EHPS/DHP Conference 2016: Summary of DHP Award for ‘Outstanding MSc Thesis’ and reflections on conference highlights

As a winner of the DHP award for ‘Outstanding MSc Thesis’, I was invited to present my work at the joint EHPS/DHP Conference 2016 in Aberdeen, Scotland. In this brief report, I provide a summary of my thesis, entitled ‘Understanding user engagement with a novel smoking cessation smartphone application in UK- based adult smokers: An exploratory analysis of usage data from a randomised controlled trial’, and my reflections on the positive aspects of the conference

Acceptability of digital health interventions: embracing the complexity

Acceptability is a core concept in digital health. Available frameworks have not clearly articulated why and how researchers, practitioners and policy makers may wish to study the concept of acceptability. Here, we aim to discuss (i) the ways in which acceptability might differ from closely related concepts, including user engagement; (ii) the utility of the concept of acceptability in digital health research and practice; (iii) social and cultural norms that influence acceptability; and (iv) pragmatic means of measuring acceptability, within and beyond the research process. Our intention is not to offer solutions to these open questions but to initiate a debate within the digital health community. We conducted a narrative review of theoretical and empirical examples from the literature. First, we argue that acceptability may usefully be considered an emergent property of a complex, adaptive system of interacting components (e.g., affective attitude, beliefs), which in turn influences (and is influenced by) user engagement. Second, acceptability is important due to its ability to predict and explain key outcomes of interest, including user engagement and intervention effectiveness. Third, precisely what people find acceptable is deeply contextualized and interlinked with prevailing social and cultural norms. Understanding and designing for such norms (e.g., through drawing on principles of user centered design) is therefore key. Finally, there is a lack of standard acceptability measures and thresholds. Star ratings coupled with free-text responses may provide a pragmatic means of capturing acceptability. Acceptability is a multifaceted concept, which may usefully be studied with a complexity science lens

Association between changes in harm perceptions and e-cigarette use among current tobacco smokers in England: A time series analysis

Background: There is a decreasing trend in the proportion of individuals who perceive e-cigarettes to be less harmful than conventional cigarettes across the UK, Europe and the US. It is important to assess whether this may influence the use of e-cigarettes. We aimed to estimate, using a time series approach, whether changes in harm perceptions among current tobacco smokers have been associated with changes in the prevalence of e-cigarette use in England, with and without stratification by age, sex and social grade. Methods: Respondents were from the Smoking Toolkit Study, which involves monthly cross-sectional household surveys of individuals aged 16+ years in England. Data were aggregated monthly on ~ 300 current tobacco smokers between 2014 and 2019. The outcome variable was the prevalence of e-cigarette use. The explanatory variable was the proportion of smokers who endorsed the belief that e-cigarettes are less harmful than combustible cigarettes. Covariates were cigarette (vs. non-cigarette combustible) current smoking prevalence, past-year quit attempt prevalence and national smoking mass media expenditure. Unadjusted and adjusted autoregressive integrated moving average with exogeneous variables (ARIMAX) models were fitted. Results: For every 1% decrease in the mean prevalence of current tobacco smokers who endorsed the belief that e-cigarettes are less harmful than combustible cigarettes, the mean prevalence of e-cigarette use decreased by 0.48% (βadj = 0.48, 95% CI = 0.25–0.71, p < .001). Marginal age and sex differences were observed, whereby significant associations were observed in older (but not in young) adults and in men (but not in women). No differences by social grade were detected. Conclusions: Between 2014 and 2019 in England, at the population level, monthly changes in the prevalence of accurate harm perceptions among current tobacco smokers were strongly associated with changes in e-cigarette use

Exploring views on alcohol consumption and digital support for alcohol reduction in UK-based Punjabi-Sikh men: A think aloud and interview study

Introduction and Aims: We aimed to explore UK‐based Punjabi‐Sikh men's views on: (i) alcohol consumption within the community; (ii) available support for alcohol reduction; and (iii) an evidence‐informed alcohol reduction app. Design and Methods: Semi‐structured interviews and a think aloud method were employed. Participants (n = 15) were male, aged 18–27 years, identified as Punjabi‐Sikh, were hazardous or harmful drinkers (i.e. had an Alcohol Use Disorders Identification Test‐Consumption score of ≥5) and interested in using an app to reduce drinking. Interviews were audio‐recorded, transcribed verbatim and analysed with inductive thematic analysis. Results: Six themes were developed: (i) fear of drinking to cope; (ii) clash between religious and cultural norms (i.e. an internal conflict between important values); (iii) stigmatisation of mental health issues and lack of knowledge as barriers to help seeking; (iv) perceived usefulness of goal setting, monitoring and feedback (i.e. beliefs about the utility of the app's components for reducing drinking); (v) concerns about accessibility of the app within the Punjabi‐Sikh community; and (vi) desire for human support for continued app engagement. Discussion and Conclusions: Among UK‐based, Punjabi‐Sikh men, clashing religious and cultural norms give rise to internal conflict about drinking. Stigmatisation of mental health issues and lack of knowledge of available support leads to reduced help seeking. Respondents believed an evidence‐informed alcohol reduction app could be useful, but were concerned about accessibility within the wider community and wanted an element of human support. The potential for a combination of digital and face‐to‐face support should be explored

Innovative methods for observing and changing complex health behaviors: Four propositions

Precision health initiatives aim to progressively move from traditional, group-level approaches to health diagnostics and treatments toward ones that are individualized, contextualized, and timely. This article aims to provide an overview of key methods and approaches that can help facilitate this transition in the health behavior change domain. This article is a narrative review of the methods used to observe and change complex health behaviors. On the basis of the available literature, we argue that health behavior change researchers should progressively transition from (i) low- to high-resolution behavioral assessments, (ii) group-only to group- and individual-level statistical inference, (iii) narrative theoretical models to dynamic computational models, and (iv) static to adaptive and continuous tuning interventions. Rather than providing an exhaustive and technical presentation of each method and approach, this article articulates why and how researchers interested in health behavior change can apply these innovative methods. Practical examples contributing to these efforts are presented. If successfully adopted and implemented, the four propositions in this article have the potential to greatly improve our public health and behavior change practices in the near future

A systematic review and meta-analysis of tertiary interventions in clinical burnout

Clinical burnout is one of the leading causes of work absenteeism in high- and middle-income countries. There is hence a great need for the identificationof effective intervention strategies to increase return-to-work (RTW) in this population. This review aimed to assess the effectiveness of tertiary interventions for individuals with clinically significant burnout on RTW and psychological symptoms of exhaustion, depression and anxiety. Four electronic databases (Ovid MEDLINE, PsychINFO, PubMed and CINAHL Plus) were searched in April 2016 for randomized and non-randomized controlled trials of tertiary interventions in clinical burnout. Article screening and data extraction were conducted independently by two reviewers. Pooled odds ratios (ORs) and hazard ratios (HRs) were estimated with random-effects meta-analyses. Eight articles met the inclusion criteria. There was some evidence of publication bias. Included trials were of variable methodological quality. A significant effect of tertiary interventions compared with treatment as usual or wait-list controls on time until RTW was found, HR = 4.5, 95% confidence interval (CI) = 2.15–9.45; however, considerable heterogeneity was detected. The effect of tertiary interventions on full RTW was not significant, OR = 1.33, 95% CI = 0.59–2.98. No significant effects on psychological symptoms of exhaustion, depression or anxiety were observed. In conclusion, tertiary interventions for individuals with clinically significant burnout may be effective in facilitating RTW. Successful interventions incorporated advice from labor experts and enabled patients to initiate a workplace dialogue with their employers

Does the addition of a supportive chatbot promote user engagement with a smoking cessation app? An experimental study

Does the addition of a supportive chatbot promote user engagement with a smoking cessation app? An experimental study Show all authors Olga Perski, David Crane, Emma Beard, ... First Published September 30, 2019 Research Article https://doi.org/10.1177/2055207619880676 Article information Article has an altmetric score of 27 Open AccessCreative Commons Attribution 4.0 License Abstract Objective The objective of this study was to assess whether a version of the Smoke Free app with a supportive chatbot powered by artificial intelligence (versus a version without the chatbot) led to increased engagement and short-term quit success. Methods Daily or non-daily smokers aged ≥18 years who purchased the ‘pro’ version of the app and set a quit date were randomly assigned (unequal allocation) to receive the app with or without the chatbot. The outcomes were engagement (i.e. total number of logins over the study period) and self-reported abstinence at a one-month follow-up. Unadjusted and adjusted negative binomial and logistic regression models were fitted to estimate incidence rate ratios (IRRs) and odds ratios (ORs) for the associations of interest. Results A total of 57,214 smokers were included (intervention: 9.3% (5339); control: 90.7% (51,875). The app with the chatbot compared with the standard version led to a 101% increase in engagement (IRRadj = 2.01, 95% confidence interval (CI) = 1.92–2.11, p < .001). The one-month follow-up rate was 10.6% (intervention: 19.9% (1,061/5,339); control: 9.7% (5,050/51,875). Smokers allocated to the intervention had greater odds of quit success (missing equals smoking: 844/5,339 vs. 3,704/51,875, ORadj = 2.38, 95% CI = 2.19–2.58, p < .001; follow-up only: 844/1,061 vs. 3,704/5,050, ORadj = 1.36, 95% CI = 1.16–1.61, p < .001). Conclusion The addition of a supportive chatbot to a popular smoking cessation app more than doubled user engagement. In view of very low follow-up rates, there is low quality evidence that the addition also increased self-reported smoking cessation

Face masks to prevent community transmission of viral respiratory infections: A rapid evidence review using Bayesian analysis [Preprint, version 1]

Background: Face masks have been proposed as an important way of reducing transmission of viral respiratory infections, including SARS-CoV-2. / Objective: To assess the likelihood that wearing face masks in community settings reduces transmission of viral respiratory infections. / Methods: We conducted a rapid evidence review and used a Bayesian statistical approach to analysing experimental and observational studies conducted in community-dwelling children and adults that assessed the effectiveness of face mask wearing (vs. no face masks) on self-reported, laboratory-confirmed, or clinically diagnosed viral respiratory infections. / Results: Eleven RCTs and 10 observational studies met the inclusion criteria. The calculation of Bayes factors and cumulative posterior odds from the RCTs showed a moderate likelihood of a small effect of wearing surgical face masks in community settings in reducing self-reported influenza-like illness (ILI) (cumulative posterior odds = 3.61). However, the risk of reporting bias was high and evidence of reduction of clinically- or laboratory-confirmed infection was equivocal (cumulative posterior odds = 1.07 and 1.22, respectively). Observational studies yielded evidence of a negative association between face mask wearing and ILI but with high risk of confounding and reporting bias. / Conclusions: Available evidence from RCTs is equivocal as to whether or not wearing face masks in community settings results in a reduction in clinically- or laboratory-confirmed viral respiratory infections. No relevant studies concerned SARS-CoV-2 or were undertaken in community settings in the UK

Smoking and COVID Living Review (v11): a bayesian analysis

Aims: To estimate the association of smoking status with rates of i) infection, ii) hospitalisation, iii) disease severity, and iv) mortality from SARS-CoV-2/COVID-19 disease. Design: Living rapid review of observational and experimental studies with random-effects hierarchical Bayesian meta-analyses. Published articles and pre-prints were identified via MEDLINE and medRxiv. Setting: Community or hospital. No restrictions on location. Participants: Adults who received a SARS-CoV-2 test or a COVID-19 diagnosis. Measurements: Outcomes were SARS-CoV-2 infection, hospitalisation, disease severity and mortality stratified by smoking status. Study quality was assessed (i.e. ‘good’, ‘fair’ and ‘poor’). Findings: v11 (searches up to 2021-02-16) included 405 studies with 62 ‘good’ and ‘fair’ quality studies included in unadjusted meta-analyses. 121 studies (29.9%) reported current, former and never smoking status with the remainder using broader categories. Recorded smoking prevalence among people with COVID-19 was generally lower than national prevalence. Current compared with never smokers were at reduced risk of SARS-CoV-2 infection (RR = 0.71, 95% Credible Interval (CrI) = 0.61-0.82, τ = 0.34). Data for former smokers were inconclusive (RR = 1.03, 95% CrI = 0.95-1.11, τ = 0.17) but favoured there being no important association (4% probability of RR ≥1.1). Former compared with never smokers were at increased risk of hospitalisation (RR = 1.19, CrI = 1.1-1.29, τ = 0.13), greater disease severity (RR = 1.8, CrI = 1.27-2.55, τ = 0.46) and mortality (RR = 1.56, CrI = 1.23-2, τ = 0.43). Data for current smokers on hospitalisation, disease severity and mortality were inconclusive (RR = 1.1, 95% CrI = 0.99-1.21, τ = 0.15; RR 1.26, 95% CrI = 0.92-1.73, τ = 0.32; RR = 1.12, 95% CrI = 0.84-1.47, τ = 0.42, respectively) but favoured there being no important associations with hospitalisation and mortality (49% and 56% probability of RR ≥1.1, respectively) and a small but important association with disease severity (83% probability of RR ≥1.1). Conclusions: Compared with never smokers, current smokers appear to be at reduced risk of SARS-CoV-2 infection while former smokers appear to be at increased risk of hospitalisation, greater disease severity and mortality from COVID-19. However, it is uncertain whether these associations are causal