Imperial College London

MrJackElkes

Faculty of MedicineSchool of Public Health

NIHR Doctoral Fellow
 
 
 
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Contact

 

+44 (0)20 7594 1747j.elkes Website

 
 
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Location

 

Stadium HouseWhite City Campus

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Summary

 

Publications

Publication Type
Year
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10 results found

Blythin AM, Elkes J, van Lindholm T, Bhogal A, Wilkinson TMA, Saville C, Kirk Aet al., 2023, Can digital health apps provide patients with support to promote structured diabetes education and ongoing self-management? A real-world evaluation of myDiabetes usage, Digital Health, Vol: 9, Pages: 1-12, ISSN: 2055-2076

ObjectiveStructured diabetes education has evidenced benefits yet reported uptake rates for those referred to traditional in-person programmes within 12 months of diagnosis were suboptimal. Digital health interventions provide a potential solution to improve diabetes education delivery at population scale, overcoming barriers identified with traditional approaches. myDiabetes is a cloud-based interactive digital health self-management app. This evaluation analysed usage data for people with type 2 diabetes focusing on digital structured diabetes education.MethodsDescriptive quantitative analyses were conducted on existing anonymised user data over 12 months (November 2019–2020) to evaluate whether digital health can provide additional support to deliver diabetes education. Data was divided into two equal 6-month periods. As this overlapped the onset of COVID-19, analyses of its effect on usage were included as a secondary outcome. All data was reported via myDiabetes. Users were prescribed myDiabetes by National Health Service healthcare primary care teams. Those who registered for app use within the study period (n = 2783) were assessed for eligibility (n = 2512) and included if activated.ResultsWithin the study period, n = 1245/2512 (49.6%) registered users activated myDiabetes. No statistically significant differences were observed between gender (p = 0.721), or age (p = 0.072) for those who activated (59.2 years, SD 12.93) and those who did not activate myDiabetes (57.6 years, SD 13.77). Activated users (n = 1119/1245 (89.8%)) viewed 11,572 education videos. No statistically significant differences were observed in education video views across age groups (p = 0.384), gender (p = 0.400), diabetes treatment type (p = 0.839) or smoking status (p = 0.655). Comparison of usage pre-COVID-19 and post-COVID-19 showed statistic

Journal article

Sin J, Henderson C, Elkes J, Cornelius V, Woodham LA, Batchelor R, Chen T, Corredor AM, Coughlan D, Dhital R, Evans S, Haider B, Heathcote J, Mansfield S, O'Brien A, Qassim M, Sserunkuma J, Travis CH, Williams E, Gillard Set al., 2022, Effect of digital psychoeducation and peer support on the mental health of family carers supporting individuals with psychosis in England (COPe-support): a randomised clinical trial, The Lancet Digital Health, Vol: 4, Pages: e320-e329, ISSN: 2589-7500

BACKGROUND: Psychoeducation delivered face-to-face is effective in alleviating mental health morbidities in family carers of individuals with psychosis. However, research in such interventions delivered online is scarce. We evaluated the effectiveness of a digital multicomponent intervention-COPe-support-in improving carers' mental wellbeing and caregiving-related outcomes. METHODS: In this two-arm, individually randomised, superiority trial, people aged 18 years or older who provided at least weekly support in any format for a relative or close friend affected by psychosis across England were randomly assigned (1:1) to either COPe-support or a passive online information resource using an independent online system. Participants were recruited through 30 mental health UK National Health Service trusts. The study team were masked to allocation and assessment of outcomes as all data collection took place online. Participants had access to either condition for 40 weeks and were advised to spend at least half an hour per week over the initial 20 weeks to go through materials at their own pace and to allow time to integrate knowledge and skills learned into practice. It was not feasible to mask participants or the online facilitator to intervention allocation. COPe-support provided psychoeducation on psychosis-related caregiving strategies and forums with professionals and other carers, and the control intervention comprised a passive online information resource. The primary outcome at 20 weeks was mental wellbeing measured by the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS; minimally clinically important difference [MCID] 3). This trial is registered with ISRCTN, 89563420. FINDINGS: Between March 1, 2018, and Feb 14, 2020, 407 participants were randomly assigned, with 204 allocated to COPe-support and 203 allocated to control. The participants (mean age 53·1 years, SD 13·2) were mostly female (330 [81%] of 407 participants) and White (359 [88%] of 407

Journal article

Batchelor R, Gulshan S, Shritharan H, Williams E, Henderson C, Gillard S, Woodham LA, Cornelius V, Elkes J, Sin Jet al., 2022, Perceived acceptability and experiences of a digital psychoeducation and peer support intervention (COPe-support): interview study with carers supporting individuals with psychosis, Journal of Medical Internet Research, Vol: 24, ISSN: 1438-8871

Background:Web-based mental health interventions offer a novel, accessible, and self-paced approach to care delivery to family carers (ie, relatives and close friends who support a loved one with psychosis). We coproduced COPe-support (Carers fOr People with Psychosis e-support), a psychoeducational intervention delivered via an enriched web-based learning environment with network support from professionals and peers. In addition to the rigorous investigation of the effectiveness of COPe-support on the well-being of carers and mental health outcomes, it is imperative to understand the experiences of using the web-based intervention by carers and its associated web-based implementation and facilitation strategies.Objective:This study aims to explore the experiences of carers and perceived acceptability of COPe-support and its different components, how carers found engagement with COPe-support affected their own well-being and caregiving, and the ideas of carers for improving COPe-support and its delivery to inform any future wider implementation.Methods:We conducted a qualitative study, individually interviewing 35 carers, following their use of COPe-support for 8 months through a web-based, randomized controlled trial across England. A semistructured guide with open-ended questions was used to explore the experiences of carers and perceived acceptability of the intervention and their ideas to improve the provision. All interviews were conducted remotely through mobile phones or internet communication media, audio recorded and transcribed verbatim. We used a thematic analysis framework to analyze the data.Results:Three key themes were identified: remote, flexible, and personalized support; impacts on well-being and outlook on caregiving; and future implementation and integration with existing services. Overall, carers found COPe-support a flexible source of knowledge and support from professionals and peers that they could personalize to suit their own needs and conv

Journal article

Batchelor R, Gulshan S, Shritharan H, Williams E, Henderson C, Gillard S, Woodham LA, Cornelius V, Elkes J, Sin Jet al., 2021, Perceived acceptability and experiences of a digital psychoeducation and peer support intervention (COPe-support): interview study with carers supporting individuals with psychosis (Preprint), Publisher: JMIR Publications Inc.

Background:Digital mental health interventions offer a novel, accessible and self-paced approach to care delivery to family carers, i.e., relatives and close friends who support a loved one with psychosis. We co-produced COPe-support, a psychoeducational intervention delivered via an enriched online environment with network support from professionals and peers. In addition to rigorous investigation of the effectiveness of COPe-support on carers’ wellbeing and mental health outcomes, it is imperative to understand carers’ experiences in using the digital intervention and its associated online implementation and facilitation strategies.Objective:This study aimed to explore (1) carers’ experience and perceived acceptability of COPe-support and its different components, and (2) how they found engagement with COPe-support affected their own wellbeing and caregiving.Methods:We conducted a qualitative study, individually interviewing 35 carers after their use of COPe-support for 8 months through an online randomised controlled trial across England. A semi-structured guide with open-ended questions was used to explore carers’ experience and perceived acceptability of the intervention, and their ideas to improve the provision. All interviews were conducted remotely through mobile phone or internet communication media, audio-recorded, and transcribed verbatim. We used the thematic analysis framework approach to analyse the data.Results:Three key themes were identified: (i) remote, flexible and personalised, (ii) impacts on well-being and outlook on caregiving, and (iii) future implementation and integration with existing services. Overall, carers identified COPe-support as a helpful resource for themselves and for their caregiving role. Participants’ experiences, usage and activity on COPe-support varied a great deal and differed amongst carers of various ages and level of computer literacy.Conclusions:Carers found COPe-support a flexible source

Working paper

Sin J, Elkes J, Batchelor R, Henderson C, Gillard S, Woodham LA, Chen T, Aden A, Cornelius Vet al., 2021, Mental health and caregiving experiences of family carers supporting people with psychosis, Epidemiology and Psychiatric Sciences, Vol: 30, Pages: 1-9, ISSN: 2045-7979

Background: Family carers supporting an individual with psychosis often experience distress associated with caregiving responsibility. However, scarce research evidence exists investigating mental health morbidities in carers of people with psychosis. Methods: We conducted an online cross-sectional study with adult carers supporting a relative or close friend with psychosis in England. We collected participants’ demographic and health outcome data, including wellbeing (primary outcome) using Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). We explored the relationships between carers’ characteristics for each outcome in turn, using linear regression. We compared carers’ wellbeing with Health Survey England (HSE 2016) general population data using a meta-analysis.Findings: Between March 2018 and February 2020, 407 carers across England provided study data. Carers had a mean WEMWBS score of 42∙2 (SD 9∙21), and their overall weighted pooled WEMWBS score was 7∙3 (95% CI -8∙6 to -6∙0, p<0∙01) lower than the HSE sample, indicating carers have poorer mental wellbeing by more than double the minimum clinically important difference of 3 points on WEMWBS. Among all caring relationships, partners had poorer wellbeing compared to parents with lower WEMWBS score (-6∙8, -16∙9 to 3∙3, p=0∙03). Single or lone carers had significantly poorer wellbeing (-3∙6, -5∙6 to -1∙5, p<0∙01) than those who were cohabiting.Interpretation: Carers of people with psychosis have poorer mental health than non-carers; partners and lone carers most at risk of poor outcomes. Future large-scale prospective studies are needed to develop a predictive model for healthcare clinicians to use and to inform tailored intervention development.Funding Statement: NIHR Post-Doctoral Research Fellowship.Declaration of Interests: All authors have no conflicts of interests to declare.Ethics Approval Statement: The RCT has been reviewed and approved by South Central – Oxford C Research Et

Journal article

North M, Bourne S, Green B, Chauhan AJ, Brown T, Winter J, Jones T, Neville D, Blythin A, Watson A, Johnson M, Culliford D, Elkes J, Cornelius V, Wilkinson TMAet al., 2020, A randomised controlled feasibility trial of E-health application supported care vs usual care after exacerbation of COPD: the RESCUE trial (vol 3, 145, 2020), npj Digital Medicine, Vol: 3, ISSN: 2398-6352

Journal article

North M, Bourne S, Green B, Chauhan A, Brown T, Winter J, Jones T, Neville D, Blythin A, Watson A, Johnson M, Culliford D, Elkes J, Cornelius V, Wilkinson Tet al., 2020, A randomised controlled feasibility trial of E-health application supported care vs usual care after exacerbation of COPD: The RESCUE trial, npj Digital Medicine, Vol: 3, Pages: 1-8, ISSN: 2398-6352

Exacerbations of COPD are one of the commonest causes of admission and re-admission to hospital. The role of digital interventions to support self-management in improving outcomes is uncertain. We conducted an open, randomised controlled trial of a digital health platform application (app) in 41 COPD patients recruited following hospital admission with an acute exacerbation. Subjects were randomised to either receive usual care, including a written self-management plan (n=21), or the myCOPD app (n=20) for 90 days. The primary efficacy outcome was recovery rate of symptoms measured by COPD Assessment Test (CAT) score. Exacerbations, readmission, inhaler technique quality of life and patient activation (PAM) scores were also captured by a blinded team. The app 24 was acceptable in this care setting and was used by 17 of the 21 patients with sustained use over the study period. The treatment effect on CAT score was 4.49 (95% CI: -8.41, -0.58) points lower in the myCOPD arm. Patients’ inhaler technique improved in the digital intervention arm (101 improving to 20 critical errors) compared to usual care (100 to 72 errors). Exacerbations tended to be less frequent in the digital arm compared to usual care; 34 vs 18 events. Hospital readmissions risk was numerically lower in the digital intervention arm: OR for readmission 0.383 (95%CI 0.074, 1.987; n=35). In this feasibility study of the digital self-management platform myCOPD, the app has proven acceptable to patients to use and use has improved exacerbation recovery rates, with strong signals of lower re-exacerbation and re-admission rates over 90 days. myCOPD reduced the number of critical errors in inhaler technique compared to usual care with written self-management. This provides a strong basis for further exploration of the use of app interventions in the context of recently hospitalised patients with COPD and informs the potential design of a large multi-centre trial

Journal article

Crooks M, Elkes J, Storrar W, Roy K, North M, Blythin A, Watson A, Cornelius V, Wilkinson Tet al., 2020, Evidence generation for the clinical impact of myCOPD in patients with mild, moderate and newly diagnosed COPD: a randomised controlled trial, ERJ Open Research, Vol: 6, Pages: 1-10, ISSN: 2312-0541

Self-management interventions in COPD aim to improve patients’ knowledge, skills and confidence to make correct decisions, thus improving health status and outcomes. myCOPD is a web-based self-management app known to improve inhaler use and exercise capacity in individuals with more severe COPD. We explored its impact in patients with mild-moderate or recently diagnosed COPD through a 12-week, 34open-label, parallel-group, randomised-controlled trial of myCOPD compared with usual care. The co-primary outcomes were between group differences in mean COPD assessment test (CAT) score at 90 days and critical inhaler errors. Key secondary outcomes were app usage and patient activation measurement (PAM) score. 3860 patients were randomised (29 myCOPD, 31 usual care). Groups were balanced for FEV1% predicted but baseline imbalance between groups for exacerbation frequency and CAT score. There was no significant adjusted mean difference in CAT score at study completion, -1.27 (95% CI -4.47 to 1.92, p=0.44) lower in COPD. However increasing app use associated with greater CAT score improvement. The odds of ≥1 critical inhaler error was lower in the myCOPD arm (adjusted odds ratio of 0.30 (0.09; 431.06, p=0.061)). The adjusted odds ratio for being in a higher PAM level at 90 days was 1.65 (0.46; 5.85) in favour of myCOPD. The small sample size and phenotypic difference between groups limited our ability to demonstrate statistically significant evidence of benefit beyond inhaler technique. However, our findings provide important insights into associations between increased app use and clinically meaningful benefit 48warranting further study in real world settings.

Journal article

Sin J, Henderson C, Cornelius V, Chen T, Elkes J, Woodham LA, Hernandez AS, Spence-Polin D, Batchelor R, Gillard Set al., 2020, COPe-support-a multi-component digital intervention for family carers for people affected by psychosis: study protocol for a randomized controlled trial, BMC Psychiatry, Vol: 20, Pages: 1-14, ISSN: 1471-244X

BackgroundPsychosis often causes significant distress and impacts not only in the individuals, but also those close to them. Many relatives and friends (‘carers’) provide long-term support and need resources to assist them. We have co-produced a digital mental health intervention called COPe-support (Carers fOr People with Psychosis e-support) to provide carers with flexible access to high quality psychoeducation and interactive support from experts and peers. This study evaluates the effectiveness of COPe-support to promote mental wellbeing and caregiving experiences in carers.MethodsThis study is a single-blind, parallel arm, individually randomized controlled trial (RCT) comparing COPe-support, with attention control. Both groups continue to receive usual care. COPe-support provides interactive web-based psychoeducation on psychosis-related issues, wellbeing-promotion and network support through forums. The attention-control is a non-interactive online information resource pack. Carers living in England are eligible if they provide at least weekly support to a family member or close friend affected by psychosis, and use internet communication (including emails) daily. All trial procedures are run online, including collection of outcome measurements which participants will directly input into our secure platform. Following baseline assessment, a web-based randomization system will be used to allocate 360 carers to either arm. Participants have unlimited access to the allocated condition for 40 weeks. Data collection is at three time points (10, 20, and 40 weeks after randomization). Analyses will be conducted by trial statisticians blinded to allocation. The primary outcome is mental wellbeing measured by Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), at 20 weeks. As well as an intention-to-treat analysis, a complier average causal effect (CACE) analysis will be conducted to estimate the intervention effect in participants who

Journal article

Sin J, Elkes J, Batchelor R, Henderson C, Gillard S, Woodham LA, Chen T, Aden A, Cornelius Vet al., Mental Health and Caregiving Experiences of Family Carers Supporting People with Psychosis, Publisher: Elsevier BV

Working paper

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