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Kids In Control OF Food

Kids In Control OF Food . Dr Katherine Price Sheffield Children’s Hospital. The KICk-OFF Journey . Background Development Pilot KICk-OFF RCT. WHO DEALS WITH DIABETES?. Hours spent with diabetes over 3 months 2160 480 12 0.25 - 0.50. Patient. School . Health Care Professional.

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Kids In Control OF Food

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  1. Kids In Control OF Food Dr Katherine Price Sheffield Children’s Hospital

  2. The KICk-OFF Journey • Background • Development • Pilot • KICk-OFF RCT

  3. WHO DEALS WITH DIABETES? Hours spent with diabetes over 3 months 2160 480 12 0.25 - 0.50 Patient School Health Care Professional Clinic Setting Peter Hindmarsh

  4. Background • DAFNE study group • Good outcomes in diabetes control and quality of life from cross over study in adults British Medical Journal 2002;325(7367):746. • 2001 – Diabetes UK met with several UK paediatric centres • Sheffield given task of taking forward paediatric DAFNE

  5. Research question: What is the effect of an intensive, structured education course on glycaemic control and quality of life in children with Type 1 diabetes? • Medical Research Council – A framework for development and • evaluation of RCTs for complex interventions to improve health • ( www.mrc.ac.uk April 2000, updated 2008) • 4 phase approach • Theoretical “ Modelling” phase • Development phase • Pilot evaluation • Randomised controlled trial

  6. Phase 1 – theoretical modelling • DAFNE is based on model of therapeutic patient education developed in Germany ( Dusseldorf model) • DAFNE trial in UK demonstrated benefit in 150 adults – improved blood sugar control, improved quality of life, less hypos • Social learning theory – Bandura

  7. Social Learning Theory – A. Bandura 1977 • People learn from one another via: • observation of behaviour and attitudes • imitation and adaptation • Requires : • attention – affected by complexity, functional value • retention – affected by imagery, organisation • reproduction - physical capability, self observation • motivation - reinforced by past and promised incentives

  8. Phase 2 – development Aim: to produce an education course for children with type 1 diabetes, that - was age appropriate - was acceptable to children and families - used recognised educational techniques • Julie Knowles - Research nurse, Helen Waller - Psychologist • PDSN survey (Autumn 2002) • Journal Of Diabetes Nursing 2005;9:332-339. • Focus groups (Jan. 2003) • Child: Care, Health and Development 2005;31(3):283-289. • Lubeck, Germany (Jan. 2004)

  9. How do we develop and implement educational interventions? • Understand how children learn Educational Theories • Understand how to teach Learning styles • Develop a curriculum

  10. How do you learn?

  11. Principles of Adult Learning • Adults are autonomous and self-directed • Adults have a wealth of life experiences and knowledge • Adults are goal orientated • Adults are relevancy orientated • Adults are practical • Adults demand respect from instructors The adult learner a neglected species. Malcolm Knowles 1994

  12. How do children learn? “Theories • Behaviourism Learning from external stimuli.It can be conditioned by giving rewards and punishments • Piaget – 4 stages of child development. Focused on maturation. Growing up does not mean knowing more but it changes how we think. • Vygotsky – Learning is a social process Language development and learning through interaction with others of same age and older. • IQ – Focused on the concept of a general intelligence • Gardener – “multiple intelligences” allowing different learning styles Muijs et al (2005). Effective Teaching

  13. Working with teachers and educationalists • Presentation • Reading age • Lesson planning • Specific teaching skills • Style of teaching (observation) • Setting boundaries/learning environment King Edward V11 Secondary School

  14. Lesson planning A step by step guide to the education session to allow replication by others and achievement of goals Office For Standards in Education (OFSTED) • Is it clear what the purpose of the lesson is? • Has the lesson taken into account the learners needs?

  15. KICk-OFF course • 5 day out patient course for 11-16 yr olds • 8 per group • Age banded 11-13 years and 14-16 years • Modular structure, • Involves parents and friends • Variety of teaching styles – very practical and interactive

  16. Modules from the Paediatric KICk-OFF Curriculum What is diabetes? Food and diabetes Insulin management Sick day rules Hypoglycaemia Monitoring Living with diabetes School and Diabetes Transition of care

  17. KICk-OFF curriculum – day 2

  18. Day 2, session 4. Counting grams of carbohydrate

  19. Carbohydrate counting in snacks and recipes Chocolate Chip Muffins Ingredients150g/5oz self-raising flour150g/5oz margarine150g/5oz sugar2 eggs75g/3oz chocolate chips100g/3½oz drinking chocolate powder Session 4 2.30pm-4.00pm Prepare food for parents to practice CHO estimation Quiz

  20. Phase 3 –Pilot evaluation December 2003 - 2004 : 6 courses – 48 young people, age 11-16 yrs from 3 centres • Outcomes over 6 months • Educational evaluation • Process evaluation • Interviews with psychologist • Biomedical – HbA1c, Hypos, BMI • Psychological – quality of life, self • efficacy, family conflict etc Results Good evaluation – some changes to programme More parent teaching HbA1c – unchanged overall Improved in those with poor control Improved in younger age group QOL – improved Self efficacy, coping with diabetes etc improved

  21. Hands on Learning … Social Support…

  22. Cooking and Counting Carbs … Exercising in the Gym Eating Out and Bowling

  23. Improve presentation : Cell energy

  24. Phase 4 – randomised controlled trial In 11-16 year olds on intensive insulin therapy : - Does the KICk-OFF structured education course affect outcomes, measured over 2 years? • Primary outcome measures: • Biomedical – blood sugar control (HbA1c), hypoglycaemia • Psychological – quality of life, fear of hypoglycaemia, self efficacy • Secondary outcomes • Process evaluation, sustainability of education • Weight, diet • Is it cost effective ? • Website support

  25. Educator training and support 5 day Educator Training course – Sheffield Hallam University Quality assurance/ peer review How do we ensure uniformity of teaching in all centres? Does the curriculum allow key learning points to be achieved? Can there be flexibility within a curriculum? How do we support the learning needs of educators?

  26. Trial Design • Risk of “ contamination of control group in clinic trained to deliver the course – cluster randomisation • The intervention will be delivered to groups rather than individuals • Variation between centres –in HbA1c, staffing levels, ethnic & social mix of patients, current educational practise – stratification

  27. 30 centres KICk-OFF courses 5 days 3 educators (2 research staff, 1 local) 8 participants 11-13 or 14-16 yrs Each recruit 16-32 N=560 Centre stratification n= 280 n= 280 15 Control 15 Intervention KICk-OFF courses Usual care Follow up 6,12 & 24 months

  28. 4 year project from Sept 08 • Martin Fox – project coordinator • Julie Knowles- lead educator • Project group – Educationalists - Jerry Wellington, Grace Hoskins1 Health Economics – Alan Brennan, Katherine Stephens 1 Psychology – Chris Eiser 1 Clinical – Simon Heller, Jerry Wales1 Statistician – Jenny Freeman1 Website development and evaluation – Amy McPherson2 1 = University of Sheffield, 2 = University of Nottingham

  29. Current priorities • local R&D/ ethics approval and centre stratification • recruitment of participants then centre randomisation • 6 educator posts start Sept 09 • educational material – printing, purchase etc • website – to support learning of those in KICk-OFF groups • www.kick-off.org.uk

  30. Thank you : • Diabetes UK • Julie Knowles and all the research team • To all the centres participating • Children and families for their support

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