Evaluating the impact of a digital leadership programme on national digital priorities: a mixed methods study.

OBJECTIVES: This study aimed to determine the impact of the United Kingdom's National Health Service Digital Academy (NHSDA) Digital Health Leadership course on high-level recommendations in digital preparedness and the development of a proficient leadership to oversee digital transformation, which has been a longstanding priority within the NHS. DESIGN: A mixed methods study incorporating an online questionnaire, in-depth interviews and focus groups that were then analysed through a thematic analysis, underpinned by a constructivist approach. SETTINGS: An online mixed methods study of a defined cohort of participants who had completed the NHSDA course. PARTICIPANTS: 26 participants were recruited to the study, of whom 50% were clinicians, 26.9% in management and 19.2% in data science. All had completed the 2-year NHSDA programme in Digital Health Leadership more than 6 months prior. RESULTS: Interviews and focus groups elicited two key areas of impact of the course: loco-regional digitisation and the development of a network of change agents. The dissertation project had direct effects on local digital transformation efforts. Most of these projects focused on clinician (11.7%) or service user (10.3%) engagement, as oppose to de novo digital processes (9.4%). The development of a network of digital leaders has facilitated communication between organisations and improved the efficiency of the national digital infrastructure. CONCLUSIONS: A bespoke course incorporating a dissertation of practice model for digital health leaders can have broader impact for the attainment of digital priorities. This includes helping trusts to successfully adopt digital solutions, as well as fostering shared organisational learning. These influences, however, are mediated by resource and cultural barriers, which continue to hinder transformation efforts.

Investigating the Implementation of SMS and Mobile Messaging in Population Screening (the SIPS Study): Protocol for a Delphi Study.

BACKGROUND: The use of mobile messaging, including SMS, and web-based messaging in health care has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances, including population screening. These programs, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. OBJECTIVE: The aim of this protocol is to describe the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programs in England. METHODS: This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will include a review of literature published from January 1, 2000, to October 1, 2021. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry, and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used during consensus generation. Patient and Public Involvement and Engagement groups will be convened to ensure that a comprehensive item list is generated that represents the public's perspective. Each item will then be anonymously voted on by experts as to its importance and feasibility of implementation in screening during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible being eligible for inclusion in the final recommendation. A list of desirable items (ie, important but not currently feasible) will be developed to guide future work. RESULTS: The Institutional Review Board at Imperial College London has granted ethical approval for this study (reference 20IC6088). Results are expected to involve a list of recommendations to screening services, with findings being made available to screening services through Public Health England. This study will, thus, provide a formal guideline for the use of mobile messaging in screening services and will provide future directions in this field. CONCLUSIONS: The use of mobile messaging has grown significantly across health care services, especially given the COVID-19 pandemic, but its implementation in screening programs remains challenging. This modified Delphi approach with leading experts will provide invaluable insights into facilitating the incorporation of messaging into these programs and will create awareness of future developments in this area. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/32660.

Impact of the COVID-19 Pandemic on Emergency Adult Surgical Patients and Surgical Services: An International Multi-center Cohort Study and Department Survey.

OBJECTIVES: The PREDICT study aimed to determine how the COVID-19 pandemic affected surgical services and surgical patients and to identify predictors of outcomes in this cohort. BACKGROUND: High mortality rates were reported for surgical patients with COVID-19 in the early stages of the pandemic. However, the indirect impact of the pandemic on this cohort is not understood, and risk predictors are yet to be identified. METHODS: PREDICT is an international longitudinal cohort study comprising surgical patients presenting to hospital between March and August 2020, conducted alongside a survey of staff redeployment and departmental restructuring. A subgroup analysis of 3176 adult emergency patients, recruited by 55 teams across 18 countries is presented. RESULTS: Among adult emergency surgical patients, all-cause in-hospital mortality (IHM) was 3.6%, compared to 15.5% for those with COVID-19. However, only 14.1% received a COVID-19 test on admission in March, increasing to 76.5% by July.Higher Clinical Frailty Scale scores (CFS >7 aOR 18.87), ASA grade above 2 (aOR 4.29), and COVID-19 infection (aOR 5.12) were independently associated with significantly increased IHM.The peak months of the first wave were independently associated with significantly higher IHM (March aOR 4.34; April aOR 4.25; May aOR 3.97), compared to non-peak months.During the study, UK operating theatre capacity decreased by a mean of 63.6% with a concomitant 27.3% reduction in surgical staffing. CONCLUSION: The first wave of the COVID-19 pandemic significantly impacted surgical patients, both directly through co-morbid infection and indirectly as shown by increasing mortality in peak months, irrespective of COVID-19 status.Higher CFS scores and ASA grades strongly predict outcomes in surgical patients and are an important risk assessment tool during the pandemic.

COVID-19 vaccinations among Black Asian and Minority Ethnic (BAME) groups: Learning the lessons from influenza.

BACKGROUND: The COVID-19 vaccination roll-out continues to grow at significant pace around the world. There is, however, growing concern regarding vaccine hesitancy amongst Black, Asian and Minority Ethnic (BAME) populations. Such inequalities have the potential for exposing, an already at-risk population, further. Whilst the COVID-19 vaccination programme is in its infancy, influenza programmes have been undertaken for over 50 years, and may provide invaluable insights. In this commentary, we aim to examine the lessons from influenza vaccinations, and how this can help reduce inequalities with COVID-19 vaccinations. MAIN TEXT: Several factors have been associated with both seasonal and pandemic influenza vaccine hesitancy amongst BAME groups. One of the most prevalent barriers in both types of immunisation programmes is the mistrust of medical organisations. This is often a multi-faceted issue, with previous negative healthcare discrimination, and historical unethical practices contributing towards this scepticism. This mistrust, however, is predominantly aimed towards healthcare systems, as opposed to individual physicians. In fact, physician endorsement is often a strong driver to vaccination, with Black patients who receive this support 8 times more likely to receive seasonal influenza vaccination. On the other hand, with H1N1 pandemic influenza vaccination, social norms or community influence, was an important determinant. In both seasonal and pandemic immunisation programmes, a significant amount of concern regarding side-effects, including misinformation, was reported amongst BAME groups. CONCLUSIONS: The use of community-based approaches, with local advocacy, has the potential to counteract misinformation, and concerns regarding side-effects. Moreover, using consistent physician endorsement not only in media campaigns but also through messaging would potentially help to address longstanding healthcare mistrust amongst minority ethnic groups. Close attention regarding how the vaccination programme, and the health policies introduced as a consequence, affect BAME communities in order to prevent widening inequalities in the future.

The Reliability and Quality of YouTube Videos as a Source of Public Health Information Regarding COVID-19 Vaccination: Cross-sectional Study.

BACKGROUND: Recent emergency authorization and rollout of COVID-19 vaccines by regulatory bodies has generated global attention. As the most popular video-sharing platform globally, YouTube is a potent medium for the dissemination of key public health information. Understanding the nature of available content regarding COVID-19 vaccination on this widely used platform is of substantial public health interest. OBJECTIVE: This study aimed to evaluate the reliability and quality of information on COVID-19 vaccination in YouTube videos. METHODS: In this cross-sectional study, the phrases "coronavirus vaccine" and "COVID-19 vaccine" were searched on the UK version of YouTube on December 10, 2020. The 200 most viewed videos of each search were extracted and screened for relevance and English language. Video content and characteristics were extracted and independently rated against Health on the Net Foundation Code of Conduct and DISCERN quality criteria for consumer health information by 2 authors. RESULTS: Forty-eight videos, with a combined total view count of 30,100,561, were included in the analysis. Topics addressed comprised the following: vaccine science (n=18, 58%), vaccine trials (n=28, 58%), side effects (n=23, 48%), efficacy (n=17, 35%), and manufacturing (n=8, 17%). Ten (21%) videos encouraged continued public health measures. Only 2 (4.2%) videos made nonfactual claims. The content of 47 (98%) videos was scored to have low (n=27, 56%) or moderate (n=20, 42%) adherence to Health on the Net Foundation Code of Conduct principles. Median overall DISCERN score per channel type ranged from 40.3 (IQR 34.8-47.0) to 64.3 (IQR 58.5-66.3). Educational channels produced by both medical and nonmedical professionals achieved significantly higher DISCERN scores than those of other categories. The highest median DISCERN scores were achieved by educational videos produced by medical professionals (64.3, IQR 58.5-66.3) and the lowest median scores by independent users (18, IQR 18-20). CONCLUSIONS: The overall quality and reliability of information on COVID-19 vaccines on YouTube remains poor. Videos produced by educational channels, especially by medical professionals, were higher in quality and reliability than those produced by other sources, including health-related organizations. Collaboration between health-related organizations and established medical and educational YouTube content producers provides an opportunity for the dissemination of high-quality information on COVID-19 vaccination. Such collaboration holds potential as a rapidly implementable public health intervention aiming to engage a wide audience and increase public vaccination awareness and knowledge.

A national survey assessing public readiness for digital health strategies against COVID-19 within the United Kingdom.

There is concern that digital public health initiatives used in the management of COVID-19 may marginalise certain population groups. There is an overlap between the demographics of groups at risk of digital exclusion (older, lower social grade, low educational attainment and ethnic minorities) and those who are vulnerable to poorer health outcomes from SARS-CoV-2. In this national survey study (n = 2040), we assessed how the UK population; particularly these overlapping groups, reported their preparedness for digital health strategies. We report, with respect to using digital information to make health decisions, that those over 60 are less comfortable (net comfort: 57%) than those between 18 and 39 (net comfort: 78%) and lower social grades are less comfortable (net comfort: 63%) than higher social grades (net comfort: 75%). With respect to a preference for digital over non-digital sources in seeking COVID-19 health information, those over 60 (net preference: 21%) are less inclined than those between 18 and 39 (net preference: 60%) and those of low educational attainment (net preference: 30%) are less inclined than those of high educational attainment (net preference: 52%). Lastly, with respect to distinguishing reliable digital COVID-19 information, lower social grades (net confidence: 55%) are less confident than higher social grades (net confidence: 68%) and those of low educational attainment (net confidence: 51%) are less confident than those of high educational attainment (net confidence: 71%). All reported differences are statistically significant (p < 0.01) following multivariate regression modelling. This study suggests that digital public health approaches to COVID-19 have the potential to marginalise groups who are concurrently at risk of digital exclusion and poor health outcomes from SARS-CoV-2.

Evaluating the effect of infographics on public recall, sentiment and willingness to use face masks during the COVID-19 pandemic: a randomised internet-based questionnaire study.

BACKGROUND: The use of face masks remains contentious, with international variation in practice. Their prevalence in the UK, is likely to increase due to new legislation. Clear information regarding the appropriate use of masks is needed, to ensure compliance with policies to reduce transmission of COVID-19. We aimed to assess the impact of visual representations of guidance, or infographics, upon the knowledge of appropriate face mask usage in a representative UK cohort. METHODS: Adult patients were recruited to this randomised internet-based questionnaire study during the 12-14 May 2020 from across the UK. Respondents viewed one of five public health stimuli regarding the use of face masks, or no stimulus. The groups accessed aids by the European Centre for Disease Control (EUCDC), World Health Organisation (WHO), Singaporean Ministry of Health (SMOH), text from the UK government (UK Gov), or an infographic designed by the Behavioural Insights Team (BIT). The primary outcome was to evaluate the effect of each infographic upon participants' recall of face mask technique, sentiments and willingness to wear a face covering. Secondary outcomes included the effect of symptomology and socio-demographic factors. RESULTS: 4099 respondents were randomised (1009 control, 628 EUCDC, 526 WHO, 639 SMOH, 661 UKGOV and 606 BIT). Stimuli from the WHO, SMOH and BIT demonstrated significantly higher average recall scores compared to the controls (7.40 v. 7.38 v. 7.34 v. 6.97, P < 0.001). BIT's stimulus led to the highest confidence about mask-wearing (87%). Only 48.2% of the cohort felt stimuli reduced anxiety about COVID-19. However, willingness to use a mask was high, (range 84 to 88%). CONCLUSIONS: To ensure the appropriate use of masks, as mandated by UK law, guidance must provide sufficient information, yet remain understandable. Infographics can aid the recall of correct mask techniques by highlighting salient steps and reducing cognitive burden. They have also demonstrated greater trustworthiness than text-only guidance. The effect of infographics upon COVID-19-related anxiety was poor, and they should be further developed to address this sentiment. A willingness to wear face masks has, however, been demonstrated.