Uptake and Use of Care Companion, a Web-Based Information Resource for Supporting Informal Carers of Older People: Mixed Methods Study.

BACKGROUND: Informal carers play a major role in supporting relatives and friends who are sick, disabled, or frail. Access to information, guidance, and support that are relevant to the lives and circumstances of carers is critical to carers feeling supported in their role. When unmet, this need is known to adversely affect carer resilience and well-being. To address this problem, Care Companion was co-designed with current and former carers and stakeholders as a free-to-use, web-based resource to provide access to a broad range of tailored information, including links to local and national resources. OBJECTIVE: This study aimed to investigate the real-world uptake and use of Care Companion in 1 region of England (with known carer population of approximately 100,000), with local health, community, and social care teams being asked to actively promote its use. METHODS: The study had a convergent parallel, mixed methods design and drew on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Data included metrics from carers' use of Care Companion, surveys completed by users recruited through general practice, and interviews with carers and health and social care providers regarding their views about Care Companion and their response to it. Quantitative data were analyzed using descriptive statistics. Interview data were analyzed thematically and synthesized to create overarching themes. The qualitative findings were used for in-depth exploration and interpretation of quantitative results. RESULTS: Despite awareness-raising activities by relevant health, social care, and community organizations, there was limited uptake with only 556 carers (0.87% of the known carer population of 100,000) registering to use Care Companion in total, with median of 2 (mean 7.2; mode 2) visits per registered user. Interviews with carers (n=29) and stakeholders (n=12) identified 7 key themes that influenced registration, use, and perceived value: stakeholders' signposting of carers to Care Companion, expectations about Care Companion, activity levels and conflicting priorities, experience of using Care Companion, relevance to personal circumstances, social isolation and networks, and experience with digital technology. Although many interviewed carers felt that it was potentially useful, few considered it as being of direct relevance to their own circumstances. For some, concerns about social isolation and lack of hands-on support were more pressing issues than the need for information. CONCLUSIONS: The gap between the enthusiastic views expressed by carers during Care Companion's co-design and the subsequent low level of uptake and user experience observed in this evaluation suggests that the co-design process may have lacked a sufficiently diverse set of viewpoints. Numerous factors were identified as contributing to Care Companion's level of use, some of which might have been anticipated during its co-design. More emphasis on the development and implementation, including continuing co-design support after deployment, may have supported increased use.

Socio-economic correlates of childhood obesity in urban and rural England.

OBJECTIVE: Physical access to food may affect diet and thus obesity rates. We build upon existing work to better understand how socio-economic characteristics of locations are associated with childhood overweight. DESIGN: Using cross-sectional design and publicly available data, the study specifically compares rural and urban areas, including interactions of distance from supermarkets with income and population density. SETTING: We examine cross-sectional associations with obesity prevalence both in the national scale and across urban and rural areas differing in household wealth. PARTICIPANTS: Children in reception class (aged 4-5) from all state-maintained schools in England taking part in the National Child Measurement Programme (n 6772). RESULTS: Income was the main predictor of childhood obesity (adj. R-sq=.316, p<.001), whereas distance played only a marginal role (adj. R-sq=.01, p<.001). In urban areas, distance and density correlate with obesity directly and conditionally. Urban children were slightly more obese, but the opposite was true for children in affluent areas. Association between income poverty and obesity rates was stronger in urban areas (7·59 %) than rural areas (4·95 %), the former which also showed stronger association between distance and obesity. CONCLUSIONS: Obesogenic environments present heightened risks in deprived urban and affluent rural areas. The results have potential value for policy making as for planning and targeting of services for vulnerable groups.

Global evidence on the rapid adoption of telemedicine in primary care during the first 2 years of the COVID-19 pandemic: a scoping review protocol.

BACKGROUND: Before the declaration of the COVID-19 pandemic in March 2020, primary care in most countries relied on face-to-face consultations, with relatively limited use of telemedicine. Lockdowns and social distancing measures during the early stages of the pandemic led to rapid, widely spread telemedicine adoption in healthcare settings. The rapid uptake that occurred following the onset of these pandemic-induced measures in countries such as the UK, Canada and New Zealand prompts questions around the drivers, extent and sustainability of this transformation in clinical practice at the global level, as the research in this area is still emerging. The purpose of this scoping review is to explore the global evidence surrounding the rapid adoption of telemedicine in primary care settings during the first 2 years of the COVID-19 pandemic through three lenses: patient experience, health inequalities and patient-clinician trust, with the purpose of identifying elements contributing to the sustainability of this innovation. METHODS: A draft protocol was tested through an initial search on Ovid Medline, Web of Science and Google Scholar with additional searches on the Cochrane Database. This informed the final selection of terms which will be used to search Ovid, Web of Science, Google Scholar, PROSPERO, Cochrane Library and others, filtering for studies from the pandemic declaration onwards. Additional grey literature reports will be sourced through simplified searches on Google in widely spoken languages. Duplicates will be removed by screening titles. Abstracts and grey literature text extracts will be screened based on pre-set eligibility criteria by two researchers. Abstracts (and extracts in the case of grey literature) will be mapped against the domains of the Non-adoption, Abandonment, and challenges to Scale-up, Spread and Sustainability (NASSS) framework by two researchers. Data will be presented in table format. DISCUSSION: This review will map the current literature to identify current gaps in evidence related to the adoption of telemedicine after the declaration of the pandemic in March 2020. The use of simplified searches in the several spoken languages in the world is aimed at capturing more immediate non-academic reflections and experiences on this major service change at a global level. SYSTEMATIC REVIEW REGISTRATION: The study has been registered on Open Science Framework and can be accessed through the following URL: https://osf.io/4z5ut/.

Assessing physical access to healthy food across United Kingdom: A systematic review of measures and findings.

Background: Existing research suggests that physical access to food can affect diet quality and thus obesity rates. When defining retail food environment (RFE) quantitatively, there is a little agreement on how to measure "lack of healthy food" and what parameters to use, resulting in a heterogeneity of study designs and outcome measures. In turn, this leads to a conflicting evidence base being one of the many barriers to using evidence in policy-making. Aims: This systematic review aimed to identify and describe methods used to assess food accessibility in the United Kingdom (UK) to overcome heterogeneity by providing a classification of measures. Materials & Methods: The literature search included electronic and manual searches of peer-reviewed literature and was restricted to studies published in English between January 2010 and March 2021. A total of 9365 articles were assessed for eligibility, of which 44 articles were included in the review. All included studies were analysed with regards to their main characteristics (e.g., associations between variables of interest, setting, sample, design, etc.) and definition of RFE and its metrics. When defining these metrics, the present review distinguishes between a point of origin (centroid, address) from which distance was calculated, summary statistic of accessibility (proximity, buffer, Kernel), and definition of distance (Euclidean, network distance). Trends, gaps and limitations are identified and recommendations made for food accessibility research in UK. Results: Multiple theoretical and methodological constructs are currently used, mostly quantifying distance by means of Euclidean and ring-buffer distance, using both proximity- and density-based approaches, and ranging from absolute to relative measures. The association between RFE and diet and health in rural areas, as well as a spatiotemporal domain of food access, remains largely unaccounted. Discussion: Evidence suggests that the duration of exposure may bear a greater importance than the level of exposure and that density-based measures may better capture RFE when compared with proximity-based measures, however, using more complex measures not necessarily produce better results. To move the field forward, studies have called for a greater focus on causality, individual access and the use of various measures, neighbourhood definitions and potential confounders to capture different aspects and dimensions of the RFE, which requires using univariate measures of accessibility and considering the overall context in terms of varying types of neighbourhoods. Conclusion: In order to render ongoing heterogeneity in measuring RFE, researchers should prioritise measures that may provide a more accurate and realistic account of people's lives and follow an intuitive approach based on convergence of results until consensus could be reached on using some useful standards.

Quantifying people's experience during flood events with implications for hazard risk communication.

Semantic drift is a well-known concept in distributional semantics, which is used to demonstrate gradual, long-term changes in meanings and sentiments of words and is largely detectable by studying the composition of large corpora. In our previous work, which used ontological relationships between words and phrases, we established that certain kinds of semantic micro-changes can be found in social media emerging around natural hazard events, such as floods. Our previous results confirmed that semantic drift in social media can be used to for early detection of floods and to increase the volume of 'useful' geo-referenced data for event monitoring. In this work we use deep learning in order to determine whether images associated with 'semantically drifted' social media tags reflect changes in crowd navigation strategies during floods. Our results show that alternative tags can be used to differentiate naïve and experienced crowds witnessing flooding of various degrees of severity.

Trust in the smart home: Findings from a nationally representative survey in the UK.

Businesses in the smart home sector are actively promoting the benefits of smart home technologies for consumers, such as convenience, economy and home security. To better understand meanings of and trust in the smart home, we carried out a nationally representative survey of UK consumers designed to measure adoption and acceptability, focusing on awareness, ownership, experience, trust, satisfaction and intention to use. We analysed the results using theories of meanings and acceptability of technologies including semiotics, social construction of technology (SCOT) and sociotechnical affordance. Our findings suggest that the meaning and value proposition of the smart home have not yet achieved closure for consumers, but is already foregrounding risks to privacy and security amongst the other meaning-making possibilities it could afford. Anxiety about the likelihood of a security incident emerges as a prominent factor influencing adoption of smart home technology. This factor negatively impacts adoption. These findings underline how businesses and policymakers will need to work together to act on the sociotechnical affordances of smart home technology in order to increase consumers' trust. This intervention is necessary if barriers to adoption and acceptability of the smart home are to be addressed now and in the future.

Wandering as a Sociomaterial Practice: Extending the Theorization of GPS Tracking in Cognitive Impairment.

Electronic tracking through global positioning systems (GPSs) is used to monitor people with cognitive impairment who "wander" outside the home. This ethnographic study explored how GPS-monitored wandering was experienced by individuals, lay carers, and professional staff. Seven in-depth case studies revealed that wandering was often an enjoyable and worthwhile activity and helped deal with uncertainty and threats to identity. In what were typically very complex care contexts, GPS devices were useful to the extent that they aligned with a wider sociomaterial care network that included lay carers, call centers, and health and social care professionals. In this context, "safe" wandering was a collaborative accomplishment that depended on the technology's materiality, affordances, and aesthetic properties; a distributed knowledge of the individual and the places they wandered through, and a collective and dynamic interpretation of risk. Implications for design and delivery of GPS devices and services for cognitive impairment are discussed.

A longitudinal analysis of the public perception of the opportunities and challenges of the Internet of Things.

The Internet of Things (or IoT), which enables the networked interconnection of everyday objects, is becoming increasingly popular in many aspects of our lives ranging from entertainment to health care. While the IoT brings a set of invaluable advantages and opportunities with it, there is also evidence of numerous challenges that are yet to be resolved. This is certainly the case with regard to ensuring the cyber security of the IoT, and there are various examples of devices being hacked. Despite this evidence, little is known about the public perceptions of the opportunities and challenges presented by the IoT. To advance research in this direction, we mined the social media platform Twitter to learn about public opinion about the IoT. Analysing a longitudinal dataset of more than 6.7 million tweets, we reveal insights into public perceptions of the IoT, identifying big data analytics as the most positive aspect, whereas security issues are the main public concern on the negative side. Our study serves to highlight the importance of keeping IoT devices secure, and remind manufacturers that it is a concern that remains unresolved, at least insofar as the public believes.

Correction to: Facilitating the implementation of clinical technology in healthcare: what role does a national agency play?

Upon publication of the original article [1], Gregory Maniatopoulos' name was incorrectly given as 'Greg Maniatopoulous'. This has now been corrected in the original article.

Facilitating the implementation of clinical technology in healthcare: what role does a national agency play?

BACKGROUND: Accelerating the implementation of new technology in healthcare is typically complex and multi-faceted. One strategy is to charge a national agency with the responsibility for facilitating implementation. This study examines the role of such an agency in the English National Health Service. In particular, it compares two different facilitation strategies employed by the agency to support the implementation of insulin pump therapy. METHODS: The research involved an empirical case study of four healthcare organisations receiving different levels of facilitation from the national agency: two received active hands-on facilitation; one was the intended recipient of a more passive, web-based facilitation strategy; the other implemented the technology without any external facilitation. The primary method of data collection was semi-structured qualitative interviews with key individuals involved in implementation. The integrated-PARIHS framework was applied as a conceptual lens to analyse the data. RESULTS: The two sites that received active facilitation from an Implementation Manager in the national agency made positive progress in implementing the technology. In both sites there was a high level of initial receptiveness to implementation. This was similar to a site that had successfully introduced insulin pump therapy without facilitation support from the national agency. By contrast, a site that did not have direct contact with the national agency made little progress with implementation, despite the availability of a web-based implementation resource. Clinicians expressed differences of opinion around the value and effectiveness of the technology and contextual barriers related to funding for implementation persisted. The national agency's intended roll out strategy using passive web-based facilitation appeared to have little impact. CONCLUSIONS: When favourable conditions exist, in terms of agreement around the value of the technology, clinician receptiveness and motivation to change, active facilitation via an external agency can help to structure the implementation process and address contextual barriers. Passive facilitation using web-based implementation resources appears less effective. Moving from initial implementation to wider scale-up presents challenges and is an issue that warrants further attention.

Analysing the role of complexity in explaining the fortunes of technology programmes: empirical application of the NASSS framework.

BACKGROUND: Failures and partial successes are common in technology-supported innovation programmes in health and social care. Complexity theory can help explain why. Phenomena may be simple (straightforward, predictable, few components), complicated (multiple interacting components or issues) or complex (dynamic, unpredictable, not easily disaggregated into constituent components). The recently published NASSS framework applies this taxonomy to explain Non-adoption or Abandonment of technology by individuals and difficulties achieving Scale-up, Spread and Sustainability. This paper reports the first empirical application of the NASSS framework. METHODS: Six technology-supported programmes were studied using ethnography and action research for up to 3 years across 20 health and care organisations and 10 national-level bodies. They comprised video outpatient consultations, GPS tracking technology for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organising software and integrated case management via data warehousing. Data were collected at three levels: micro (individual technology users), meso (organisational processes and systems) and macro (national policy and wider context). Data analysis and synthesis were guided by socio-technical theories and organised around the seven NASSS domains: (1) the condition or illness, (2) the technology, (3) the value proposition, (4) the adopter system (professional staff, patients and lay carers), (5) the organisation(s), (6) the wider (institutional and societal) system and (7) interaction and mutual adaptation among all these domains over time. RESULTS: The study generated more than 400 h of ethnographic observation, 165 semi-structured interviews and 200 documents. The six case studies raised multiple challenges across all seven domains. Complexity was a common feature of all programmes. In particular, individuals' health and care needs were often complex and hence unpredictable and 'off algorithm'. Programmes in which multiple domains were complicated proved difficult, slow and expensive to implement. Those in which multiple domains were complex did not become mainstreamed (or, if mainstreamed, did not deliver key intended outputs). CONCLUSION: The NASSS framework helped explain the successes, failures and changing fortunes of this diverse sample of technology-supported programmes. Since failure is often linked to complexity across multiple NASSS domains, further research should systematically address ways to reduce complexity and/or manage programme implementation to take account of it.

Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies.

BACKGROUND: Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at the organization or system level. OBJECTIVE: Our objective was to produce an evidence-based, theory-informed, and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program. METHODS: The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) to identify key domains, and (2) empirical case studies of technology implementation to explore, test, and refine these domains. We studied 6 technology-supported programs-video outpatient consultations, global positioning system tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organizing software, and integrated case management via data sharing-using longitudinal ethnography and action research for up to 3 years across more than 20 organizations. Data were collected at micro level (individual technology users), meso level (organizational processes and systems), and macro level (national policy and wider context). Analysis and synthesis was aided by sociotechnically informed theories of individual, organizational, and system change. The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback. RESULTS: The literature review identified 28 previous technology implementation frameworks, of which 14 had taken a dynamic systems approach (including 2 integrative reviews of previous work). Our empirical dataset consisted of over 400 hours of ethnographic observation, 165 semistructured interviews, and 200 documents. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework included questions in 7 domains: the condition or illness, the technology, the value proposition, the adopter system (comprising professional staff, patient, and lay caregivers), the organization(s), the wider (institutional and societal) context, and the interaction and mutual adaptation between all these domains over time. Our empirical case studies raised a variety of challenges across all 7 domains, each classified as simple (straightforward, predictable, few components), complicated (multiple interacting components or issues), or complex (dynamic, unpredictable, not easily disaggregated into constituent components). Programs characterized by complicatedness proved difficult but not impossible to implement. Those characterized by complexity in multiple NASSS domains rarely, if ever, became mainstreamed. The framework showed promise when applied (both prospectively and retrospectively) to other programs. CONCLUSIONS: Subject to further empirical testing, NASSS could be applied across a range of technological innovations in health and social care. It has several potential uses: (1) to inform the design of a new technology; (2) to identify technological solutions that (perhaps despite policy or industry enthusiasm) have a limited chance of achieving large-scale, sustained adoption; (3) to plan the implementation, scale-up, or rollout of a technology program; and (4) to explain and learn from program failures.

Google Trends can improve surveillance of Type 2 diabetes.

Recent studies demonstrate that people are increasingly looking online to assess their health, with reasons varying from personal preferences and beliefs to inability to book a timely appointment with their local medical practice. Records of these activities represent a new source of data about the health of populations, but which is currently unaccounted for by disease surveillance models. This could potentially be useful as evidence of individuals' perception of bodily changes and self-diagnosis of early symptoms of an emerging disease. We make use of the Experian geodemographic Mosaic dataset in order to extract Type 2 diabetes candidate risk variables and compare their temporal relationships with the search keywords, used to describe early symptoms of the disease on Google. Our results demonstrate that Google Trends can detect early signs of diabetes by monitoring combinations of keywords, associated with searches for hypertension treatment and poor living conditions; Combined search semantics, related to obesity, how to quit smoking and improve living conditions (deprivation) can be also employed, however, may lead to less accurate results.

Predicting floods with Flickr tags.

Increasingly, user generated content (UGC) in social media postings and their associated metadata such as time and location stamps are being used to provide useful operational information during natural hazard events such as hurricanes, storms and floods. The main advantage of these new sources of data are twofold. First, in a purely additive sense, they can provide much denser geographical coverage of the hazard as compared to traditional sensor networks. Second, they provide what physical sensors are not able to do: By documenting personal observations and experiences, they directly record the impact of a hazard on the human environment. For this reason interpretation of the content (e.g., hashtags, images, text, emojis, etc) and metadata (e.g., keywords, tags, geolocation) have been a focus of much research into social media analytics. However, as choices of semantic tags in the current methods are usually reduced to the exact name or type of the event (e.g., hashtags '#Sandy' or '#flooding'), the main limitation of such approaches remains their mere nowcasting capacity. In this study we make use of polysemous tags of images posted during several recent flood events and demonstrate how such volunteered geographic data can be used to provide early warning of an event before its outbreak.

Predicting the impact of urban flooding using open data.

This paper aims to explore whether there is a relationship between search patterns for flood risk information on the Web and how badly localities have been affected by flood events. We hypothesize that localities where people stay more actively informed about potential flooding experience less negative impact than localities where people make less effort to be informed. Being informed, of course, does not hold the waters back; however, it may stimulate (or serve as an indicator of) such resilient behaviours as timely use of sandbags, relocation of possessions from basements to upper floors and/or temporary evacuation from flooded homes to alternative accommodation. We make use of open data to test this relationship empirically. Our results demonstrate that although aggregated Web search reflects average rainfall patterns, its eigenvectors predominantly consist of locations with similar flood impacts during 2014-2015. These results are also consistent with statistically significant correlations of Web search eigenvectors with flood warning and incident reporting datasets.

Analysing How People Orient to and Spread Rumours in Social Media by Looking at Conversational Threads.

As breaking news unfolds people increasingly rely on social media to stay abreast of the latest updates. The use of social media in such situations comes with the caveat that new information being released piecemeal may encourage rumours, many of which remain unverified long after their point of release. Little is known, however, about the dynamics of the life cycle of a social media rumour. In this paper we present a methodology that has enabled us to collect, identify and annotate a dataset of 330 rumour threads (4,842 tweets) associated with 9 newsworthy events. We analyse this dataset to understand how users spread, support, or deny rumours that are later proven true or false, by distinguishing two levels of status in a rumour life cycle i.e., before and after its veracity status is resolved. The identification of rumours associated with each event, as well as the tweet that resolved each rumour as true or false, was performed by journalist members of the research team who tracked the events in real time. Our study shows that rumours that are ultimately proven true tend to be resolved faster than those that turn out to be false. Whilst one can readily see users denying rumours once they have been debunked, users appear to be less capable of distinguishing true from false rumours when their veracity remains in question. In fact, we show that the prevalent tendency for users is to support every unverified rumour. We also analyse the role of different types of users, finding that highly reputable users such as news organisations endeavour to post well-grounded statements, which appear to be certain and accompanied by evidence. Nevertheless, these often prove to be unverified pieces of information that give rise to false rumours. Our study reinforces the need for developing robust machine learning techniques that can provide assistance in real time for assessing the veracity of rumours. The findings of our study provide useful insights for achieving this aim.

SCALS: a fourth-generation study of assisted living technologies in their organisational, social, political and policy context.

INTRODUCTION: Research to date into assisted living technologies broadly consists of 3 generations: technical design, experimental trials and qualitative studies of the patient experience. We describe a fourth-generation paradigm: studies of assisted living technologies in their organisational, social, political and policy context. Fourth-generation studies are necessarily organic and emergent; they view technology as part of a dynamic, networked and potentially unstable system. They use co-design methods to generate and stabilise local solutions, taking account of context. METHODS AND ANALYSIS: SCALS (Studies in Co-creating Assisted Living Solutions) consists (currently) of 5 organisational case studies, each an English health or social care organisation striving to introduce technology-supported services to support independent living in people with health and/or social care needs. Treating these cases as complex systems, we seek to explore interdependencies, emergence and conflict. We employ a co-design approach informed by the principles of action research to help participating organisations establish, refine and evaluate their service. To that end, we are conducting in-depth ethnographic studies of people's experience of assisted living technologies (micro level), embedded in evolving organisational case studies that use interviews, ethnography and document analysis (meso level), and exploring the wider national and international context for assisted living technologies and policy (macro level). Data will be analysed using a sociotechnical framework developed from structuration theory. ETHICS AND DISSEMINATION: Research ethics approval for the first 4 case studies has been granted. An important outcome will be lessons learned from individual co-design case studies. We will document the studies' credibility and rigour, and assess the transferability of findings to other settings while also recognising unique aspects of the contexts in which they were generated. Academic outputs will include a cross-case analysis and progress in theory and method of fourth-generation assisted living technology research. We will produce practical guidance for organisations, policymakers, designers and service users.

Co-production in practice: how people with assisted living needs can help design and evolve technologies and services.

BACKGROUND: The low uptake of telecare and telehealth services by older people may be explained by the limited involvement of users in the design. If the ambition of 'care closer to home' is to be realised, then industry, health and social care providers must evolve ways to work with older people to co-produce useful and useable solutions. METHOD: We conducted 10 co-design workshops with users of telehealth and telecare, their carers, service providers and technology suppliers. Using vignettes developed from in-depth ethnographic case studies, we explored participants' perspectives on the design features of technologies and services to enable and facilitate the co-production of new care solutions. Workshop discussions were audio recorded, transcribed and analysed thematically. RESULTS: Analysis revealed four main themes. First, there is a need to raise awareness and provide information to potential users of assisted living technologies (ALTs). Second, technologies must be highly customisable and adaptable to accommodate the multiple and changing needs of different users. Third, the service must align closely with the individual's wider social support network. Finally, the service must support a high degree of information sharing and coordination. CONCLUSIONS: The case vignettes within inclusive and democratic co-design workshops provided a powerful means for ALT users and their carers to contribute, along with other stakeholders, to technology and service design. The workshops identified a need to focus attention on supporting the social processes that facilitate the collective efforts of formal and informal care networks in ALT delivery and use.

What is quality in assisted living technology? The ARCHIE framework for effective telehealth and telecare services.

BACKGROUND: We sought to define quality in telehealth and telecare with the aim of improving the proportion of patients who receive appropriate, acceptable and workable technologies and services to support them living with illness or disability. METHODS: This was a three-phase study: (1) interviews with seven technology suppliers and 14 service providers, (2) ethnographic case studies of 40 people, 60 to 98 years old, with multi-morbidity and assisted living needs and (3) 10 co-design workshops. In phase 1, we explored barriers to uptake of telehealth and telecare. In phase 2, we used ethnographic methods to build a detailed picture of participants' lives, illness experiences and technology use. In phase 3, we brought users and their carers together with suppliers and providers to derive quality principles for assistive technology products and services. RESULTS: Interviews identified practical, material and organisational barriers to smooth introduction and continued support of assistive technologies. The experience of multi-morbidity was characterised by multiple, mutually reinforcing and inexorably worsening impairments, producing diverse and unique care challenges. Participants and their carers managed these pragmatically, obtaining technologies and adapting the home. Installed technologies were rarely fit for purpose. Support services for technologies made high (and sometimes oppressive) demands on users. Six principles emerged from the workshops. Quality telehealth or telecare is 1) ANCHORED in a shared understanding of what matters to the user; 2) REALISTIC about the natural history of illness; 3) CO-CREATIVE, evolving and adapting solutions with users; 4) HUMAN, supported through interpersonal relationships and social networks; 5) INTEGRATED, through attention to mutual awareness and knowledge sharing; 6) EVALUATED to drive system learning. CONCLUSIONS: Technological advances are important, but must be underpinned by industry and service providers following a user-centred approach to design and delivery. For the ARCHIE principles to be realised, the sector requires: (1) a shift in focus from product ('assistive technologies') to performance ('supporting technologies-in-use'); (2) a shift in the commissioning model from standardised to personalised home care contracts; and (3) a shift in the design model from 'walled garden', branded products to inter-operable components that can be combined and used flexibly across devices and platforms. Please see related article: http://dx.doi.org/10.1186/s12916-015-0305-8.

Moving beyond local practice: reconfiguring the adoption of a breast cancer diagnostic technology.

This paper explores the ways in which technological innovation becomes adopted and incorporated into healthcare practice. Drawing upon the notion of 'field of practices', we examine how adoption is subject to spatially and temporally distributed reconfigurations across a multi-level set of practices, ranging from the policy level to the micro-level setting of individual action. The empirical backdrop is provided by a case study of the adoption of Breast Lymph Node Assay (BLNA), a diagnostic technology innovation for the treatment of breast cancer patients. Our aim is to contribute to the development of a more comprehensive analysis of the processes surrounding the adoption and incorporation of complex healthcare technologies into routine practice.