‘Seven thousand feet’ was an exhibition and series of events about diabetes (causes, prevention, management and insight into patient lives). This collaborative and innovative project brought together diverse stakeholders to engage with the public in Greater Manchester about diabetes, through visual artworks and associated science exhibits and activities. The exhibition title reflected the number of people in the UK undergoing diabetes-related amputations annually and featured 7,000 single, donated socks. It took place at Manchester Central Library during the 11-day Manchester Science Festival (MSF) in October 2018, running on until World Diabetes Day on 14 November. Artworks were later displayed at the 2019 Diabetes UK conference. Almost 2,000 members of the public and a wide range of diabetes healthcare professionals saw it. This novel approach was a cost-effective way to raise awareness of diabetes as a public engagement and behavioural change activity that was well received by the local population.
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The idea was conceived in early 2017 by North West artist Christine Wilcox-Baker and Dr Martin Rutter, senior lecturer in cardiometabolic medicine and honorary consultant physician at Manchester NHS Foundation Trust. They recognised the challenges of traditional approaches when encouraging the healthy lifestyle and behaviour changes needed to prevent and manage diabetes effectively. They wanted an original way to engage both people diagnosed with, or at risk of, diabetes and the general public, the majority of whom remain unconcerned about the impact of their current lifestyle on their risk of developing diabetes. They wished to generate discussion about diabetes away from the traditional health environment and help the public reflect and identify how lifestyle behaviour changes could reduce their risk of developing Type 2 diabetes. They wanted to educate, promote self-management to those with diabetes and highlight how health research can discover the best ways to prevent, diagnose and manage the condition. Wilcox-Baker and Rutter brought together clinicians, scientists and artists to create visual messages to engage with the Greater Manchester public. Consultation with healthcare professionals, Diabetes UK and industry suggested significant interest. The annual MSF was identified as ideal for the project as it attracts over 130,000 people, of all ages and backgrounds, and receives local, national and international publicity. ‘Seven thousand feet’ was the name of the main exhibit, comprising a large installation of over 7,000 single, donated socks, each representing a lower limb amputation as a consequence of diabetes.
Methodologies used to evaluate the project included: an initial survey and semi-structured interviews with local residents living with diabetes to shape the exhibition; a pre-event online quiz to obtain baseline data on knowledge of diabetes and complications; capture of visitor numbers to the exhibition and events; knowledge-based questionnaires and coding of themes from qualitative feedback cards distributed throughout the exhibition using a spot-check and sampling technique to capture responses and changes in knowledge and behaviour; a quiz at the Best Foot Forward investigation day to assess learning outcomes; noting numbers of people undertaking HbA1c testing (World Diabetes Day); social media analytics (exhibition, collaborative partner organisations); a post-exhibition focus group and interviews to gather qualitative feedback and attitudes; self-evaluation by project partners to establish the benefits of collaboration and long-term impacts, plus a review of MSF evaluation data.
Around 900 visitors attended the exhibition during the MSF, with an additional 200 attending daily activities and 500 going to Best Foot Forward. Another aspect of the event, the Diabetes Tech Fest, attracted approximately 300 adults and 400 children. A further 1,000+ visited between the close of the MSF and the exhibition ending with the World Diabetes Day celebration. The Best Foot Forward quiz suggested visitor knowledge about foot complications and motivational behaviours for a healthy lifestyle had increased on leaving the event: 80%+ correctly identified ‘balanced healthy diet’ and ‘physical activity’ to prevent Type 2 diabetes; 52% identified loss of touch as the reason neuropathy can be dangerous; 122 comments (8.1% response) from the 1,850 most engaged visitors indicated that 41% had new or deeper knowledge of diabetes. Many comments highlighted the main installation as a powerful way to demonstrate the shocking reality of amputation. Extrapolating to the total number of engaged visitors meant 33-50% deepened their knowledge about diabetes, 36% indicated greater empathy towards people living with the condition and 17% indicated an intention to change their lifestyles. Around 40 people had a ‘diabetes risk score’ and HbA1c test on World Diabetes Day. A large proportion suggested pre-diabetes and were advised to visit their GP.
Based on local diabetes prevalence data, it is estimated that the exhibition reached at least 224 adults living with diagnosed diabetes and a further 224 people at risk. Social media analytics from ‘Seven thousand feet’ accounts demonstrated a high engagement rate. The exhibition attracted a significant amount of media coverage and was commended in the University of Manchester ‘Making a Difference Awards for Social Responsibility’ 2018.
Sustainability and Spread
The exhibits are available for use by healthcare professionals to support their work with patients. Research for the Future (RftF) plans to use the Fascinating Family exhibit – speaking figures which convey health messages – to engage with the public to open conversations about diabetes research. The vascular assessment team will use the character ‘Jack’ at patient events. The artist is in contact with Diabetes UK, conference delegates and exhibitors who expressed interest in using the artworks at future events. A University of Manchester student developed a website to showcase the exhibition as part of her degree coursework and this and the artworks are still being promoted to further extend the project. The plan is to maintain project momentum, seek funding for further development/tours and ensure this effective route to patient and public engagement around diabetes continues to have an impact.
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