Elizabeth Murray

University College London | UCL · Department of Primary Care and Population Health (PCPH)

Background: Little is known about the long-term effectiveness of behavioural therapy for tics. We aimed to assess the long-term clinical and cost-effectiveness of online therapist-supported exposure and response prevention (ERP) therapy for tics 12 and 18 months after treatment initiation. Methods: ORBIT (online remote behavioural intervention f...

Aims: To assess weight change in the Healthier You: NHS Diabetes Prevention Programme (NHS DPP) delivered via video conferencing (remote) sessions or delivered via specific digital interventions through apps or websites, during the COVID-19 pandemic compared to group-based face-to-face interventions, pre-pandemic. Methods: Prospectively collecte...

Background Digital interventions offer a potentially cost-effective means to support patient self-management in primary care, but evidence for the feasibility, acceptability and cost-effectiveness of digital interventions remains mixed. This programme focused on the potential for self-management digital interventions to improve outcomes in two comm...

This study gathered expert perspectives in the management of anterior cruciate ligament (ACL) rehabilitation to explore current practice, variations in care and optimal management strategies. This was a qualitative semi‐structured interview study. The participants' experiences were considered in terms of their roles as employees, managers, clinicia...

Background: Normalization Process Theory (NPT) identifies mechanisms that have been demonstrated to play an important role in implementation processes. It is now widely used to inform feasibility, process evaluation, and implementation studies in healthcare and other areas of work. This qualitative synthesis of NPT studies aims to better understand...

Background Target-D, a new person-centred e-health platform matching depression care to symptom severity prognosis (minimal/mild, moderate or severe) has demonstrated greater improvement in depressive symptoms than usual care plus attention control. The aim of this study was to evaluate the cost-effectiveness of Target-D compared to usual care from...

Introduction ‘Healthier You’, the National Health Service (NHS) diabetes prevention programme (DPP) offers adults in England at high risk of type 2 diabetes (T2DM) an evidence-based behavioral intervention to prevent or delay T2DM onset. This study assesses the impact of a pilot digital stream of the DPP (DDPP) on glycated hemoglobin (HbA1c) and we...

The Online Remote Behavioural Intervention for Tics (ORBIT) trial found that an internet-delivered, therapist-supported, and parent-assisted Exposure and Response Prevention (ERP) intervention reduced tic severity and improved clinical outcomes. This process evaluation aimed to explore mechanisms of impact and factors influencing efficacy. Particip...

Background Normalisation Process Theory (NPT) is frequently used to inform qualitative research that aims to explain and evaluate processes that shape late-stage translation of innovations in the organisation and delivery of healthcare. A coding manual for qualitative researchers using NPT will facilitate transparent data analysis processes and wil...

BACKGROUND Digital health interventions (DHIs) have become increasingly common across healthcare, both before and during the COVID-19 pandemic. Health inequalities, particularly by ethnicity, are recognised across diseases, but may be excluded in frameworks addressing implementation of DHIs. OBJECTIVE Using cardiometabolic disease as an exemplar,...

Background: Digital health interventions have become increasingly common across health care, both before and during the COVID-19 pandemic. Health inequalities, particularly with respect to ethnicity, may not be considered in frameworks that address the implementation of digital health interventions. We considered frameworks to include any models,...

Health care interventions are increasingly being delivered through digital technologies, offering major opportunities for delivering more health gains from scarce health care resources. Digital health interventions (DHIs) raise distinct challenges for economic evaluations compared with drugs and medical devices, not least due to their interacting,...

Introduction Long COVID-19 is a distressing, disabling and heterogeneous syndrome often causing severe functional impairment. Predominant symptoms include fatigue, cognitive impairment (‘brain fog’), breathlessness and anxiety or depression. These symptoms are amenable to rehabilitation delivered by skilled healthcare professionals, but COVID-19 ha...

Background Prostate cancer is highly prevalent and impacts profoundly on patients' quality of life, leading to a range of supportive care needs. Methods An updated systematic review and thematic synthesis of qualitative data using the Preferred Reporting Items for Systematic Reviews (PRISMA) reporting guidelines, to explore prostate cancer patient...

This study aimed to explore user engagement with ‘My Breathing Matters’, a digital self-management intervention for asthma, and identify factors that may influence engagement. In a mixed methods design, adults with asthma allocated to the intervention arm of a feasibility trial ( n = 44) participated in semi-structured interviews ( n = 18) and a sa...

Objective To identify and characterise activities for deprescribing used in general practice and to map the identified activities to pioneering principles of deprescribing. Setting Primary care. Data sources Medline, EMBASE (Ovid), CINAHL, Australian New Zealand Clinical Trials Registry (ANZCTR), Clinicaltrials.gov, ISRCTN registry, OpenGrey, Ann...

Background. Qualitative studies, especially those conducted by teams of researchers, may benefit from clearly structured, parsimonious, coding manuals. The process of creating rigorous and robust coding manuals for individual studies is rarely described, and generalizable coding manuals are rare. Normalization Process Theory (NPT) provides conceptu...

Background Exposure and Response Prevention (ERP) is a form of behavioural therapy for tics; however, its effectiveness remains uncertain. We aimed to evaluate the effectiveness of internet-delivered, therapist-supported, and parent-assisted ERP for treatment of tics in children and young people with Tourette syndrome or chronic tic disorder. Meth...

Objective Oesophageal cancer patients have complex care needs. Cancer clinical nurse specialists play a key role in coordinating their care but often have heavy workloads. Digital health interventions can improve patient care but there are few examples for oesophageal cancer. This paper aims to describe the multidisciplinary co-design process of a...

BACKGROUND: Digital health interventions (DHIs) have the potential to improve public health by combining effective interventions and population reach. However, what biomedical researchers and digital developers consider an effective intervention differs, thereby creating an ongoing challenge to integrating their respective approaches when evaluatin...

UNSTRUCTURED Digital health interventions (DHIs) refer to interventions designed to support health-related knowledge transfer and deployed via digital technologies, such as mobile applications (apps) (Soobiah et al., 2020). DHIs are a double-edged sword: they have the potential to reduce health inequalities, for example by making treatments availab...

Background: Digital health interventions refer to interventions designed to support health-related knowledge transfer and are delivered via digital technologies, such as mobile apps. Digital health interventions are a double-edged sword: they have the potential to reduce health inequalities, for example, by making treatments available remotely to...

The internet provides access to a huge variety of information, including health information. There is, however, a dearth of evidence as to how, and to what ends, patients raise prior use of the internet during medical visits. Analysis is based on the ((STUDY TITLE REMOVED)) study. Drawing on data from 281 video-recorded primary care consultations,...

BACKGROUND Digital health research encompasses methods from Human-Computer Interaction, and health research. OBJECTIVE The aim of this paper is to describe how these methods were combined to develop HeLP-Diabetes: Starting Out, an online structured education programme for people newly diagnosed with type 2 diabetes. METHODS The development proces...

Background Digital health research encompasses methods from human-computer interaction and health research. Objective This paper aims to describe how these methods were combined to develop HeLP-Diabetes: Starting Out, a web-based structured education program for people newly diagnosed with type 2 diabetes. Methods The development process consiste...

Objectives To evaluate the feasibility of trialling taxonomy for the rehabilitation of knee conditions—ACL (TRAK-ACL), a digital health intervention that provides health information, personalised exercise plans and remote clinical support combined with treatment as usual (TAU), for people following ACL reconstruction. Methods The study design was...

Objectives To examine patients’ accounts of their use of the internet before seeing a general practitioner (GP) using thematic analysis of semistructured interviews. Design Qualitative semistructured interview study with transcripts analysed thematically. Setting Primary care patients consulting with 10 GPs working at 7 GP practices of varying si...

Background Digital health interventions (DHIs) have the potential to improve public health by combining effective interventions and population reach. However, what biomedical researchers and digital developers consider an effective intervention differs, thereby creating an ongoing challenge to integrating their respective approaches when evaluating...

BACKGROUND Digital health interventions (DHIs) have the potential to improve public health by combining effective interventions and population reach. However, what biomedical researchers and digital developers consider an effective intervention differs, thereby creating an ongoing challenge to integrating their respective approaches when evaluating...

Background: Behaviour therapy is an effective treatment in children and adolescents with tic disorders but is rarely available. Online delivery could widen access to therapy. We evaluated the efficacy of internet-delivered, therapist-supported and parent-assisted Exposure and Response Prevention (ERP) for tics. / Methods: Multi-centre, parallel gro...

Background Many patients with SARS-CoV-2 infection are reporting long lasting symptoms, requiring holistic multi-disciplinary rehabilitation; however, there are severe capacity restraints in rehabilitation services. We report on the development and initial experience of a digitally-enabled remote, supported rehabilitation programme: ‘Covid Recovery...

Cancer, and the complex nature of treatment, has a profound impact on lives of patients and their families. Subsequently, cancer patients have a wide range of needs. This study aims to identify and synthesise cancer patients’ views about areas where they need support throughout their care. A systematic search of the literature from PsycInfo, Embase...

Despite widespread acknowledgement of internet use for information about health, patients report not disclosing use of online health information in consultations. This paper compares patients’ reported use of the internet with matched video recordings of consultations. The concepts of doctorability and epistemics are employed to consider similariti...

Background Mental health treatment rates are increasing, but the burden of disease has not reduced. Tools to support efficient resource distribution are required. Aim To investigate whether a person-centred e-health (Target-D) platform matching depression care to symptom severity prognosis can improve depressive symptoms relative to usual care. D...

Background Despite being the gold standard of research to determine effectiveness, randomised controlled trials (RCTs) often struggle with participant recruitment, engagement and retention. These issues may be exacerbated when recruiting vulnerable populations, such as participants with mental health issues. We aimed to update understanding of the...

Objectives The aim of structured education for type 2 diabetes is to improve knowledge, skills and confidence in self-management. It is recommended in the UK for everyone who is newly diagnosed with type 2 diabetes. We developed an on-line programme called HeLP-Diabetes: Starting Out to address poor uptake of face-to-face structured education. The...

Background/Aim: We have a limited understanding of the broader determinants of health of international migrants and how these change over time since migration to the United Kingdom (UK). To address this knowledge gap, we aim to conduct a prospective cohort study with data acquisition via a smartphone application (app). In this pilot study, we aim t...

Background/Aim : We have a limited understanding of the broader determinants of health of international migrants and how these change over time since migration to the United Kingdom (UK). To address this knowledge gap, we aim to conduct a prospective cohort study with data acquisition via a smartphone application (app). In this pilot study, we aim...

BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality in the world. Prevalence is estimated at around 100 million patients worldwide. There is evidence that antiplatelet agents and antihypertensive medication reduce the risk of new vascular events in this population, but treatment adherence is very low. OBJECT...

Background Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide, with a prevalence of approximately 100 million patients. There is evidence that antiplatelet agents and antihypertensive medications could reduce the risk of new vascular events in this population; however, treatment adherence is very low. An SMS...

BACKGROUND The Online Remote Behavioural Intervention for Tics (ORBIT) study was a multicentre randomized controlled trial of a complex intervention that consisted of an online behavioural intervention for children and young people (CYP) with tic disorders. In this first part of a two-stage process evaluation, we conducted a mixed-methods study exp...

Background The Online Remote Behavioral Intervention for Tics (ORBIT) study was a multicenter randomized controlled trial of a complex intervention that consisted of a web-based behavioral intervention for children and young people with tic disorders. In the first part of a two-stage process evaluation, we conducted a mixed methods study exploring...

Objective The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting...

Background Digital health interventions have the potential to improve the delivery of psychoeducation to people with mental health problems and their relatives. Despite substantial investment in the development of digital health interventions, successful implementation into routine clinical practice is rare. Objectives Use the implementation of th...

Background: Digital technology offers good opportunities for HIV prevention. This systematic review assesses the effectiveness of interactive digital interventions (IDIs) for prevention of sexually transmitted HIV. Methods: We conducted a systematic search for randomised controlled trials (RCTs) of IDIs for HIV prevention, defining 'interactive'...

Background Relatives caring for people with severe mental health problems find information and emotional support hard to access. Online support for self-management offers a potential solution. Objective The objective was to determine the clinical effectiveness and cost-effectiveness of an online supported self-management tool for relatives: the Re...

Background: The Anterior Cruciate Ligament (ACL) stabilises the knee and is commonly injured in sport. Surgical repair and rehabilitation are common. However, rehabilitation randomised controlled trials do not always report the resources used to deliver ACL rehabilitation. This may lead to suboptimal availability of resources for evidence based car...

Background: The Relatives Education And Coping Toolkit (REACT) is an online supported self-management toolkit for relatives of people with psychosis or bipolar designed to improve access to NICE recommended information and emotional support. Aims: Our aim was to determine clinical and cost-effectiveness of REACT including a Resource Directory (R...

Background: Despite the potential of digital health interventions to improve the delivery of psychoeducation to people with mental health problems and their relatives, and substantial investment in their development, there is little evidence of successful implementation into clinical practice. We report the first implementation study of a digital...

Background: Effective mobile health (mHealth) interventions have been developed to support patients with their medication use, however to date few are widely used in pharmacy practice. Normalization of an intervention is essential to have a population impact, which is defined as ‘the process of getting a new intervention into routine practice’. / O...

Background: Process evaluations are an important component in the interpretation and understanding of outcomes in trials. The Online Remote Behavioural Intervention for Tics (ORBIT) study is a randomized controlled trial evaluating the effectiveness of an Internet-delivered behavioural intervention (called BIP TIC) compared to an Internet-delivere...

Introduction Anti-platelet therapy, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta-blockers and statins are cost-effective in patients with atherosclerotic cardiovascular diseases (ASCVD) for reducing the risk of ASCVD events. Unfortunately, there is abundant evidence that adherence to these cardiovascular medicatio...

Background Process evaluations are an important component in the interpretation and understanding of outcomes in trials. The ‘Online Remote Behavioural Intervention for Tics’ (ORBIT) study is a randomized controlled trial evaluating the effectiveness of an internet delivered behavioural intervention (called BIP TIC) compared to an internet delivere...

Background Type 2 Diabetes (T2DM) is a global public health priority affecting 425 million adults with 352 million more at risk of developing T2DM. Intensive group programmes focusing on weight loss and physical activity can prevent or postpone the development of T2DM, but certain groups (e.g working age) find it difficult to attend sessions. Digit...

Objectives To explore the relationship between popularity of mobile application (apps) for physical activity (PA) and their likely efficacy. The primary objective was to assess the association between app popularity (indicated by user ratings) and likely efficacy (indicated by the number of Behaviour Change Techniques (BCT) present). The secondary...

In an increasingly connected world, information about health can be exchanged at any time, in any location or direction, and is no longer dominated by traditional authoritative sources. We consider the ways information and advice given in consultations by doctors transcends the boundary between the clinic and the home. We explore how information th...

UNSTRUCTURED There has been a growth in the number of online trials of online interventions, adding to an increasing evidence base. However, there are challenges associated with such trials, which researchers must address. This discussion paper follows the structure of the Down Your Drink trial methodology paper, providing an update from the litera...

International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2017-016965

BACKGROUND Structured education for patients with type 2 diabetes improves outcomes, but uptake is low globally. In the UK in 2016, only 8.3% of patients who were referred to education programmes attended. We have developed an online structured education programme called HeLP-Diabetes: Starting Out; (HDSO), as an alternative to face-to-face courses...

Background: Structured education for people with type 2 diabetes improves outcomes, but uptake is low globally. In the United Kingdom in 2016, only 8.3% of people who were referred to education programs attended the program. We have developed a Web-based structured education program named Healthy Living for People with type 2 Diabetes (HeLP-Diabet...

Background: Cardiovascular medication for secondary prevention has been shown to be effective. However, cardiovascular patients have poor medication adherence, the consequences of which include premature death, recurrence risk, hospitalization, and high financial cost for the healthcare system. Behavioral interventions based on text messaging techn...

Objectives Significant problems with patients engaging with diabetes self-management education (DSME) exist. The role of healthcare professionals (HCPs) has been highlighted, with a lack of enthusiasm, inadequate information provision and poor promotion of available programmes all cited as affecting patients’ decisions to attend. However, little is...

Randomized control trials in those with impaired glucose tolerance have shown that the onset of Type 2 diabetes can be prevented or delayed through behavioural interventions that promote weight loss, increase physical activity, and improve the quality of nutrition. In 2016, the Healthier You: NHS Diabetes Prevention Programme was established to pre...

Background Process evaluations are an important component in the interpretation and understanding of outcomes in trials. The ‘Online Remote Behavioural Intervention for Tics’ (ORBIT) study is a randomized controlled trial evaluating the effectiveness of an internet delivered behavioural intervention (called BIP TIC) compared to an internet delivere...

Background: Evidence for online interventions to help women experiencing intimate partner violence is scarce. We assessed whether an online interactive healthy relationship tool and safety decision aid (I-DECIDE) would increase women's self-efficacy and improve depressive symptoms compared with an intimate partner violence information website. Me...

Background: Effective mobile health (mHealth) interventions have been developed to support patients with their medication use, however to date few are widely used in pharmacy practice. Normalization of an intervention is essential to have a population impact, which is defined as ‘the process of getting a new intervention into routine practice’. Ob...

Introduction The prevalence of type 2 diabetes is rising steeply. National Health Service England (NHSE) is exploring the potential of a digital diabetes prevention programme (DDPP) and has commissioned a pilot with embedded evaluation. Methods and analysis This study aims to determine whether, and if so, how, should NHSE implement a national DDPP...

Background: Digital health interventions have potential to contribute to better health outcomes, better healthcare and lower costs. However, evidence for their effectiveness is variable. The development and content of digital health interventions are often not described in enough detail to enable others to replicate the research or improve on prev...

Sexual difficulties are common and can negatively impact health and wellbeing. A wide range of support is available, but there are multiple barriers to accessing help. Interactive Digital Interventions (IDIs) for sexual difficulties have the potential to provide a convenient, wide-reaching and cost-effective source of support but little is known ab...

Introduction Tourette syndrome and chronic tic disorder are common, disabling childhood-onset conditions. Guidelines recommend that behavioural therapy should be offered as first-line treatment for children with tics. However, there are very few trained behaviour therapists for tics and many patients cannot access appropriate care. This trial inves...

Background Face-to-face brief interventions for problem drinking are effective, but they have found limited implementation in routine care and the community. Internet-based interventions could overcome this treatment gap. We investigated effectiveness and moderators of treatment outcomes in internet-based interventions for adult problem drinking (i...