What is DESMOND? How did it begin? What makes it special as a diabetes education programme? The answers begin here…
DESMOND stands for Diabetes Education and Self Management for Ongoing and Newly Diagnosed. And it’s a name associated with a number of enterprises in diabetes.
DESMOND is a collaborative group working together to improve opportunities for learning and support for people with diabetes and the health care professionals involved with them. DESMOND is one of the several programmes now available to make those opportunities a reality. And DESMOND is the several research studies currently active in developing new programmes to meet specific needs.
So then, it’s busy in the world of DESMOND!
The programme for those newly diagnosed with Type 2 diabetes, is the aspect of DESMOND which will be most familiar to people. This education course is mainly delivered in primary care in the UK, as part of the service offered by local primary care trusts. In some areas, courses are also run by specialist diabetes services in hospitals or diabetes centres. The programme has been designed to meet the standards outlined in national policy, for example, the Diabetes National Service Framework (NSF), and the National Institute for Health and Clinical Excellence (NICE). The fact that it fulfils these criteria gives anyone delivering the programme, and anyone attending, the confidence that they are involved in something worthwhile.
But in 2003, when these two detailed policy documents were published, it was a very different story. Education programmes which did exist in diabetes had no evidence against which to benchmark results, and even less guidance in whether they were being effective. This was the starting point for the work of the DESMOND Collaborative, a group of over 45 individuals around the UK representing over 15 diabetes services and including people with diabetes and patient representatives. The Collaborative began with a daring vision: to develop a structured education programme which, beginning with a module suited to people newly diagnosed with Type 2 diabetes, would develop into a pathway of care for people throughout their lifetime’s journey with diabetes.
Starting at the beginning of this challenging task, the Collaborative focused on education at diagnosis. The DESMOND programme (which is called either Newly Diagnosed or Foundation) currently being provided in England is made up of 6 hours of group sessions delivered in the community to a maximum of 10 people newly diagnosed with Type 2 diabetes. The participants can choose to be accompanied by a family member or friend. The programme has a detailed written curriculum to ensure consistency, no matter where the programme is being delivered. The Educators or facilitators delivering the programme are healthcare professionals working in the community - mainly practice nurses, diabetes specialist nurses or dietitians, although there are now some podiatrist and pharmacist educators! Resources include patient support material especially written or produced for the programme and meeting its empowering philosophy. Participants are not ‘taught’ in a formal way, but are rather supported to discover and work out knowledge, and to allow this to inform the goals and plans they make for themselves. Educators have been trained to deliver DESMOND through preparation and self study, an initial two-day residential training course and supported by an ongoing quality assurance and professional development programme. The training programme has been devised by an experienced multidisciplinary team drawn from the Collaborative membership.
The programme was originally piloted in 17 primary care trusts across England before the start of a randomised controlled trial, the gold-standard scientific evaluation in which over 1,000 participants took part. This makes the trial one of the largest scientific studies of its kind ever conducted, and the largest global study into education provided at diagnosis of Type 2 diabetes. The results of this important research were published in the British Medical Journal in February 2008.
The question is frequently asked as to how DESMOND differs from other structured education programmes, and what makes it so special. Whilst the curriculum is based on topics most healthcare professionals would of this type, DESMOND is unusual in having a theoretical and philosophical basis. The DESMOND philosophy informs the whole structure of the programme from the choice of topics to the emphasis of the training programme for Educators, and the style of delivery which focuses firmly on the individual circumstances of the participants.
The DESMOND philosophy recognises that individualising health risks may improve motivation. While it is important not to minimise negative messages of the complications of diabetes, these should be followed by an action plan, which allows people to think positively about their control of their own situation. In the DESMOND programme, individuals are supported to identify their own health risks and then respond by setting personalised goals which are behavioural and specific. Supporting people to be confident self managers of their diabetes is essential to achieving these goals.
Feedback from primary care trusts involved in the DESMOND programme has been positive. Healthcare professionals have gained new and transferable skills as Educators, and patients have been full of praise for their experience. The programme has also raised awareness of diabetes issues in GP practices, and in some cases even strengthened links between primary care and specialist diabetes services.
Following the success of the Newly Diagnosed Programme, the DESMOND Team have completed and made available a Foundation Programme for people with established diabetes and a version of these programmes which is culturally appropriate for the South Asian community.
New research studies are developing a prevention education module for people at risk of diabetes, and a module of ongoing diabetes education for life.
The Training and Quality Development Programme for Educators delivering DESMOND has been recognised in its own right by winning the Skills Development category in the Health Service Journal Awards for 2007.
It’s also good to hear the voices of people with diabetes and DESMOND participants:
“…for the first time in years I feel better, I eat properly, I swim everyday, I walk approx 25 miles each week, I have gone from 15 stone 5 pounds to 13 stone. Having diabetes has improved my life. Sounds silly, but it has.”
“Losing weight has been a real boost to my life, the number of times I have dieted and failed. Thanks to you, I feel a different person. Will be sad when the project finishes. Thank you.”
If you would like to find out more about DESMOND – visit our website often while it is under development. Better still, if you are someone with diabetes and DESMOND is being offered in your local area, speak to your GP or practice nurse about attending a course.
If you are a health professional or health organisation interested in finding out more about DESMOND, use our location map to find your nearest DESMOND centre. Observers are welcome, and arrangements should be made with the local co-ordinator.