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      Seven lessons for interdisciplinary research on interactive digital health interventions

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          Abstract

          Research and development for interactive digital health interventions requires multi-disciplinary expertise in identifying user needs, and developing and evaluating each intervention. Two of the central areas of expertise required are Health (broadly defined) and Human–Computer Interaction. Although these share some research methods and values, they traditionally have deep differences that can catch people unawares, and make interdisciplinary collaborations challenging, resulting in sub-optimal project outcomes. The most widely discussed is the contrast between formative evaluation (emphasised in Human–Computer Interaction) and summative evaluation (emphasised in Health research). However, the differences extend well beyond this, from the nature of accepted evidence to the culture of reporting. In this paper, we present and discuss seven lessons that we have learned about the contrasting cultures, values, assumptions and practices of Health and Human–Computer Interaction. The lessons are structured according to a research lifecycle, from establishing the state of the art for a given digital intervention, moving through the various (iterative) stages of development, evaluation and deployment, through to reporting research results. Although our focus is on enabling people from different disciplinary backgrounds to work together with better mutual understanding, we also highlight ways in which future research in this interdisciplinary space could be better supported.

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          Design and Evaluation in eHealth: Challenges and Implications for an Interdisciplinary Field

          Much has been written about insufficient user involvement in the design of eHealth applications, the lack of evidence demonstrating impact, and the difficulties these bring for adoption. Part of the problem lies in the differing languages, cultures, motives, and operational constraints of producers and evaluators of eHealth systems and services. This paper reflects on the benefits of and barriers to interdisciplinary collaboration in eHealth, focusing particularly on the relationship between software developers and health services researchers. It argues that the common pattern of silo or parallel working may be ameliorated by developing mutual awareness and respect for each others’ methods, epistemologies, and contextual drivers and by recognizing and harnessing potential synergies. Similarities and differences between models and techniques used in both communities are highlighted in order to illustrate the potential for integrated approaches and the strengths of unique paradigms. By sharing information about our research approaches and seeking to actively collaborate in the process of design and evaluation, the aim of achieving technologies that are truly user-informed, fit for context, high quality, and of demonstrated value is more likely to be realized. This may involve embracing new ways of working jointly that are unfamiliar to the stakeholders involved and that challenge disciplinary conventions. It also has policy implications for agencies commissioning research and development in this area.
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            A Hermeneutic Approach for Conducting Literature Reviews and Literature Searches

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              Understanding heart failure; explaining telehealth – a hermeneutic systematic review

              Background Enthusiasts for telehealth extol its potential for supporting heart failure management. But randomised trials have been slow to recruit and produced conflicting findings; real-world roll-out has been slow. We sought to inform policy by making sense of a complex literature on heart failure and its remote management. Methods Through database searching and citation tracking, we identified 7 systematic reviews of systematic reviews, 32 systematic reviews (including 17 meta-analyses and 8 qualitative reviews); six mega-trials and over 60 additional relevant empirical studies and commentaries. We synthesised these using Boell’s hermeneutic methodology for systematic review, which emphasises the quest for understanding. Results Heart failure is a complex and serious condition with frequent co-morbidity and diverse manifestations including severe tiredness. Patients are often frightened, bewildered, socially isolated and variably able to self-manage. Remote monitoring technologies are many and varied; they create new forms of knowledge and new possibilities for care but require fundamental changes to clinical roles and service models and place substantial burdens on patients, carers and staff. The policy innovation of remote biomarker monitoring enabling timely adjustment of medication, mediated by “activated” patients, is based on a modernist vision of efficient, rational, technology-mediated and guideline-driven (“cold”) care. It contrasts with relationship-based (“warm”) care valued by some clinicians and by patients who are older, sicker and less technically savvy. Limited uptake of telehealth can be analysed in terms of key tensions: between tidy, “textbook” heart failure and the reality of multiple comorbidities; between basic and intensive telehealth; between activated, well-supported patients and vulnerable, unsupported ones; between “cold” and “warm” telehealth; and between fixed and agile care programmes. Conclusion The limited adoption of telehealth for heart failure has complex clinical, professional and institutional causes, which are unlikely to be elucidated by adding more randomised trials of technology-on versus technology-off to an already-crowded literature. An alternative approach is proposed, based on naturalistic study designs, application of social and organisational theory, and co-design of new service models based on socio-technical principles. Conventional systematic reviews (whose goal is synthesising data) can be usefully supplemented by hermeneutic reviews (whose goal is deepening understanding). Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0594-2) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Digit Health
                Digit Health
                DHJ
                spdhj
                Digital Health
                SAGE Publications (Sage UK: London, England )
                2055-2076
                03 May 2018
                Jan-Dec 2018
                : 4
                : 2055207618770325
                Affiliations
                [1 ]UCL Institute of Digital Health, Ringgold 4919, universityUniversity College London; , UK
                [2 ]UCL Interaction Centre, Ringgold 4919, universityUniversity College London; , UK
                [3 ]UCL Centre for Population Research in Sexual Health & HIV, Institute of Global Health, UK
                [4 ]eHealth Unit, Research Department of Primary Care and Population Health, Ringgold 4919, universityUniversity College London; , Royal Free Hospital, UK
                [5 ]Department of Clinical, Educational and Health Psychology, Ringgold 4919, universityUniversity College London; , UK
                Author notes
                [*]Ann Blandford, University College London, Gower Street, London WC1E 6BT, UK. Email: A.Blandford@ 123456ucl.ac.uk Twitter: @annblandford
                Author information
                http://orcid.org/0000-0002-3198-7122
                http://orcid.org/0000-0003-3285-3174
                Article
                10.1177_2055207618770325
                10.1177/2055207618770325
                6016567
                29942629
                9d8f06a4-1f5c-4b23-8783-7ab2292140e4
                © The Author(s) 2018

                Creative Commons CC-BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 30 September 2017
                : 19 March 2018
                Categories
                Tutorial
                Custom metadata
                January-December 2018

                human–computer interaction; e-health; digital health interventions; interdisciplinarity; multidisciplinary teams; development lifecycles

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