation workbook was created for completion when watching the course observation videos. The Remote DAFNE Educator Programme (RDEP) was piloted Oct-Dec 2020. In parallel a Remote DAFNE Doctor Programme (RDDP) was developed, incorporating some of the course observation videos created for the RDEP. The RDDP was piloted Nov 20-Mar 21. Anonymised evaluation SurveyMonkey questionnaires were sent to all pilot RDEP and RDDP trainees.
Equality, Diversity and Variation
Completion of the RCC, RDEP and RDDP requires access to WiFi and a PC/tablet to complete both the online learning and virtual workshops. The RCC enabled existing DAFNE services to deliver the Remote DAFNE course to PWD, to continue access to DAFNE training during the pandemic. The RDEP and RDDP not only enabled additional educators and doctors from existing DAFNE centres to train but, importantly, enabled training for new DAFNE centres, increasing access of DAFNE to more PWD. Seven new centres came on board during the pandemic. The virtual nature of the RCC, RDEP and RDDP made it easier for HCPs to train and for the national training team to deliver the training. In addition, RCC training was provided to DAFNE colleagues in Oz DAFNE (Australia, New Zealand and Singapore) and DAFNE Kuwait. Further online units could be shared with members of the wider diabetes team, who had not completed an educator or doctor training, ensuring PWD received the same messages using the same language as DAFNE trained team members, ultimately improving service user experience. The RCC, RDEP and RDDP training programmes were highly rated by trainees.
Results
The RCC was piloted with 91 existing educators from 38 DAFNE centres that volunteered for the pilot. These educators delivered 62 pilot courses between 20 July and 4 August; 227 PWD commenced the course and 201 (89%) completed all five weeks, with a retention rate similar to that of face-to-face courses. All the educators rated the RCC as useful for preparing them to deliver the Remote DAFNE course (33% very useful, 61% useful and 6% OK). To date 303 existing DAFNE educators (61%) from 78 DAFNE services have completed the RCC. The RDEP was piloted with 47 trainee educators, 45 of whom successfully completed all assessments and became DAFNE educators. Following positive feedback the RDEP was rolled out, with a further 62 educators completing the training. In total 109 new DAFNE educators from 51 DAFNE centres have been trained via the programme. The RDDP was piloted with 60 doctors. Compared to previous face-to-face HCP training, the new remote programmes resulted in resource/cost savings to the national programme.
Dissemination and Sustainability
DAFNE is a national, ‘off the peg’, structured education programme, open to any diabetes service wanting to offer it that joins the DAFNE consortium. As all the training in Remote DAFNE is provided online, location of trainees is not an issue. The RCC and RDEP are only available to HCPs at DAFNE centres. To date 303 (61%) of existing DAFNE educators from 78 DAFNE services have completed the RCC; 109 new DAFNE educators from 51 DAFNE centres have been trained via the programme. RCC training has been given to DAFNE educators from DAFNE Kuwait and Oz DAFNE. Unlike educator training packages, the RDDP is open to any doctor, even those from non-DAFNE centres. Of the 81 doctors who completed the RDDP, 72 were from 38 DAFNE centres, two were from DAFNE Kuwait and seven were from non-DAFNE services. The creation of the RDEP and RDDP for the training of new educators and doctors enabled seven new diabetes services in the UK and ROI to come on board during the pandemic, enabling them to deliver the Remote DAFNE course to PWD in their service. The success and feedback from the Remote DAFNE course indicate that this will remain a delivery option post pandemic. Further online and virtual training programmes will be developed for both PWD and HCPs. The RDEP has CPD endorsement from the British Dietetic Association. An application has been made to the RCP for CPD accreditation for the RDDP.
User Feedback
All participants in the pilots of the RCC, RDEP and RDDP were asked to provide anonymous feedback. National trainers reviewed the collated feedback for each pilot, amending the programme as appropriate.
The trainers delivering the courses compared their own experiences to highlight improvements.
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