Publications
63 results found
Zaman TN, Mujahid K, Mahmud S, et al., 2022, What are the barriers and facilitators to seeking help for mental health in NHS doctors: a systematic review and qualitative study, BMC Psychiatry, Vol: 22, Pages: 1-24, ISSN: 1471-244X
BackgroundThe mental health of healthcare professionals is reaching a breaking point, and the COVID-19 pandemic has exacerbated current mental health issues to unprecedented levels. Whilst some research has been carried out on the barriers that doctors face when seeking mental health help, there is little research into factors which may facilitate seeking help. We aimed to expand the research base on factors which act as barriers to seeking help, as well as gain insight into facilitators of help-seeking behaviour for mental health in NHS doctors.Methods We conducted a systematic literature review which identified the barriers and facilitators to seeking help for mental health in healthcare professionals. Following this, we conducted semi-structured interviews with 31 NHS doctors about their experiences with mental health services. Finally, through thematic analysis, key themes were synthesised from the data.ResultsOur systematic literature review uncovered barriers and facilitators from pre-existing literature, of which the barriers were: preventing actions, self-stigma, perceived stigma, costs of seeking treatment, lack of awareness and availability of support, negative career implications, confidentiality concerns and a lack of time to seek help. Only two facilitators were found in the pre-existing literature, a positive work environment and availability of support services. Our qualitative study uncovered additional barriers and facilitators, of which the identified barriers include: a negative workplace culture, lack of openness, expectations of doctors and generational differences. The facilitators include positive views about mental health, external confidential service, better patient outcomes, protected time, greater awareness and accessibility, open culture and supportive supervisors.ConclusionOur study began by identifying barriers and facilitators to seeking mental health help in healthcare workers, through our systematic literature review. We contributed
Shabir H, D'Costa M, Mohiaddin Z, et al., 2022, The barriers and facilitators to the use of lifestyle apps: a systematic review of qualitative studies, European Journal of Investigation in Health, Psychology and Education, Vol: 12, Pages: 144-165, ISSN: 2254-9625
Background: Mobile-health applications are revolutionising the way healthcare is being delivered. However, current research focusses on apps aimed at monitoring of conditions rather than the prevention of disease. Healthcare apps that prevent disease can be classified as lifestyle apps (LAs) and encompass mindfulness, exercise, and diet apps. In order for widespread implementation of these apps, perspectives of the user must be taken into consideration. Therefore, this systematic literature review identifies the barriers and facilitators to the use of LAs from a user’s perspective. Objective: To both identify the facilitators to the use of LAs from a user perspective as well as identify the barriers to the use of LAs from a user perspective. Methods: A systematic literature review was conducted following PRISMA guidelines. Qualitative articles focussed on a healthy non-diseased population were obtained. Two independent researchers coded the articles, and themes were identified. Results: Our results found that there were five barriers and five facilitators to app use. The facilitators included (1) motivational aspects to the user, (2) effective marketing and communication, (3) user-centred design and content, (4) humanising technology, and (5) accessibility. The five barriers identified were (1) a non-conducive, (2) poor marketing and branding, (3) controlling and invasive, (4) disengaging content, and (5) inaccessibility. Conclusions: By overcoming the barriers of LAs and encouraging the facilitators found, users are more likely to engage with this method of health promotion. Future research must be conducted on the barriers and facilitators to development and distribution of apps in order for LAs to be implemented in widespread healthcare practice.
Dawoodbhoy FM, Delaney J, Cecula P, et al., 2021, AI in patient flow: applications of artificial intelligence to improve patient flow in NHS acute mental health inpatient units, Heliyon, Vol: 7, ISSN: 2405-8440
Introduction:Growing demand for mental health services, coupled with funding and resource limitations, creates an opportunity for novel technological solutions including artificial intelligence (AI). This study aims to identify issues in patient flow on mental health units and align them with potential AI solutions, ultimately devising a model for their integration at service level.Method:Following a narrative literature review and pilot interview, 20 semi-structured interviews were conducted with AI and mental health experts. Thematic analysis was then used to analyse and synthesise gathered data and construct an enhanced model.Results:Predictive variables for length-of-stay and readmission rate are not consistent in the literature. There are, however, common themes in patient flow issues. An analysis identified several potential areas for AI-enhanced patient flow. Firstly, AI could improve patient flow by streamlining administrative tasks and optimising allocation of resources. Secondly, real-time data analytics systems could support clinician decision-making in triage, discharge, diagnosis and treatment stages. Finally, longer-term, development of solutions such as digital phenotyping could help transform mental health care to a more preventative, personalised model.Conclusions:Recommendations were formulated for NHS trusts open to adopting AI patient flow enhancements. Although AI offers many promising use-cases, greater collaborative investment and infrastructure are needed to deliver clinically validated improvements. Concerns around data-use, regulation and transparency remain, and hospitals must continue to balance guidelines with stakeholder priorities. Further research is needed to connect existing case studies and develop a framework for their evaluation.
Cecula P, Yu J, Dawoodbhoy F, et al., 2021, Applications of artificial intelligence to improve patient flow on mental health inpatient units - Narrative literature review, Heliyon, Vol: 7, ISSN: 2405-8440
Background:Despite a growing body of research into both Artificial intelligence and mental health inpatient flow issues, few studies adequately combine the two. This review summarises findings in the fields of AI in psychiatry and patient flow from the past 5 years, finds links and identifies gaps for future research.Methods:The OVID database was used to access Embase and Medline. Top journals such as JAMA, Nature and The Lancet were screened for other relevant studies. Selection bias was limited by strict inclusion and exclusion criteria.Research:3,675 papers were identified in March 2020, of which a limited number focused on AI for mental health unit patient flow. After initial screening, 323 were selected and 83 were subsequently analysed. The literature review revealed a wide range of applications with three main themes: diagnosis (33%), prognosis (39%) and treatment (28%). The main themes that emerged from AI in patient flow studies were: readmissions (41%), resource allocation (44%) and limitations (91%). The review extrapolates those solutions and suggests how they could potentially improve patient flow on mental health units, along with challenges and limitations they could face.Conclusion:Research widely addresses potential uses of AI in mental health, with some focused on its applicability in psychiatric inpatients units, however research rarely discusses improvements in patient flow. Studies investigated various uses of AI to improve patient flow across specialities. This review highlights a gap in research and the unique research opportunity it presents.
Sayma M, Saleh D, Kerwat D, et al., 2020, A qualitative inquiry into the barriers and facilitators to achieving home death, BMJ Supportive and Palliative Care, Vol: 10, ISSN: 2045-4368
OBJECTIVES: To explore the barriers and facilitators to patients achieving death at home. METHODS: In-depth, semistructured interviews with end-of-life care experts were conducted to develop an insight into the barriers and facilitators to achieving death at home. Thirty-three interviews were conducted compromising of a mixture of face-to-face and tele interviews. Experts included healthcare professionals working in the community, hospital and policy/academic settings. Thematic analysis was undertaken on interview transcripts. RESULTS: Three overarching themes, further divided into a total of 12 subthemes were identified. The three themes were 'managing people', 'education' and 'planning'. The 'managing people' theme included subthemes of patient preferences and family influences; the 'education' theme encompassed knowledge and training, perceptions of death and communication and the 'planning' theme contained seven subthemes including 'coordination', 'resources' and 'cost'. CONCLUSIONS: Multiple barriers and facilitators to achieving death at home were identified in this study. Of particular significance was the identification of the fear and stigma associated with death among doctors, patients and their families serving as a barrier to home death, not previously identified in the literature. Additionally, the importance of social networks and resource provision were highlighted as key in influencing patient death at home.
Silva G, Gor R, Patel N, et al., 2019, How effective are organ donation committees, and how can they be improved?, British Journal of Health Care Management, Vol: 25, Pages: 113-121, ISSN: 1358-0574
Background: Organ donation committees were established in 2008 by NHS Blood and Transplant to improve the rates of organ donation in the UK. Aims: The aims of this study were three-fold: to review the role and structure of organ donation committees in England; to assess how effective organ donation committees are at driving improvements; and to make recommendations regarding the future role, responsibilities and structure of organ donation committees. Methods: This study adopted a cross-sectional mixed-methods research approach using questionnaires and semi-structured interviews. results: There was a divergence between how each committee functioned and how effective they were in achieving their aims. Discussion: There were seven key findings which related to the effectiveness of organ donation committees. These included, but were not limited to, a lack of consistency in how the role of an organ donation committee was viewed by members of NHS Blood and Transplant; and that the influence a chair has within their respective NHS Trust is key to an organ donation committee being effective in achieving its aims. conclusion: A framework and several recommendations were produced and aimed to help improve the effectiveness of organ donation committees.
Ahmed I, Ahmad NS, Ali S, et al., 2018, Medication adherence apps: A review and content analysis, JMIR mHealth and uHealth, Vol: 6, ISSN: 2291-5222
Background:Medication adherence is a costly and damaging problem for both healthcare providers and patients alike. Patients adhere to only 50% of drugs prescribed for chronic diseases in developed nations. Digital health has paved the way for innovative smartphone solutions to tackle this challenge. However, despite the numerous applications (apps) available claiming to improve adherence, a thorough review of adherence applications has not been carried out to date.Objective:(i)To review medication adherence apps (otherwise known as mAdherence app) in the Apple App store and the Google Play repository in terms of their evidence base, medical professional involvement in development, and strategies used to facilitate behaviour change and improve adherence.(ii)To provide a system of classification for these apps. Methods:In April 2015, relevant mAdherence apps were identified by systematically searching the Apple and Google Play app stores using a combination of relevant search terms. Data extracted for each app included app store source, app price, documentation of healthcare professional (HCP) involvement during app development and evidence base for each respective app.Free apps were downloaded to explore the strategies used to promote medication adherence. Testing involved a standardised medication regimen of three reminders over a four-hour period. Non-adherence features designed to enhance user experience were also documented.Results:The App repository search identified a total of 5889 applications. 806 fulfilled the inclusion criteria initially and were tested. 682 applications were further analysed for data extraction. Of these, 61.7% were free for testing, 8.5% were inaccessible and 29.8% required payment. Of the 421 free applications, 13.8% were developed with HCP involvement and an evidence base was identified in only 0.95%. Of the paid apps, 4.4% had HCP involvement, 0.5% had a documented evidence base and 0.5% had both. 31% of inaccessible apps were produce
Weldon SM, Kelay T, Ako E, et al., 2017, Sequential simulation used as a novel educational tool aimed at healthcare managers: a patient-centred approach, BMJ Simulation & Technology Enhanced Learning, Vol: 4, Pages: 13-18, ISSN: 2056-6697
Background A new challenge for healthcare managers is to improve the patient experience. Simulation is often used for clinical assessment and rarely for those operating outside of direct clinical care. Sequential simulation (SqS) is a form of simulation that re-creates care pathways, widening its potential use.Local problem Numbers, outcome measures and system profiling are used to inform healthcare decisions. However, none of these captures the personal subtleties of a patient’s experience.Intervention 56 students attended a teaching module using SqS and facilitated workshops as part of their induction week on an MSc International Health Management course. The workshop was voluntary and was offered as an opportunity for the students to gain an insight into the UK health system through the medium of simulation.Methods An evaluation survey incorporating quantitative and qualitative student feedback was conducted. Descriptive statistics were generated from the quantitative data, and thematic analysis was undertaken for the qualitative data.Results There was strong agreement for the acceptability of the workshop approach in relation to the aims and objectives. Likert scale (1–-5) mean total=4.49. Participants responded enthusiastically (revealed through the qualitative data) with ideas related to perspectives sharing, understanding healthcare management and processes and the consideration of feasibility and practicalities. They also suggested other applications that SqS could be used for.Conclusion The SqS approach has demonstrated that simulation has a wider potential than for clinical assessment alone. Further studies are required to determine its potential uses and affordances beyond its current format.
Wahid AS, Sayma M, Jamshaid S, et al., 2017, Barriers and facilitators influencing death at home: A meta-ethnography., Palliative Medicine, ISSN: 0269-2163
BACKGROUND: In many countries, achieving a home death represents a successful outcome from both a patient welfare and commissioning viewpoint. Significant variation exists in the proportion of home deaths achieved internationally, with many countries unable to meet the wishes of a large number of patients. This review builds on previous literature investigating factors influencing home death, synthesising qualitative research to supplement evidence that quantitative research in this field may have been unable to reach. AIM: To identify and understand the barriers and facilitators influencing death at home. DESIGN: Meta-ethnography. DATA SOURCES: The review adhered to the PRISMA guidelines. A systematic literature search was conducted using five databases: PubMed, EMBASE, Ovid, CINAHL and PsycINFO. Databases were searched from 2006 to 2016. Empirical, UK-based qualitative studies were included for analysis. RESULTS: A total of 38 articles were included for analysis. Seven overarching barriers were identified: lack of knowledge, skills and support among informal carers and healthcare professionals; informal carer and family burden; recognising death; inadequacy of processes such as advance care planning and discharge; as well as inherent patient difficulties, either due to the condition or social circumstances. Four overarching facilitators were observed: support for patients and healthcare professionals, skilled staff, coordination and effective communication. CONCLUSION: Future policies and clinical practice should develop measures to empower informal carers as well as emphasise earlier commencement of advance care planning. Best practice discharge should be recommended in addition to addressing remaining inequity to enable non-cancer patients greater access to palliative care services.
Lefevre DJ, cox B, 2016, Delayed instructional feedback may be more effective, but is this contrary to learners' preferences?, British Journal of Educational Technology, Vol: 48, Pages: 1357-1367, ISSN: 0007-1013
This research investigates learners' preferences for the timing of feedback provided to multiple-choice questions within technology-based instruction, hitherto an area of little empirical attention. Digital materials are undergoing a period of renewed prominence within online learning and multiple-choice questions remain a common component. There is evidence that a delay in the provision of feedback following a learner's response to multiple-choice questions leads to an increase in subsequent performance. However, the learner's perspective on delayed feedback is yet to be explored. Learner preferences are pertinent as learning designs that run contrary to preferred learning behaviours can have a negative affect on motivation and therefore engagement. During a series of formative tests, subjects were presented with a choice of viewing either immediate or delayed feedback and their choices were recorded. Over a 2-year period data were collected relating to 599 subjects. Qualitative interviews were also conducted to investigate why subjects made their choices. In this research, subjects expressed a marked preference for immediate feedback, 95.33% chose to view feedback immediately following their response to a question. The reasons for this preference are explored and the implications for learning design are considered.
Lefevre D, Cox B, 2016, Feedback in technology-based instruction: Learner preferences, BRITISH JOURNAL OF EDUCATIONAL TECHNOLOGY, Vol: 47, Pages: 248-256, ISSN: 0007-1013
King D, Zaman S, Zaman SS, et al., 2015, Identifying Quality Indicators Used by Patients to Choose Secondary Health Care Providers: A Mixed Methods Approach, JMIR MHEALTH AND UHEALTH, Vol: 3, ISSN: 2291-5222
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- Citations: 10
Murugesh-Warren A, Dubb S, Sudbury D, et al., 2015, An extension of the UTAUT 2 with a focus of age in healthcare: What do different ages want?, INTERNATIONAL JOURNAL OF INTEGRATED CARE, Vol: 15, ISSN: 1568-4156
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- Citations: 1
Johnston MJ, King D, Arora S, et al., 2014, Requirements of a new communication technology for handover and the escalation of patient care: a multi-stakeholder analysis, Journal of Evaluation in Clinical Practice, Vol: 20, Pages: 486-497, ISSN: 1356-1294
Rationale, aims and objectivesIn order to enable safe and efficient information transfer between health care professionals during clinical handover and escalation of care, existing communication technologies must be updated. This study aimed to provide a user‐informed guide for the development of an application‐based communication system (ABCS), tailored for use in patient handover and escalation of care.MethodsCurrent methods of inter‐professional communication in health care along with information system needs for communication technology were identified through literature review. A focus group study was then conducted according to a topic guide developed by health innovation and safety researchers. Fifteen doctors and 11 nurses from three London hospitals participated in a mixture of homogeneous and heterogeneous sessions. The sessions were recorded and transcribed verbatim before being subjected to thematic analysis.ResultsSeventeen information system needs were identified from the literature review. Participants identified six themes detailing user perceptions of current communication technology, attitudes to smartphone technology and anticipated requirements of an application produced for handover and escalation of care. Participants were in favour of an ABCS over current methods and expressed enthusiasm for a system with integrated patient information and group‐messaging functions.ConclusionDespite concerns regarding confidentiality and information governance a robust guide for development and implementation of an ABCS was produced, taking input from multiple stakeholders into account. Handover and escalation of care are vital processes for patient safety and communication within these must be optimized. An ABCS for health care professionals would be a welcome innovation and may lead to improvements in patient safety.
Kesavan S, Kelay T, Collins RE, et al., 2013, Clinical information transfer and data capture in the acute myocardial infarction pathway: an observational study, JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Vol: 19, Pages: 805-811, ISSN: 1356-1294
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- Citations: 6
Gauher ST, Khehar R, Rajput G, et al., 2013, The factors that influence attitudes toward organ donation for transplantation among UK university students of Indian and Pakistani descent, CLINICAL TRANSPLANTATION, Vol: 27, Pages: 359-367, ISSN: 0902-0063
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- Citations: 25
Kelay T, Kesavan S, Collins RE, et al., 2013, Techniques to aid the implementation of novel clinical information systems: A systematic review, INTERNATIONAL JOURNAL OF SURGERY, Vol: 11, Pages: 783-791, ISSN: 1743-9191
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- Citations: 1
Yang X, Han R, Guo Y, et al., 2012, Modelling and performance analysis of clinical pathways using the stochastic process algebra PEPA, Bmc Bioinformatics, Vol: 13, ISSN: 1471-2105
Cox B, Kuzmenko O, Swartzman S, 2010, Ethical data sharing involving industry: Government-industry collaboration
Collaborations that involve the sharing of medical and biometric data between government and industry partners present particular ethical challenges. In this paper, ethical implications of data sharing and recommendations for data management in these collaborations are identified. Recommendations for adhering to privacy laws and examples of government-industry collaborations using medical or biometric data are also discussed. Conflicts of interest, ownership, and the purpose of the collaboration are identified as pertinent ethical issues. These issues and recommendations are intended to contribute to international debate and consensus-building among experts. This investigation contributes to the European Union's FP7 ETHICAL Project, which aims to encourage international discussion on medical and biometric data ethics. Copyright © 2010 The Authors.
Swartzman S, Cox B, 2010, Information technology and ethical international data sharing
The exchange of medical and biometric data across borders can present ethical concerns and dilemmas. This paper provides examples of existing national and international normative frameworks, including binding legislation and non-binding guidelines on international data sharing, to illustrate the status quo and cross-national inconsistencies. Ethical implications of these normative frameworks and of international data sharing in general are discussed. Ethical recommendations extracted from academic literature on transborder data flows are sampled. This analysis of current norms and ethical implications and recommendations is intended to promote international debate towards a consensus on ethical exchange of medical and biometric data between countries. Copyright © 2010 The Authors.
Siew ST, Mohd-Nor R, Swartzman S, et al., 2010, Ethical implications of digitised medical and biometric data
In this paper, ethical implications of data collection, use and retention of medical and biometric data in biometrics and medical applications are identified. These implications are discussed in the context of five main ethical principles - privacy, confidentiality, security, property and ownership, and reliability and trustworthiness. In addition, to illustrate unethical uses of medical and biometric data, cases of misuse are described. Our research contributes to the European Union's FP7 ETHICAL project, which aims to promote international debate on ethical implications of data collection, use, and retention of biometric and medical data. Copyright © 2010 The Authors.
Meyer D, Cox B, 2010, Can Signalling Theory and the Semaphoric Nature of Information Systems Explain Clinicians' Ambivalence to Informatics?, 13th World Congress on Medical and Health Informatics of International-Medical-Informatics-Association (Medinfo), Publisher: IOS PRESS, Pages: 671-675, ISSN: 0926-9630
Bayer S, Petsoulas C, Cox B, et al., 2010, Facilitating stroke care planning through simulation modelling, Health Informatics Journal, Vol: 16, Pages: 129-143
Stroke is a leading cause of death and long-term severe disability. A major difficulty facing stroke care provision in the UK is the lack of service integration between the many authorities, professionals and stakeholdersinvolved in the process. The objective of this article is to describe a prototype model to support integrative planning for local stroke care services. The model maps the flow of care in the acute and community segments of the care pathway for stroke patients and allows xploring alternatives for care provision. Simulationmodelling can help to develop an understanding of the systemic impact of service change and improve the design and targeting of future services.
Morris S, Cox B, Bosanquet N, 2009, Cost of skin cancer in England, EUROPEAN JOURNAL OF HEALTH ECONOMICS, Vol: 10, Pages: 267-273, ISSN: 1618-7598
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- Citations: 35
Cauldwell M, Beattie C, Cox B, et al., 2007, The Impact of Electronic Patient Records on Workflow in General Practice, Health Informatics Journal, Vol: 13, Pages: 155-160, ISSN: 1460-4582
Cox B, Lefevre D, Brenton H, 2007, Towards an osmotic strategy for overcoming academic attitudinal barriers to e-learning, 2nd International Conference on e-Learning (ICEL 2007), Publisher: ACADEMIC CONFERENCES LTD, Pages: 113-116
Handley K, Cox B, 2007, 'Beyond model answers: learners' perceptions of self-assessment materials in e-learning applications', ALT-J Research in Learning Technology, Vol: 15, Pages: 21-36, ISSN: 0968-7769
Lefevre DJ, Cox B, 2006, Do cultural schemata impact on students’ engagement with eLearning content?, CATaC 2006
Lefevre DJ, Cox B, Bourguet M-J, et al., 2005, Adaptive learning environments to overcome cultural and language barriers to learning, IADIS International Conference on Cognition and Exploratory Learning in Digital Age
Morris S, Cox B, Bosanquet N, 2005, Cost of skin cancer in England (Discussion Paper), TBS/DP05/39
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