Evaluation and assessment of the usefulness of a mail delivered personalised diabetes information booklet and the association of non-response with clinical risk: the WICKED Project

Introduction: Patient activation can promote partnership working between people with diabetes and their healthcare professionals. We sent to people with diabetes a personalised, structured information booklet containing the results of their latest nine key care processes in order to inform and activate them. We present the findings of a survey to assess the utility of this report, with an analysis of the association of non-response to the survey, a surrogate for poorer patient activation, with adverse diabetes and clinical outcomes. Methods: All 14,559 people with diabetes in the Wolverhampton health economy received a mailed report of the results of their latest nine diabetes care processes. Of these, 6,282 patients aged <75 years were mailed this report twice; 1000 of these 6,282 patients were selected randomly to receive a structured questionnaire to assess the report’s effectiveness. Results: Of 1,000 patients, 419 (42%) responded (mean age 62±10 years, 246 males, 249 Caucasians, 389 had type 2 diabetes). Patients found this report useful (89%), a source of knowledge (78%), a source of increased confidence (74%) and it helped them understand their diabetes (78%). Non-response was associated with significantly higher surrogate markers of micro- and macrovascular risk. Conclusion: A structured and personalised diabetes report, without direct professional or health service intervention, may improve the understanding and confidence of people with diabetes in their self-care and it may help to activate them to take a stronger partnership role in their health care. Non-response as a marker of patient activation is associated with increased clinical risk.