Mark J. Weal’s research while affiliated with University of Southampton and other places

In the past thirty years, the Web has developed from its inception as a layer of protocols on top of the Internet to use by more than 5 billion people and organizations. This has driven the creation of vast quantities of data and led to deep concerns about the politics of digital data and computational methods. To date, critical investigation of these concerns has focused on large commercial platforms built on top of the Web, and their use of machine learning methods. Meanwhile, less attention has been paid to the underlying design and protocols of Web itself, and how these might be implicated in the very same process and concerns. We explore ongoing endeavors to transform the Web from a library of documents intended for humans to a “semantic Web” using symbolic artificial intelligence to enable machine reasoning across multiple heterogenous data sources. In principle, this would transform the production and circulation of knowledge at Web scale. We present the findings from an experimental, interdisciplinary study exploring the epistemological politics and sociomaterial practices involved in situated accomplishment of the semantic Web. Our findings have consequences for the future of the Web and the future of Web-based platforms.

Background Although patient accessible electronic health records (PAEHRs) offer great potential in enhancing the provision of patient-centered care and improving satisfaction, the adoption rate is still low. Currently, few studies are there for researchers and health organization leaders to understand patients’ thoughts and related factors of PAEHRs adoption in developing countries. China adopted more limited practices of PAEHRs, among which we selected Yuebei People's Hospital as an example. Objective The study aimed to research patient attitudes toward PAEHRs use and the associated factors of patients’ adoption of PAEHRs in China, which is achieved by both qualitative and quantitative studies. Methods This study employed sequential mixed-methods. The DeLone & McLean information systems (D&M IS) success model, Unified Theory of Acceptance and Use of Technology (UTAUT) and task-technology fit (TTF) model were used to guide the research. Finally, we collected 28 valid in-depth interview responses, 51 valid semi-structured interview responses and 235 valid questionnaire responses. The research model was tested and validated using data collected. Results The findings of the qualitative study reveal that patients’ rate perceived task productivity and customer satisfaction as benefits, and poor-quality information as flaws. Results of the quantitative study show that the drivers of behavioral intention are performance expectance, effort expectancy and social influence; the predictors of use behavior are TTF and behavioral intention. Conclusion It is necessary to consider PAEHRs’ task-tool role in patients’ adoption behavior. Hospitalized patients value PAEHRs’ practical attributes and attach much importance to the information content and application design.

It has previously been shown that readers spend a great deal of time skim reading on the Web and that this type of reading can affect comprehension of text. Across two experiments, we examine how hyperlinks influence perceived importance of sentences and how perceived importance in turn affects reading behaviour. In Experiment 1, participants rated the importance of sentences across passages of Wikipedia text. In Experiment 2, a different set of participants read these passages while their eye movements were tracked, with the task being either reading for comprehension or skim reading. Reading times of sentences were analysed in relation to the type of task and the importance ratings from Experiment 1. Results from Experiment 1 show readers rated sentences without hyperlinks as being of less importance than sentences that did feature hyperlinks, and this effect is larger when sentences are lower on the page. It was also found that short sentences with more links were rated as more important, but only when they were presented at the top of the page. Long sentences with more links were rated as more important regardless of their position on the page. In Experiment 2, higher importance scores resulted in longer sentence reading times, measured as fixation durations. When skim reading, however, importance ratings had a lesser impact on online reading behaviour than when reading for comprehension. We suggest readers are less able to establish the importance of a sentence when skim reading, even though importance could have been assessed by information that would be fairly easy to extract (i.e. presence of hyperlinks, length of sentences, and position on the screen).

Background: Approximately 57 million physician appointments annually in the United Kingdom are for minor ailments. These illnesses could be self-cared for, which would potentially lower patients' anxiety, increase their confidence, and be more convenient. In a randomized controlled trial of the Internet Dr digital intervention, patients with access to the intervention had fewer consultations for respiratory tract infections (RTIs). Having established intervention efficacy, further examination of trial data is required to understand how the intervention works. Objective: This paper reports a process evaluation of Internet Dr usage by the intervention group. The evaluation aims to demonstrate how meaningful usage metrics (ie, interactions that are specific and relevant to the intervention) can be derived from the theoretical principles underlying the intervention, then applied to examine whether these interactions are effective in supporting self-care for RTIs, for whom, and at what time. Methods: The Internet Dr trial recorded patients' characteristics and usage data over 24 weeks. At follow-up, users reported whether their levels of enablement to cope with their illness changed over the trial period. The Medical Research Council process evaluation guidance and checklists from the framework for Analyzing and Measuring Usage and Engagement Data were applied to structure research questions examining associations between usage and enablement. Results: Viewing pages containing advice on caring for RTIs were identified as a meaningful metric for measuring intervention usage. Almost half of the users (616/1491, 42.31%) viewed at least one advice page, with most people (478/616, 77.6%) accessing them when they initially enrolled in the study. Users who viewed an advice page reported increased enablement to cope with their illness as a result of having participated in the study compared with users who did not (mean 2.12, SD 2.92 vs mean 1.65, SD 3.10; mean difference 0.469, 95% CI 0.082-0.856). The target population was users who had visited their general practitioners for an RTI in the year before the trial, and analyses revealed that this group was more likely to access advice pages (odds ratio 1.35, 95% CI 1.159-1.571; P<.001). Conclusions: The process evaluation identifies viewing advice pages as associated with increased enablement to self-care, even when accessed in the absence of a RTI, meaning that dissemination activities need not be restricted to targeting users who are ill. The intervention was effective at reaching the target population of users who had previously consulted their general practitioners. However, attrition before reaching advice pages was high, highlighting the necessity of prioritizing access during the design phase. These findings provide guidance on how the intervention may be improved and disseminated and have wider implications for minor ailment interventions.

Digital behavior change interventions (DBCIs) provide customized advice, ongoing support, and web- and mobile-based platforms for learners who want to change their undesirable behaviors. DBCIs have been successful in the past for delivering interventions which support sustained changes to health behaviors, such as disease prevention and health promotion. During research tasks, university students can require interventions associated with critical thinking skills and behaviors. By using a DBCI, educators can assist students with improving their learning skills in research projects. This study aims to understand student interactions and engagement with mobile-based DBCIs with the objective of improving their critical thinking skills. An experimental group was used to explore the effects of students' interactions with an engaging mobile-based DBCI with real-time feedback, and was designed using the LifeGuide Toolbox platform which supports their critical thinking skills over a period of two months whilst they conduct a research project. A comparison between formative expert assessments and self-reported evaluation was also performed. This experiment reveals that using a DBCI to encourage critical thinking skills within a research project context can significantly improve engagement with intervention components, as well as recommend areas which require further exploration where specific critical thinking skills and digital interventions components are the most promising.

BACKGROUND Cochlear implants provide hearing to approximately 750,000 people with deafness worldwide; these patients require lifelong follow-up. Care for adults with implants in the United Kingdom occurs at one of 19 centers, which may be far from the patients’ homes. In a previous randomized controlled trial, we successfully introduced person-centered care. We designed, implemented, and evaluated the following remote care pathway: a personalized web-based support tool, home hearing check, self–device adjustment, and upgrading of sound processors at home rather than in the clinic. The remote care group had a significant increase in empowerment after using the tools, and the patients and clinicians were keen to continue. We would now like to scale up these improvements as an option for >12,000 UK adults using implants; we are commissioning an independent evaluation of this intervention and rollout to establish if it achieves its aims of more empowered and confident patients; more accessible and equitable care; stable hearing; more efficient, person-centered, and scalable service; and more satisfied and engaged patients and clinicians. OBJECTIVE This study aims to evaluate the impact and rollout of a person-centered clinical care pathway via telemedicine for adults with cochlear implants in the United Kingdom, using both outcomes and process evaluation. METHODS This project will scale up and evaluate a person-centered long-term follow-up pathway for adults using cochlear implants through a personalized website, including a home hearing check, uploading photos of cochlear implant site, listening in noise and music practice, ordering of spares, questionnaires, and other resources. Both quantitative and qualitative analyses will be conducted, and they will be both an outcome and process evaluation. RESULTS As of July 2021, the trial is closed, and all data collection is complete. The evaluation report is expected to be published in December 2021, and the research data have not yet been analyzed. CONCLUSIONS This project will present the results of the first scaling up of a remote care pathway for adults with cochlear implants in the United Kingdom. CLINICALTRIAL International Standard Randomized Controlled Trial Number ISRCTN51668922; https://www.isrctn.com/ISRCTN51668922 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/27207

br/>BACKGROUND: Cochlear implants provide hearing to around 750,000 people with deafness worldwide; patients require lifelong follow-up. Care for adults with implants in the UK occurs at one of 19 centres, which may be far from the patient's home. In a previous RCT, we successfully introduced person-centred care. We designed, implemented and evaluated a remote care pathway: a personalised online support tool, home hearing check, self device adjustment, and upgrading of sound processors at home rather than in clinic. The remote care group had a significant increase in empowerment after using the tools; patients and clinicians were keen to continue. We would now like to scale up these improvements as an option to the more than 12,000 UK adults using implants; we are commissioning an independent evaluation of this intervention and roll out to establish if it achieves its aims of more empowered and confident patients; more accessible and equitable care; stable hearing; more efficient, person-centred and scalable service; more satisfied and engaged patients and clinicians. OBJECTIVE: To evaluate the impact and roll out of a person-centred clinical care pathway via telemedicine for adults with cochlear implants in the UK, using both outcomes and process evaluation. METHODS: This project will scale up and evaluate a person-centred long-term follow-up pathway for adults using cochlear implants using a personalised website including a home hearing check, upload of photos of cochlear implant site, listening in noise and music practice, spares ordering, questionnaires, and other resources. Both quantitative and qualitative analyses will occur, and it will be both an outcomes and process evaluation. RESULTS: As of July 2021, the trial is closed, and all data collection is complete. The evaluation report is expected to be published in December 2021; the research data have not been analysed yet. CONCLUSIONS: This project will present results of the first scaling up of a remote care pathway for adults with cochlear implants in the UK.

BACKGROUND Washing hands helps prevent transmission of seasonal and pandemic respiratory viruses. The PRIMIT study developed a fully automated, digital intervention to promote handwashing. In a randomised controlled trial during the Swine Flu outbreak, participants who had access to the intervention reported washing their hands more and experienced less respiratory tract infections than those without access. Using these findings, the intervention was subsequently adapted, renamed ‘Germ Defence’, and a study designed to assess a preliminary dissemination of the intervention to the general public to help prevent the spread of seasonal colds and flu. OBJECTIVE This paper compares process evaluations of the PRIMIT trial and Germ Defence dissemination to examine: 1) how online research enrollment procedures impacted on who used the intervention; 2) intervention usage in the two contexts; 3) whether increased intentions to wash hands are replicated once disseminated. The purpose of this paper is to provide insight so that the Germ Defence intervention could be optimized for wide-scale dissemination in the event of a global pandemic. METHODS The PRIMIT trial ran between 2010 and 2012 recruiting participants offline from General Practices, with restricted access to the intervention (N=9155). Germ Defence was disseminated as an open access website for use by the general public from 2016 to 2019 (N=624). The process evaluation plan was developed using Medical Research Council guidance and the framework for Analysing and Measuring Usage and Engagement Data. Both interventions contained a goal-setting section where users self-reported current and intended handwashing behaviour across seven situations. RESULTS During online enrolment, 54.30% (n=17,511) of PRIMIT study participants dropped out of the study compared to 36.46% (n=358) of Germ Defence users. Having reached the intervention, 93.79% (n=8586) of PRIMIT users completed the core section, whereas 65.06% (n=406) of Germ Defence users reached the same point. Users across both studies selected to increase their handwashing in five out of seven situations, including before eating snacks (PRIMIT MD=1.040 [CI 1.016, 1.063], Germ Defence MD=.949 [CI 766, 1.132]) and after blowing their nose, sneezing or coughing (PRIMIT MD=.995 [CI .972, 1.019], Germ Defence MD=.842 [CI .675, 1.008]). CONCLUSIONS By comparing a preliminary dissemination of Germ Defence to the PRIMIT trial we have been able to examine the potential effects of research procedures on uptake and attrition, such as the sizeable dropout during the PRIMIT trial enrolment procedure that may have led to a more motivated sample. The Germ Defence study highlighted points of attrition within the intervention. Despite sample bias in the trial context, the intervention replicated increases in intentions to handwash when used ‘in the wild’. This preliminary dissemination study informed the adaptation of the intervention for the COVID-19 health emergency, and it has now been disseminated globally. CLINICALTRIAL ISRCTN75058295