The acceptability and feasibility of WICKED plus in diabetes centres in Yorkshire

UPDATE 30th November 2016 document here

The WICKED Translation project takes the fantastic work and success of the WICKED Project from NIHR CLAHRC for South Yorkshire and aims to explore the process that happens when the course is 'translated' to different settings, in this case different hospitals.

WICKED Project Development: The original WICKED intervention was developed and tested in NIHR CLAHRC for South Yorkshire. It was based on 2 DAFNE (dose adjustment for normal eating) courses, with 8 young people on each course (1 of these was a DAFNE course and 1 was a DAFNE/KICk-OFF course). Feedback was taken from both courses and used when writing the WICKED scheme of work. There was 1 follow up session for participants at 6 weeks after these courses, as suggested by DAFNE.There were 8 WICKED courses, with each course being delivered over 5 days (as the DAFNE course and the KICk-OFF course do) the WICKED courses were run in May, June, July, August and October of 2012, February and August of 2013 and February 2014.

In 2014 a further 3 courses were run in May, August and November in Sheffield.

For each course every participant was given a key worker. Each course had group follow up sessions at 3, 6 and 9 weeks, each participant being followed up by their key worker and again at 12 weeks in adolescent clinic.

The WICKED courses were open to all newly diagnosed inpatients and those on MDI, CSII (pumps), BD (twice a day) and TDS (three times a day) regimens. Also those patients with a high HbA1c (The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming 'glycated'. By measuring glycated haemoglobin (HbA1c), clinicians are able to get an overall picture of what our average blood sugar levels have been over a period of weeks/months.) 

Participants included those with mental health conditions, disordered eating, insulin omission and self harming patients. Young people with ADHD, dyspraxia, dyslexia and epilepsy were also invited to attend. We have also had patients dealing with pregnancy, homeless, hostel, bail hostel, child protection plans, domestic violence, STI (sexually transmitted infection), risk taking behaviours, bereavement all from a multicultural background.

WICKED was based on constructivist learning incorporating differentiated learning objectives and outcomes linked to assessment for learning. Young people construct new knowledge and understanding using what they already know. WICKED aims to use terminology which is understood and used by young people.

WICKED also includes assessment for learning as this is seen as an essential part of the learning process. WICKED also includes essential peer support, personal target ranges and individualised goal setting.

The structured education programme WICKED is specifically designed to meet the needs of young people with type 1 diabetes transitioning from paediatric to adult care. WICKED covers important key concepts such as think, act and results, carbohydrate counting and calculation, adjusting insulin doses and regimens, management of short and long term health complications, what care to expect and exercise. Additional concepts important to young people such as managing diabetes whilst eating out, drinking alcohol and potential risk taking behaviours such as using recreational drugs, smoking, sexual health, preconception advice and pregnancy, driving, travel, employment, leaving home, relationships and sharing their experiences of living with diabetes are discussed and shared in a confidential and peer supported environment.

WICKED aims to engage young people with their condition and provide them with the competences which will enable them to self manage there diabetes more effectively and safely, which we hope will be sustained.

Translation project: Currently the WICKED course is being trialed with Diabetes Teams in Leeds and Harrogate. Both teams were able to observe the WICKED course that ran in August 2014 and then to trial it in their own centers. Sheffield’s WICKED team will be supervising with this and spend some time in Leeds and Harrogate when needed.

We continue to run WICKED in Sheffield Teaching Hospitals. Leeds, Harrogate and Addenbrookes hospital teams have all observed a full WICKED course and were both very enthusiastic to take it to their centres . Other hospitals are also very interested in having WICKED.

Leeds and Harrogate have run the courses and evaluation of the young peoples experience was undertaken by the work funded by the NIHR CLAHRC YH. Participants completed pre- and post-course questionnaires assessing diabetes-related distress, self-efficacy, outcome expectancies, attitudes to diabetes, fear of hypoglycaemia, perceived knowledge, and frequency of self-management behaviours. Semi-structured interviews, focusing on YP’s experiences during and since the course, were also conducted three months after the course and were analysed using Thematic Analysis.

Results: 32 young people (17 Females, mean age: 19 yrs) participated across six courses in two centres in the North of England. Self-efficacy (p<.001), Negative Outcome Expectancy (p=.030) Perceived Knowledge (p<.001) and Self-Reported Self-Management Behaviours (p=.008) increased over the WICKED course. There were no significant changes in other assessed outcomes.

18 participants were interviewed. We identified three overarching themes; positive group identity (e.g. modelling others’ self-management behaviours), WICKED as a safe place (e.g. to make changes to regimen) and transformative perspectives (e.g. feeling more empowered in their interactions with health professionals).

We will publish the qualitative and quantitative results over the next few months and explore the unique challenges of taking this innovative course to different hospital settings through the TK2A theme's work.