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.
The DESMOND Programme team is a collaborative working together to improve opportunities for learning and support for people with diabetes or the risk of developing Type 2 diabetes and the health care professionals involved with them.
The module for those newly diagnosed with Type 2 diabetes, is the aspect of the DESMOND Programme 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 module 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, 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 courses 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 the DESMOND Newly Diagnosed and Foundation modules are made up of 6 hours of group sessions delivered in the community to a maximum of 10 people with Type 2 diabetes. The participants can choose to be accompanied by a family member or friend.
The modules has detailed written curriculums to ensure consistency, no matter where they are delivered. The Educators delivering the courses 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 modules 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 the DESMOND modules through preparation and self study, various training days and supported by an ongoing quality assurance and professional development pathway. Our training has been devised by an experienced multidisciplinary team drawn from the Collaborative membership.
The Newly Diagnosed module 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 the DESMOND modules differs from other structured education, and what makes it so special.
Whilst the curriculum is based on topics most healthcare professionals would of this type, all DESMOND modules are unusual in having a theoretical and philosophical basis.
The DESMOND philosophy informs the whole structure of the patient courses from the choice of topics to the emphasis of the training 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 all DESMOND modules, 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 has been positive. Healthcare professionals have gained new and transferable skills as Educators, and patients have been full of praise for their experience. The DESMOND 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 module, the DESMOND Team have completed and made available a Foundation module for people with established diabetes, a version of these which is culturally appropriate for the South Asian community BME (Back Minority and Ethnic) and a prevention module called Walking Away from Diabetes
New research studies are developing a prevention education module Let's prevent Diabetes for people at risk of diabetes, and a module of Ongoing Diabetes education for life.
Our Training and Quality Development Programme for Educators has been recognised in its own right by winning the Skills Development category in the Health Service Journal Awards for 2007.