Supplemental material, Supplemental_file_A_B_C for Time to change the paradigm? A mixed method st... more Supplemental material, Supplemental_file_A_B_C for Time to change the paradigm? A mixed method study of the preferred and potential features of an asthma self-management app by Chi Yan Hui, Robert Walton, Brian McKinstry and Hilary Pinnock in Health Informatics Journal
Health Informatics Conference 2017: BCS The Chartered Institute for IT, Health & Care Scotland, Oct 4, 2017
Self-management improves asthma outcomes. Mobile apps are an option for self-management though en... more Self-management improves asthma outcomes. Mobile apps are an option for self-management though engaging users is challenging. The features that patients want in an app are unclear. We aimed to identify 'wanted' app features from online forums. We systematically searched (November 2013-January 2017) Google for 'asthma' 'forums', retrieved posts in which patients discussed app features, and synthesised the perceptions thematically using a framework approach. We included 29 threads from nine forums. 59 patients commented on 33 different features in four categories: self-monitoring, feedback/advice, professional/carer support, reminders. Most patients 'wanted' self-monitoring features (logging peak flow, medication and symptoms, personal indoor/outdoor monitoring for triggers) but did not explicitly mention action plans. Fitness tracking, smart device provoked a wide range of responses. The lack of discussion about action plans, suggests today's apps are limited to self-monitoring rather than self-management. Further research is needed to understand this limitation as well as the adoptive and adherent features which encourage self-management.
Springer Proceedings in Mathematics & Statistics, 2019
Chain Event Graphs (CEGs) are recent probabilistic graphical modelling tools that have proved suc... more Chain Event Graphs (CEGs) are recent probabilistic graphical modelling tools that have proved successful in modelling scenarios with context-specific independencies. Although the theory underlying CEGs supports appropriate representation of structural zeroes, the literature so far does not provide an adaptation of the vanilla CEG methods for a real-world application presenting structural zeroes also known as the non-stratified CEG class. To illustrate these methods, we present a non-stratified CEG representing a public health intervention designed to reduce the risk and rate of falling in the elderly. We then compare the CEG model to the more conventional Bayesian Network model when applied to this setting.
International Journal of Environmental Research and Public Health, 2021
Use of e-cigarettes (vaping) has potential to help pregnant women stop smoking. This study explor... more Use of e-cigarettes (vaping) has potential to help pregnant women stop smoking. This study explored factors influencing adherence among participants in the vaping arm of the first trial of vaping for smoking cessation in pregnancy. We conducted semi-structured telephone interviews (n = 28) with women at three-months postpartum. Interviews were analysed using thematic analysis, informed by the Theoretical-Domains Framework, Necessity-Concerns Framework and Perceptions and Practicalities Approach. Interviewees generally reported high levels of vaping. We found that: (1) intervention adherence was driven by four necessity beliefs—stopping smoking for the baby, and vaping for harm reduction, smoking cessation or as a last resort; (2) necessity beliefs outweighed vaping concerns, such as dependence and safety; (3) adherence was linked to four practicalities themes, acting as barriers and facilitators to vaping—device and e-liquid perceptions, resources and support, whether vaping became ...
International Journal of Environmental Research and Public Health, 2016
A reliable assessment of smoking status has significant public health implications and is essenti... more A reliable assessment of smoking status has significant public health implications and is essential for research purposes. The aim of this study was to determine optimal saliva cotinine cutoff values for smoking during pregnancy. The analyses were based on data from 1771 women from the Polish Mother and Child Cohort. Saliva cotinine concentrations were assessed by high performance liquid chromatography coupled with tandem mass spectrometry (HPLC-ESI + MS/MS). The saliva cotinine cutoff value for active smoking was established at 10 ng/mL (sensitivity 96%, specificity 95%) and for passive smoking at 1.5 ng/mL (sensitivity 63%, specificity 71%). About 5% of the self-reported non-smoking women were classified as smokers based on the cotinine cutoff value. Significantly more younger, single, and less educated self-reported non-smokers had a cotinine concentration higher than 10 ng/mL compared to those who were older, married, and who had a university degree. Close to 30% of the non-smokers who indicated that smoking was not allowed in their home could be classified as exposed to passive smoking based on the cutoff value. The study suggests that self-reported smoking status is a valid measure of active smoking, whereas in the case of passive smoking, a combination of questionnaire data and biomarker verification may be required.
Background Community pharmacies serve people with high levels of tobacco-related illness, but thr... more Background Community pharmacies serve people with high levels of tobacco-related illness, but throughput in NHS Stop Smoking Services in pharmacies remains relatively low. We investigated the effectiveness of a complex intervention to increase service uptake and retention. Methods We randomised 60 pharmacies in England and Wales to the STOP intervention or usual practice in a pragmatic, parallel-group, controlled trial over 11 months. Smokers were blind to the allocation. The intervention was theory-based consultation skills training for pharmacy staff with environmental prompts (badges, calendars and behavioural cues). The primary outcome was the number of smokers attending an initial consultation and setting a quit date. Results The intervention made no significant difference in setting a quit date, retention or quit rate. A total of 631 adult smokers (service users) enrolled and set a quit date in intervention pharmacies compared to 641 in usual practice pharmacies, a rate ratio ...
Background: Smoking is one of the greatest threats to public health worldwide. We integrated phen... more Background: Smoking is one of the greatest threats to public health worldwide. We integrated phenomewide association study (PheWAS) and Mendelian randomization (MR) approaches to explore causal effects of genetically predicted smoking intensity across the human disease spectrum. Methods: We conducted PheWAS case-control analyses in 152,483 ever smokers of White-British ancestry, aged 39À73 years. Disease diagnoses were based on hospital inpatient and mortality registrations. Smoking intensity was instrumented by four genetic variants, and disease risks estimated for one cigarette per day heavier intakes. Associations passing the FDR threshold (p<00025) were assessed for causality using several complementary MR approaches. Findings: Genetically instrumented smoking intensity was associated with 48 conditions, with MR supporting a possible causal effect for 28 distinct outcomes. Each cigarette smoked per day elevated the odds of respiratory diseases by 5% to 33% (nine distinct diseases, including pneumonia, emphysema, obstructive chronic bronchitis, pleurisy, pulmonary collapse, respiratory failure) and the odds of circulatory disease by 5% to 23% (seven diseases, including atherosclerosis, myocardial infarction, congestive heart failure, arterial embolisms). Further effects were seen for cancer within the respiratory system and other neoplasms, renal failure, septicaemia, and retinal disorders. No associations were observed in sensitivity analyses on 185,002 never smokers. Interpretation: These genetic data demonstrate the substantial adverse health impacts by smoking intensity and suggest notable increases in the risks of several diseases. Public health initiatives should highlight the damage caused by smoking intensity and the potential benefits of reducing or ideally quitting smoking.
To facilitate smoking genetics research we determined whether a screen of mutagenized zebrafish f... more To facilitate smoking genetics research we determined whether a screen of mutagenized zebrafish for nicotine preference could predict loci affecting smoking behaviour. From 30 screened F3 sibling groups, where each was derived from an individual ethyl-nitrosurea mutagenized F0 fish, two showed increased or decreased nicotine preference. Out of 25 inactivating mutations carried by the F3 fish, one in the slit3 gene segregated with increased nicotine preference in heterozygous individuals. Focussed SNP analysis of the human SLIT3 locus in cohorts from UK (n=863) and Finland (n=1715) identified two variants associated with cigarette consumption and likelihood of cessation. Characterisation of slit3 mutant larvae and adult fish revealed decreased sensitivity to the dopaminergic and serotonergic antagonist amisulpride, known to affect startle reflex that is correlated with addiction in humans, and increased htr1aa mRNA expression in mutant larvae. No effect on neuronal pathfinding was de...
ObjectivesSmokers are more likely to quit if they use the National Health Service (NHS) Stop Smok... more ObjectivesSmokers are more likely to quit if they use the National Health Service (NHS) Stop Smoking Service (SSS). However, community pharmacies experience low service uptake. The Smoking Treatment Optimisation in Pharmacies (STOP) programme aims to address this problem by enhancing staff training using a theory-based intervention. In this study, we evaluated intervention fidelity using simulated smokers (actors) to assess smoker engagement and enactment of key intervention components by STOP trained staff.DesignAn observational pilot study.SettingsFive community pharmacies in North East London with an NHS SSS.MethodsSix actors, representative of East London’s population, were recruited and trained to complete intervention fidelity assessments. Consenting pharmacy staff from five participating pharmacies received STOP Intervention training. Four weeks after the staff training, the actors visited the participating pharmacies posing as smokers eligible for smoking cessation support. ...
Introduction Assessing the fidelity of complex behavioural interventions and examining the contex... more Introduction Assessing the fidelity of complex behavioural interventions and examining the contextual reasons why such interventions succeed, or fail are important activities but challenging and rarely reported. The Smoking Treatment Optimisation in Pharmacies (STOP) trial is a cluster randomised trial evaluating the effectiveness of a complex intervention to optimise the National Health Service (NHS) Stop Smoking Service delivered in community pharmacies. This complex intervention comprises a training package for pharmacy staff involving motivational interviewing and communication skills aimed at increasing smoking cessation knowledge and proactive client engagement. We report on a process evaluation which was planned along-side the trial to offer findings that will assist in the interpretation of the main trial results and help inform potential implementation in community pharmacy settings on a wider scale. Methods and analysis Quantitative data on recruitment and retention proces...
BACKGROUNDAlthough there is clear evidence of genetic contributions to susceptibility to nicotine... more BACKGROUNDAlthough there is clear evidence of genetic contributions to susceptibility to nicotine addiction, it has proved difficult to identify causal alleles and pathways from studies in humans. Mutagenesis in model species generates strong phenotypes not present in wildtype populations and can be used to identify biological mechanisms underlying quantifiable behaviours. We tested the hypothesis that a forward genetic screen for nicotine preference in zebrafish can predict loci and biological mechanisms influencing human smoking behaviour.METHODSA population-based forward genetic screen of ethylnitrosurea-mutagenized zebrafish was used to identify lines of fish showing altered nicotine preference. Immunohistochemical, behavioral and quantitative PCR analyses were used to characterize mutant larvae. Focussed SNP analysis of the homologous human locus in cohorts from the UK and a Finnish Twin study assessed the predictive validity of the zebrafish data for human smoking behavior.RES...
We explored the potential of asthma apps to support self-management and identified preferred feat... more We explored the potential of asthma apps to support self-management and identified preferred features that enable users to live with asthma. We recruited patients from five UK practices and social media; observed their usage of our app, administered a questionnaire and interviewed a purposive sample of patients and professionals to explore preferred features. Thematic analysis of interview was synthesised with quantitative data. A total of 111 patients used our app for 3 months. We interviewed 15 patients and 16 professionals. Participants were interested in a broad range of self-management support strategies, including action plans, monitoring with feedback, allergy/weather warnings and tailor-made running coaching. Professionals wanted to integrate patients’ logs with practice records, though were concerned about data overload and risk of patient dependency. We propose a paradigm shift - from apps developed to provide features that are easy to implement technologically, to an appr...
Supplemental material, Supplemental_file_A_B_C for Time to change the paradigm? A mixed method st... more Supplemental material, Supplemental_file_A_B_C for Time to change the paradigm? A mixed method study of the preferred and potential features of an asthma self-management app by Chi Yan Hui, Robert Walton, Brian McKinstry and Hilary Pinnock in Health Informatics Journal
Health Informatics Conference 2017: BCS The Chartered Institute for IT, Health & Care Scotland, Oct 4, 2017
Self-management improves asthma outcomes. Mobile apps are an option for self-management though en... more Self-management improves asthma outcomes. Mobile apps are an option for self-management though engaging users is challenging. The features that patients want in an app are unclear. We aimed to identify 'wanted' app features from online forums. We systematically searched (November 2013-January 2017) Google for 'asthma' 'forums', retrieved posts in which patients discussed app features, and synthesised the perceptions thematically using a framework approach. We included 29 threads from nine forums. 59 patients commented on 33 different features in four categories: self-monitoring, feedback/advice, professional/carer support, reminders. Most patients 'wanted' self-monitoring features (logging peak flow, medication and symptoms, personal indoor/outdoor monitoring for triggers) but did not explicitly mention action plans. Fitness tracking, smart device provoked a wide range of responses. The lack of discussion about action plans, suggests today's apps are limited to self-monitoring rather than self-management. Further research is needed to understand this limitation as well as the adoptive and adherent features which encourage self-management.
Springer Proceedings in Mathematics & Statistics, 2019
Chain Event Graphs (CEGs) are recent probabilistic graphical modelling tools that have proved suc... more Chain Event Graphs (CEGs) are recent probabilistic graphical modelling tools that have proved successful in modelling scenarios with context-specific independencies. Although the theory underlying CEGs supports appropriate representation of structural zeroes, the literature so far does not provide an adaptation of the vanilla CEG methods for a real-world application presenting structural zeroes also known as the non-stratified CEG class. To illustrate these methods, we present a non-stratified CEG representing a public health intervention designed to reduce the risk and rate of falling in the elderly. We then compare the CEG model to the more conventional Bayesian Network model when applied to this setting.
International Journal of Environmental Research and Public Health, 2021
Use of e-cigarettes (vaping) has potential to help pregnant women stop smoking. This study explor... more Use of e-cigarettes (vaping) has potential to help pregnant women stop smoking. This study explored factors influencing adherence among participants in the vaping arm of the first trial of vaping for smoking cessation in pregnancy. We conducted semi-structured telephone interviews (n = 28) with women at three-months postpartum. Interviews were analysed using thematic analysis, informed by the Theoretical-Domains Framework, Necessity-Concerns Framework and Perceptions and Practicalities Approach. Interviewees generally reported high levels of vaping. We found that: (1) intervention adherence was driven by four necessity beliefs—stopping smoking for the baby, and vaping for harm reduction, smoking cessation or as a last resort; (2) necessity beliefs outweighed vaping concerns, such as dependence and safety; (3) adherence was linked to four practicalities themes, acting as barriers and facilitators to vaping—device and e-liquid perceptions, resources and support, whether vaping became ...
International Journal of Environmental Research and Public Health, 2016
A reliable assessment of smoking status has significant public health implications and is essenti... more A reliable assessment of smoking status has significant public health implications and is essential for research purposes. The aim of this study was to determine optimal saliva cotinine cutoff values for smoking during pregnancy. The analyses were based on data from 1771 women from the Polish Mother and Child Cohort. Saliva cotinine concentrations were assessed by high performance liquid chromatography coupled with tandem mass spectrometry (HPLC-ESI + MS/MS). The saliva cotinine cutoff value for active smoking was established at 10 ng/mL (sensitivity 96%, specificity 95%) and for passive smoking at 1.5 ng/mL (sensitivity 63%, specificity 71%). About 5% of the self-reported non-smoking women were classified as smokers based on the cotinine cutoff value. Significantly more younger, single, and less educated self-reported non-smokers had a cotinine concentration higher than 10 ng/mL compared to those who were older, married, and who had a university degree. Close to 30% of the non-smokers who indicated that smoking was not allowed in their home could be classified as exposed to passive smoking based on the cutoff value. The study suggests that self-reported smoking status is a valid measure of active smoking, whereas in the case of passive smoking, a combination of questionnaire data and biomarker verification may be required.
Background Community pharmacies serve people with high levels of tobacco-related illness, but thr... more Background Community pharmacies serve people with high levels of tobacco-related illness, but throughput in NHS Stop Smoking Services in pharmacies remains relatively low. We investigated the effectiveness of a complex intervention to increase service uptake and retention. Methods We randomised 60 pharmacies in England and Wales to the STOP intervention or usual practice in a pragmatic, parallel-group, controlled trial over 11 months. Smokers were blind to the allocation. The intervention was theory-based consultation skills training for pharmacy staff with environmental prompts (badges, calendars and behavioural cues). The primary outcome was the number of smokers attending an initial consultation and setting a quit date. Results The intervention made no significant difference in setting a quit date, retention or quit rate. A total of 631 adult smokers (service users) enrolled and set a quit date in intervention pharmacies compared to 641 in usual practice pharmacies, a rate ratio ...
Background: Smoking is one of the greatest threats to public health worldwide. We integrated phen... more Background: Smoking is one of the greatest threats to public health worldwide. We integrated phenomewide association study (PheWAS) and Mendelian randomization (MR) approaches to explore causal effects of genetically predicted smoking intensity across the human disease spectrum. Methods: We conducted PheWAS case-control analyses in 152,483 ever smokers of White-British ancestry, aged 39À73 years. Disease diagnoses were based on hospital inpatient and mortality registrations. Smoking intensity was instrumented by four genetic variants, and disease risks estimated for one cigarette per day heavier intakes. Associations passing the FDR threshold (p<00025) were assessed for causality using several complementary MR approaches. Findings: Genetically instrumented smoking intensity was associated with 48 conditions, with MR supporting a possible causal effect for 28 distinct outcomes. Each cigarette smoked per day elevated the odds of respiratory diseases by 5% to 33% (nine distinct diseases, including pneumonia, emphysema, obstructive chronic bronchitis, pleurisy, pulmonary collapse, respiratory failure) and the odds of circulatory disease by 5% to 23% (seven diseases, including atherosclerosis, myocardial infarction, congestive heart failure, arterial embolisms). Further effects were seen for cancer within the respiratory system and other neoplasms, renal failure, septicaemia, and retinal disorders. No associations were observed in sensitivity analyses on 185,002 never smokers. Interpretation: These genetic data demonstrate the substantial adverse health impacts by smoking intensity and suggest notable increases in the risks of several diseases. Public health initiatives should highlight the damage caused by smoking intensity and the potential benefits of reducing or ideally quitting smoking.
To facilitate smoking genetics research we determined whether a screen of mutagenized zebrafish f... more To facilitate smoking genetics research we determined whether a screen of mutagenized zebrafish for nicotine preference could predict loci affecting smoking behaviour. From 30 screened F3 sibling groups, where each was derived from an individual ethyl-nitrosurea mutagenized F0 fish, two showed increased or decreased nicotine preference. Out of 25 inactivating mutations carried by the F3 fish, one in the slit3 gene segregated with increased nicotine preference in heterozygous individuals. Focussed SNP analysis of the human SLIT3 locus in cohorts from UK (n=863) and Finland (n=1715) identified two variants associated with cigarette consumption and likelihood of cessation. Characterisation of slit3 mutant larvae and adult fish revealed decreased sensitivity to the dopaminergic and serotonergic antagonist amisulpride, known to affect startle reflex that is correlated with addiction in humans, and increased htr1aa mRNA expression in mutant larvae. No effect on neuronal pathfinding was de...
ObjectivesSmokers are more likely to quit if they use the National Health Service (NHS) Stop Smok... more ObjectivesSmokers are more likely to quit if they use the National Health Service (NHS) Stop Smoking Service (SSS). However, community pharmacies experience low service uptake. The Smoking Treatment Optimisation in Pharmacies (STOP) programme aims to address this problem by enhancing staff training using a theory-based intervention. In this study, we evaluated intervention fidelity using simulated smokers (actors) to assess smoker engagement and enactment of key intervention components by STOP trained staff.DesignAn observational pilot study.SettingsFive community pharmacies in North East London with an NHS SSS.MethodsSix actors, representative of East London’s population, were recruited and trained to complete intervention fidelity assessments. Consenting pharmacy staff from five participating pharmacies received STOP Intervention training. Four weeks after the staff training, the actors visited the participating pharmacies posing as smokers eligible for smoking cessation support. ...
Introduction Assessing the fidelity of complex behavioural interventions and examining the contex... more Introduction Assessing the fidelity of complex behavioural interventions and examining the contextual reasons why such interventions succeed, or fail are important activities but challenging and rarely reported. The Smoking Treatment Optimisation in Pharmacies (STOP) trial is a cluster randomised trial evaluating the effectiveness of a complex intervention to optimise the National Health Service (NHS) Stop Smoking Service delivered in community pharmacies. This complex intervention comprises a training package for pharmacy staff involving motivational interviewing and communication skills aimed at increasing smoking cessation knowledge and proactive client engagement. We report on a process evaluation which was planned along-side the trial to offer findings that will assist in the interpretation of the main trial results and help inform potential implementation in community pharmacy settings on a wider scale. Methods and analysis Quantitative data on recruitment and retention proces...
BACKGROUNDAlthough there is clear evidence of genetic contributions to susceptibility to nicotine... more BACKGROUNDAlthough there is clear evidence of genetic contributions to susceptibility to nicotine addiction, it has proved difficult to identify causal alleles and pathways from studies in humans. Mutagenesis in model species generates strong phenotypes not present in wildtype populations and can be used to identify biological mechanisms underlying quantifiable behaviours. We tested the hypothesis that a forward genetic screen for nicotine preference in zebrafish can predict loci and biological mechanisms influencing human smoking behaviour.METHODSA population-based forward genetic screen of ethylnitrosurea-mutagenized zebrafish was used to identify lines of fish showing altered nicotine preference. Immunohistochemical, behavioral and quantitative PCR analyses were used to characterize mutant larvae. Focussed SNP analysis of the homologous human locus in cohorts from the UK and a Finnish Twin study assessed the predictive validity of the zebrafish data for human smoking behavior.RES...
We explored the potential of asthma apps to support self-management and identified preferred feat... more We explored the potential of asthma apps to support self-management and identified preferred features that enable users to live with asthma. We recruited patients from five UK practices and social media; observed their usage of our app, administered a questionnaire and interviewed a purposive sample of patients and professionals to explore preferred features. Thematic analysis of interview was synthesised with quantitative data. A total of 111 patients used our app for 3 months. We interviewed 15 patients and 16 professionals. Participants were interested in a broad range of self-management support strategies, including action plans, monitoring with feedback, allergy/weather warnings and tailor-made running coaching. Professionals wanted to integrate patients’ logs with practice records, though were concerned about data overload and risk of patient dependency. We propose a paradigm shift - from apps developed to provide features that are easy to implement technologically, to an appr...
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