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Introducing Inter-professional Simulation Education

25 Apr, 16 | by hnoble


Photo Gail

Gail Anderson, Lead Midwife for Education, Queens University Belfast

An inter-professional educational initiative was developed within the Schools of Nursing and Midwifery and Medicine. The collaborative aim was to provide interactive workshops focusing on the concepts of normal labour and birth to fourth year medical students and were led by final year midwifery students. Significant emphasis is placed upon the importance of relationship building with women in labour and the concept of being ‘with woman’ is a core focus. Introducing inter-professional simulation education has been suggested to reduce stereotypical views and promote better understanding of the respective roles of the professional in addition to enhancing future collaborative practice. However, the logistics of incorporating inter-professional education (IPE) within the University setting is challenging not least due to the competing demands of separate educational curricula but also due to the respective differing sizes of student cohorts and ensuring equity of experience for all students. A small team of midwifery lecturers and medical colleagues met to explore ways of promoting inter-professional learning and overcoming some of these barriers within the University setting.

It was felt that providing an opportunity for medical students and midwifery students to interact and communicate prior to the undertaking of an obstetric placement within labour ward would help to improve the overall student experience and potentially enhance inter-professional relationships. Midwifery students would benefit from the opportunity to teach and facilitate learning in relation to normal labour and birth, whilst medical students would benefit by learning about the process of birth and familiarisation with the birth environment. This opportunity could provide midwifery students with a positive, confidence building forum where the utilised teaching and learning strategies would be transferable to their professional role as registered midwives and additionally in their health promoting role in providing parent education to women and their partners. Equally, medical students would be supported to understand their role and feel comfortable with assessing and supporting women in normal physiological labour.

The teaching strategy which was developed involves final year midwifery students providing an interactive labour and birth scenario whereby various roles, including mother, partner, midwife and narrator are adopted. A member of the midwifery teaching team facilitates the sessions and ensures a high quality learning experience for both sets of students. The midwifery students use a variety of birth mannequins and support aids to promote learning and the sessions also encourage ‘hands on’ participation and interaction by medical students to enhance the learning experience. Artistic licence is encouraged with the midwifery students to allow them to deliver a unique workshop that demonstrates their own personalities and identities. Low fidelity simulation is the chosen approach for the simulated workshops. Whilst low fidelity simulation does not imitate the realism of the mother in labour it does provide the medical students with an appropriate learning opportunity prior to undertaking their first maternity placement. A low fidelity simulated approach is considered more beneficial for novice learners in addition to which midwifery students may also feel more comfortable and confident with their own teaching abilities using this approach.

Following the interactive workshops the students complete an evaluation questionnaire. To date the results of the evaluation questionnaires strongly suggest a distinct benefit of this education initiative for both sets of students. The findings support much of the current evidence regarding the benefits of inter-professional learning particularly in relation to promoting increased levels of confidence and the understanding of professional roles within the multidisciplinary team. Furthermore the inter-professional learning workshop serves to highlight the importance of all health professionals aiming to promote normal birth for low risk women. This education initiative provides an opportunity for medical students to recognise how to care for healthy low risk women in labour whilst also gaining an insight into their own role within this setting and the role of the midwife as the expert in normal birth. The midwifery students perceive themselves to have achieved a greater level of confidence which will be of benefit to them in their future educative role as health promoting midwives in teaching women and their families as well as other health professionals. This perceived increase in confidence will also enhance their ability for future inter-professional collaboration.

Low fidelity simulation offers ideal opportunities for improved interaction and provides a safe non-threatening learning environment. The benefits of this innovative education initiative have been recognised. Such is the considered success of this education initiative that a commitment has been made by both Schools to embed this education strategy within each of their respective curriculums with a vision for further growth and development of undergraduate inter-professional education involving student midwives and medical students. This innovative education strategy holds promise for the future of inter professional collaboration and goes some way to eradicating a ‘them and us’ culture in clinical practice. However, this concept requires further research to identify the long term benefit of undergraduate inter professional education within the university setting.








Creating tools to improve opportunities for shared decision making during pregnancy

21 Apr, 16 | by ashorten

My research in nursing and midwifery has been shaped by a firm belief that all people should have the opportunity to make informed and supported choices about their healthcare, using the best available evidence. I began my research career in the 1990s when I conducted an economic evaluation of a new midwifery early discharge program at my local hospital, where I was practicing as a midwife.1 As a young midwife studying for my Masters degree I became interested in identifying which models of healthcare provided the best outcomes for pregnant women.

At the time I was curious about large and unexplained variations in Australian obstetric interventions and birth outcomes for women. I found that birth experience and mode of birth depends greatly on health insurance, where women give birth and what type of healthcare professional they choose to provide their care. My colleagues and I examined data that had been collected routinely by midwives for every birth in New South Wales over a 10 year period. From these records we were able to discover that hospital funding models (public or private), provider type (midwife or obstetrician), and models of care were the strongest predictors of interventions and outcomes for birth, even when medical risk factors were considered.2-5 I was hooked on data and the power of gathering evidence to tell the story of healthcare.

The systematic search for the best quality evidence to inform pregnancy care quickly became a way of life. As an educator, the next logical step for my work was to find better ways to translate and share new evidence about birth options with women and families, so they could make birth decisions that were best for them.

Birth Choices after Cesarean Decision Aid: The evidence I had gathered about obstetric and midwifery practices in the Australian healthcare system, combined with my midwifery philosophy of promoting physiological birth, motivated me to explore how to support women as they gather knowledge about the risks and benefits of their options and participate in decision making during pregnancy. Childbirth trends in Australia around that time mirrored the United States, with rising caesarean section rates and declining opportunities for women to attempt vaginal birth after previous caesarean (VBAC). This was despite evidence from research that VBAC was safe for most women, with advantages over repeated caesarean surgery. I had completed a cost-effectiveness analysis of trial of labour versus elective repeat caesarean and found important financial advantages in supportive VBAC policies as well.6 Promoting VBAC as a viable option for women became an important motivator for me to help address gaps between evidence and practice in pregnancy care. A multi-faceted approach was clearly necessary to change routine practice. For my PhD I focused on the question of whether improvements in women’s knowledge about birth options could influence their choices and outcomes. Utilizing the Ottawa Decision Support Framework (DSF), I developed the first decision aid booklet for pregnant women who had experienced previous cesarean birth and called it Birth Choices.7 My goal was to inform women about their birth options, and support them in identifying their values and preferences in the decision making process. I designed and conducted a multi-site randomized controlled trial (RCT), funded by a Medical Benefits Fund grant.

Through this work I discovered that my decision aid booklet improved women’s knowledge about their options, which also resulted in less decision conflict.8 The decision aid is listed in the International Inventory of Patient Decision Aids, has been internationally validated in studies to standardize decision aids, and is featured in international systematic reviews of patient decision aids. The Birth Choices decision aid has been updated and is still used in clinical practice, which is the most exciting part of research for me. So far it has been translated into French, Japanese, and Spanish, and adapted for a study in New Zealand. A Chinese translation is currently underway.

Shared Decision Making and Health Information Technology: While my previous research found that decision aids were effective in preparing women for making decisions during pregnancy, one of the critical discoveries was that despite decision aid effectiveness, method of birth was highly influenced by organisational factors within pregnancy care services.13 I was back to the powerful effect of where women chose to give birth (which hospital or health service) and who provided their care. The next phase of my research has focused on exploring new ways to overcome organisational and cultural barriers to shared decision making (SDM), in diverse pregnancy care settings. Over the last three years I have been leading a multi-disciplinary team of US researchers with expertise in midwifery, obstetrics, psychology, decision science and health information technology (IT) to identify innovative approaches to combine decision aids for women with shared decision making in busy, urban ethnically diverse clinical settings.

Our research team received funding from the Agency for Healthcare Research and Quality (AHRQ) in 2013 for a feasibility study “Using Interactive Health IT to Support Women’s Choices for Birth after Cesarean” 1R21HS022114-01. Phase one engaged targeted users (women and providers) in an instructional design process, to translate my original paper-based tool into an interactive web-based format for ethnically diverse groups of women.10 Phase two (in progress) involves a feasibility study of the process of integrating the Birth Choices decision aid into busy urban outpatient clinics within the Yale New Haven Hospital (YNHH) system. We are working to fill a gap in knowledge about integrating web-based decision aids into busy clinical practice environments. Our next steps will be towards identifying the best ways to implement decision aids in practice using a SDM framework, with the goal of maintaining the practice change.

Research has become a way of life. After more than 20 years in academic life it is still exciting to plan new projects and uncover new evidence to inform our practice, with the enduring commitment to improving patient experiences and outcomes.

Allison Shorten PhD RN RM FACM

Associate Professor

Yale University School of Nursing



1.     Shorten, A. (1995). Obstetric early discharge versus traditional hospital stay: Analysing the cost of postnatal care. Australian Health Review, 18(2), 19-39.

2.     Shorten, A., Shorten, B. (1999) Episiotomy in NSW hospitals 1993-1996:  Towards understanding variations between public and private hospitals. Australian Health Review, 21(1), 18-32.

3.     Shorten, A., Shorten, B. (2000) Women’s choice? The impact of private health insurance on episiotomy rates in Australian hospitals. Midwifery, 16, 204-212.

4.     Shorten, B., Shorten, A. (2004) Impact of private health insurance incentives on obstetric outcomes in NSW hospitals. Australian Health Review, 27(1), 27-38.

5.     Shorten, A., Shorten, B. (2007) What happens when a private hospital comes to town? The impact of the ‘public’ to ‘private’ hospital shift on regional birthing outcomes. Women and Birth, 20(2), 49-55.

6.     Shorten, A, Lewis, D.E., Shorten, B. (1998) Trial of labour versus elective repeat caesarean section: A cost-effectiveness analysis. Australian Health Review, 21(1), 8-28.

7.     Shorten, A. (2000) Birth Choices: What is best for you…vaginal or caesarean birth. A decision-aid for women making choices about birth after caesarean section. UOW Printery. Wollongong.

8.     Shorten, A., Shorten, B., Keogh, J., West, S., Morris, J. (2005) Making choices for childbirth: A randomized controlled trial of a decision-aid for informed birth after cesarean. Birth , 32(4), 253-262 .

9.     Shorten, A., Fagerlin, A., Illuzzi, J., Kennedy H.P., Lakehomer, H., Pettker, C., Saran, A., Witteman, H.,   Whittemore R., (2015) Developing an Internet-based decision aid for women choosing between vaginal birth after cesarean and repeat cesarean birth, Journal of Midwifery and Women’s Health. (Early View 8 JUN 2015 | DOI: 10.1111/jmwh.12298


Health care management of advanced, irreversible chronic kidney

21 Apr, 16 | by josmith

Helen Noble, Associate Editor EBN

I am a researcher in health services research contributing to health care management of advanced, irreversible chronic kidney disease (CKD). This is evidenced by publications in leading international journals, leadership of successful funding bids, (most recently a multi-institutional NIHR study) and research awards. My research mainly focuses on people with advanced chronic kidney disease opting for conservative management rather than dialysis. The number of these patients is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice.

I am leading the PAlliative Care in chronic Kidney diSease: (PACKS study) which is exploring quality of life, decision making, costs and impact on carers in people managed without dialysis. This study, funded by the National Institute of Health Research in the UK, is also investigating symptoms, cognition, frailty and performance. Recruitment opened in January 2015 and patients are being recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Recrutiment finishes in May 2016 with a further 3 months follow up. Carers are asked to ‘opt-in’ with consent from patients. The approach includes longitudinal quantitative surveys of quality of life and quality of life and costs for carers. Additionally, the decision making process is being explored via qualitative interviews with renal physicians/clinical nurse specialists.

The study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It is exploring the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.

The challenges & rewards of combing teaching & learning, research & scholarly activity

21 Apr, 16 | by josmith

Joanna Smith (@josmith175),IMG_0206

Lecturer Children’s Nursing, University of Leeds & Associate Editor EBN

I have worked in higher education for 15 years, and draw on over 15 years’ clinical experiences, primarily caring for children with complex needs to inform my teaching and research. I qualified as a registered general nurse in 1986, and registered children’s nurse in 1987, with my academic achievements beginning while working in clinical practice and culminating in achieving a doctorate in 2011. I am passionate about children’s nursing and main research interests relate to the way in which health professionals’ work with and involve children, young people and their families in care and acre decisions in the context of childhood long-term conditions. In relation to working with parents key findings from studies undertaken to date suggests:

  • Parents’ satisfaction with their relationships with health professionals is variable;
  • Professional/parent communication is primarily aimed at information provision;
  • Parents’ perceive their expertise & contribution to care is not always valued & they not involved in care & care decisions.

Smith J, Swallow V, Coyne I (2015) Involving Parents in Managing Their Child’s Long-Term Condition-A Concept Synthesis of Family-Centered Care and Partnership-in-Care. Journal of Pediatric Nursing, 30(1):143-59.

Smith J, Cheater F, Bekker H. (2015) Parents’ experiences of living with a child with hydrocephalus: a cross sectional interview based study. Health Expectations, 18 (5): 1709-20.

Smith, J., Cheater, F., Bekker, H, Chatwin, J. (2015) Are parents and professionals making shared decisions about a child’s care on presentation of a suspected shunt malfunction: a mixed method study? Health Expectations, 18 (5):1299-315.

Smith, J., Cheater, F., Bekker, H. (2015) Parents’ experiences of living with a child with a long-term condition: a rapid structured review of the literature. Health Expectations, 18 (4) 452-474.


My current post enables me to combine my clinical experiences with managing and supporting teaching and learning for undergraduate, post-qualifying and post-graduate students, and research scholarship nationally and internationally. In addition to my role of Associate Editor for EBN, I am a member of editorial board for Nursing Children and Young People, and review articles for a range of journals. I have been invited to join the steering group as the nurse representative for two inquiries by the UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD) relating to the care of on children. In addition to presenting research findings at a range of conferences, I was the country liaison for last years prestigious International Family Nursing Association Conference held in Denmark, and was chair the local organising committee for the Pediatric Nurses Association of Europe Congress in 2013. Throughout all these opportunities the knowledge and networking have shaped my thinking. However, there are many challenges in juggling all aspects of an academic career; excellent time management and organisation skills are essential, but ultimately the driver is a desire to ensure care delivered to children and families is based on the best evidence, whether though approaches to teaching and interacting with student or developing research that makes a difference.

Nurse academics rewards and challenges: undertaking research and scholarly activity

18 Apr, 16 | by josmith

This week’s EBN Twitter Chat on Wednesday 20th April between 8-9 pm (GMT) will be hosted by Professor Alison Twycross (@alitwy) who is editor of EBN and Dr Joanna Smith (@josmith175) one of the journal’s associate editors and will focus on the following question:

What promotes and what stops nurse academics undertaking research & scholarly activity?

Participating in the Twitter Chat

Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at Once you have an account contributing is straightforward, You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN Twitter chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

Tensions within professional-oriented departments can be a result of:

  • Organisational requirements such as increasing the number of nursing students to respond to commissioners needs to meet workforce demands;
  • Pressures to develop research capacity, and secure funding through competitive funding streams, particularly for research intense universities;
  • Professional & academic role conflicts, where professional identities may be more meaningful than an academic identity.

These tensions may be hindering nurse academic embracing research and scholarship. There is a growing body of evidence about the challenges, and rearwards, of nurses moving from professions practice to academia for example:

Smith, C. and Boyd, P., 2012. Becoming an academic: The reconstruction of identity by recently appointed lecturers in nursing, midwifery and the allied health professions. Innovations in Education and Teaching International, 49(1), pp.63-72.

Schulz, J., 2013. The impact of role conflict, role ambiguity and organizational climate on the job satisfaction of academic staff in research-intensive universities in the UK. Higher Education Research & Development, 32(3), pp.464-478.

Findlow, S., 2012. Higher education change and professional-academic identity in newly ‘academic’ disciplines: the case of nurse education. Higher Education, 63(1), pp.117-133.

Some things to think about before the Twitter Chat

  1. How do you define scholarly activity?
  2. Does your university have a workload model? If so, does this include time allocated for research and scholarly activity?
  3. How do you balance competing demands, student teaching and learning activities with research and scholarly activities?
  4. What are the expectations within your organization in relation to engaging in research and scholarly activity?
  5. What helps you engage in research and scholarly activity?
  6. What support is available to help you engage in research and scholarly activity?

Managing Pain in Children: Helping to Improve the Use of Evidence in Practice

18 Apr, 16 | by josmith

Alison Twycross (@alitwy), Head of Department for Children’s Nursing and Professor of Children’s Nursing, London South Bank University

I have been editor of Evidence Based Nursing since August 2010 and during that time I have worked with a team of associate editors to make the evidence to guide practice more accessible to nurses working in clinical practice. Alongside this I have also carried out research relating to managing pain in children. My current research focuses on the management of acute, post-operative and cancer-related pain in children and in particular on supporting parents to manage their child’s pain at home. I have also edited three books pulling together the evidence for managing pain in children. Details of the 2014 book can be found at:


The importance of research about patient care

18 Apr, 16 | by josmith

By Roberta Heale, Associate Editor EBN

I am working on a number of research projects, but one that is currently taking the forefront is related to advance care planning. Advance care planning has been defined as an ongoing process of reflection, communication, and documentation of a person’s values and wishes for future health and personal care in the event that they become incapable of consenting to or refusing treatment (Canadian Nurses Association, 2015). I, along with a group of researchers sent to a survey to nurse practitioners (NPs) to determine their beliefs, attitudes, and level implementation of ACP in their practice. We found that organizational culture had a significant impact on whether or not an NP implemented advance care planning discussions with her patients. Based on the findings of this study, NP Advance Care Planning Competencies were drafted. Using a modified Delphi approach, NPs are providing feedback and input to finalize the competencies.

Canadian Nurses Association. (2015). Joint position statement:The palliative approach to care and the role of the nurse. Ottawa: Canadian Nurses Association.

EBN Spotlighting the Editorial Team

18 Apr, 16 | by josmith

This week at Evidenced Based Nursing we are spotlighting on the editorial team, watch out for our series of blogs and join in the Twitter chat:

Alison Twycross will emphasis the need to improve the use of evidence in practice when managing pain in children;

  • Roberta Heale will focus on the importance of undertaking research about patient care;
  • Helen Noble will highlight health care management of advanced, irreversible chronic kidney and the impartance of reaserch teams;
  • Jo Smith will discuss the challenges and rewards of combing teaching and learning, research and scholarly activity;
  • Allison Shorten shares her expertise in evidence based midwifery and women’s health. 

The Twitter Chat on Wednesday 20th April between 8-9 pm (GMT) hosted by Professor Alison Twycross (@alitwy) who is editor of EBN and Dr Joanna Smith (@josmith175) one of the journal’s associate editors will focus on the following question (read the blog for further details):

What promotes and what stops nurse academics undertaking research & scholarly activity?

Helping patients make decisions: a two-way approach

11 Apr, 16 | by hnoble

Sarah Hallahan & Dr Helen Noble, Belfast City Hospital and Queens University Belfast, Northern Ireland.

IMG_2251 Sarah Hallahan

 The involvement of patients in decision making is a principle of the National Health Service (NHS) Constitution, which emphasises how patients play a key role in managing their own health and should be actively supported by the NHS to do so. The NHS should be coordinated and tailored to suit individual patient needs and preferences and patients and their families have the right to be involved directly, or through representatives, in decision making regarding their health and care where appropriate. It is paramount that health professionals accept the patient as ‘the expert’ in relation to their own individual values and preferences regarding care, and involvement in the decision making process is crucial. This point along with an increase in chronic illness leading to increased mortality has given rise to self-care and expert patient initiatives. The Expert Patient Programme (EPP) is an NHS initiative which aims to support people by promoting self-advocacy, increasing their confidence, improving their quality of life and providing information on informed decision making in regards to their condition; therefore increasing the individual’s ability to take the lead in their own care. See

Decision making is situational and decisions are made in light of a particular set of circumstances. The involvement of the patient and health professional in the decision making process depends on the model used; the most common models of medical decision making being the Shared Model, Informed Model and Paternalistic Model (Charles et al 1997). The Shared Model of decision making is now advocated as the preferred model throughout health-care, referred to as the ‘crux’ of patient-centred care (Legare et al 2010). The process of shared decision making involves consulting, negotiating and collaborating with patients, relatives and members of the multi-disciplinary team, to promote health and to inform the delivery of high quality patient-centred care. Health care practitioners share information with the patient about their medical condition and the patient is then invited to share information about their individual beliefs. In order to do this, the health care practitioner must draw on a contemporary evidence base relating to the relevant area and share this information with the patient thereby enabling them to make informed choices and decisions about the care that they will receive.

Despite its potential, the Shared Decision Making Model has not yet been adopted in all clinical practice. Although patients who are actively involved in decision making about their health have better outcomes, healthcare professionals often do not involve them in these decisions. Reasons for this include factors which influence shared decision making such as the patient’s ability to participate; or patients may request a new treatment but research may not exist to support its use. In addition the effectiveness of shared decision making is dependent on establishing effective relationships with patients and families and confidence is an essential factor that health care practitioners need to incorporate in clinical decision making, but may be lacking. Trust is also paramount in the process of building therapeutic relationships and successful communication is key in individualising care and promoting patient involvement in decision making. It is essential that health professionals give patients the information they require in terms they understand, rather than using complex medical language in order for them to understand the situation and enable them to take control of the decision making process. The use of colloquial language is important in empowering patients to participate in decision making; however this is dependent on the health care practitioner’s willingness to engage with this process and initiate these discussions. Gaining insight into patients’ preferences and individualised needs is facilitated by meaningful interaction and depends on both the patients’ willingness and capacity in participating in the process and the health care practitioners interviewing skills.

The patient-centred focus reinforces the importance of health care practitioner professionals working collaboratively with the patient to prioritise their needs and together agree a plan of care to meet the patients’ health and social care requirements. True collaboration requires mutual respect along with open and honest communication. Patient-centred care planning starts with the recognition of the individuals’ strengths, hopes and wants; this allows for genuine expression of what the person perceives as his/her goals. Patient involvement through shared decision making is encouraged to support patients in deciding on care suitable to their condition, lifestyle and social circumstances and includes ‘getting to know the patient’ and providing opportunities for choice regarding the care the client would like to receive. Patients are offered choices whilst being educated about the potential consequences and risks of the choices that are made.

Involvement of patients as active participants in care represents a shift in power distribution from service providers to service users. Individuals must act as active participants in their empowerment and health care practitioners essentially act as empowerment facilitators. Empowerment is a journey that will lead the patient to self-efficacy, which is defined as ones belief in their own ability to change behaviour. A patient-centred approach to empowerment is one in which the individual truly makes decisions together with the health care practitioner.



Charles, C., Gafni, A. and Whelan, T. (1997) ‘Shared decision-making in the medical encounter: what does it mean? (Or it takes at least two to tango)’, Social Science & Medicine, 49(5), pp. 651-661.


Legare, F., Ratte, S., Stacy, D., Kryworuchko, J., Gravel, K., Graham, I.D. and Turcotte, S. (2010) ‘Interventions for improving the adoption of shared decision making by healthcare professionals’, Cochrane Database of Systematic Reviews 2010, (5).

Beat Diabetes: WHO World Health Day, April 7, 2016

3 Apr, 16 | by rheale

@RobertaHeale  Associate Editor EBN

Every year on April 7, the birthday of the World Health Organization, the organization highlights a global public health concern. In 2016, the theme is diabetes. The organization explains why this in an important theme on their website:

I can’t imagine meeting anyone in health care who hasn’t had to work with patients with diabetes. It’s difficult to ignore the colossal impact that this condition has on the lives of those affected. Diabetes isn’t just a health issue. It has enormous economic and social consequences for those who develop it, particularly for people and countries with low or middle incomes.

The WHO hopes to increase awareness of the rise in diabetes as well as the ‘staggering burden’ and consequences. Coinciding with the release of the first WHO Global Report on diabetes, the goal is to incite specific, effective and affordable actions to tackle diabetes. Check out the WHO core social media and marketing materials, as well as the countdown to World Health Day here:

Let’s all work together to squelch the rise of diabetes and to make the lives of those with the disease better.

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