The Know Diabetes website (www.knowdiabetes.org.uk) was created in 2015 to provide information about user group activities. Since 2017, MyWay Digital Health and Dynamic Health Systems have partnered to redesign and extend the Know Diabetes Service, to: support over 300,000 people with diabetes, previous gestational diabetes or non-diabetic hyperglycaemia; encourage sustained behavioural change using personalised proactive communications; promote public awareness of diabetes; provide information to high-risk ethnicity groups; increase access to formal education programmes with a single point of referral, and support self-management. The relaunched Know Diabetes Service (KDS) had over 70,000 users in the last three months and positive feedback.
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Following consultation with users and clinicians in 2016, a tender process was undertaken in 2017 to expand and improve the Know Diabetes website. Funding limitations meant this consisted of two stages: an upgrade to the website and addition of eLearning (MyWay Digital Health); the wider digital health marketing, patient record access and education booking platform (MyWay and Dynamic Health Systems). Payment of technology providers was linked to completion of work packages. The programme is an innovative initiative, introducing new practices and digital tools into the health system. A Diabetes Digital Team of subject matter experts worked closely with clinicians and patients. Web and campaign content were designed with an eye on clinical content, accessibility and behavioural change best practice. Delivering this in the midst of significant local health system change required considerable flexibility. The team adopted agile methods and tools across the programme to assure maximum responsiveness. A Programme Collaboration Framework was developed to support all planning, delivery and reporting activity, deploying a number of procedures and tools to measure engagement and outcomes, and refine future developments. These included Google analytics to track the total number of web visitors, pages visited, length of visit, bounce rate, geographical location, source of referral, demographic data and more. Cloud-based collaboration tools were used, including Miro, Microsoft Teams, and Teamwork. Campaign automation tracking was used to monitor email delivery, open rate and click-through rate. Satisfaction surveys were used to discover the views of patients receiving email newsletters and campaigns. In addition, topics-of-interest surveys provided greater insights into patients’ preferences.
Currently, data from 350 GP practices is being fed into Know Diabetes. Analytics on initial email campaigns demonstrate that North West London (NWL) patients are engaging with the site and levels of engagement are expected to increase as campaigns extend to all people impacted by diabetes or at risk of T2DM in the region. An accelerator to full operation and evidence that the solution scales was the COVID-19 crisis. The rapid rise in numbers of patients with COVID-19 in March 2020 demonstrated the need to provide clear messaging to people with diabetes, not just about shielding, self-isolation and sick day rules, but also about wellbeing more broadly. A COVID-19 section
(https://www.knowdiabetes.org.uk/for- you/Covid-19-staying-healthy/) was created within a week of lockdown, which was shared widely via SMS from GP practices. This included: sick day rules; key messages about optimising diabetes self-care in order to reduce risk of severe COVID-19; how to get/remain active during the pandemic; eating well on a budget; advice on mental wellbeing; COVID-related blogs, as well as signposting to language-specific resources. Current analytics data demonstrate: 800-3,300 user visits per day; over 70,000 users and over 196,000 page-views in the past three months, with over 36,000 visits to the
COVID-19 pages and over 8,000 visits to the T2DM prevention page; a 48% open rate and 12.3% click rate on the latest newsletter (industry standards are 35% and 5%, respectively).
Every month there is a meeting with clinicians, patients and other experts in diabetes to review the content of the website and email/SMS campaigns. Examples include engaging with the BME Health forum to implement a new black and minority ethnic (BAME) part of the website, and work with MenCap and learning disability charities to produce easy-read areas and provide blogs from people with diabetes and learning disabilities on the website.
Sustainability and Spread
NHSE and CCG funding have been provided to improve diabetes care in NWL, including deployment of the KDS and enhancement of the website as the centrepiece and service access point for all people with, or at risk of, T2DM in NWL. The KDS and its core eLearning Platform have been designed in layers to assure that the service can extend regionally and nationally and can scale appropriately. The technology partners operate UK-wide and collaboration with other London partners assures interoperability. Access to the One London LHCRE (Local Health and Care Record Exemplars) Discovery Data Service enables ease of service extension into all five London Sustainability and Transformation Plans (STPs), and beyond. KDS is a demonstrator for the One London LHCRE programme, focused on delivering long-term interoperability between healthcare systems. A recent presentation at the NWL Digital Strategy Board was well received, with clinicians, commissioners and digital teams impressed with the capabilities and architecture of the system. KDS is now part of the NWL Recovery Plan and the key capabilities of the system are written into the current NWL Digital Strategy Roadmap for FY20-21. A barrier to building a sustainable service has been the impact of the NWL financial deficit. However, the team has worked with the STP leadership to ensure ongoing service funding. The capabilities are seen as core requirements for future support for patients with other long-term conditions. An evaluation partnership, funded by the HDRUK (Health Data Research Hub for Real World Evidence) NWL Discover-NOW programme, is being used to further refine the service. Core KPIs and associated metrics are negotiated with NHSE and the NWL STP leadership.
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