bump2bump: Designing and Evaluating Technology to Promote Maternal Wellbeing in the Transition to Motherhood

The notion of wellbeing is synonymous with feeling competent, supported and satisfied with one’s life. Understanding how to sustain one’s own wellbeing is important at times of significant life change. The transition to motherhood is characterised by major emotional and physiological changes, which can impact on maternal subjective wellbeing and affect pregnancy outcomes. While Human Computer Interaction (HCI) has begun to address some of the challenges in the prevention and treatment of affective disorders in vulnerable perinatal groups, approaches that promote holistic maternal wellbeing in the low-risk majority have received less attention. This thesis draws on the multidisciplinary legacy of digital intervention development, utilising best practice from eHealth and HCI. Six studies using quantitative and qualitative methods were conducted. Study 1 was a systematic, interdisciplinary literature review, which proposed an integrated framework of factors involved in the successful development and evaluation of digital perinatal wellbeing resources. Study 2 used qualitative methods to explore the contextualised usage of digital resources by perinatal women. Studies 3, 4 and 5 involved the iterative development and formative evaluation of a prototype (bump2bump). Study 6 used mixed methods to explore the longitudinal, in-the-wild usage of bump2bump by a group of women as they became mothers. This thesis contributes to current discourse in HCI on how technology might be used positively and presents recommendations regarding the development and use of digital resources in first time pregnancy. Digital resources are increasingly relied upon when community services are lacking, and usage of such resources is particularly nuanced at the transition to motherhood. Design features that support users’ trust in content, facilitate face-to-face interaction with local similar others, and provide brief, practical information were found to be most important in meeting user needs. These findings can be used to inform the development and evaluation of digital perinatal wellbeing resources

A novel experience-based internet intervention for smoking cessation : feasibility randomised controlled trial

The iPEx programme presents independent research funded by the UK National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-0608-10147). The views expressed in this paper are those of the authors, representing iPEx, and not necessarily those of the NHS, the NIHR or the Department of Health.Peer reviewedPublisher PD

HCI and Health: Learning from Interdisciplinary Interactions

HCI has multidisciplinary roots and has drawn from and contributed to different disciplines, including computer science, psychology, sociology, and medicine. There is a natural overlap between health and HCI researchers, given their joint focus on utilising technologies to better support people’s health and wellbeing. However, the best digital health interventions are not simply the result of the ‘application’ of HCI to the domain of healthcare, but emerge when researchers from both camps seek to overcome differences in disciplinary practices, traditions, and values in order to collaborate more effectively and productively. We propose a special interest group (SIG) to include interdisciplinary researchers (i.e., participants active in both communities) as well as researchers from either discipline, but with interests in the other field

Implementing a text message-based intervention to support type 2 diabetes medication adherence in primary care: a qualitative study with general practice staff

Background: The Support through Mobile Messaging and digital health Technology for Diabetes (SuMMiT-D) project has developed, and is evaluating, a mobile phone-based intervention delivering brief messages targeting identified behaviour change techniques promoting medication use to people with type 2 diabetes in general practice. The present study aimed to inform refinement and future implementation of the SuMMiT-D intervention by investigating general practice staff perceptions of how a text message-based intervention to support medication adherence should be implemented within current and future diabetes care. Methods: Seven focus groups and five interviews were conducted with 46 general practice staff (including GPs, nurses, healthcare assistants, receptionists and linked pharmacists) with a potential role in the implementation of a text message-based intervention for people with type 2 diabetes. Interviews and focus groups were audio-recorded, transcribed and analysed using an inductive thematic analysis approach. Results: Five themes were developed. One theme ‘The potential of technology as a patient ally’ described a need for diabetes support and the potential of technology to support medication use. Two themes outlined challenges to implementation, ‘Limited resources and assigning responsibility’ and ‘Treating the patient; more than diabetes medication adherence’. The final two themes described recommendations to support implementation, ‘Selling the intervention: what do general practice staff need to see?’ and ‘Fitting the mould; complementing current service delivery’. Conclusions: Staff see the potential for a text message-based support intervention to address unmet needs and to enhance care for people with diabetes. Digital interventions, such as SuMMiT-D, need to be compatible with existing systems, demonstrate measurable benefits, be incentivised and be quick and easy for staff to engage with. Interventions also need to be perceived to address general practice priorities, such as taking a holistic approach to care and having multi-cultural reach and relevance. Findings from this study are being combined with parallel work with people with type 2 diabetes to ensure stakeholder views inform further refinement and implementation of the SuMMiT-D intervention

Quantified Baby:Parenting and the Use of a Baby Wearable in the Wild

Baby wearable technologies are becoming increasingly popular, particularly in early infancy. However, little research has been conducted to investigate how baby wearable technologies are adopted and used in parenting. This paper presents a two-week in-depth situated study with six mothers in their homes consisting of contextual entry and exit interviews, video recordings of "out-of-box" experiences, and a diary study. Using interpretative phenomenological analysis, participants' use and expectations of the baby wearable technology were examined. Use of the device directly impacted upon parents' knowledge production and anxiety, and influenced the perceived physicality and social factors of parenting. We frame these findings around sociological norms of the vulnerable child and responsible mother, as well as the notion of "lived informatics", where individuals' interaction with the technology influenced the perception, use and impact of the baby wearable on everyday parenting practices and familial relationships

Recruiting patients to a digital self-management study whilst in hospital for a chronic obstructive pulmonary disease exacerbation: A feasibility analysis

Background Patients with chronic obstructive pulmonary disease (COPD) are often hospitalised with acute exacerbations (AECOPD) and many patients get readmitted. Intervening with hospitalised patients may be optimal timing to provide support. Our previous work demonstrated use of a digital monitoring and self-management support tool in the community. However, we wanted to explore the feasibility of recruiting patients whilst hospitalised for an AECOPD, and to identify the rate of dropout attrition around admission for AECOPD. Methods Patients were recruited to the EDGE2 study between May 2019 and March 2020. Patients were identified by the clinical teams and patients were recruited by members of the clinical research team. Participants were aged 40 years or older, had a diagnosis of COPD and were attending or admitted to hospital for an AECOPD. Participants were given a tablet computer, Bluetooth-linked pulse oximeter and wrist-worn physical activity monitor to use until 6 months post-discharge. Use of the system aimed to support COPD self-management by enabling self-monitoring of vital signs, COPD symptoms, mood and physical activity, and access to multi-media educational resources. Results 281 patients were identified and 126 approached. The main referral source was the specialist respiratory nursing and physiotherapist team (49.8% of patients identified). Twenty-six (37.1%) patients were recruited. As of 21 April 2020, 14 (53.8%) participants withdrew and 11 (of 14; 78.6%) participants withdrew within four weeks of discharge. The remaining participants withdrew between one and three months follow-up (1 of 14; 7.1%) and between three and six months follow-up (2 of 14; 14.3%). Conclusion A large number of patients were screened to recruit a relatively small sample and a high rate of dropout was observed. It does not appear feasible to recruit patients with COPD to digital interventional studies from the hospital setting when they have the burden of coping with acute illness

Understanding acceptability in the context of text messages to encourage medication adherence in people with type 2 diabetes

From Springer Nature via Jisc Publications RouterHistory: received 2021-01-29, accepted 2021-05-11, registration 2021-06-22, pub-electronic 2021-06-28, online 2021-06-28, collection 2021-12Publication status: PublishedAbstract: Background: Acceptability is recognised as a key concept in the development of health interventions, but there has been a lack of consensus about how acceptability should be conceptualised. The theoretical framework of acceptability (TFA) provides a potential tool for understanding acceptability. It has been proposed that acceptability measured before use of an intervention (anticipated acceptability) may differ from measures taken during and after use (experienced acceptability), but thus far this distinction has not been tested for a specific intervention. This paper 1) directly compares ratings of anticipated and experienced acceptability of a text message-based intervention, 2) explores the applicability of the TFA in a technology-based intervention, and 3) uses these findings to inform suggestions for measuring acceptability over the lifespan of technology-based health interventions. Methods: Data were obtained from a quantitative online survey assessing anticipated acceptability of the proposed text messages (n = 59) and a 12-week proof-of-concept mixed methods study assessing experienced acceptability while receiving the text messages (n = 48). Both quantitative ratings by return text message, and qualitative data from participant interviews were collected during the proof-of-concept study. Results: The quantitative analysis showed anticipated and experienced acceptability were significantly positively correlated (rs > .4). The qualitative analysis identified four of the seven constructs of the TFA as themes (burden, intervention coherence, affective attitude and perceived effectiveness). An additional two themes were identified as having an important impact on the TFA constructs (perceptions of appropriateness and participants’ role). Three suggestions are given related to the importance of appropriateness, what may affect ratings of acceptability and what to consider when measuring acceptability. Conclusions: The high correlation between anticipated and experienced acceptability was a surprising finding and could indicate that, in some cases, acceptability of an intervention can be gauged adequately from an anticipated acceptability study, prior to an expensive pilot or feasibility study. Directly exploring perceptions of appropriateness and understanding whether the acceptability described by participants is related to the intervention or the research - and is for themselves or others - is important in interpreting the results and using them to further develop interventions and predict future use

Supporting People With Type 2 Diabetes in the Effective Use of Their Medicine Through Mobile Health Technology Integrated With Clinical Care to Reduce Cardiovascular Risk : Protocol for an Effectiveness and Cost-effectiveness Randomized Controlled Trial

Funding Information: The Support Through Mobile Messaging and Digital Health Technology for Diabetes research team acknowledges the support of the National Institute for Health Research (NIHR) through the Clinical Research Networks. AF, LT, and RR have received support from the NIHR Oxford Biomedical Research Centre. RH received support from the NIHR Collaboration for Leadership in Applied Health Research and Care and North Thames at Bart's Health National Health Service (NHS) Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. This paper presents independent research funded by the NIHR under its Program Grants for Applied Research as part of a wider program of work (RP-PG-1214-20003). The authors thank the personnel of the University of Oxford Primary Care and Vaccines Clinical Trials Collaborative for providing support in the conduct of the trial.Peer reviewedPublisher PD

Exploring the potential of digital resources as a source of social support in first time pregnancy

Background First-time pregnancy is a significant life event and holistic maternal wellbeing is important. Dominant social narratives state that pregnancy is a time of fulfilment and stability but many women report feeling otherwise. Healthcare prioritises generic information relating to physical health and psychological support is often overlooked. Up to 20% of women experience clinical levels of anxiety or depression during pregnancy [1] and poor antenatal wellbeing is associated with negative outcomes for mother and baby [2]. Research suggests that standard antenatal care often does not meet women’s wellbeing needs [3] and that poor antenatal wellbeing in uncomplicated first time pregnancy is connected to issues of identity change and low perceived social support [4]. Social support in first time pregnancy is associated with better maternal health, relationship satisfaction, child outcomes and coping [5]. Satisfaction with social support protects against postpartum depressive symptoms and has a positive association with parental self-efficacy [6]. HCI research is starting to explore technology’s growing role in the experience of pregnancy [7]. Pregnant women seek out support in navigating new responsibilities through social connection offered via digital media. Internet and smartphone access and usage is ubiquitous within this group, and research confirms that pregnant women routinely source information and support via the Internet, particularly when they deem their antenatal care to be insufficient [8]. The potential for online resources to provide social connectedness and support to pregnant women is profound [9]. Pregnancy has unquestionably ‘gone wired’ [10]. However, a minority of antenatal digital resources focus specifically on social support: peer-to-peer contact is usually unmoderated and offered as an add-on to the main event of ‘pushed-out’ information dissemination. This is despite women consistently stating a desire to connect with other women ‘like them’ and acknowledgement of the benefits of well-designed online peer support in parenting. Aim This research seeks to answer the following question: Can online peer support during first time pregnancy improve subjective wellbeing? An exploratory approach is being followed with a focus on user studies guiding the development of a working prototype of an online peer support resource. Method / Results In order to answer the research objective, several sub-problems need to be addressed. The project follows the Medical Research Council’s iterative framework for the development of complex interventions [11]. Goal1: Evaluation of current evidence. Methods: The current state of the multidisciplinary evidence for the potential for digital resources to provide social support in first time pregnancy will be evaluated by means of a critical interpretive synthesis of the relevant literatures, to include computer science, digital sociology, perinatal care, wellbeing. Goal 2: Conceptual clarification of ‘wellbeing’ in first time pregnancy. Methods: (i) Conduct semi-structured interviews with pregnant women, mothers and health professionals; (ii) Analysis of the interview data will determine key features of antenatal wellbeing. Goal 3: Understanding what characteristics define those who are willing to engage with online peer support. Methods: (i) Conduct semi-structured interviews with pregnant women, mothers and health professionals; (ii) Analysis of the interview data will determine which group/s of women might find online peer support more useful than others. Goal 4: What are the user requirements of those who are willing to engage with online peer support? Methods: (i) Conduct semi-structured interviews with pregnant women, mothers and health professionals; (ii) Analysis of the interview data will provide basic user requirements which will inform the development of a preliminary prototype. (iii) Test these basic user requirements in subsequent participatory design development cycles. Goal 5: Understanding the impact of the intervention. Methods: (i) Evaluate the prototype ‘in the wild’, incorporating measures of satisfaction, acceptability and adherence. (ii) Conduct interviews with users. Findings from the critical interpretive synthesis and semi-structured interviews will be presented. Conclusions First-time pregnancy is a time of huge physical and emotional change and women often need support. One way of providing this is to provide wellbeing information. However, pregnant women are bombarded with information, much of it generic, conflicting or anecdotal. Large numbers of women look for information and advice online, increasingly engaging with alternative forms of ‘expert’ information, in the form of other people’s experiences. This context provides a unique opportunity for digital resources to act as preventative medicine: bringing women together in a safe online environment allows them to speak freely, develop practical skills and feel supported as they become parents. This in turn relieves healthcare burden by preventing negative maternal and neonatal outcomes. This project will determine the context-driven user needs and requirements of a unique group of people and demonstrates the importance of a multidisciplinary approach to the development of pragmatic digital health solutions