"I took my doctorate between 2000 and 2003. My undergraduate degree was in nutrition and dietetics, as I had a strong interest in health promotion and the prevention of ill health and disease. When I qualified as a dietitian I did the basic rotations, and after a year took a post in paediatric diabetes – and eventually became a diabetes specialist dietitian for children and adults. I got more and more frustrated with a traditional medical model. I recognised that traditional diabetes treatment was based on acute models of care – where people with diabetes were treated as ’patients’ by health professionals, and were instructed to comply with prescriptive practices and regimes to keep their disorder within controlled limits. The patient was viewed as a recipient of regimens that were to be accepted and obeyed. Diabetes education was delivered on a one-to-one basis in an unstructured fashion, with infrequent follow-up due to increased prevalence and limited resources.
"Recognising that services needed to be redesigned to offer more patient-centred education, I took my PGCE in adult education. This led to experimentation with communicating and educating people with diabetes in a different way – but I didn’t have the opportunity to design the structured group education programme until I was on maternity leave. The X-PERT Programme is a six-week diabetes self-management programme to enable people to take charge and make informed decisions about their condition.
"On my return from maternity leave, I was told that under the current system I couldn’t be released to deliver the X-PERT Programme to people with diabetes. As with many large organisations, the bureaucracy levels felt insurmountable, which often means that in order to develop and innovate you often have no choice but to do it independently. At this stage I began looking into securing funds to test the effectiveness of the X-PERT Programme by carrying out a randomised controllled trial (RCT). During the interim years I took a few research modules to enable me to write the research proposal and apply for research grants. I didn’t actually want to do a doctorate, but in the end it was the only way I could get the funding to further develop the programme and undertake a RCT. The results of the RCT were outstanding, in that the X-PERT Programme brought significant health and wellbeing benefits to people with diabetes both in the short and longer term.
"After national recognition through the receipt of several national awards, many NHS organisations started contacting me saying that they wanted to implement the X-PERT Programme. I designed numerous visual aids which were paramount to the delivery of the education programme. These needed mass producing, so I had to start liaising with manufacturers. I also had to develop the X-PERT Train the Trainer Course to train healthcare professionals with the competences to deliver the programme. There are now 970 X-PERT Educators from several disciplines. The structure of the education programmes assists in up-skilling healthcare professionals to reduce the conflicting messages that people with diabetes receive.
"The X-PERT Programme is implemented nationally in the UK and in the Republic of Ireland through a not-for-profit social enterprise – X-PERT Health CIC. There are now 127 organisations in the UK who are implementing the X-PERT Programme. The materials (Educator’s Manual, Workbook and Patient Handbook) are updated as required in line with the latest knowledge and evidence base. A new education programme, X-PERT Insulin, was launched in January 2010, and X-PERT Diabetes Junior for children and adolescents is under development.
"During my doctorate, I investigated the epidemiology of diabetes, the evidence base for the treatment and management of diabetes, the theories for health behaviour change, and a systematic review of diabetes self-management programmes – in addition to the randomised controlled trial to evaluate the X-PERT Programme. I use the skills and knowledge I developed throughout my doctorate on a daily basis. However, there has been a steep learning curve to develop business skills such as sales, marketing and managing cash flow.
"We have just been awarded a SEIF grant to develop a training and healthy living centre, which will enable X-PERT Health CIC to put into operation its business plan – and transfer the active components to other self-management programmes for patients with other long term conditions, such as obesity and heart disease."