Imperial College London

DrLorainneTudor Car

Faculty of MedicineSchool of Public Health

Honorary Senior Research Fellow
 
 
 
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Contact

 

l.tudor.car

 
 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
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180 results found

Martinengo L, Lin X, Jabir AI, Kowatsch T, Atun R, Car J, Tudor Car Let al., 2023, Conversational Agents in Health Care: Expert Interviews to Inform the Definition, Classification, and Conceptual Framework., J Med Internet Res, Vol: 25

BACKGROUND: Conversational agents (CAs), or chatbots, are computer programs that simulate conversations with humans. The use of CAs in health care settings is recent and rapidly increasing, which often translates to poor reporting of the CA development and evaluation processes and unreliable research findings. We developed and published a conceptual framework, designing, developing, evaluating, and implementing a smartphone-delivered, rule-based conversational agent (DISCOVER), consisting of 3 iterative stages of CA design, development, and evaluation and implementation, complemented by 2 cross-cutting themes (user-centered design and data privacy and security). OBJECTIVE: This study aims to perform in-depth, semistructured interviews with multidisciplinary experts in health care CAs to share their views on the definition and classification of health care CAs and evaluate and validate the DISCOVER conceptual framework. METHODS: We conducted one-on-one semistructured interviews via Zoom (Zoom Video Communications) with 12 multidisciplinary CA experts using an interview guide based on our framework. The interviews were audio recorded, transcribed by the research team, and analyzed using thematic analysis. RESULTS: Following participants' input, we defined CAs as digital interfaces that use natural language to engage in a synchronous dialogue using ≥1 communication modality, such as text, voice, images, or video. CAs were classified by 13 categories: response generation method, input and output modalities, CA purpose, deployment platform, CA development modality, appearance, length of interaction, type of CA-user interaction, dialogue initiation, communication style, CA personality, human support, and type of health care intervention. Experts considered that the conceptual framework could be adapted for artificial intelligence-based CAs. However, despite recent advances in artificial intelligence, including large language models, the technology is not able to ensure

Journal article

Tudor Car L, 2023, Smartphone apps for point-of-care information summaries: systematic assessment of the quality and content, BMJ Evidence-Based Medicine, Vol: 28, Pages: 320-327, ISSN: 2515-446X

Background Clinicians need easy access to evidence-based information to inform their clinical practice. Point-of-care information summaries are increasingly available in the form of smartphone apps. However, the quality of information from the apps is questionable as there is currently no regulation on the content of the medical apps.Objectives This study aimed to systematically assess the quality and content of the medical apps providing point-of-care information summaries that were available in two major app stores. We evaluated apps designed specifically for healthcare professionals and assessed their content development, editorial policy, coverage of medical conditions and trustworthiness.Methods We conducted a systematic assessment of medical apps providing point-of-care information summaries available in Google Play and Apple app stores. Apps launched or updated since January 2020 were identified through a systematic search using 42matters. Apps meeting the inclusion criteria were downloaded and assessed. The data extraction and app assessment were done in parallel and independently by at least two reviewers. Apps were evaluated against the adapted criteria: (1) general characteristics, (2) content presentation of the summaries, (3) editorial quality, (4) evidence-based methodology, (5) coverage (volume) of the medical conditions, (6) usability of apps and (7) trustworthiness of the app based on HONcode principles. HONcode principles are guidelines used to inform users about the credibility and reliability of health information online. The results were reported as a narrative review.Results Eight medical apps met the inclusion criteria and were systematically appraised. Based on our evaluation criteria, UpToDate supported 16 languages, and all other apps were English. Bullet points and brief paragraphs were used in all apps, and only DynaMed and Micromedex and Pathway-medical knowledge provided a formal grading system for the strength of recommendations for al

Journal article

Roystonn K, AshaRani PV, Devi F, Wang P, Zhang Y, Jeyagurunathan A, Abdin E, Car LT, Chong SA, Subramaniam Met al., 2023, Exploring views and experiences of the general public's adoption of digital technologies for healthy lifestyle in Singapore: a qualitative study, Frontiers in Public Health, Vol: 11, ISSN: 2296-2565

Objective: Little is known about the general adult population’s adoption of digital technology to support healthy lifestyle, especially when they are expected to take greater personal responsibility for managing their health and well-being today. The current qualitative study intended to gain an in-depth understanding of determinants of digital technology adoption for healthy lifestyle among community-dwelling adults in Singapore.Design: A qualitative study design, with thematic framework analysis was applied to develop themes from the data.Setting: Semi-structured individual interviews were conducted with participants either face-to-face or online through a videoconferencing platform.Participants: 14 women and 16 men from the general population who were between the ages of 22 and 71 years.Results: Three major themes were developed: (1) digitally disempowered (2) safety and perceived risks and harm; (3) cultural values and drives. Adoption of technology among the general population is needs-driven, and contingent on individual, technological and other cross-cultural contextual factors.Conclusion: Our findings highlight there is no one solution which fits all individuals, emphasizing the challenges of catering to diverse groups to reduce barriers to adoption of digital technologies for healthy lifestyle. Digital guidance and training, as well as social influences, can motivate technological adoption in the population. However, technical problems as well as data security and privacy concerns should first be adequately addressed. This study provides rich cross-cultural insights and informs policy-making due to its alignment with government public health initiatives to promote healthy lifestyle.

Journal article

Lin X, Martinengo L, Jabir AI, Ho AHY, Car J, Atun R, Car LTet al., 2023, Scope, Characteristics, Behavior Change Techniques, and Quality of Conversational Agents for Mental Health and Well-Being: Systematic Assessment of Apps, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 25, ISSN: 1438-8871

Journal article

Ng MSP, Jabir AI, Ng TDR, Ang Y-I, Chia JL, Tan DNH, Lee J, Mahendran DCJ, Car LT, Chia CLKet al., 2023, Evaluating TESLA-G, a gamified, telegram-delivered, quizzing platform for surgical education in medical students: protocol for a pilot randomised controlled trial, BMJ OPEN, Vol: 13, ISSN: 2044-6055

Journal article

Tan JW, Chong DKS, Ng KB, Car LT, Mogali SRet al., 2023, Rehearsal-based digital serious boardgame versus a game-free e-learning tool for anatomical education: Quasi-randomized controlled trial, ANATOMICAL SCIENCES EDUCATION, ISSN: 1935-9772

Journal article

Wolfenden L, Close S, Finch M, Lecathelinais C, Ramanathan S, De Santis KK, Car LT, Doyle J, McCrabb Set al., 2023, Improving academic and public health impact of Cochrane public health reviews: what can we learn from bibliographic metrics and author dissemination strategies? A cross-sectional study, JOURNAL OF PUBLIC HEALTH, ISSN: 1741-3842

Journal article

Castro O, Mair JL, Salamanca-Sanabria A, Alattas A, Keller R, Zheng S, Jabir A, Lin X, Frese BF, Lim CS, Santhanam P, van Dam RM, Car J, Lee J, Tai ES, Fleisch E, von Wangenheim F, Car LT, Mueller-Riemenschneider F, Kowatsch Tet al., 2023, Development of "LvL UP 1.0": a smartphone-based, conversational agent-delivered holistic lifestyle intervention for the prevention of non-communicable diseases and common mental disorders, FRONTIERS IN DIGITAL HEALTH, Vol: 5

Journal article

Momtazmanesh S, Moghaddam SS, Ghamari S-H, Rad EM, Rezaei N, Shobeiri P, Aali A, Abbasi-Kangevari M, Abbasi-Kangevari Z, Abdelmasseh M, Abdoun M, Abdulah DM, Abdullah AYM, Abedi A, Abolhassani H, Abrehdari-Tafreshi Z, Achappa B, Adane DEA, Adane TD, Addo IY, Adnan M, Adnani QES, Ahmad S, Ahmadi A, Ahmadi K, Ahmed A, Ahmed A, Rashid TA, Al Hamad H, Alahdab F, Alemayehu A, Alif SM, Aljunid SM, Almustanyir S, Altirkawi KA, Alvis-Guzman N, Dehkordi JA, Amir-Behghadami M, Ancuceanu R, Andrei CL, Andrei T, Antony CM, Anyasodor AE, Arabloo J, Arulappan J, Ashraf T, Athari SS, Attia EF, Ayele MT, Azadnajafabad S, Babu AS, Bagherieh S, Baltatu OC, Banach M, Bardhan M, Barone-Adesi F, Barrow A, Basu S, Bayileyegn NS, Bensenor IM, Bhardwaj N, Bhardwaj P, Bhat AN, Bhattacharyya K, Bouaoud S, Braithwaite D, Brauer M, Butt MH, Butt ZA, Calina D, Camera LA, Chanie GS, Charalampous P, Chattu VK, Chimed-Ochir O, Chu D-T, Cohen AJ, Cruz-Martins N, Dadras O, Darwesh AM, Das S, Debela SA, Delgado-Ortiz D, Dereje D, Dianatinasab M, Diao N, Diaz D, Digesa LE, Dirirsa G, Doku PN, Dongarwar D, Douiri A, Dsouza HL, Eini E, Ekholuenetale M, Ekundayo TC, Elagali AEM, Elhadi M, Enyew DB, Erkhembayar R, Etaee F, Fagbamigbe AF, Faro A, Fatehizadeh A, Fekadu G, Filip I, Fischer F, Foroutan M, Franklin RC, Andras Gaal P, Gaihre S, Gaipov A, Gebrehiwot M, Gerema U, Getachew ME, Getachew T, Ghafourifard M, Ghanbari R, Ghashghaee A, Gholami A, Gil AU, Golechha M, Goleij P, Golinelli D, Guadie HA, Gupta B, Gupta S, Gupta VB, Gupta VK, Hadei M, Halwani R, Hanif A, Hargono A, Harorani M, Hartono RK, Hasani H, Hashi A, Hay S, Heidari M, Hellemons ME, Herteliu C, Holla R, Horita N, Hoseini M, Hosseinzadeh M, Huang J, Hussain S, Hwang B-F, Iavicoli I, Ibitoye SE, Ibrahim S, Ilesanmi OS, Ilic IM, Ilic MD, Immurana M, Ismail NE, Merin JL, Jakovljevic M, Jamshidi E, Janodia MD, Javaheri T, Jayapal SK, Jayaram S, Jha RP, Johnson O, Joo T, Joseph N, Jozwiak JJ, Vaishali K, Kaambwa B, Kabir Z, Kalankesh LR, Kalhet al., 2023, Global burden of chronic respiratory diseases and risk factors, 1990-2019: an update from the Global Burden of Disease Study 2019, ECLINICALMEDICINE, Vol: 59

Journal article

Jabir AI, Lin X, Martinengo L, Sharp G, Theng Y-L, Tudor Car Let al., 2023, Attrition in conversational agent delivered mental health interventions: A systematic review and meta-analysis (Preprint), Journal of Medical Internet Research

Journal article

Jabir AI, Martinengo L, Lin X, Torous J, Subramaniam M, Car LTet al., 2023, Evaluating Conversational Agents for Mental Health: Scoping Review of Outcomes and Outcome Measurement Instruments, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 25, ISSN: 1438-8871

Journal article

Salamanca-Sanabria A, Jabir AI, Lin X, Alattas A, Kocaballi AB, Lee J, Kowatsch T, Car LTet al., 2023, Exploring the Perceptions of mHealth Interventions for the Prevention of Common Mental Disorders in University Students in Singapore: Qualitative Study, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 25, ISSN: 1438-8871

Journal article

Global Burden of Disease 2021 Health Financing Collaborator Network, 2023, Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026, The Lancet Global Health, Vol: 11, Pages: e385-e413, ISSN: 2214-109X

BACKGROUND: The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. METHODS: In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. FINDINGS: In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95% uncertainty interval [UI] 9·1-9·3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7·3 trillion (95% UI 7·2-7·4) in 2019; 293·7 times the $24·8 billion (95% UI 24·3-25·3) spent by low-income countries in 20

Journal article

Lee M, Bin Mahmood ABS, Lee ES, Smith HE, Car LTet al., 2023, Smartphone and Mobile App Use Among Physicians in Clinical Practice: Scoping Review, JMIR MHEALTH AND UHEALTH, Vol: 11, ISSN: 2291-5222

Journal article

Kingsland M, Barnes C, Doherty E, McCrabb S, Finch M, Cumpston M, Armstrong R, Car LT, Doyle J, Wolfenden Let al., 2022, Identifying topics for future Cochrane Public Health reviews, JOURNAL OF PUBLIC HEALTH, Vol: 44, Pages: E578-E581, ISSN: 1741-3842

Journal article

Soon CSL, Car LT, Ng CJ, Tan NC, Smith Het al., 2022, What Is the Utility of Posters? Qualitative Study of Participants at a Regional Primary Healthcare Conference in Asia, MEDICAL SCIENCE EDUCATOR, Vol: 32, Pages: 1405-1412

Journal article

Chan FHF, Goh ZZS, Zhu X, Car LT, Newman S, Khan BA, Griva Ket al., 2022, Subjective cognitive complaints in end-stage renal disease: a systematic review and meta-analysis, HEALTH PSYCHOLOGY REVIEW, ISSN: 1743-7199

Journal article

Martinengo L, Jabir AI, Goh WWT, Lo NYW, Ho M-HR, Kowatsch T, Atun R, Michie S, Car LTet al., 2022, Conversational Agents in Health Care: Scoping Review of Their Behavior Change Techniques and Underpinning Theory, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 24, ISSN: 1438-8871

Journal article

Subramaniam M, Lau JH, Asharani P, Abdin E, Roystonn K, Wang P, Devi F, Vaingankar JA, Car LT, Sum CF, Lee ES, van Dam RM, Chong SAet al., 2022, Sources of information on diabetes and its demographic correlates: a nationwide survey among Singapore residents, HEALTH PROMOTION INTERNATIONAL, Vol: 37, ISSN: 0957-4824

Journal article

Dhinagaran DA, Car LT, 2022, Public perceptions of a healthy lifestyle change conversational agent in Singapore: A qualitative study, DIGITAL HEALTH, Vol: 8, ISSN: 2055-2076

Journal article

Dhinagaran DA, Martinengo L, Ho M-HR, Joty S, Kowatsch T, Atun R, Car LTet al., 2022, Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER): Development of a Conceptual Framework, JMIR MHEALTH AND UHEALTH, Vol: 10, ISSN: 2291-5222

Journal article

Soon MKS, Martinengo L, Lu J, Car LT, Chia CLKet al., 2022, The Use of Telegram in Surgical Education: Exploratory Study., JMIR Med Educ, Vol: 8, ISSN: 2369-3762

BACKGROUND: The COVID-19 pandemic has disrupted medical education, shifting learning online. Social media platforms, including messaging apps, are well integrated into medical education. However, Telegram's role in medical education remains relatively unexplored. OBJECTIVE: This study aims to explore the perceptions of medical students regarding the role of messaging apps in medical education and their experience of using Telegram for surgical education. METHODS: A Telegram channel "Telegram Education for Surgery Learning and Application (TESLA)" was created to supplement medical students' learning. We invited 13 medical students who joined the TESLA channel for at least a month to participate in individual semistructured interviews. Interviews were conducted via videoconferencing using an interview guide and were then transcribed and analyzed by 2 researchers using inductive thematic content analysis. RESULTS: Two themes were identified: (1) learning as a medical student and (2) the role of mobile learning (mLearning) in medical education. Students shared that pandemic-related safety measures, such as reduced clinic allocations and the inability to cross between wards, led to a decrease in clinical exposure. Mobile apps, which included proprietary study apps and messaging apps, were increasingly used by students to aid their learning. Students favored Telegram over other messaging apps and reported the development of TESLA as beneficial, particularly for revision and increasing knowledge. CONCLUSIONS: The use of apps for medical education increased during the COVID-19 pandemic. Medical students commonly used apps to consolidate their learning and revise examination topics. They found TESLA useful, relevant, and trustworthy.

Journal article

Peng Ng MS, Jabir AI, De Rong Ng T, Ang Y-I, Chia JL, Hao Tan DN, Lee J, Junis Mahendran DC, Car LT, Khng Chia CLet al., 2022, Evaluating TESLA-G, a gamified, Telegram-delivered, quizzing platform for surgical education in medical students: a protocol for a pilot randomised controlled trial

<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>Online multiple-choice question (MCQ) quizzes are popular in medical education due to their ease of access and ability for test-enhanced learning. However, a general lack of motivation among students often results in decreasing usage over time. We aim to address this limitation by developing Telegram Education for Surgical Learning and Application Gamified (TESLA-G), an online platform for surgical education that incorporates game elements into conventional MCQ quizzes.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>This online, pilot randomised control trial will be conducted over two weeks. Fifty full-time undergraduate medical students will be recruited and randomised into an intervention group (TESLA-G) and an active control group (non-gamified quizzing platform) with a 1:1 allocation ratio, stratified by year of study.</jats:p><jats:p>We will evaluate TESLA-G in the area of endocrine surgery education. Our platform is designed based on Bloom’s taxonomy of learning domains: questions are created in blocks of 5 questions per endocrine surgery topic, with each question corresponding to one level on Bloom’s taxonomy. This structure promotes mastery while boosting student engagement and motivation. All questions are created by two board-certified general surgeons and one endocrinologist, and validated by the research team.</jats:p><jats:p>The feasibility and acceptability of the pilot study will be assessed by participant recruitment and retention rates, acceptability of the intervention, adherence and task completion rate, fidelity of the intervention delivery, and perception of the intervention. The effectiveness of the intervention (TESLA-G) compared to the control will be assessed by improvement in knowledge from pre- to post-intervent

Journal article

Chen S, Sam XH, Soong A, Car LT, Lian S, Smith HEet al., 2022, Recruitment of general practitioners in China: a scoping review of strategies and challenges, BMC PRIMARY CARE, Vol: 23

Journal article

Tudor Car L, Chan FHF, Lin X, Griva K, Subramaniam M, Ćelić Iet al., 2022, Information needs and sources of information among people with depression and anxiety: a scoping review, BMC Psychiatry, Vol: 22, ISSN: 1471-244X

Background: Previous studies have identified substantial unmet information needs in people with depression and anxiety. Sufficient information about the disorder, treatment, available services, and strategies for self-management is essential as it may influence quality of care and patients’ quality of life. This scoping review aimed to provide a broad overview of information needs of people with depression and anxiety as well as the sources that they use to seek this information.Methods: We included all primary research published in English that investigated information needs or information sources in people with depression or anxiety, with no restrictions imposed on the study design, location, setting, or participant characteristics. Six electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, LISTA, Web of Science) and the grey literature (Google and Google Scholar) were searched for relevant studies published up to November 2021. Two reviewers independently screened articles and extracted data. Narrative synthesis was performed to identify key themes of information needs and information sources. Factors associated with information needs/sources such as demographic variables and symptom severity were also identified.Results: Fifty-six studies (comprising 8320 participants) were included. Information needs were categorised into seven themes, including general facts, treatment, lived experience, healthcare services, coping, financial/legal, and other information. The most frequently reported needs in both people with depression and anxiety were general facts and treatment information. Subclinical samples who self-reported depressive/anxious symptoms appeared less interested in treatment information than patients with clinical diagnoses. Information sources were summarised into five categories: health professionals, written materials, media, interpersonal interactions, and organisational resources. Health professionals and media (including the internet) were th

Journal article

Salamanca-Sanabria A, Castro O, Alattas A, Teepe GW, Leidenberger K, Fleisch E, Tudor Car L, Mueller-Riemenschneider F, Kowatsch Tet al., 2022, Top-Funded Companies Offering Digital Health Interventions for the Prevention and Treatment of Depression: A Systematic Market Analysis (Preprint)

<sec> <title>BACKGROUND</title> <p>Digital innovations in the mental health care field provide an opportunity to mitigate the global burden of mental disorders such as depression by facilitating timely, accessible, scalable, and affordable interventions. However, there is little evidence on how much these interventions rely on novel automated approaches, such as conversational agents (CAS), just-in-time adaptive interventions (JITAIs), or low-burden sensing technologies.</p> </sec> <sec> <title>OBJECTIVE</title> <p>Our objectives were: (i) to identify the top-funded companies offering digital health interventions for the prevention and treatment of depression (DHID), (ii) to review DHIDs’ scientific evidence, (iii) to identify which psychotherapy approaches are being used, and (iv) to examine the degree to which these DHIDs include novel automated approaches such as CAs, JITAIs, and low-burden sensing technologies.</p> </sec> <sec> <title>METHODS</title> <p>A systematic search was conducted using two venture capital databases (Crunchbase and Pitchbook) to identify the top 30 funded companies offering DHIDs. In addition, studies related to the DHIDs were identified via scientific databases (PubMed, Cochrane Library, and APA Psych-info) and hand-searching (companies’ websites).</p> </sec> <sec> <title>RESULTS</title> <p>The top-30 funded companies offering DHIDs received total funding of 2’592 billion USD up to February 2022. A total of 83 studies were identified by fewer than half of the companies (n=14; 46.6%), of whic

Journal article

GBD 2019 Diabetes and Air Pollution Collaborators, 2022, Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2·5 air pollution, 1990-2019: an analysis of data from the Global Burden of Disease Study 2019, The Lancet Planetary Health, Vol: 6, Pages: e586-e600, ISSN: 2542-5196

BACKGROUND: Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2·5 originating from ambient and household air pollution. METHODS: We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2·5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure-response curve from the extracted relative risk estimates using the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2·5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2·5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals. FINDINGS: In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2·5 exposure, with an estimated 3·78 (95% uncertainty interval 2·68-4·83) deaths per 100 000 population and 167 (117-223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13·4% (9·49-17·5) of deaths and 13·6% (9·73-17·9) of DALYs due to type 2 diabetes were contributed by ambient PM2·5, and 6·50% (4·22-9·53) of deaths and 5·92% (3·81-8·64) of DALYs by household air pollution. High burdens, in

Journal article

Martinengo L, Jabir AI, Goh WWT, Lo NYW, Ho M-HR, Kowatsch T, Atun R, Michie S, Tudor Car Let al., 2022, Conversational agents in healthcare: a scoping review of their behavior change techniques and underpinning theory (Preprint)

<sec> <title>BACKGROUND</title> <p>Conversational agents (CAs) are increasingly used in healthcare to deliver behavior change interventions. Their evaluation often includes categorizing the behavior change techniques (BCTs), using a classification system of which the BCT Taxonomy V1 is one of the most common. Previous studies have presented descriptive summaries of behavior change interventions delivered by CAs, but no in-depth study reporting the use of BCTs in these interventions has been published to date.</p> </sec> <sec> <title>OBJECTIVE</title> <p>We aimed to describe behavior change interventions delivered by CAs and identify the behavior change techniques (BCTs) and theories guiding their design.</p> </sec> <sec> <title>METHODS</title> <p>We searched PubMed, Embase, Cochrane’s CENTRAL, and the first ten pages of Google and Google Scholar in April 2021. We included primary, experimental studies evaluating a behavior change intervention delivered by a CA. BCTs coding followed the BCT Taxonomy v1. Two independent reviewers selected the studies and extracted the data. Descriptive analysis and frequent itemset mining to identify BCT clusters were performed. </p> </sec> <sec> <title>RESULTS</title> <p>We included 47 studies reporting on mental health (n=19, 40%), chronic disorders (n=14, 30%), and lifestyle change (n=14, 30%) interventions. There were 20 embodied CAs (43%) and 27 CAs (57%) represented a female character. Most CAs were rule-based (n=34, 72%). Experimental interventions included 63 BCTs, (mean: 9 BCTs, range 2-21)

Journal article

Dhinagaran DA, Martinengo L, Ho M-HR, Joty S, Kowatsch T, Atun R, Tudor Car Let al., 2022, Designing, developing, evaluating, and Implementing a Smartphone-delivered, rule-based COnVERsational agent (DISCOVER): a conceptual framework (Preprint)

<sec> <title>BACKGROUND</title> <p>Conversational agents (CAs), also known as chatbots are computer programs that simulate human conversations using predetermined rule-based responses or employing artificial intelligent algorithms. They are increasingly used in healthcare, particularly via smartphones. There is, at present no conceptual framework guiding the development of smartphone rule-based CAs in healthcare. To fill this gap we propose structured and tailored guidance for their design, development, evaluation, and implementation.</p> </sec> <sec> <title>OBJECTIVE</title> <p>To develop a conceptual framework for the design, evaluation, and implementation of smartphone-delivered, rule-based, goal-oriented, and text-based CAs for healthcare.</p> </sec> <sec> <title>METHODS</title> <p>We followed Jabareen’s approach to develop this conceptual framework. We performed two literature reviews focusing on healthcare CAs and conceptual frameworks for the development of mHealth interventions. We identified, named, categorized, integrated, and synthesized the information retrieved from the literature reviews to develop the conceptual framework. We then applied this framework by developing a CA and testing it in a feasibility study.</p> </sec> <sec> <title>RESULTS</title> <p>The DISCOVER conceptual framework includes eight iterative steps, grouped into three stages: (1) Design, comprising defining the goal, creating an identity, assembling the team, and selecting the delivery interface, (2) Development, including developing the content an

Journal article

Tudor Car L, Kyaw BM, Teo A, Fox TE, Vimalesvaran S, Apfelbacher C, Kemp S, Chavannes Net al., 2022, Outcomes, measurement instruments and their validity evidence in randomised trials on virtual, augmented and mixed reality in undergraduate medical education: a systematic mapping review, JMIR Serious Games, Vol: 10, ISSN: 2291-9279

Background: Extended reality, encompassing virtual, augmented and mixed reality, is increasingly used in medical education. Studies assessing effectiveness of these new educational modalities should measure relevant outcomes using outcome measurement tools with validity evidence. Our aim was to determine the choice of outcomes, measurement instruments and the use of measurement instruments with validity evidence in randomized controlled trials (RCTs) on the effectiveness of virtual reality (VR), augmented reality (AR) and mixed reality (MR) in medical student education.Methods: We conducted a systematic mapping review. We searched seven major bibliographic databases from January 1990 to April 2020. Two reviewers screened the citations and extracted data independently from the included studies. We report our findings in line with PRISMA guidelines.Results: Of 127 retrieved RCTs, 116 were on VR, eleven on AR. No RCTs on MR in medical student education were found. Of the studies on VR, 64 studies were on VR simulators, 31 studies on screen-based VR, 9 on VR patient simulations and 12 on VR serious games. Most studies reported only one outcome and immediate, post-intervention assessment data. Skills outcome was the most common outcome in studies on VR simulators, VR patient simulations and AR. Knowledge was the most common outcome in studies on screen-based VR and VR serious games. Less common outcomes included participants’ attitudes, satisfaction, cognitive or mental load, learning efficacy, engagement and/or self-efficacy beliefs, emotional state, competency developed and patient outcomes. At least one form of validity evidence was found in around half of the studies on VR simulator, VR patient simulations, VR serious games and AR, and in only a quarter of studies on screen-based VR. Most studies used assessment methods that were implemented in a non-digital format such as paper-based written exercises or in-person assessments where examiners observed performan

Journal article

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