Using multiple data sources to evaluate a campaign to improve care for children with Type 1 diabetes in school. 

Background
Diabetes UK’s Make the Grade campaign was launched in 2014 in response to evidence gathered that many UK schools were not managing Type 1 diabetes adequately. The strategy was to ensure that parents and children were aware of their rights and to give schools and clinicians the tools they need to put the right care in place. The objective of the campaign was to increase parental satisfaction, to improve awareness and management of diabetes in schools and to increase the number of schools with the appropriate policies in place.
To meet these objectives the following actions and products were developed:
•	Free practical support material
•	A helpline to provide advocacy support to parents
•	Training sessions for schools
•	A short film competition to engage young people to generate their own awareness raising films
•	An award recognising schools who are providing good diabetes care
•	Influencing work directed at government and policy makers 

Aims
To evaluate the different aspects of the Make the Grade campaign using quantitative and qualitative data, to establish the most useful actions and products and to identify where resources are best targeted to further improve care for children with Type 1 diabetes in school. 

Methodology
A variety of and quantitative and qualitative data sources were analysed through a Theory of Change model. This included:
•	Primary quantitative and qualitative data collected from parents, schools and clinicians through on-line surveys into specific aspects of the campaign
•	Secondary quantitative information from key performance indicators for the Make the Grade campaign 
•	Analysis of the applications for the Good Care in School Award
•	Data from the Care in School Helpline
•	Freedom of Information requests sent to randomly selected schools and Local Authorities

Results 
Support, awareness and motivation
Free practical support information for school was well received, with over 24,000 support packs being ordered or downloaded by schools. School staff have reported that the most useful aspect of the pack is the specific information about diabetes and its management in school.
100% of school staff who accessed training reported that it has helped them to better support a child with Type 1diabetes.
There have been 1732 applications for the Good Diabetes Care in School award, and formal applications for the award have increased from 55 in 2015 to 127 in 2016. This demonstrates that more schools are aware of what good practice looks like and feel they have the ability to accomplish it. All schools who applied for the award, reported that the award is a positive and motivating way to improve diabetes care in school. 
Collaboration
There remain issues with collaboration in care.  Nearly 18% of schools who applied for the Good Diabetes Care in School award claimed that the main challenge when applying was gathering supporting information from clinicians and parents. Surveys have also demonstrated an increase in comments from schools that are critical of parents’ management of or attitude to their child’s diabetes.
Collaboration between schools and Local Authorities also needs improvement, with flaws found in understanding of roles and responsibilities.  
Improvement in care
Schools have reported that help for children by trained members of staff has increased from 59.8% to 82.6%. However this differs from parents’ views who report a decrease in the availability of staff to support their children. Additionally, the number of parents who would nominate their child’s school for an award has dropped from 60.1% to 45.8%. This is further evidence of a disconnect between school and parents’ perceptions, and the need for closer collaboration.    
 
Discussion
Analysis of a variety of data has enabled a detailed evaluation of all the Make the Grade actions and products. This has highlighted that practical support and training is well received by schools but collaboration in care remains a significant issue. This must be addressed in order to improve care. It has become clear then, that the priority for further work must be around parents and schools achieving shared expectations in the management of Type 1 diabetes in school.

Using multiple data sources to evaluate a campaign to improve care for children with type 1 diabetes in school