Adapting your program to suit local needs
Guidance on adapting your DESMOND groups
This guide has been designed to provide you with support to ensure that your DESMOND groups meet the needs of your local population including cultural adaptation, highlighting when we can help you in the process.
STEP ONE
Needs Assessment
In order to understand the needs of your local population, you should firstly carry out a needs assessment. You may find that this has been carried out by your local public health department; if so, review this to find out what your considerations are.
If this has not been completed, the NICE Health Needs Assessment: A Practical Guide will help to provide you with a framework.
A local health needs assessment will provide you with details on diabetes prevalence as well as the population size of potential target groups.
STEP TWO
Defining your population
From your local health needs assessment, you should be able to select the target group/s for whom you wish to adapt DESMOND. It is recommended that you work with one group at a time, although this may not be possible where you are considering cultural adaptation in a very diverse locality, as there may not be sufficient group sizes to warrant separate programmes. In this situation you would need to use this pathway to adapt your courses to simultaneously meet the needs of different communities.
It is important for you to be clear upfront as to the population/community you wish to adapt for, as this will provide a focus and rationale for each of your next steps.
STEP THREE
Establish links with local community leads and target groups
Establishing links within the community or target group you are adapting for is extremely important to the success of the adaptation project. Explain the work that you wish to carry out and the role the community/group leads will play in this project.
STEP FOUR
Forming and running a local reference group
With the help of local community leaders or those from your chosen target group, create a small, local user reference group.
The following details our recommended process for completing this:
Identify 10+ people who are from the target group that you are adapting for
It will be beneficial to include people with/at risk of Type 2 diabetes also in this group
Organise a venue that is appropriate for the group to meet
The meeting should be at a mutually convenient time
YOu may benefit from purchasing a copy of the book: Carbs and Cals: World Foods available from https://www. carbsandcals.com/books/world-foods). This can help to support you when discussing changes to food models/images
Structure for the meeting
Open the meeting with an explanation of the work you are carrying out
Describe importance of structured education to people with/at risk of Type 2 diabetes
Guide the group through the programme’s activities, sharing resources and key messages throughout
Ask the group a range of questions to understand where the current activities and resources are not entirely suitable, and what would be more appropriate for the target group
A sample question/topic guide for culturally adapting DESMOND programmes has been created to help provide structure, and is available from desmondnationalprogramme@uhl-tr.nhs.uk
Write up your findings in order to share with DESMOND National Office
STEP FIVE
Adaptation proposal
Working with others in your locality, review the findings of the meeting and develop a proposal of the adaptations you wish to make (a template for this is available from desmondnationalprogramme@uhl-tr.nhs.uk). Your considerations may include:
The use of interpreters
Terminology
New food models and resources
Style of delivery
Alternative timetables e.g. alternative break up of sessions
Use of pictures rather than the written word
It will be beneficial to write up a proposal of changes so that all interested parties can see the suggested changes and associated rationale
Using this, develop a proposal about your adaptations to share with DESMOND National Office - if you have not shared details with us already please include detail of your local needs assessment, the user reference group as well as the changes you wish to propose. This will then be reviewed by our cultural adaptation lead, who will contact you for a discussion about this before you progress to Step Six.
Please note: If you are planning on delivering with interpreters then it may be recommended that they have some form of DESMOND training in order that they understand the style and philosophy.
STEP SIX
Delivering a pilot
Once you have received approval for your adaptations, deliver a pilot/s of your adapted programme to a representative group (this could be your local user reference group members, if they are appropriate). It’s recommended that only accredited DESMOND Educators deliver any version of adapted DESMOND.
You may wish to ask some members of your team to observe and take notes on how the adaptations are received. At the end of the pilot, gather the attendees’ thoughts and comments on your adaptations. The Educators should also reflect on how it went and was received.
STEP SEVEN
Finalise your curriculum and resources
Review all feedback, reflections and notes, and from this, review your original proposal and track any final changes to this, before sharing with the Cultural Adaptation lead. They will review this and, where necessary, will organise a site visit with you and your team to discuss the results and support you in next steps.
STEP EIGHT
Embedding your culturally-adapted DESMOND
You will be advised by our Cultural Adaptation Lead on next steps. These may include but are not limited to:
Ensure all Educators in your locality are informed of the differences of the cultural adaptation, and are trained accordingly, including being provided with the detail of the rationale behind them - we would recommend running a halfday event with your team to share all of this
Recommend that only accredited DESMOND Educators deliver any adapted version of DESMOND
Put together an agreed strategy for implementation including internal and external promotion. DESMOND National Office can help you develop press releases and other promotional opportunities, should you need it
Begin offering promotional introduction presentations in the community - here is an example PowerPoint that you can adapt
Coordinate all resource changes/additions
Begin to roll out your adapted programme
Continue evaluation of how the adaptations are going
Finally, please do not hesitate to get in touch with any queries/questions you have along the way – desmondnationalprogramme@uhl-tr.nhs.uk