The STADIA trial aimed to assess the effectiveness of a standardised diagnostic assessment tool (Development and Wellbeing Assessment, DAWBA) in aiding clinician-made diagnosis decisions in Child and Adolescent Mental Health Services (CAMHS). This study reports the qualitative process evaluation of the STADIA trial, which aimed to identify barriers and facilitators to using the online-completed DAWBA in CAMHS. Qualitative data were collected through 109 semi-structured interviews with young people, parents/carers, healthcare professionals and service commissioners/funders in 8 CAMHS sites across England. Deductive thematic analysis was guided by the domains of the Consolidated Framework for Implementation Research. Young people and parents/carers showed high levels of engagement with the DAWBA. They perceived a validation of symptoms from the generated DAWBA report, which they actively used as ‘evidence’ when seeking help from other services. Clinicians involved in determining referral acceptance/rejection decisions were positive about its use and saw benefits in aiding decision-making. In contrast, however, barriers to clinicians engaging with the DAWBA report during the assessment stage arose from limited awareness and accessibility to the report, a context of high workload and pressure, and general concerns about the value of a diagnosis. The DAWBA was not widely used by clinicians in the expected way to aid diagnostic decision-making. However, it may offer children and young people much-needed engagement during long waiting times for initial assessment in CAMHS. The DAWBA may be more acceptable to clinical teams in triaging referrals to help with timely decisions about the most suitable services. Trial registration ISRCTN15748675 (29/05/2019).

Background:Emotional disorders are common in children and young people and can significantly impair their quality of life. Evidence-based treatments require a timely and appropriate diagnosis. The utility of standardised diagnostic assessment tools may aid the detection of emotional disorders, but there is limited evidence of their clinical value. Objectives:To assess the clinical effectiveness and cost effectiveness of a standardised diagnostic assessment for children and young people with emotional difficulties referred to Child and Adolescent Mental Health Services. A nested qualitative process evaluation aimed to identify the barriers and facilitators to using a standardised diagnostic assessment tool in Child and Adolescent Mental Health Services. Design:A United Kingdom, multicentre, two-arm, parallel-group randomised controlled trial with a nested qualitative process evaluation. Setting:Eight National Health Service Trusts providing multidisciplinary specialist Child and Adolescent Mental Health Services. Participants:Children and young people aged 5-17 years with emotional difficulties referred to Child and Adolescent Mental Health Services, excluding emergency/urgent referrals that required an expedited assessment. In the qualitative process evaluation, 15 young people aged 16-17 years, 38 parents/carers and 56 healthcare professionals participated in semistructured interviews. Interventions:Participants were randomly assigned (1 : 1) following referral receipt to intervention (the development and well-being assessment) and usual care, or usual care only. Main outcome measures:Primary outcome was a clinician-made diagnosis decision about the presence of an emotional disorder within 12 months of randomisation, collected from Child and Adolescent Mental Health Services clinical records. Secondary outcomes collected from clinical records included referral acceptance, time to offer and start treatment/interventions and discharge. Data were also self-reported from participants through online questionnaires at baseline, 6 and 12 months post randomisation, and the cost effectiveness of the intervention was investigated. Results:One thousand two hundred and twenty-five (1225) children and young people were randomly assigned (1 : 1) to study groups between 27 August 2019 and 17 October 2021; 615 were assigned to the intervention and 610 were assigned to the control group. Adherence to the intervention (full/partial completion of the development and well-being assessment) was 80% (494/615). At 12 months, 68 (11%) participants in the intervention group received an emotional disorder diagnosis versus 72 (12%) in the control group [adjusted risk ratio 0.94 (95% confidence interval 0.70 to 1.28); p = 0.71]. Child and Adolescent Mental Health Services acceptance of the index referral [intervention 277 (45%) vs. control 262 (43%); risk ratio: 1.06 (95% confidence interval: 0.94 to 1.19)] or any referral by 18 months [intervention 374 (61%) vs. control 352 (58%); risk ratio: 1.06 (95% confidence interval: 0.97 to 1.16)] was similar between groups. There was no evidence of any differences between groups for any other secondary outcomes. The qualitative nested process evaluation identified a number of barriers and facilitators to the use of the development and well-being assessment during the trial, particularly at the assessment and diagnosis stages of the Child and Adolescent Mental Health Services pathway. Limitations:It was not possible to mask participants, clinicians or site researchers collecting source data to treatment allocation. Conclusions:We found no evidence that completion of the development and well-being assessment aided the detection of emotional disorders in this study. Using the development and well-being assessment in this way cannot be recommended for clinical practice. Future research:To determine longer-term service use outcomes and to investigate whether receipt of a clinical diagnosis makes a difference to clinical outcomes and care/intervention receipt. Funding:This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/96/09.

Background The STADIA trial evaluated the effectiveness of a standardised diagnostic assessment tool for children and young people (CYP) referred to Child and Adolescent Mental Health Services. Six- and 12-month follow-up questionnaires were completed by either CYP, parents/carers or both depending on the CYP’s age. A voucher was given upon completion of the questionnaires. A Study Within A Trial (SWAT) was embedded to investigate the effect of voucher timing and value on questionnaire return. Methods Participants were randomly allocated to either: (A) receive a £10 voucher at each time point, conditional on completion of the questionnaire or (B) a £20 voucher on completion of their 12-month questionnaire. Outcomes included return of at least one questionnaire, questionnaire return at both 6- and 12-month follow-up, number of questionnaires returned (0,1,2) and time from randomisation to questionnaire return. Parent/carers, 11–15-year-olds and 16–17-year-olds were analysed separately. For each, between group comparisons were presented for each outcome along with 95% confidence intervals (CI). Results 284 participants were recruited (142 per arm). There was evidence of increased questionnaire return at both time points when giving two £10 vouchers, for 11–15-year-olds (adjusted risk ratio (ARR): 1.72 (95% confidence interval (CI):1.15 to 2.56)) and parents/carers (ARR 1.18 (95% CI:1.01 to 1.38)) but not for 16–17-year-olds (ARR 1.01 (95% CI:0.58 to 1.75)). Similarly, an increased number of questionnaires were returned for 11–15-year-olds (common odds ratio (COR): 3.25: (95% CI:1.41 to 7.52)) and parents/carers (COR 1.95 (95% CI:1.09 to 3.47)) but not for 16–17-year-olds (COR 1.18 (95% CI:0.29 to 4.77)). Discussion Smaller but regular incentives may increase questionnaire return within a trial rather than larger incentives at the end of follow-up. However, due to the small sample size, further research is required to confirm these findings both in the study population and wider population.

This paper presents the perception of the process of glucose self-monitoring by older adults diagnosed with type 2 diabetes mellitus. The study was conducted in a health service in Mexico using semi-structured interviews to physicians and it was based on the behavioural model. Diabetes mellitus type 2 (DM2) is one of the 3 main causes of death in Mexico. The self-monitoring of blood glucose (SMBG) behaviour is one of the most valuable tools in controlling of diabetes. In health care, it is common for interventions to be developed, implemented or evaluated to promote healthier lifestyle behaviours for patients; however, these interventions are often designed without an analysis or diagnosis to determine what needs to be changed to change the behaviour. This work focuses on the perception of people working in Mexican health services that provide medical care to the older adult population diagnosed with T2DM. The objectives of this research were: (1) Identify the organizational aspects that influence or affect the use of the blood glucose meter (BGM) in elderly patients with T2DM; (2) define the barriers and enablers for older adults to use the BGM detected by clinician in patients with T2DM and whether these characteristics differ with the rest of the population diagnosed with T2DM and; (3) understand the importance of the BGM for the treatment of T2DM in an elderly patient. Six semi-structured interviews with clinicians with specialization in Family Medicine (FM) of the first level of the Mexican Social Security Institute (IMSS) were undertaken. The interviews were divided into five aspects: (a) Clinicians’ background, (b) context and support by IMSS, (c) glucose meter in home and use, (d) information that patients receive, and (e) barriers and enablers to use the BGM. A thematic analysis of the qualitative data collected in the interviews with the clinicians was carried out to identify, analyze and report the patterns. The coding of the themes was based on the theory of the COM-B model. As a result of the interviews, it was identified that SMBG is composed of three different behaviours and that each behaviour requires different capabilities, motivations and opportunities. In order to perform the SMBG behaviour, clinicians considered 12 physical capacities necessary, 22 psychological capabilities, seven physical opportunities, three social opportunities, five reflective motivations and two automatic motivations. Physicians consider that older people have barriers to achieving the behaviour. The study further demonstrated that the target behaviour of SMBG use is not only the interaction with a single medical device; rather the older adult is required to interact with four medical devices to achieve SMBG.

BackgroundStandardised Diagnostic Assessment tools, such as the Development and Well‐Being Assessment (DAWBA), may aid detection and diagnosis of emotional disorders but there is limited real‐world evidence of their clinical or cost effectiveness.MethodsWe conducted a multicentre, two‐arm parallel group randomised controlled trial in eight large National Health Service Trusts in England providing multidisciplinary specialist Child and Adolescent Mental Health Services (CAMHS). Participants (5–17 year‐olds with emotional difficulties referred to CAMHS) were randomly assigned (1:1), following referral receipt, to either receive the DAWBA and assessment‐as‐usual (intervention group) or assessment‐as‐usual (control group). Data were self‐reported by participants (parents and/or young person, depending on age) at baseline, 6‐ and 12‐month post‐randomisation and collected from clinical records up to 18 months post‐randomisation. The primary outcome was a clinician‐made diagnosis decision about the presence of an emotional disorder within 12 months of randomisation. Trial registration: ISRCTN15748675.ResultsIn total, 1,225 children and young people (58% female sex) were randomised (615 intervention; 610 control). Adherence to the intervention (full/partial completion) was 80% (494/615). At 12 months, 68 (11%) participants in the intervention group received an emotional disorder diagnosis versus 72 (12%) in the control group (adjusted risk ratio (RR) 0.94 [95% CI 0.70, 1.28]). The intervention was not cost effective. There was no evidence of any differences between groups for service‐related or participant‐reported secondary outcomes, for example, CAMHS acceptance of the index referral (intervention 277 (45%) versus control 262 (43%); RR: 1.06 [95% CI: 0.94, 1.19]) was similar between groups.ConclusionsAs delivered in this pragmatic trial, we found no evidence for the effectiveness or cost effectiveness of using a Standardised Diagnostic Assessment tool in aiding the detection of emotional disorders or clinical outcomes in clinically referred children and young people. Despite regular efforts to encourage clinicians to view the DAWBA report and consider its findings as part of assessment and diagnosis, we did not collect data on usage and therefore cannot confirm the extent to which clinicians did this. As a pragmatic trial that aimed to test the effectiveness of incorporating the DAWBA into usual practice and clinical care, our study found that, in the format as delivered in this trial, there was no impact on diagnosis or clinical outcomes.

Background: While regional-level self-medication sales data has been shown to enhance disease surveillance, individual-level sales data remains unexplored. This pilot study evaluates the feasibility of linking individual loyalty card data with health data to improve COVID-19 forecasting accuracy. The primary aims were to test a data-sharing protocol, evaluate the data's quality and representativeness, and explore initial signals. Methods: A data-sharing protocol was developed, considering public preferences for sharing loyalty card data for health research. Participants used Tesco Clubcard’s data portability function to share data and completed an online health survey. Descriptive analysis was primarily used due to the small sample size, and a post-hoc sample size calculation was later conducted to assess statistical power for future studies. Recruitment occurred online from 18/01/2022 to 04/02/2022, targeting 200 participants. Results: A total of 197 participants shared loyalty card and health survey data, resulting in 893,414 transactions across 65,310 unique items purchased from 2015-2022. Participants averaged 4,653 transactions (SD 5,256) over 5.5 years (SD 836 days), with 81% purchasing medications (44 per individual, SD 68). Importantly, 56.35% disclosed pre-existing health conditions, 43.65% confirmed prescription medication use, and 42.13% specified these prescriptions. Despite variability in transaction frequency, trends in self-medication purchases aligned with participants’ reported health conditions. Gender differences were observed in purchasing behaviour, and elderly and younger populations were underrepresented. Medication purchases aligned with COVID-19 symptom spikes during the OMICRON variant, particularly for throat-related remedies. Seasonal buying patterns corresponded with higher mortality periods, and a notable connection was observed between peak deaths before the pandemic (winter 2018/2019) and medication purchases among participants with regular prescriptions. Conclusion: This study demonstrates the feasibility of integrating individual-level loyalty card data with health information for disease monitoring, presenting a protocol adaptable for larger studies. Key considerations include refining the protocol to ensure inclusivity by addressing age group underrepresentation, health disparities, and digital exclusion. Additionally, resolving discrepancies between self-reported and actual behaviours, and managing data quality variability are essential. Researchers should also focus on gender influences and linking medication purchases to specific health conditions. By addressing these factors, personal loyalty card data could enhance public health surveillance.

Background: Referral processes in Child and Adolescent Mental Health Services (CAMHS) have been reported as stressful and inadequate by young people and parents/carers, who struggle during waiting periods for the referral outcome decision. The Covid19 pandemic was an unprecedented time of distress for young people, parents/carers, and healthcare staff, with increased mental health challenges and stretched staff having to adapt modes of care, thus exacerbating difficulties for CAMHS. Aim: This qualitative study aimed to capture the unique lived experiences of young people, parents/carers, and CAMHS staff during the referral process in the peak of the Covid19 pandemic. Methods: As part of the STADIA trial, between 2020 and 2022, 109 semi-structured interviews across 8 NHS sites were conducted with young people (aged 16-17), parents/carers, and NHS staff including clinicians, commissioners, managers, and researchers embedded in clinical services. Interviews were analysed using thematic analysis. Results: Three themes were elicited to express young people, staff, and parents/carer experiences of the referral process, CAMHS, and the impact of Covid19: 1) referral as a starting point; 2) changes to methods of appointment delivery and their effect on CAMHS experience; and 3) experiences and evaluation of services. Conclusion: Although CAMHS was seen as the pinnacle of mental health support, there was dissatisfaction with waiting times, limited communication, unclear referral processes, and limited clinical capacity and resources for young people, parent/carers, and staff. Covid19 forced CAMHS into adapting to a hybrid model of care, increasing accessibility for young people, parents/carers and staff and highlighting areas for improvement. Secure and consistent support and increases in staff resources are essential to address challenges with CAMHS delivery and improve the experiences of young people, parent/carers, and staff.

This paper describes early results of a small qualitative study investigating the potential impact of shopping loyalty card data (SLCD) in the diagnostic pathway for ovarian cancer. There is early evidence that pharmaceutical products such as pain relief and medications for irritable bowel syndrome and bloating are bought by women to manage the early symptoms of ovarian cancer. Designed to be a formative interview study, two General Practitioners (GPs) in England were recruited to discuss the current pathway of ovarian cancer from a primary care perspective and to consider the value and impact of SLCD in medical decision making, and its potential role in supporting improved referral times and patient outcomes. The findings indicate a potential role for SLCD, specifically in extending the diagnostic pathway to support earlier health information seeking and consultation with GPs. Communication with patients about this would need considering in regards to well established understanding about personal health behaviors and the wider system of primary and community care.

Human factors is an evidence-based scientific discipline used in safety critical industries to improve safety and worker well-being. The implementation of human factors strategies in anaesthesia has the potential to reduce the reliance on exceptional personal and team performance to provide safe and high-quality patient care. To encourage the adoption of human factors science in anaesthesia, the Difficult Airway Society and the Association of Anaesthetists established a Working Party, including anaesthetists and operating theatre team members with human factors expertise and/or interest, plus a human factors scientist, an industrial psychologist and an experimental psychologist/implementation scientist. A three-stage Delphi process was used to formulate a set of 12 recommendations: these are described using a 'hierarchy of controls' model and classified into design, barriers, mitigations and education and training strategies. Although most anaesthetic knowledge of human factors concerns non-technical skills, such as teamwork and communication, human factors is a broad-based scientific discipline with many other additional aspects that are just as important. Indeed, the human factors strategies most likely to have the greatest impact are those related to the design of safe working environments, equipment and systems. While our recommendations are primarily provided for anaesthetists and the teams they work with, there are likely to be lessons for others working in healthcare beyond the speciality of anaesthesia.

Background Shopping data can be analyzed using machine learning techniques to study population health. It is unknown if the use of such methods can successfully investigate prediagnosis purchases linked to self-medication of symptoms of ovarian cancer. Objective The aims of this study were to gain new domain knowledge from women’s experiences, understand how women’s shopping behavior relates to their pathway to the diagnosis of ovarian cancer, and inform research on computational analysis of shopping data for population health. Methods A web-based survey on individuals’ shopping patterns prior to an ovarian cancer diagnosis was analyzed to identify key knowledge about health care purchases. Logistic regression and random forest models were employed to statistically examine how products linked to potential symptoms related to presentation to health care and timing of diagnosis. Results Of the 101 women surveyed with ovarian cancer, 58.4% (59/101) bought nonprescription health care products for up to more than a year prior to diagnosis, including pain relief and abdominal products. General practitioner advice was the primary reason for the purchases (23/59, 39%), with 51% (30/59) occurring due to a participant’s doctor believing their health problems were due to a condition other than ovarian cancer. Associations were shown between purchases made because a participant’s doctor believing their health problems were due to a condition other than ovarian cancer and the following variables: health problems for longer than a year prior to diagnosis (odds ratio [OR] 7.33, 95% CI 1.58-33.97), buying health care products for more than 6 months to a year (OR 3.82, 95% CI 1.04-13.98) or for more than a year (OR 7.64, 95% CI 1.38-42.33), and the number of health care product types purchased (OR 1.54, 95% CI 1.13-2.11). Purchasing patterns are shown to be potentially predictive of a participant’s doctor thinking their health problems were due to some condition other than ovarian cancer, with nested cross-validation of random forest classification models achieving an overall in-sample accuracy score of 89.1% and an out-of-sample score of 70.1%. Conclusions Women in the survey were 7 times more likely to have had a duration of more than a year of health problems prior to a diagnosis of ovarian cancer if they were self-medicating based on advice from a doctor rather than having made the decision to self-medicate independently. Predictive modelling indicates that women in such situations, who are self-medicating because their doctor believes their health problems may be due to a condition other than ovarian cancer, exhibit distinct shopping behaviors that may be identifiable within purchasing data. Through exploratory research combining women sharing their behaviors prior to diagnosis and computational analysis of these data, this study demonstrates that women’s shopping data could potentially be useful for early ovarian cancer detection.

BACKGROUND:A variety of smartphone apps and wearables are available both to help patients monitor their health and to support health care professionals (HCPs) in providing clinical care. As part of the RADAR-CNS consortium, we have conducted research into the application of wearables and smartphone apps in the care of people with multiple sclerosis, epilepsy, or depression.METHODS:We conducted a large online survey study to explore the experiences of HCPs working with patients who have one or more of these conditions. The survey covered smartphone apps and wearables used by clinicians and their patients, and how data from these technologies impacted on the respondents' clinical practice. The survey was conducted between February 2019 and March 2020 via a web-based platform. Detailed statistical analysis was performed on the answers.RESULTS:Of 1009 survey responses from HCPs, 1006 were included in the analysis after data cleaning. Smartphone apps are used by more than half of responding HCPs and more than three quarters of their patients use smartphone apps or wearable devices for health-related purposes. HCPs widely believe the data that patients collect using these devices impacts their clinical practice. Subgroup analyses show that views on the impact of this data on different aspects of clinical work varies according to whether respondents use apps themselves, and, to a lesser extent, according to their clinical setting and job role.CONCLUSIONS:Use of smartphone apps is widespread among HCPs participating in this large European survey and caring for people with epilepsy, multiple sclerosis and depression. The majority of respondents indicate that they treat patients who use wearables and other devices for health-related purposes and that data from these devices has an impact on clinical practice.

Healthcare relies on high levels of human performance, as described by the 'human as the hero' concept. However, human performance varies and is recognised to fall in high-pressure situations, meaning that it is not a reliable method of ensuring safety. Other safety-critical industries embed human factors principles into all aspects of their organisations to improve safety and reduce reliance on exceptional human performance; there is potential to do the same in anaesthesia. Human factors is a broad-based scientific discipline which aims to make it as easy as possible for workers to do things correctly. The human factors strategies most likely to be effective are those which 'design out' the chance of an error or adverse event occurring. When errors or adverse events do happen, barriers are in place to trap them and reduce the risk of progression to patient and/or worker harm. If errors or adverse events are not trapped by these barriers, mitigations are in place to minimise the consequences. Non-technical skills form an important part of human factors barriers and mitigation strategies and include: situation awareness; decision-making; task management; and team working. Human factors principles are not a substitute for proper investment and appropriate staffing levels. Although applying human factors science has the potential to save money in the long term, its proper implementation may require investment before reward can be reaped. This narrative review describes what is known about human factors in anaesthesia to date.

The home is becoming a key location for healthcare delivery, including the use of technology driven by autonomous systems (AS) to monitor and support healthcare plans. Using the example of a smart mirror, this paper describes the outcomes of focus groups with people with multiple sclerosis (MS; n = 6) and people who have had a stroke (n = 15) to understand their attitudes towards the use of AS for healthcare in the home. Qualitative data were analysed using a thematic analysis. The results indicate that the use of such technology depends on the level of adaptability and responsiveness to users’ specific circumstances, including their relationships with the healthcare system. A smart mirror would need to support manual entry, responsive goal setting, the effective aggregation of data sources and integration with other technology, have a range of input methods, be supportive rather than prescriptive in messaging, and give the user full control of their data. The barriers to its adoption include a perceived lack of portability and practicality, a lack of accessibility and inclusivity, a sense of redundancy, feeling overwhelmed by multiple technological devices, and a lack of trust in data sharing. These results inform the development and deployment of future health technologies based on the lived experiences of people with health conditions who require ongoing care.

Introduction Emotional disorders (such as anxiety and depression) are associated with considerable distress and impairment in day-to-day function for affected children and young people and for their families. Effective evidence-based interventions are available but require appropriate identification of difficulties to enable timely access to services. Standardised diagnostic assessment (SDA) tools may aid in the detection of emotional disorders, but there is limited evidence on the utility of SDA tools in routine care and equipoise among professionals about their clinical value. Methods and analysis A multicentre, two-arm, parallel group randomised controlled trial, with embedded qualitative and health economic components. Participants will be randomised in a 1:1 ratio to either the Development and Well-Being Assessment SDA tool as an adjunct to usual clinical care, or usual care only. A total of 1210 participants (children and young people referred to outpatient, specialist Child and Adolescent Mental Health Services with emotional difficulties and their parent/carers) will be recruited from at least 6 sites in England. The primary outcome is a clinician-made diagnosis about the presence of an emotional disorder within 12 months of randomisation. Secondary outcomes include referral acceptance, diagnosis and treatment of emotional disorders, symptoms of emotional difficulties and comorbid disorders and associated functional impairment. Ethics and dissemination The study received favourable opinion from the South Birmingham Research Ethics Committee (Ref. 19/WM/0133). Results of this trial will be reported to the funder and published in full in the Health Technology Assessment (HTA) Journal series and also submitted for publication in a peer reviewed journal. Trial registration number ISRCTN15748675; Pre-results.

Background: Consideration of ergonomic factors is important for the practice of safe and efficient minimally invasive surgery (MIS). Surgeons with smaller glove sizes have previously been reported to have increased difficulties with some minimally invasive instruments. We aim to investigate hand anthropometrics and their relationship to surgeon comfort when using MIS instruments. Methods: Male and female surgeons from two centres were surveyed on their experience of handling MIS instruments and images obtained of the dorsal and palmar aspects of their dominant hand. Photographs of hands were transformed to calibrated coordinates to enable anthropometric measurements of finger length and width as well as palm width and hand span photogrammetrically. Surgeon-perceived discomfort, fatigue, pressure points and techniques to mitigate difficulty handling instruments were compared to hand measurements. Results: Questionnaires were completed by 58 surgeons; 20 (34%) were consultants, 17 (29%) were women. Glove size ranged from 6 to 8 (median 7.5). Male participants had significantly larger hands than females in all measured dimensions. Female surgeons and those with smaller finger and hand dimensions were significantly more likely to experience difficulty or discomfort across a range of variables when using MIS instruments. Conclusions: Surgeons with smaller hands reported increased problems handling MIS instruments. This represents an issue of equity in surgery, with women being more significantly affected than men. Hand size varies greatly between surgeons and anthropometric variability should be considered in design of MIS instruments. (c) 2022 The Authors. Published by Elsevier Ltd on behalf of Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. This is an open access article under the CC BY license (http://creativecommons.org/ licenses/by/4.0/).

Practitioner summary: The study highlights the propensity of face touching whilst driving through the analysis of on-road video datasets. Results have implications for the design of technological interventions (such as touchless interfaces and driver monitoring systems) and can inform awareness campaigns to reduce the risk of self-inoculation and infection transmission while driving. Analysis of thirty-one hours of video-data documenting 36 experienced drivers highlighted the prevalence of face-touching, with 819 contacts identified (mean frequency: 26.4 face touches/hour (FT/h); mean duration: 3.9-seconds). Fewer face-touches occurred in high primary workload conditions (where additional physical/cognitive demands were placed on drivers), compared to low workload (4.4 and 26.1 FT/h, respectively). In 42.5% of touches (or 11.2 FT/h), mucous membrane contact was made, with fingertips (33.1%) and thumbs (35.6%) most commonly employed. Individual behaviours differed (ranging from 5.1 to 90.7 FT/h), but there were no significant differences identified between genders, age-groups or hand used. Results are of relevance from an epidemiological/hygiene perspective within the context of the COVID-19 pandemic (and can therefore inform the design of practical solutions and encourage behavioural change to reduce the risk of self-inoculation while driving), but they also help to elucidate how habitual human behaviours are imbricated with the routine accomplishment of tasks.

We reflect on our experiences using Responsible Research and Innovation (RRI) in the project “TAS for Health at Home”. Driven by a multi-disciplinary research team that consisted of experts in mental health, stroke rehabilitation, management of multiple sclerosis, human factors, human-computer interaction, privacy, cybersecurity, architecture, and Patient and Public Involvement (PPI) groups, the project aimed at eliciting user perceptions of autonomous systems supporting healthcare regimes at home. We discuss the home as a unique place to consider RRI approaches and reflect on the actual process of carrying out RRI within the project, including the multi-disciplinarity of the project, our engagement with PPI groups, and how we involved the wider community concerned with Trustworthy Autonomous Systems (TAS). We conclude by summarising our reflections and providing a first step towards RRI-based guidelines for developing healthcare technology for the home.

Background Epilepsy, multiple sclerosis (MS) and depression are long term, central nervous system disorders which have a significant impact on everyday life. Evaluating symptoms of these conditions is problematic and typically involves repeated visits to a clinic. Remote measurement technology (RMT), consisting of smartphone apps and wearables, may offer a way to improve upon existing methods of managing these conditions. The present study aimed to establish the practical requirements that would enable clinical integration of data from patients’ RMT, according to healthcare professionals. Methods This paper reports findings from an online survey of 1006 healthcare professionals currently working in the care of people with epilepsy, MS or depression. The survey included questions on types of data considered useful, how often data should be collected, the value of RMT data, preferred methods of accessing the data, benefits and challenges to RMT implementation, impact of RMT data on clinical practice, and requirement for technical support. The survey was presented on the JISC online surveys platform. Results Among this sample of 1006 healthcare professionals, respondents were positive about the benefits of RMT, with 73.2% indicating their service would be likely or highly likely to benefit from the implementation of RMT in patient care plans. The data from patients’ RMT devices should be made available to all nursing and medical team members and could be reviewed between consultations where flagged by the system. However, results suggest it is also likely that RMT data would be reviewed in preparation for and during a consultation with a patient. Time to review information is likely to be one of the greatest barriers to successful implementation of RMT in clinical practice. Conclusions While further work would be required to quantify the benefits of RMT in clinical practice, the findings from this survey suggest that a wide array of clinical team members treating epilepsy, MS and depression would find benefit from RMT data in the care of their patients. Findings presented could inform the implementation of RMT and other digital interventions in the clinical management of a range of neurological and mental health conditions.

BACKGROUND Shopping data can be analysed using machine learning techniques to study population health. It is unknown if use of such methods can successfully investigate pre-diagnosis purchases linked to self-medication of symptoms of ovarian cancer. OBJECTIVE To gain new domain knowledge from women’s experiences, to better understand how women’s shopping behaviour relates to their pathway to diagnosis of ovarian cancer, and to inform research on computational analysis of shopping data for insights into population health. METHODS An online survey about individuals’ shopping patterns occurring prior to an ovarian cancer diagnosis was analysed to identify key knowledge about healthcare purchases. Logistic regression and random forest models were employed to statistically examine how products linked to potential symptoms related to presentation to healthcare and timing of diagnosis. RESULTS Of 101 women surveyed with ovarian cancer 58% bought non-prescription healthcare products for up to more than a year prior to diagnosis, including pain relief and abdominal products. General Practitioner advice was the primary reason for purchases (40%), with 51% occurring due to misdiagnosis. Associations were shown between purchases made due to misdiagnosis and the following variables: health problems for longer than a year prior to diagnosis (OR 7.33; 95% CI 1.58 – 33.97), buying healthcare products for more than 6 months to a year (OR 3.82; 95% CI 1.04 – 13.98) or for more than a year (OR 7.64; 95% CI 1.38 – 42.33), and the amount of healthcare product types purchased (OR 1.54; 95% CI 1.13 - 2.11). Purchasing patterns are shown to be potentially predictive of misdiagnosis of women in the study, with nested cross-validation of random forest classification models achieving an average in-sample accuracy score of 89.1%, and 70.1% out-of-sample. CONCLUSIONS The study indicates a delay to diagnosis of ovarian cancer is significantly associated with buying healthcare products due to a doctor’s misdiagnosis. Women in the survey who self-medicated were seven times more likely to wait longer than a year for an accurate diagnosis if their decision to self-medicate was made due to advice from a doctor, rather than independently. Results indicate that misdiagnosis could potentially be identified via analysis of women’s shopping behaviours; and highlight the need to investigate whether receiving advice from a doctor is disproportionately increasing the time women self-manage symptoms before re-seeking help, and leading to prolonged misdiagnosis.