In this post Anasztazia Gubijev a research associate working on the Contraception Choices project with Dr Julia Bailey and Professor Judith Stephenson talks about her experiences on the contraception choices project which is split between PCPH and The Institute for Women’s Health.

The Contraception Choices project involves designing a digital intervention (a website) to help women choose a method of contraception that suits their needs. Many women are not aware of the wide range of contraceptive methods that are available to them and there are various misconceptions that deter women from using contraception. We are aiming to design a website that addresses some of the common misconceptions (such as thinking that hormones are harmful, that contraception causes infertility or that your body needs a break from contraception), and suggests contraceptive methods that may suit a woman’s preferences and lifestyle.

There are two phases in our project. Phase 1 involves doing a qualitative evaluation of women’s contraceptive knowledge and common misconceptions. Phase 2 is a pilot randomised controlled trial to evaluate effectiveness of our website. We are currently finishing up phase 1 and hoping to start phase 2 soon.

After a year and a half of working on this project there are a lot of things that I have learned, often by trial and error. We have made good progress on this project, but there have also been a few setbacks on the way. As an early careers researcher I wish I had known a few things before I started, so I will share these with you:

NHS ethics and R&D applications always take longer than you think they will.

Our project is a multi-site project because we recruit women from 5 different sites, so it made getting approval for recruitment quite tricky. It took us nearly 6 months to be given full approval to go ahead with recruitment at one of our project sites, which we definitely didn’t expect.

Make sure the sites you recruit from have the right population sample.

Our study population sample is women from the age of 15-30. One of our recruitment sites for phase 1 was the maternity unit at UCLH. After going through a lengthy and tedious process of getting NHS ethics and R&D approval we discovered that most women at UCLH were having babies in their late thirties or well into their forties! This meant that it was essential for us to change this maternity site so that we could recruit the population sample we needed for phase 2. Ideally you want to make sure the sites you recruit from have the right population sample from the start.

Food, drinks and incentives go a long way if you are struggling with recruitment.

We have been very lucky to have had a budget for offering the women we recruit incentives in the form of shopping vouchers. However, I still struggled with recruitment at some of our project sites, so we decided to also offer women drinks and pizza for taking part in our focus groups. Not only did this make recruitment a lot easier, offering women food before we started our focus groups was a nice ice breaker to get conversation flowing. If you don’t have the budget or ethics approval for offering incentives in the form of payment, then offering food and drinks is a budget friendly way of being able to offer something small in return for your participants giving up their time to help with your research.

And now onto what I enjoy most about being a research associate on this project:

I can honestly say that I have really enjoyed being a researcher on this project. Yes, there have been a few setbacks on the way, but the work that I have been involved in has been really interesting. One of the tasks that I really enjoyed was doing a literature review on women’s views of contraception on social media. I watched and analysed videos and comments posted on YouTube to gain a better understanding of contraceptive misconceptions. Social media is an underused resource for research, however we live in an increasingly digital world and it would be a shame to ignore all the voices and views we can learn from through social media.

I have also really enjoyed the qualitative field work, such as running focus groups and conducting individual interviews with women we have recruited. We have been actively seeking women’s views throughout this project, and their views have shaped the design and content of our website. I may have been dreaming of focus groups and interviews at some point because we have conducted so many, but we wouldn’t have been able to create our website without the valuable feedback we have received.

In this post Ghadah Alkhaldi who was recently awarded her PhD from PCPH talks about her time here and how to survive your PhD as an international student.

Doing a PhD is not an easy, simple, or stress-free experience. PhD students go through years of endless deadlines, no breaks during weekends and quite often question their sanity about why they chose to do a PhD in the first place

I do not think I appreciated the challenges of being a PhD student until I started mine three years ago.  My experience at PCPH was also unique in a way. I was from Saudi Arabia -a socio-cultural context that is quite different from that of the UK; a non-English native speaker; and a novice researcher (I’ve always been a student).

I thought that if I was able to do a one year’s master programme at a UK university, it would not be that difficult to do a 3 year PhD. This assumption -I realised later on- was not exactly right…

Fortunately, I was lucky to do my PhD within PCPH, where I found a supportive, friendly and extremely helpful environment. Working in such an environment is an important element of survival for any PhD student, but specifically for an international student like myself. Doing a PhD is a lonely journey as my supervisor told me when I first started my PhD and she was right. It is especially lonely when you do not have the support circle you are used to your whole life, for example family and friends.

Hence, any PhD student needs to find a supportive and understanding environment, somewhere where there are researchers who were just recently awarded a PhD or other PhD students.

And that is my first tip for surviving your PhD: a supportive and helpful environment!

Indeed, I made sure to work most of my time in my office surrounded with other PhD students and early career researchers. They provided me with the professional and personal support and advice that I needed to maintain my sanity and ensure my PhD progressed well.

Another piece of advice is to read, attend talks and discuss research other than your own topic.  It will inspire you and may help add an element of creativity to your research. It will also deepen your understanding of the amazing research culture of the UK, appreciate the variety of research conducted all around the country, and provide you with good networking opportunities.

And do not ever forget to focus completely on finishing your PhD. Do not be distracted with other interesting non-PhD related projects. If you get distracted, there is a big possibility that in ten-years time, you might find yourself still a PhD student instead of a senior researcher in your field of choice. Seriously, I have seen that happen before.

My final tip is to make sure you have a good justification for any decision you make about the research in your PhD. Never decide on doing something whether it is related to collecting data, analysis methodology or writing up that does not make sense to you or you are not convinced by it, because you will need to defend it and defend it well. It is your PhD after all. Any PhD student should never utter these words ever: ‘my supervisor told me so’.

Finally, enjoy your PhD. Find any way to enjoy it, because you will live, breathe and dream about your PhD for three to four years. My method of enjoying my PhD was by celebrating the small successes no matter how insignificant they might have seemed to be!

There are many tips online and different published books on how to survive a PhD, I did not repeat those ones. I only shared what helped me pass and pass successfully.

In this post Shoba Poduval from the e-Health Unit talks about her exciting visit to California as part of the Ubihealth exchange Programme.

In March, thanks to the UbiHealth Exchange Programme, I visited the Informatics department at University of California in Irvine (UCI) supervised by Gillian Hayes and Yunan Chen. Ubihealth is a global consortium of research institutions with expertise in technology and healthcare, and the exchange programme allows researchers from member institutions to share knowledge and apply it to their own fields of work.

During my visit I met with researchers and clinicians involved in eHealth and patient self-management support. Josh Tannenbaum is an Associate Professor whose research looks at the use of digital games as an educational tool in interactive storytelling and identity transformation, with the purpose of challenging people’s assumptions about others. Professor Tannenbaum suggests that interactive digital games could be developed which allow people to experience life with diabetes, acquire greater empathy, and interact with people with diabetes in a way that is more supportive of positive lifestyle changes.

I met with Terrye Peterson, a nurse and certified diabetes educator at UCI Medical Centre. Terrye delivers diabetes education by visiting patients on the wards to discuss their management and deliver the education. Most people with type 2 diabetes in the US do not receive any structured self-management education, and barriers include limitations to access due to socioeconomic and cultural factors, health insurance shortfalls, or lack of encouragement from healthcare providers to seek diabetes education. In England, referral to diabetes self-management education has become a national Quality and Outcomes Framework (pay for performance) item for GPs, incentivising them to refer patients to a programme. In the US healthcare is funded by government programs like Medicaid, private insurance plans and out-of-pocket payments, and there is no national standardised reward and incentive scheme for referring. Other issues for diabetes management in the US include unaffordable co-payments (top-up payments) for essential treatments and lack of integration between outpatient and hospital care.

I also visited the UCI Centre on Stress & Health which, together with the Children’s Hospital of Orange County, develops interventions to relieve the pain, anxiety and stress of disease and the healthcare environment for children. I met with Drs Michelle Fortier and Zeev Kain to learn more about their work on a web-based tailored intervention for preparation of parents and children for outpatient surgery (WebTIPS). The programme consists of an interactive website which teaches children what to expect from surgery, and skills for coping with anxiety prior to the surgery. There are games which allow children to place equipment on animated animals and deep breathing exercises to encourage calm. The team have published findings from their randomized controlled trial of the program with children age 2 to 7 years old undergoing outpatient elective surgery. They found that children and their families found the programme helpful, easy to use and it led to a reduction in preoperative anxiety.

Finally, I met with PhD student Kate Ringland who is studying an online community for children with autism built around the game Minecraft. Minecraft is a creative game which allows players to dig (mine) and build (craft) with 3D blocks whilst exploring a variety of terrains and landscapes. Kate’s research looks at how online communities can help support social interaction for people who find face-to-face communication challenging, such as children with autism. Her results suggest that people with autism are finding new ways to express themselves and connect with others in order to form communities.

Working at the eHealth unit has taught me about the potential for technology to change the way we interact with patients and deliver healthcare. UK eHealth research addresses some similar themes as that of our US colleagues, including patient education and social interaction, but there are also differences in our health systems which mean that interventions need to be implemented in different ways. We can learn from both our similarities and differences, and international exchange and collaboration is vital for sustaining this learning.

Acknowledgements: With thanks to UbiHealth, Nadia Bertzhouse, Elizabeth Murray, Nikki Newhouse, Aisling O’Kane, Louise Gaynor, UCI Informatics, Gillian Hayes, Yunan Chen, Josh Tannenbaum, Terrye Peterson, Michelle Fortier, Zeev Kain and Kate Ringland.

In our latest blog post Fiona Giles talks about her attendance to a conference on the importance of sleep in our health. 

In December I was lucky enough to attend a two day conference held by the Royal Society of Medicine and the Nutrition Society on the importance of sleep in health.  This was a fantastic opportunity to hear some new and original research on the importance of sleep quality and duration in reducing obesity and the risk of metabolic diseases such as diabetes.  The conference covered a wide variety of topics relating to sleep and circadian cycles, ranging from the importance of vitamin D for sleep to the effects of shift work and the importance of regular meals in maintaining a healthy body weight.

This conference was of interest to me both as a member of the eHealth Unit, working on the HeLP-Diabetes project and as a Public Health Nutritionist.  Several research studies presented across the two days demonstrated interesting findings in relation to sleep and diabetes. These studies showed that longer sleep duration was associated with better glucose control and less variation in glucose levels.  This suggests that improving one’s sleeping environment, going to bed earlier and using relaxation techniques could all help diabetic patients better control their condition.

The importance of regular meals and, in particular, eating breakfast was also mentioned throughout the conference.  The take home message of many conference papers was that eating earlier in the day was related to significantly higher weight loss than eating late in the day.  Furthermore, studies showed that participants who skipped breakfast were significantly less likely to lose weight, over six weeks, compared to participants who did eat breakfast, even though the breakfast group consumed substantially more calories.  An interesting point considering breakfast is the meal most often skipped by those trying to lose weight!

Although there is lots of interesting new research on sleep and the effects of circadian cycles on metabolism, much of the evidence comes from rodent studies and small, limited, human cohorts.  Therefore it is difficult to generalise findings to the population as a whole. Nevertheless, current evidence shows us that improved sleep quality and duration could have a substantial effect on reducing the risk of metabolic diseases and be a key tool in helping diabetic patients to better control their condition.

In this post Orla O’Donnell from the eHealth Unit talks about the HeLP Diabetes research and rolling it out across the NHS with a not-for-profit social enterprise. 

Current NICE guidance recommends that anyone who is newly diagnosed with type 2 diabetes (within the last 9 months) should be offered structured education but all of the current education offered by the NHS is delivered face to face in a group setting. This means that take up can be low as it’s harder for people who work or have caring responsibilities to attend. The offer of online education in addition, or instead of is one potential solution to increasing uptake as it’s more available and attractive to those who cannot or do not want to attend groups. Online interventions are also considerably cheaper to run en masse than repeated face to face sessions and have the added advantage of being able to offer on-going access to information about the condition.

In light of this, Elizabeth Murray and our team at the eHealth Unit have developed an innovative and sophisticated online self-management programme (called ‘HeLP-Diabetes’) and an accompanying structured education pathway (called ‘HeLP-Diabetes: Starting Out’) for adults with type 2 diabetes.

HeLP-Diabetes stands for ‘Healthy Living for People with type 2 diabetes’ and it was developed through funding from an NIHR Programme Grant for Applied Health Research. With the research programme coming to an end next year and due to popular demand for the programme (from CCGs in London and now England wide), Elizabeth decided to set up a not-for-profit social enterprise (a spin out Community Interest Company/CIC) to roll out the programme across the NHS and I’ve been working closely with UCL Business to establish this over the last few months.

In 2014 we applied to, and were successful in being selected for the Health and Social Innovators (HSI) programme; an accelerator programme for small start-up companies offering a 4 month incubator scheme plus financial investment which we will use to cover the costs of setting up the CIC (legal, accountancy fees, etc). The programme involved colleagues and I attending a number of different seminars and workshops on subjects such as financial modelling, marketing, competitor analysis, elevator pitching and legal matters. There were 7 successful ‘Ventures’ who took part and it was a really worthwhile and enjoyable programme. I managed to establish excellent networks and acquired some quite influential business mentors. I’ve since been in contact with colleagues at UCL Partners, and others and have met with some influential people at NHS England, and Diabetes UK as well.

Upon completion of the HSI Programme there were various steps we needed to follow and forms we needed to fill out to set up and become a registered company which we did in June 2015. One of the biggest challenges I had was the protection of IP at the other institutions who had allowed us to use content within the programme, with the nature of academic research being so collaborative, however, persistence paid off and we’re ready to commence with the roll out now all of the collaboration agreements are agreed.

The sales aspect has also been a learning curve but on contacting NHS commissioners to tell them about the programme the initiative has been welcomed (by most) with open arms. I’ve been invited to various meetings to present and am having fun travelling the country to do so! We’ve now got four contracts in progress with CCG’s who are going to commission HeLP-Diabetes which is offered free at the point of delivery as part of a menu of options for patients to choose from.

What’s made my job easier is the fact that good quality, trusted online education for Diabetes was clearly something which was much wanted and needed so the requirement was already there; but also the fact that HeLP is a great product with an excellent team behind it to work with.

Orla O’Donnell (o.o’donnell@ucl.ac.uk)

This article presents independent research commissioned by the National Institute for Health Research (NIHR) through a Programme Grant for Applied Health Research (RP-PG-0609-10135). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

The sexual health research network (SHRN) is designed to bring together academics across disciplines, working in sexual health. Not only do they provide a community for collaboration and knowledge sharing, they also assist with dissemination by circulating a weekly ’roundup’ of all research in the area. They have recently started recording and publishing podcasts – conversations with sexual health researchers, talking about their work. The theme for the first few is ‘technology’, and Rosie Webster of the E-Health unit was asked to talk about the project she works on – designing and evaluating an online interactive intervention to improve condom use in men. To listen to the podcast, follow this link:

http://www.sexualhealthnetwork.org.uk/podcast_ep2_rosie_webster/

This project has been funded by the NIHR HTA programme (http://www.hta.ac.uk/project/2898.asp). The views and opinions expressed are those of Rosie Webster and do not necessarily reflect those of the Programme, NIHR, or University College London.

Rosie Webster a Research Associate within the Research Department of Primary Care and Population Health shares her thoughts on sharing knowledge of technology development in the E-Health Unit technology-sharing seminars.

Members of the E-Health unit at PCPH come from a variety of backgrounds: clinical, psychology, public health, sociology, and others. While we have extensive knowledge of health and human behaviour, we do not have specific in-house experts in technology. As a group, we have extensive experience in working to develop online interventions, and have a lot to offer with regard to experience. However, it can be difficult to efficiently share this knowledge between projects, especially when everyone is very busy.

Last year, a colleague in the E-Health unit (Kingshuk Pal) and I decided that there should be a more official way of sharing our knowledge and experience of working with technology. It makes sense for us to share what we have learnt during our experiences, to help future projects run more smoothly, and to prevent people from repeating any mistakes. We therefore established a quarterly half-day seminar series, the ‘E-Health unit technology-sharing seminars’.

Each seminar is organised by a different team of staff/PhD students, and has a different focus. The first seminar (in July last year) focussed on the theory that we use for intervention development, how to select your software developer, and technologies used to develop existing interventions within the E-Health unit. The second seminar focussed on online alcohol interventions.

The latest seminar was held recently (10^th April 2014). The first half of the seminar saw members of the E-Health unit talking about how they translated behaviour change techniques (standardised elements of an intervention) into online interactive features. It arose that there are often challenges in doing this – we may have ‘ideal’ intervention ideas, but various things can limit how this might be presented in practice (e.g. limits of the technology, time, and money!).

The highlight of this section were the presentations from the HeLP-Diabetes group, who had invited one of their software developers to come and speak with them. This gave a unique insight into the challenges of developing online interventions. Charlotte Dack reported how she developed clear Powerpoint wireframes of a goal-setting tool, to demonstrate how she expected the activity to work. Their software developers then talked about the development process of this tool, highlighting the challenges of fitting Charlotte’s ideas into the set templates provided by the development platform. This issue seemed to come up repeatedly – software developers often don’t create ‘bespoke’ websites, they use set templates. Features that fit into these templates are very straightforward to develop, but anything outside of that provides a bit of a challenge. This may explain why, when we feel something is very simple to create, developers often tell us it’s much more complex than we expect! The team also spoke of the importance of face-to-face meetings, and prioritising which elements are important/essential/’nice to have’, and why.

The second half of the seminar saw insights from computer science about the best ways to communicate ideas. Anne Hsu from Queen Mary’s University talked about systems analysis: defining the requirements of the system, specifying all the potential scenarios of use (use cases), and how the system should respond. Geraint Jones from UCL interaction centre (UCLIC) then highlighted the importance of drawing when it comes to translating your ideas. Nic Marquardt (also UCLIC) then extended this, by delivering an exciting workshop encouraging us to get sketching and storyboarding our ideas. These sketches should start as hand-drawn and rough –by getting down ideas down quickly, with minimal effort, you explore more potential ideas, rather than being strongly invested in one idea that may not be the best.

During the discussion, it was pointed out that as E-Health researchers, we should be aware of these basic skills and processes in computer science. Presenters from the latter half of the seminar kindly offered to share information about useful resources; however, it’s important that we engage in learning about these things. These seminars provide a useful starting point, but it’s important to continue the conversation, and for E-Health researchers to take an interest in learning about the basics of computer science.

Another way to facilitate learning and knowledge sharing is to maintain connections and communications with other departments. These seminars seem to be an excellent way of doing this. The seminar was originally planned to be internal, with attendees from the E-Health unit. This quickly spread to the department of clinical, educational, and health psychology, who also use online platforms for behaviour change. We now also have a lot of input (and attendees) from UCLIC, who do a lot of work in human-computer interaction. For the most recent seminar, the contribution from UCLIC really helped to increase the technological knowledge of the group. UCLIC have kindly offered to be involved in the organisation of the next seminar, and we hope that the knowledge sharing fostered by these seminars can be of mutual benefit to both groups. I’d also be keen to hear of anyone else within UCL, working in E-Health from a computer science perspective. The more we can learn from each other, the better!