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Aims: A 10-month project funded by the NewMind network sought to develop the specification of a visualisation toolbox that could be applied on digital platforms (web- or app-based) to support adults with lived experience of mental health difficulties to present and track their personal wellbeing in a multi-media format. Methods: A participant co-design methodology, Double Diamond from the Design Council (Great Britain), was used consisting of four phases: Discover – a set of literature and app searches of wellbeing and health visualisation material; Define – an initial workshop with participants with lived experience of mental health problems to discuss wellbeing and visualisation techniques and to share personal visualisations; Develop – a second workshop to add detail to personal visualisations, for example, forms of media to be employed, degree of control over sharing; and Deliver – to disseminate the learning from the exercise. Results: Two design workshops were held in December 2017 and April 2018 with 13 and 12 experts-by-experience involved, respectively, including two peer researchers (co-authors) and two individual-carer dyads in each workshop, with over 50% of those being present in both workshops. A total of 20 detailed visualisations were produced, the majority focusing on highly personal and detailed presentations of wellbeing. Discussion: While participants concurred on a range of typical dimensions of wellbeing, the individual visualisations generated were in contrast to the techniques currently employed by existing digital wellbeing apps and there was a great diversity in preference for different visualisation types. Participants considered personal visualisations to be useful as self-administered interventions or as a step towards seeking help, as well as being tools for self-appraisal. Conclusion: The results suggest that an authoring approach using existing apps may provide the high degree of flexibility required. Training on such tools, delivered via a module on a recovery college course, could be offered.

Background Remote measurement technologies (RMT) can be used to collect data on a variety of bio-behavioral variables, which may improve the care of patients with central nervous system disorders. Although various studies have explored their potential, prior work has highlighted a knowledge gap in health care professionals’ (HCPs) perceptions of the value of RMT in clinical practice. Objective This study aims to understand HCPs’ perspectives on using RMT in health care practice for the care of patients with depression, epilepsy, or multiple sclerosis (MS). Methods Semistructured interviews were conducted with 26 multidisciplinary primary and secondary care HCPs who care for patients with epilepsy, depression, or MS. Interviews were transcribed verbatim and analyzed using thematic analysis. Results A total of 8 main themes emerged from the analysis: (1) potential clinical value of RMT data; (2) when to use RMT in care pathways; (3) roles of health care staff who may use RMT data; (4) presentation and accessibility of data; (5) obstacles to successful use of RMT; (6) limits to the role of RMT; (7) empowering patients; and (8) considerations around alert-based systems. Conclusions RMT could add value to the system of care for patients with central nervous system disorders by providing clinicians with graphic summaries of data in the patient record. Barriers of both technical and human nature should be considered when using these technologies, as should the limits to the benefits they can offer.

Background: Traditional evaluation methods are not keeping pace with rapid developments in mobile health. More flexible methodologies are needed to evaluate mHealth technologies, particularly simple, self-help tools. One approach is to combine a variety of methods and data to build a comprehensive picture of how a technology is used and its impact on users. Objective: This paper aims to demonstrate how analytical data and user feedback can be triangulated to provide a proportionate and practical approach to the evaluation of a mental wellbeing smartphone app (‘In Hand’). Methods: A three-part process was used to collect data: 1) app analytics; 2) an online user survey; and 3) interviews with users. Findings: Analytics showed that >50% of user sessions counted as ‘meaningful engagement’. User survey findings (N=108) revealed that In Hand was perceived to be helpful on several dimensions of mental wellbeing. Interviews (N=8) provided insight into how these self-reported positive effects were understood by users. Conclusions: This evaluation demonstrates how different methods can be combined to complete a real-world, naturalistic evaluation of a self-help digital tool and provide insights into how and why an app is used and its impact upon users’ wellbeing. Clinical implications: This triangulation approach to evaluation provides insight into how wellbeing apps are used and their perceived impact on users’ mental wellbeing. This approach is useful for mental healthcare professionals and commissioners who wish to recommend simple digital tools to their patients and evaluate their uptake, use and benefits.

User-centred evaluation of brain-training and coaching applications is discussed, with a focus on dementia. A brief outline of outcomes measures used for cognitive training is presented. The design of a set of four patient and public involvement workshops is described which are intended to examine user aspects of relevance to brain-training, including motivation, attitudes to learning, trust in technology and cultural relationships to the playing of games and their content. The groups involved researchers, facilitators, three people living with dementia and three care-givers, two of these being dyads. Data was audio recorded and field notes were taken. Initial results are given from the ongoing qualitative study.

Appropriate measurement of emotional health by all those working with children and young people is an increasing focus for professional practice. Most of the tools used for assessment or self-assessment of emotional health were designed in the mid-20th century using language and technology derived from pen and paper written texts. However, are they fit for purpose in an age of pervasive computing with increasingly rich audiovisual media devices being in the hands of young people? This thought piece explores how the increased use of visual imagery, especially forms that can be viewed or created on digital devices, might provide a way forward for more effective measuring of emotional health, including smiley faces, other emojis and other potential forms of visual imagery. The authors bring together perspectives from healthcare, counselling, youth advocacy, academic research, primary care and school-based mental health support to explore these issues.

IntroductionMany patients with psychosis experience everyday social situations as anxiety-provoking. The fears can arise, for example, from paranoia, hallucinations, social anxiety or negative-self beliefs. The fears lead patients to withdraw from activities, and this isolation leads to a cycle of worsening physical and mental health. Breaking this cycle requires highly active treatment directly in the troubling situations so that patients learn that they can safely and confidently enter them. However patients with psychosis seldom receive such life-changing interventions. To solve this problem we have developed an automated psychological treatment delivered in virtual reality (VR). It allows patients to experience computer simulations of the situations that they find anxiety-provoking. A virtual coach guides patients, using cognitive techniques, in how to overcome their fears. Patients are willing to enter VR simulations of anxiety-provoking situations because they know the simulations are not real, but the learning made transfers to the real world.Methods and analysis432 patients with psychosis and anxious avoidance of social situations will be recruited from National Health Service (NHS) secondary care services. In the gameChange trial, they will be randomised (1:1) to the six-session VR cognitive treatment added to treatment as usual or treatment as usual alone. Assessments will be conducted at 0, 6 (post-treatment) and 26 weeks by a researcher blind to allocation. The primary outcome is avoidance and distress in real-life situations, using a behavioural assessment task, at 6 weeks. The secondary outcomes are psychiatric symptoms, activity levels and quality of life. All main analyses will be intention-to-treat. Moderation and mediation will be tested. An economic evaluation will be conducted.Ethics and disseminationThe trial has received ethical approval from the NHS South Central - Oxford B Research Ethics Committee (19/SC/0075). A key output will be a high-quality automated VR treatment for patients to overcome anxious avoidance of social situations.Trial registration numberISRCTN17308399.

Background: With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge.\ud \ud \ud Objective: The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research.\ud \ud \ud Methods: Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases.\ud \ud \ud Results: According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies.\ud \ud \ud Conclusions: Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.

BackgroundGuidelines in the United Kingdom recommend that medication titration for attention deficit hyperactivity disorder (ADHD) should be completed within 4-6 weeks and include regular reviews. However, most clinicians think that weekly clinic contact is infeasible, and audits have shown that this timeline is rarely achieved. Thus, a more effective monitoring and review system is needed; remote monitoring technology (RMT) may be one way to improve current practice. However, little is known about whether patients with ADHD, their families, and clinicians would be interested in using RMT. ObjectiveTo explore patients’, parents’, and health care professionals’ views and attitudes toward using digital technology for remote monitoring during titration for ADHD. MethodsThis was a qualitative study, and data were collected through 11 focus groups with adults and young people with ADHD, parents of children with ADHD, and health care professionals (N=59). ResultsAll participant groups were positive about using RMT in the treatment of ADHD, but they were also aware of barriers to its use, especially around access to technology and integrating RMT into clinical care. They identified that RMT had the most potential for use in the ongoing management and support of ADHD, rather than during the distinct titration period. Participants identified features of RMT that could improve the quality of consultations and support greater self-management. ConclusionsRMT has the potential to augment support and care for ADHD, but it needs to go beyond the titration period and offer more to patients and families than monitoring through outcome measures. Developing and evaluating an mHealth app that incorporates the key features identified by end users is required.

The practice of evaluating interaction with devices is embedded in disciplines such as human-computer interaction and cognitive ergonomics, including concepts such as affordances, error analysis, skill, rule and knowledge based behaviour and decision making biases. This paper considers the way in which the approach that has been routinely applied to displays and control design within the control and transport domains can be transferred to the context of medical devices. The importance of considering the context in which medical devices are used and implemented is presented, and the need for a systems approach to medical device design is emphasised. Five case studies from medical device control and display design are presented as an aide to developing an understanding of the relationship between device design and resultant behaviours. On the basis of these case studies, four types of mediating factors (catalysts, enablers, facilitators and enhancers) are proposed and a model to describe the link between device design, user, context and consequences is presented.

IntroductionTourette syndrome and chronic tic disorder are common, disabling childhood-onset conditions. Guidelines recommend that behavioural therapy should be offered as first-line treatment for children with tics. However, there are very few trained behaviour therapists for tics and many patients cannot access appropriate care. This trial investigates whether an internet-delivered intervention for tics can reduce severity of symptoms.Methods and analysisThis parallel-group, single-blind, randomised controlled superiority trial with an internal pilot will recruit children and young people (aged 9–17 years) with tic disorders. Participants will be randomised to receive 10 weeks of either online, remotely delivered, therapist-supported exposure response prevention behavioural therapy for tics, or online, remotely delivered, therapist-supported education about tics and co-occurring conditions. Participants will be followed up mid-treatment, and 3, 6, 12 and 18 months post randomisation.The primary outcome is reduction in tic severity as measured on the Yale Global Tic Severity Scale total tic severity score. Secondary outcomes include a cost-effectiveness analysis and estimate of the longer-term impact on patient outcomes and healthcare services. An integrated process evaluation will analyse quantitative and qualitative data in order to fully explore the implementation of the intervention and identify barriers and facilitators to implementation. The trial is funded by the National Institute of Health Research (NIHR), Health Technology Assessment (16/19/02).Ethics and disseminationThe findings from the study will inform clinicians, healthcare providers and policy makers about the clinical and cost-effectiveness of an internet delivered treatment for children and young people with tics. The results will be submitted for publication in peer-reviewed journals. The study has received ethical approval from North West Greater Manchester Research Ethics Committee (ref.: 18/NW/0079).Trial registration numbersISRCTN70758207andNCT03483493; Pre-results.

Early stage Health Technology Assessment (HTA) of biomedical devices requires different methods than those usually employed for pharmaceuticals. This paper reviews widely used methods for HTA, discusses their limits for early stage evaluation of biomedical devices and presents two methods for early stage HTA being developed in the Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH) project: Analytic Hierarchy Process (AHP) to elicit user needs; and early stage economic evaluations using Markov Models.

Advances in image-guided technology have resulted in a number of technologies to support surgeons in the identification of tissue and the tracking and navigation of surgical instruments in spinal surgery. There are various existing and proposed systems to support registration and intra-operative image guidance based on fluoroscopy, Computerized Tomography (CT), Magnetic Resonance Imaging (MRI) and ultrasound (US) or combinations of imaging modalities. However, the user requirements for the design of such systems are complex, dependent on medical specialty in addition to the range of instrumented and non-instrumented treatments offered in the orthopedic and neurological domains. This paper presents a review and study of user requirements for intra-operative navigation in spinal surgery. The numerous outcomes measures for successful operations are outlined, that provide a basis for understanding the needs of surgeons. A hierarchy of needs is then presented that can be used to inform an Analytic Hierarchy Process for elicitation of detailed user requirements.

Two case studies of the development of Smartphone self-reporting mHealth applications are described: a wellness diary for asthma management combined with Bluetooth pulse oximeter and manual peak flow measurements; and a questionnaire for ecological assessment of distress during fertility treat-ment. Results are presented of user experiences with the self-reporting applica-tion and the capture of physiological measurements in the case of the asthma diary project and the findings from a phone audit at an early stage of design in the case of the in vitro fertilisation (IVF) study. Issues raised by ethics commit-tees are also discussed. It is concluded that the optimal adoption of Smartphone self-reporting applications will require a good appreciation of user and ethics panel requirements at an early stage in their development, so that the correct de-sign choices can be made.

This chapter outlines the co-design process for ‘Let’s meet up!’, a hybrid electronic system, which combines traditional board games and digital features, created to facilitate and maintain social engagement for people living with dementia. It allows people with dementia to stay in touch with their loved ones and to remain socially and physically active by arranging joint activities for themselves through a simple, user-friendly tangible interface. Let’s meet up! is one of four solutions developed by a multidisciplinary team of researchers and people living with dementia as part of the European MinD project. The aim of MinD was to research and co-develop mindful design solutions to support people with dementia and their caregivers with self-empowerment and social engagement. Co-design with groups of experts with experience (GEE), including people with dementia, caregivers and care professionals, was used throughout the research and development process, comprising data collection, design idea development, decision-making, design concept and prototype development, to ensure the relevance and appropriateness of those ideas, concepts and prototypes for people with dementia. Co-production was increasingly used to enable GEE to co-host and co-curate the co-design sessions, and to take ownership of the process. The chapter explains the process of research and the activities undertaken and provides recommendations for this symbiotic approach, taking into account both the benefits and the limitations.

Online walkthrough interviews were conducted via internet video-calling, which formed part of wider Patient and Public Involvement activities investigating perceptions of digital and gamified cognitive assessment and training/coaching applications. Participants were invited to play a series of mobile mini-games which have been developed for the purposes of training of executive functions and the assessment of memory, whilst verbalizing their thought processes, using a process based on the Think-Aloud Protocol and Cognitive Walkthrough principles, before concluding with a semi-structured interview. The enquiry was particularly interested in wider motivational aspects surrounding these technologies, including identifying potential barriers to engagement and facilitators of adoption. In general, there was broad acceptance of digital cognitive assessments and training, although issues of data handling and trust were raised by participants. Several usability issues were also captured.