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RESEARCH PAPER
Feasibility, acceptability and cost efficiency of using
webinars to deliver first-line patient education for people
with Irritable Bowel Syndrome as part of a dietetic-led
gastroenterology service in primary care
M. Williams,
1
Y. Barclay,
1
L. Harper,
1
C. Marchant,
1
L. Seamark
1
& M. Hickson
2
1
Community Dietetics Service, Somerset NHS Foundation Trust, Taunton, UK
2
Institute of Health and Community, University of Plymouth, Plymouth, UK
Keywords
digital, digital transformation, IBS, patient
education, patient empowerment, webinar.
Correspondence
Mary Hickson, School of Health Professions,
Faculty of Health, University of Plymouth,
Peninsula Allied Health Centre, Room SF18,
Derriford Road, Plymouth, PL6 8BH, UK
Tel.: 01752 587542
E-mail: mary.hickson@plymouth.ac.uk
How to cite this article
Williams M., Barclay Y., Harper L., Marchant C.,
Seamark L. & Hickson M. (2020) Feasibility,
acceptability and cost efficiency of using webinars
to deliver first-line patient education for people
with Irritable Bowel Syndrome as part of a
dietetic-led gastroenterology service in primary
care. J Hum Nutr Diet. https://doi.org/10.1111/
jhn.12799
This is an open access article under the terms of
the Creative Commons Attribution License, which
permits use, distribution and reproduction in any
medium, provided the original work is properly
cited.
Abstract
Background: Irritable bowel syndrome (IBS) is a chronic functional gas-
trointestinal disorder. International research suggests dietary intervention as
a first-line approach, although dietetic services are struggling to cope with
demand. Digital technology may offer a solution to deliver appropriate
patient education. The present study aimed to assess the feasibility, accept-
ability and cost efficiency of using webinars to deliver first-line IBS advice
to patients as part of a dietetic-led gastroenterology service in primary care.
Methods: Patients were directed to an IBS First Line Advice webinar on a
specialist NHS website. Data were collected from patients pre- and post-we-
binar use using an online survey.
Results: In total, 1171 attendees completed the pre-webinar survey and 443
completed the post-webinar survey. Attendees ranged from under 17 years
to over 75 years. Of the attendees, 95% found the webinar easy to access
and 91% were satisfied with the content of the webinar. Those with excel-
lent or good knowledge rose from 25% pre-webinar to 67% post-webinar,
and confidence in managing their condition improved for 74% of attendees.
Using the webinars led to a 44% reduction in referrals for one-to-one
appointments with a specialist dietitian in the first year of use. The value of
the clinical time saved is estimated at £3593 per annum. The one-off cost of
creating the webinar was £3597.
Conclusions: The use of webinars is a feasible, acceptable and cost-efficient
way of delivering first-line patient education to people suffering with Irrita-
ble Bowel Syndrome as part of a dietetic-led gastroenterology service in pri-
mary care.
Introduction
Irritable bowel syndrome (IBS) is a non-life-threatening
chronic and relapsing functional gastrointestinal disorder
with a global prevalence of 11%
(1)
. The burden on
healthcare systems and society worldwide is substantial.
Data shows that, in the UK, the estimated total annual
costs for IBS treatment ranges from £45.6 million to £200
million
(1)
. In the USA, 25–49% of IBS patients will
consult a primary care general practitioner (GPs) each
year, with reattendance being common
(2)
. In the UK,
despite guidance from the National Institute for Health
and Care Excellence (NICE), around half of IBS patients
continue to be inappropriately referred for endoscopic
investigation
(3)
with IBS accounting for 36% of all new
patient referrals to gastroenterologists
(1)
.
From 2008 onward, UK NICE guidance has recognised
dietary intervention as a successful first-line approach for
1ª2020 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of
British Dietetic Association
Journal of Human Nutrition and Dietetics
IBS, with subsequent professional guidelines establishing
clear pathways for the dietary treatment of IBS patients
(4,5)
. However, delivery of this treatment requires dietetic
input and the demand currently exceeds capacity despite
the use of alternative approaches, such as group sessions.
Because many dietetic departments are unable to cope
with demand, the burden continues to fall on GP and
secondary care services
(6,7)
. A solution is required to
deliver high-quality dietetic advice to the large patient
population as a first-line intervention, freeing up time for
specialist care of more complex or intractable cases.
As a result of the advancement and broad adoption by
the public of digital technologies, the UK National Health
Service (NHS) is embracing digital transformation as a way
to meet increasing demand in a financially restricted envi-
ronment
(8,9)
. Up to 75% of the population now seek health
information online and convenient access is becoming an
expectation
(10)
. Virtual education shifts responsibility to
the patient and can overcome many of the barriers to face-
to-face education, such as lack of mobility or time, distance
to travel to attend appointments, lack of funds, long wait-
ing lists for appointments and caring commitments
(10,11)
.
Evidence suggests that some patients actually prefer remote
contact with healthcare providers rather than travel to
appointments
(12)
. The use of prerecorded on-demand
webinars allows access to virtual health education for
unlimited numbers of patients, enabling self-care using
appropriate expert formulated advice at first point of need,
and potentially releasing time across the healthcare system.
This project aimed to assess the feasibility, acceptability
and cost efficiency of using webinars to deliver first-line
advice to patients with suspected or newly diagnosed IBS.
Materials and methods
A single-group pre–post study design was used to evaluate
the feasibility, acceptability and cost efficiency of a webi-
nar as the first-line advice for people with IBS in primary
care. The webinar directly reflected first-line IBS advice
from the 2016 British Dietetic Association evidence-based
practice guidelines for the dietary management of IBS in
adults
(13)
. Data were collected between 26 March 2018
and 15 April 2020. The project is registered as a service
evaluation with Somerset Partnership NHS Foundation
Trust and data were collected anonymously; therefore,
further ethical approval was not required.
Healthcare professionals (HCPs) working locally referred
adult patients (aged of 18 years and over) with IBS to a newly
developed ‘IBS First Line Advice’ webinar hosted on the
NHS Community Dietetic website. Carers or friends were
directed to the website, if appropriate, to support the patient.
Before and after completion of the webinar individuals were
given the option to complete an anonymous survey.
Developing the webinar
A webinar subscription was acquired with GOTOWEBINAR
Pro Version (LogMeIn, Inc., Boston, MA, USA) and the
webinar platform was approved for use by Somerset Part-
nership NHS Foundation Trust Information Governance.
An unbranded webinar was recorded using a POWERPOINT
(Microsoft Corp., Redmond, Washington, USA) presenta-
tion delivered by three specialist gastroenterology com-
munity dietitians (MW, CM and LS). The recording was
edited and uploaded to the YouTube ’Patient Webinars’
channel (http://www.youtube.com). The YouTube link
was then embedded into the community dietetic depart-
ment website, www.patientwebinars.co.uk. With access to
4G or wi-fi, the webinars were then available ‘on-de-
mand’ to any patient via smart phone, laptop, tablet or
computer at a time and place of their choosing. Patients
could also download patient education resources directly
from the website; for example, NICE accredited dietary
advice, constipation advice, information on additional
dietary approaches, etc.
The cost of creating the webinar was £3597, including
the webinar subscription (£2363/year), microphone (£120
one-off cost), business card cost (£280 one-off cost) and
staff costs (£834). An illustration of the staff time and
process used to create the webinar is provided in the Sup-
porting information (Data S1).
Local GPs and other HCPs were given the website
address and asked to direct adult patients to the website
if the patient needed first-line IBS advice. No referral let-
ter was necessary from the referring clinician. To ensure
that HCPs were aware of the webinar, e-mails with the
website address were sent monthly to all Somerset senior
GPs, practice managers, pharmacists and health visitors.
Business cards were created for HCPs to give to patients
with the website address and these were distributed to
secondary care gastroenterology departments, endoscopy
nurses, pharmacists, acute dietitians and GPs locally.
Talks were given at county-wide GP education days high-
lighting the webinar and the website.
Data collection
Both pre- and post-IBS webinar surveys were developed
using QUESTBACK (Questback, Bridgeport, CT, USA) and
anonymous unpaired data was collected between 26
March 2018 and 15 April 2020.
Basic demographic data were collected, including age,
gender, location within the UK, who gave the webinar
details to the patient, whether IBS had been diagnosed by
an HCP, whether the patient was registered with a Som-
erset GP, and whether the webinar was being accessed by
a patient, carer, friend or HCP. HCPs and carers were
2ª2020 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of
British Dietetic Association
On-demand webinars to deliver patient education M. Williams et al.
noted and then automatically directed out of the survey
and were not included in the survey outcome data.
The surveys focused on collecting data on accessibility,
acceptability, knowledge, confidence and examined use of
healthcare services. Survey questions allowed for only one
answer per question, with the exception of questions 8
and 14 where multiple answers were allowed. The survey
questions are provided in the Supporting information
(Data S2).
Patients were also asked what other information, if any,
they would like to see included in the webinar and
responses were categorised using a simple content analy-
sis.
Data were also collected for referral rates to the diete-
tic-led gastroenterology service for one-to-one appoint-
ments for the year prior and year after the launch of the
webinar. The estimated value of dietetic time in clinic
was calculated using figures for an NHS band 6 dietitian
for 2017 to 2019 including on-costs (approximately
£23.18 per hour).
Data were analysed using SPSS, version 25 (IBM Corp.,
Armonk, NY, USA) and are presented as frequencies.
Comparisons between pre- and post-surveys compare
proportions in two unequal samples using a MEDCALC
comparisons of proportions calculator (https://www.
medcalc.org).
Results
The IBS webinar was viewed 2300 times between 1st
September 2017 and 15th April 2020. In total, 1171 atten-
dees accessed the pre-webinar survey and 443 (38%)
engaged with the post-webinar survey. There is no record
of the number of patients who were offered the webinar
but did not access it. The majority of patients had been
diagnosed with IBS by a HCP (68%) and, of those that
completed the post-webinar survey, most were registered
with a Somerset GP (84%). Respondents were principally
female (75%). Details on age, location of the patient,
referral source and whether the attendee was a patient,
carer or HCP are provided in the Supporting information
(Data S3).
Figure 1a highlights the patient acceptability of using
the webinar. The majority of patients found the webinar
easy to join, were satisfied with the overall content and
would recommend the webinar to friends with IBS. Fig-
ure 1b shows the reasons for attending the webinar were
varied, although the most frequently cited were access to
accurate and reliable information, the ability to re-watch
the webinar, and no requirement to travel or take time
off work.
The change in patient confidence and knowledge in
managing their IBS symptoms with diet is shown in
Fig. 2. These data show that patient confidence and
knowledge increased after the webinar. The categories
were dischotomised (very, fairly and some level of confi-
dence =confident; neither, not and not at all confi-
dent =not confident; excellent, good, fair
knowledge =good; limited, poor, no knowledge =poor).
Of the attendees, 45% (n=1171) were not confident to
manage their IBS pre-webinar and this decreased to 16%
(n=375) post-webinar [difference =29%; 95% confi-
dence interval (CI) =24–34%; P<0.0001]. Furthermore,
44% (n=1171) reported poor knowledge pre-webinar
and this decreased to 5% (n=443) post-webinar (differ-
ence =39%; 95% CI =35–43%; P<0.0001).
(a) (b)
Figure 1 (a) Patient feedback on how easy it was to join the webinar (n=443). (b) Patient feedback on which factors were important to them
when choosing to attend the webinar (n=375). In figure (b), patients could choose more than one answer.
3ª2020 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of
British Dietetic Association
M. Williams et al. On-demand webinars to deliver patient education
Figure 3 shows the results of questions testing specific
knowledge, which indicate whether patients listened,
assimilated and understood information in the webinar.
Of the attendees, 25% (n=1171) participants pre-webi-
nar correctly identified allergy testing was ineffective but
70% (n=375) post-webinar could answer this question
correctly (difference =45%; 95% CI =39–50%;
P<0.0001). Low lactose diet was identified correctly as
effective by 35% (n=1170) pre- and 78% (n=375) post
(difference =43%; 95% CI =38–48%; P<0.0001); low
FODMAP (fermentable oligo-, di-, mono-saccharides and
polyols) diet 71% pre 65% post (difference =5%; 95%
CI =0.04–11%; P<0.05); low fructan diet 24% pre 82%
post (difference =58%; 95% CI =53–62%; P<0.0001).
Figure 4 shows how attendees adjusted their under-
standing of which HCP would be most useful to seek
advice from for IBS. Reliance on GPs and secondary care
gastroenterology reduced, whereas the understanding that
a specialist dietitian was the most appropriate profes-
sional increased. Assuming ‘specialist dietitian’ is the cor-
rect answer; 62% (n=1171) were correct pre-webinar
and 86% (n=375) post-webinar (difference =24%; 95%
CI =19–28%; P<0.0001).
Patients were also asked if they would like to attend a
webinar specifically on the low FODMAP diet; 64% of
patients confirmed they would and a further 27%
answered ‘maybe’.
A simple content analysis of feedback from 249 patients
showed that the most frequent group of comments
related to positive satisfaction with the webinar, n=31;
comments referencing the low FODMAP diet n=29;
patients requesting further information on the low FOD-
MAP diet n=14. Answers from patients are provided in
the Supporting information (Data S4).
In the year before the webinars were available (Septem-
ber 2016 to August 2017), the dietetic-led gastroenterol-
ogy service received 350 referrals. In the year after the
availability of the webinar (September 2017 to August
2018), 195 referrals were received into this service, show-
ing a 44% drop in referral numbers. The value of the die-
tetic time saved by this project is estimated at £3593 per
annum. The time saved as a result of the reduced referral
rate has allowed the provision of a service for patients
with coeliac disease and inflammatory bowel disease in
remission, which were both previously unmet needs.
Discussion
This service evaluation showed that the delivery of a
webinar as the first form of patient education to those
diagnosed with IBS in primary care was feasible, accept-
able and cost effective. The webinar was feasible to
develop and incorporate into a clinical dietetic service
with very modest set-up costs. It was acceptable to
(a)
(b)
Figure 2 (a) Patient feedback comparing answers
before and after watching the webinar how
confident they were in managing their irritable bowel
syndrome (IBS) symptoms (pre n=1171 and post
n=375). (b) Patient feedback comparing answers
before and after watching the webinar on how they
would rate their knowledge on managing their IBS
symptoms through diet (pre n=1171 and post
n=443).
4ª2020 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of
British Dietetic Association
On-demand webinars to deliver patient education M. Williams et al.
patients in a number of ways and data indicated that
patient knowledge improved. The cost of development
and delivery of the webinar were more than off-set by
time savings, which were sufficiently significant to allow
the expansion of the service to other patient groups.
The growth of Internet use is changing the landscape
of global health care and health seeking behaviour; 60%
of people surveyed acknowledged that online advice
would influence their healthcare decisions
(14)
. One in
three adults in the USA use the Internet to diagnose or
learn about a health concern
(15)
, and over 83% of Euro-
peans look online for health information
(16,17)
.UK
research indicates that patients are increasingly happy to
embrace new technology, such as video consultations with
their GP
(14,18)
. Webinars are a simple and effective digital
innovation potentially allowing populations unprece-
dented immediate access to health advice. It is acknowl-
edged that trust and confidence in online information
remain important
(19-21)
and these webinars give patients
convenient remote access to the most up-to-date guideli-
nes and evidence-based advice directly from specialists
working in the field. The most common reason for
attending the webinars was ‘access to accurate and reliable
information’ reflecting the patients’ trust in the
(a)
(b)
Figure 3 (a) Patient feedback comparing answers
before and after watching the webinar on whether
they would find it useful to have access to allergy
testing to find a solution for their irritable bowel
syndrome (IBS) symptoms (pre n=1171 and post
n=375). (b) Patient feedback comparing answers
before and after watching the webinar on which
diets are most likely to help them in managing their
IBS symptoms (pre n=1170 and post n=375). In
Figure (b), patients could choose more than one
answer. *indicates the correct answer.
Figure 4 Patient feedback comparing answers
before and after watching the webinar on which
healthcare professional would be most useful to seek
advice from for their irritable bowel syndrome
symptoms (pre n=1171 and post n=375). (GP,
general practitioner.)
5ª2020 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of
British Dietetic Association
M. Williams et al. On-demand webinars to deliver patient education
information provided. This corresponds to international
research underlining the desire for easy access to trust-
worthy health care on the internet
(15,20,21)
. This need for
trustworthy information also highlights the importance of
specialist HCPs developing the content and delivering the
patient-focused webinars.
During the evaluation period, over 2300 people
viewed the webinar, indicating that it was a feasible
form of patient education. Furthermore the vast major-
ity of patients found the webinar easy to use and would
recommend it. Recent research suggests that age is not a
barrier to technology use
(11)
and this is reflected in our
results, with all ages between 18 and 74 years being well
represented and 33% of the sample being aged 55–
74 years (see Supporting information, Data S3) Research
shows that IBS is a more common disease in women
with an odds ratio of 1.67. Our data showed a 75%
female dominance, which is higher than expected and
may reflect a male reluctance to engage in online educa-
tion and/or a female response bias to completing ques-
tionnaires
(3,22)
The on-demand webinar could be accessed as often as
they wished at any time of day, making this an easy and
convenient way to encourage patient self-management
and consolidate knowledge, allowing patients to take the
time they required to make sense of the complex medical
and dietary information
(23)
. This approach may be par-
ticularly useful in chronic health conditions
(11,23)
such as
IBS, and may explain why the ability to re-watch the
webinar was the second most popular reason for access-
ing this form of patient education. Our data demonstrates
that attendees not only self-reported an improvement in
their knowledge after accessing the webinar, but also
showed an increase in the proportion of correctly
answered test questions post-webinar, suggesting that the
attendees had listened, assimilated and understood the
information. Research shows that virtual education may
be as effective or more effective than a routine physician
appointment. It may be that the opportunity to re-watch
the webinar and consolidate knowledge in part explains
this finding
(10)
. The increase in knowledge is also likely
to be associated with the improvements seen in self-re-
ported confidence.
Our data showed clearly that preventing the need to
travel and preventing the need to take time off work were
important to patients who accessed the webinars. Travel-
ling to appointments may pose a significant problem in
both rural and urban areas to those who have limited
mobility, insufficient funds, lack of access to transport,
lack of child or respite care cover or other time con-
straints. For these patients on-demand, webinars could
significantly improve access to health education, allowing
them to choose when and where they attend
(18)
.
The overwhelming majority of patients were satisfied
with the content of the webinar and most would recom-
mend it to friends, indicating that patients found the
webinar acceptable. Additional comments on the survey
consistently suggested that webinar content was compre-
hensive and extensive (see Supporting information, Data
S4). Requests for further information were focused pre-
dominantly on second-line dietary advice, specifically the
low FODMAP diet. Based on this feedback, we created a
low FODMAP diet webinar (available at https://patien
twebinars.co.uk), which has had 6000 views in the first
12 months, suggesting that the feedback from our sample
reflected a need in the general IBS population.
The symptoms of IBS (e.g. abdominal pain, bloating,
stool changes) can be very similar to those of bowel or
ovarian cancer and inflammatory bowel disease, and are
likely to explain why 4% of those identified with IBS are
later diagnosed with a serious organic disorder
(24)
.
Hence, any symptoms suggestive of more serious pathol-
ogy (also known as ‘red flags’), such as blood in stools,
unintended weight loss and unexplained low iron levels,
should be investigated further. For this reason, the webi-
nar clearly informs patients of these ‘red flags’, to ensure
patient safety by encouraging earlier care (Fig. 5). Feed-
back indicated that patients did understand the safety
issues, as illustrated by this quote ‘I need to see my GP as
I have some of what you call red flags’.
Recent systematic reviews from Australia and Canada
have found that virtual education can lead to a more effi-
cient use of clinical time offering a direct alternative to
seeing an HCP face-to-face
(10,11)
, a finding that is sup-
ported by our data showing a 44% reduction in face-to-
face referrals into the dietetic-led gastroenterology service
in the first year after the start of the webinars. This signif-
icant release in clinical time has allowed the dietetic team
to assess unmet needs, leading to new regional care path-
ways for both coeliac disease and inflammatory bowel
disease in remission. Additionally, from a cost-saving per-
spective, this cohort of patients did not require adminis-
tration of appointments and could download resources
directly from the website on to their own device, leading
to further savings from printing and postage costs. NHS
estates costs for room hire, staff and patient travel costs,
parking, and patient time should also be considered in
any long-term financial savings assessments.
Other data from evaluation of face-to-face IBS group
sessions shows that patients are frequently uncomfortable
discussing bowel related symptoms in a group environ-
ment (Williams M, Marchant C, unpublished data). The
webinar allows anonymity, a factor identified as a reason
for attending the webinar. This factor may explain the
stark contrast between numbers of patients engaging in
the different forms of patient education: only 48 patients
6ª2020 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of
British Dietetic Association
On-demand webinars to deliver patient education M. Williams et al.
attending monthly in-person group sessions over a 20-
month period utilising only 22% of possible capacity
(7)
.
The unbranded IBS webinar is now also available
(https://www.nhs.uk/conditions/irritable-bowel-syndrome-
ibs/ibs-diet-video-guide) and has had over 32 000 views
between April 2019 and April 2020. Access on this
national NHS website is further enabling other UK depart-
ments to use the webinar free of charge. This prevents the
need for replication of identical webinars by different clin-
ical commissioning groups and, importantly, allows
departments to benefit from financial savings without the
need for developmental costs. The 44% drop in referral
rates led to a £3.6K staff cost saving in our small service.
However, the real difference will come when the concept
of webinars is scaled up and rolled out nationally to other
larger areas of need; for example, muscoskeletal back pain,
diabetes, cardiovascular disease or post-cancer care, partic-
ularly allowing for a reduction in follow-up reviews after
hospital procedures and ongoing specialist input for long-
term health conditions
(8)
. The 2019 NHS Long Term Plan
aims to remove a third of face-to-face hospital outpatient
appointments, equivalent to 30 million outpatient visits
per year, freeing up significant clinical time and allowing
outpatient teams to work differently
(8)
. A reduction in
referrals through the use of webinars could significantly
contribute to this release in clinical time (Fig. 5), while
money saved could lead to effective reallocation of clinical
funding at a national level. It would be logical for NHS
UK to act as a site for a national repository of webinars in
the long term, although this requires further discussion.
The webinar specifically sought to educate patients on
who to consult for IBS advice, and the results showed
that patients felt that a specialist dietitian was the most
appropriate HCP to deliver dietary advice for IBS. This is
an important finding because it is well known that the
high costs of treating IBS are associated with inappropri-
ate reliance on GPs and secondary care
(25-28)
. One in
twelve GP consultations are for gastrointestinal problems
and IBS is by far the most common gastrointestinal con-
dition seen by GPs
(29)
. Therefore, the demand on GP
time can be addressed by dietitian-led treatment includ-
ing the use of webinars to manage the IBS workload in
primary care. Evidence already highlights the ability of
dietitians to work autonomously and effectively with IBS
patients in a one-to-one setting in primary care, assessing
patients without medical correspondance, as well as
Figure 5 The potential benefits to the healthcare system of using webinars for first-line irritable bowel syndrome (IBS) patient education. (GP,
general practitioner.)
7ª2020 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of
British Dietetic Association
M. Williams et al. On-demand webinars to deliver patient education
recommending appropriate treatment and/or onward
referral
(30)
. The webinars are a further development of
this role, providing patients with faster access to the right
care at the same time as encouraging patient self manage-
ment and reducing the need for expensive referrals to sec-
ondary care. Care of IBS is an example of where
dietitians could take on roles as first contact practitioners
(FCPs) in the frontline of general practice in order to
reduce GP workload.
The data collected for this feasibility study has some
limitations. The anonymity of the online data collection
made it impossible to cross-match responses pre- and
post-webinar; we do not know which post-resposes match
which pre-responses. The data collection also does not
allow for long-term follow up of patients to determine
whether watching the webinar led to improvements in
symptoms; this should form the basis for future research.
Only 38% of those completing the pre-survey completed
the post-survey and the data collection did not allow
assessment of the numbers of people who opted out of
the surveys or who declined to engage with the webinar.
This may mean there are inherent biases related to the
type of person who was willing to complete both surveys.
From an equity accessibility perspective, it would be
important to look at ways of making these webinars avail-
able to all patient groups, including in other languages, as
well as for those with hearing and/or sight disability. Dis-
cussions are already ongoing with the Deafness Support
Network and NHS UK.
Conclusions
Patient webinars for first-line advice for IBS are an inno-
vative and novel use of digital technology offering those
with IBS unprecedented access to patient education. At
very little cost to the health service, patients can increase
their knowledge and confidence with trustworthy dieti-
tian-led advice, at the same time as providing a simple
cost-effective solution to help release time across the
healthcare system. As virtual communication becomes
ubiquitous within society, the use of this form of patient
education is likely to become mainstream, enabling
patient’s needs to be addressed as early as possible and
empowering patients to better self-manage and under-
stand their condition, potentially leading to improved
clinical outcomes. More research is urgently needed to
better assess the benefits, feasibility and challenges of
implementing this technology at scale.
Acknowledgments
We thank all those on the Somerset NHS England 100
Day Project Gastroenterology team who were
instrumental in helping to support the establishment of
the webinars for IBS patients; Jeremy Wilkinson of NHS
Digital for his tireless support of this project; Richard
Hatton of NHS Digital for his help with the Benefits/Pro-
cess flow charts; and Fiona Robinson, Clinical Integration
Lead at Somerset NHS Foundation Trust, for financial
saving data.
Conflict of interests, source of funding and
authorship
The authors have no conflicts of interest.
Funding was granted by the British Dietetic Association (19/10).
MW designed the study. MW and CM devised the patient surveys.
MW and MH processed the outcome data and performed the
analysis. MW designed the figures. MW wrote the manuscript in
consultation with MH. Critical feedback and contribution to the
final version of the manuscript was given by YB, LH, CM, LS and
MH. All authors have approved the final version of the paper sub-
mitted for publication.
Transparency declaration
The lead author affirms that this manuscript is an honest,
accurate and transparent account of the study being
reported. As described in the materials and methods, the
present study was defined as a service evaluation and was
approved by Somerset Partnership NHS Foundation Trust
(approval code S562). As a service evaluation, there are
no specific reporting guidelines available. The lead author
affirms that no important aspects of the study have been
omitted and that any discrepancies from the study have
been explained.
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Supporting information
Additional supporting information may be found online
in the Supporting Information section at the end of the
article.
Data S1. The diagram indicates the proccess flow and
clinical time used to create webinars for patients with
irritable bowel syndrome.
Data S2. Survey questions.
Data S3. Patient demographics, who directed the patient
to the webinar and who attended the webinar.
Data S4. Qualitative data was collected using the ques-
tion, ‘What other information would you like to see
included in the webinar?’.
9ª2020 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of
British Dietetic Association
M. Williams et al. On-demand webinars to deliver patient education
