By the people for the people: Incorporating user feedback and adapting the Prevention Decathlon to reduce inequalities

Chris Gumble, Digital Pioneer Fellow and Project Manager for Long term conditions at South West London Health and Care Partnership, shares his experience of adapting a prevention programme to run virtually during COVID-19 and how he used cultural feedback groups to reduce inequalities with the programme.

In March 2020, the COVID-19 pandemic struck, with devastating effects emerging across the country, with a huge impact on health care services and the ability of providers to deliver much needed health and wellbeing programmes like the Prevention Decathlon. The Prevention Decathalon (recently nominated for an HSJ Value Award) is a structured education programme designed to help people avoid being diagnosed with preventable long-term conditions such as diabetes.

A Public Health report in June 2020 demonstrated the disproportionate toll COVID-19 had taken on our minority ethnic communities, with many friends and family, and elders in our communities lost to COVID-19. It also became clear that having a Long-Term Condition, especially Type 2 Diabetes, increases people’s risk of dying from the virus.

The Decathlon was hosting its first cohort of patients who were at risk of developing Type 2 Diabetes between January and March 2020, with 70% of Decathletes from ethnic backgrounds. The 10-week face-to-face programme had to be postponed at week seven due to government guidance and the remaining three weeks were delivered virtually.

As part of the pandemic response, the Prevention Decathlon team worked tirelessly to pivot the traditional face-to-face delivery to a fully virtual offering. Challenging as it was, we realised we had the perfect opportunity to reengage with our local population to get needed feedback on the curriculum and overall Decathlon offer so we could not only adapt to deliver virtually but to also enhance the content to be more culturally acceptable and reduce inequalities.

Forming a cultural feedback group

In collaboration with the Wandsworth Community Empowerment Network, we worked to create a user group that compromised of trained health coaches who were based within places of worship. The group’s role was to ensure the incorporation of patient perspectives and to review and enhance the resources that were included in the Decathlon offer, to help it meet the needs of the local population.

In the user group were eight faith leaders and members from local South Asian, African Caribbean and black African communities in Wandsworth and Merton. Over several weeks, the group experienced the curriculum of the programme first-hand with many hours of discussion and feedback on the curriculum relevancy to the group’s beliefs and cultures. The feedback group also was very fortunate in securing the support from the highly regarded dietitian, contributor to the renowned World Food book, and practising Muslim, Selma Mehar. Selma helped with translating people’s feedback into changes to the curriculum.

Diabetes Decathlon
Figure 1.The first two user groups have demonstrated that virtual delivery and co-design is possible as illustrated. Five Tuesday evening sessions were conducting to gain feedback on the Decathlon Curriculum.

Using digital technology for representative incetivisation

One element of the Prevntion Decathlon is to reward participants for being more active in between sessions via incentivisation. These incentives are offered via the Prevention Decathlon’s bespoke version of the Sweatcoin app. This wonderful group reviewed all incentives and directed us to offer rewards that represented their needs more, such as blood pressure machines and even copies of the Quran. The team also had a direct impact in choosing the visual assets the programm uses and also by engaging with our physical activty partner, The Harlequins Foundtion, to support wider inclusion in the pre-recorded physical acticity content offered throughout the programme.

The importance of co-design

The sessions highlighted just how much insight can be gathered from conversations with our communities and the importance of this co-design and production process. They have also show that virtual delivery of the programme is effective and possible. The result of this work will be a more culturally adapted curriculum which will resonate better with participants from our local communities which should increase their buy-in to the programme and generate better health and wellbeing outcomes for participants in the long run.

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