Diewerke de Zwarte – Senior Dietitian in Digital Information
An iterative approach is the process of improving and refining an initiative or process through multiple iterations. The beauty about the iterative approach is that it strives to deliver value to our service users as quickly as possible, in an incremental manner.
In early 2020, the digital team of the HSE Communications division, in collaboration with the Integrated Care Programme for Chronic Disease National Diabetes Self-Management Education and Support (DSMES) team, started research on the use of a closed diabetes online social support group for those with type 2 diabetes mellitus (T2DM).
Through a Sláintecare integration fund project, we aimed to research the use and suitability of mainstreaming an online support group to run alongside a diabetes self-management support course called DISCOVER DIABETES – Type 2 (DDT2). This course offers a 6-week online programme, where users join for weekly online diabetes group education sessions with a community dietitian. The online social support group would run alongside the course to offer additional support from a registered dietitian and peer-to-peer support/learning opportunities.
Iterative working was vital in the build up to launching this novel digital intervention. We required flexibility and adaptability throughout to manoeuvre road blocks, COVID-19 waves and more to get this innovative new project to our service users and offer the Right Care, at the Right Place and Right Time.
What are closed online social support groups?
You gain access to a closed online social support group by being invited to it on a social media platform. Users that are not invited are not able to see the content within the group.
A closed online social support group allows users with a similar condition (such as type 2 diabetes) to join a group with peers. A subject-matter expert (such as myself – a dietitian) can be present in the group to post relevant content and to moderate questions and comments. The group can be formed to supplement an existing intervention (offering additional support) or can stand on its own.
Preparation to launch the diabetes online social support group
In November 2020, I joined the HSE Digital team as a Senior Dietitian in Digital Information as part of this Sláintecare project, becoming the first clinician to join the HSE communications division. My role for this project was to prepare the content calendar, assist in project management and moderate the group.
The research team from the Dublin City University (DCU) Business Analytics Department joined the project to formally assess the closed online social support group through analysis of user interactions, patient activation measures and user confidence/trust in technology.
We selected a customisable community engagement platform to host our group on. This platform allowed us to customise our user flow and group structures. We chose to not host our groups on more wide-stream social media platforms as we were keen to opt for a GDPR compliant platform, with flexibility in user flow set-up and easy access to user analytics.
Content creation based on various rounds of feedback
We were keen to ensure that content created for this project could also be iteratively repurposed for other diabetes projects and community-based diabetes support.
Ahead of writing content, I prepared a Voice, Tone and Language guide to help maintain a steady style. I hosted a meeting with diabetes dietitians from around the country to gauge their perspectives on desired content for both this group and other projects. Video-content was in demand and a range of topics were highlighted to produce videos around.
An 8-week content calendar was prepared, incorporating a mix of content types, including videos, short-form copy and longer-form content. Content was created with various purposes in mind, including offering information about diabetes, supporting users at key milestones in their programme and encouraging peer-to-peer support and learning. The content calendar was proof-read by the national clinical specialist dietitian in diabetes to ensure that content was factually correct and was in-line with the DDT2 programme content and style.
As we were in the midst of a COVID-19 wave at this point in the process, I recorded and edited the required video content at home. An external digital marketing agency then included relevant graphics, intros and outros. They also prepared creatives to complement each post and cover imagery to suit the theme of each week of the programme.
An unexpected iteration
By April 2021, we had participants from two upcoming DDT2 courses lined up to join the first online closed social group. However, we faced one challenge: some unexpected internal issues arose in our research timeline, meaning that we could not run this upcoming group as part of our formal research trial. We had to think on our feet and make a decision quickly: Were we to launch, or not to launch?
We were confident that our content was ready. We felt strongly that our users would benefit from joining the group. We had briefed and prepared our DDT2 community dietitian educators on what was involved, and all were excited to get started. And so we decided to launch the group as a trial run, and not formally evaluate it. We were keen to offer the best possible care to our service users who were ready to go. Hence we felt that deciding to launch this trial group was in their best interests, despite adding significant additional work to our own project timelines by having to run a second group for our formal research launch later in the year.
Our focus on using an iterative approach helped us to see the unexpected value in running this trial group. We could collect internal data such as basic user analytics and review our own experiences, which would guide our formal research launch whenever we would be ready.
An unexpected extension
We launched our trial run group in April 2021. Our users joined the platform through an email invitation directly into the closed group. We posted every one or two days, as per our pre-agreed content calendar. We moderated the platform daily, answering user questions and commenting with supporting words when a user shared their concerns or wins.
However, a few weeks into the running of the group, the participating DDT2 courses had to be paused for 9 weeks due to unforeseen circumstances. Our online social support group remained live during this time, and the group duration was extended to continue offering our service users value and support during the unexpected break in the DDT2 course. Hence, our content calendar also required adjusting. We created the additional 9 weeks of content based on a review of content that had performed well to that point. This additional content was then also available if needed for future iterations of the online social support group.
Onwards and upwards
Our pilot diabetes online social support group ended September 2021. While our review of this pilot group could only be conducted informally, we collated our own moderating experiences, anonymous platform user analytics and some informal user feedback. This data was then used internally to iteratively improve our content calendar, email communications and platform user experience/flow for our formal research-launch of the next diabetes online social support group.
In November 2021, we were ready to launch our next group as part of the formal research phase of this project, which was conducted in collaboration with DCU. We will share findings from this research in an upcoming post. Onward iterations of HSE online social support groups for other conditions and life events are in progress, with research progressing for groups for new breastfeeding mothers, cancer survivors and smoking cessation support.
While the trial run of our diabetes online social support group was unexpected and the duration was extended to more than double the intended duration, through this iterative process, we moved closer to providing our service users with novel digital options to offer the right care, in the right place and at the right time.
