Raymond Bond’s research while affiliated with University of Ulster and other places

Background: Discussing weight remains a sensitive and often avoided topic in healthcare, despite rising prevalence of obesity and calls for earlier, more compassionate interventions. Many healthcare professionals report inadequate training and low confidence to discuss weight, while patients often describe feeling stigmatized or dismissed. Digital simulation offers a promising route to build communication skills through supporting repeatable and reflective practice in a safe space. VITAL-COMS (Virtual Training and Assessment for Communication Skills) is a novel simulation tool designed to support healthcare professionals in navigating weight-related conversations with greater understanding and skill.Objective: The objective of this feasibility study was to assess the potential of VITAL-COMS as a digital simulation training tool to improve weight-related communication skills among healthcare professionals.Methods: A mixed-method feasibility study was conducted online between January to July 2021, with UK-based nurses, doctors, and dietitians. The intervention comprised educational videos and two simulated patient scenarios with real-time verbal interaction. Pre- and post-training self-assessments of communication skills and conversation length were collected. Participants also completed a feasibility questionnaire. Descriptive statistics were used to analyze the feasibility questionnaire, and open-ended feedback was analyzed using content analysis. Paired-samples t-tests were used to assess changes in communication skills and conversation length pre- and post-training. Results: Thirty-one participants completed the study. There was a statistically significant improvement in self-assessed communication skills following training (mean difference = 3.9; 95% CI, 2.54-5.26; t(30) = -5.76, P = .001, Cohen d = 1.03). Mean conversation length increased significantly in both scenarios: in the female patient scenario, from 3.73 (SD 1.36) to 6.08 minutes (SD 2.26), with a mean difference of 2.35 minutes (95% CI, 1.71-2.99; t(30) = 7.49, P = .001, d = 1.34); and in the male scenario, from 3.61 (SD 1.12) to 5.65 minutes (SD 1.76), a mean difference of 2.03 minutes (95% CI, 1.51-2.55; t(30) = 8.03, P = .001, d = 1.44). Participants rated the simulation positively, with 97% [95% CI, 90-100%] supporting wider use in healthcare and 84% [95% CI, 71-97%] reporting emotional engagement. Content analysis of feedback generated two themes: (1) adapting to this form of learning and (2) recognizing the potential of simulation to support reflective, skills-based training. A minority, 13% [95% CI, 1-25%] expressed a preference for alternative learning methods.Conclusion: VITAL-COMS was feasible to implement and acceptable to a diverse group of healthcare professionals. Participants demonstrated significant improvements in self-assessed communication skills and patient-scenario engagement. The simulation was perceived as realistic, emotionally engaging, and well-suited for training in sensitive conversations. These findings support further development and integration of VITAL-COMS into health education programs. Next steps include the translation of the insights identified in this study to inform a tool supported by generative AI.Keywords: Obesity; overweight; weight stigma; weight-related communication; virtual simulation; eLearning; medical education; healthcare communication; doctors; nurses; dietitians

Background: Obesity and mental health issues are major public health concerns with a complex relationship. They share interconnections that significantly impair individuals’ physical, social, and mental well-being. Digital technology has emerged as a promising tool to facilitate communication between health professionals (HPs) and individuals living with obesity and mental health issues, but its role remains unclear. Aim: To critique the literature on the role of digital technology in supporting HP communication with individuals dealing with obesity and mental health issues. Methods: A comprehensive scoping review, guided by Arksey & O’Malley’s (2005) methodology, analysed literature from 2013-2023 across eight databases. Eight studies met the inclusion criteria, and data extraction focused on HPs' communication technologies, their roles, technology types, biopsychosocial considerations, and perceptions of technology use. Results: HPs, including psychologists, dietitians, and social workers, use digital technologies for virtual appointments, monitoring diet and mental health, and providing motivation and educational content. Digital technologies were inclusive of web-based platforms, social media groups, synchronous videos, telephone, automated SMS, and email. The findings indicate that digital technology does have a role in supporting HP communication with individuals dealing with obesity and mental health issues. This role includes enhancing the capacity of HPs to provide effective and accessible care to individuals dealing with obesity and mental health issues. Key findings highlight issues of miscommunication and conflicting messages, a need for an empathetic approach, a lack of personalisation to unique needs, and confusion regarding HP's roles in obesity and mental health care. Digital technologies have improved access to services and reduced stigma experienced with in-person evaluations, yet challenges persist in implementation, particularly in digitally underserved areas. Most notably, despite improvements in weight management in seven of the eight studies, none of the interventions showed any significant progress in mental health outcomes. Conclusion: This review demonstrates the diverse application of digital technologies by HPs in communicating education, counselling and motivation to those with obesity and mental health issues. The digital technologies facilitate improved communication between HPs and clients, allowing for consistent monitoring and support in a stigma-reduced, private setting. While effective in obesity management, the review reveals a shortfall in addressing mental health needs, emphasising the necessity for digital tools to be more than just information channels, but also a means of understanding and meeting the service user needs. Future Directions: The scoping review advocates for future research to focus on creating tailored digital interventions that cater to the complex biopsychosocial needs of individuals with obesity and mental health issues. This approach should incorporate a multidisciplinary perspective, aligning with the need to enhance workforce capacity and capability in the digital era. The findings emphasise the importance of digital technology in healthcare and the necessity for ongoing adaptation and innovation in HP communication strategies.

Background: There are currently more than 350,000 health apps in the Android and Apple app stores. The quality of a health app can be assessed by the Organization for the Review of Care and Health Apps (ORCHA), a United Kingdom based company that specialises in the quality assessment of health apps. The ORCHA baseline assessment (OBR) assess three aspects of a health app: 1) professional/clinical assurance (PCA), 2) user experience (UX) and 3) data privacy (DP). These three sections each provide a score but also contribute to an overall ORCHA score from 0 to 100 (where a score of 100 is the highest quality score and a score above 65 is desirable). Objective: To assess if there are any possible disparities in the quality of physical and mental health apps targeting four different age groups: children, teens, adults, and older people. Methods: A secondary dataset was used for this study, which included a total of 604 health apps that were previously assessed for quality using OBR. The 604 health apps comprise of 254 mental and 350 physical health apps. R language and R studio were used to analyse this data. Median and interquartile ranges (IQR) were used to assess the spread of app assessment scores achieved for PCA, UX and DP for each of the considered age groups. Unpaired two sample Wilcoxon tests were used to compare the quality assessment scores of mental and physical health apps across each age group. Bonferroni adjusted p-value was calculated for multiple tests. Results: Only physical health apps for children and older people managed to achieve a median ORCHA score above the acceptable threshold of 65. The median ORCHA score for physical health apps for teens and adults was below 65. The median ORCHA score for mental health apps for all four age groups was below 65. Physical health apps scored better than mental health apps for children, adults, and older people age group; however, this was only statistically significant for older people (p-value =.002). The PCA scores for mental health apps for older people (m=39.7, IQR=33.2) and physical health apps for teens (m=39.4, IQR=42.7) were lower than other age groups. Conclusion: This study indicates that, for older people, overall quality of physical health apps is higher when compared to mental health apps. Moreover, the professional/clinical assurance of both physical and mental health apps could be improved; specifically, mental health apps for older people and physical health apps for teens. To make adjunctive therapy regarding mental health more suitable for older people, improvements to health app quality should be made. This will allow for better integrated care as more people adopt the usage of health apps. A limitation of this analysis is that we are using a secondary dataset to study the quality of apps that were assessed by ORCHA and were included in this dataset. A similar study could be done using a random selection of apps.

The introduction of technologies and devices to support wellbeing in dementia are often evaluated using sensing technologies in a rather tech-heavy approach. With any research study involving such devices, there are unforeseen circumstances that emerge when operating this technology within a new site. This study considers the specific case of a lighting technology to support the synchronisation of the circadian rhythm for people living with dementia in care homes. Such a study requires an overlap in expertise between lighting design, networking, sensor processing, data analytics and dementia care. Therefore, this study makes use of a collaboration between industry (Chroma Lighting), academia (Ulster University) and the care sector in order to both support the wellbeing for people living with dementia and to support staff in maximising the benefits the technology can administer. Consequently, an integrated approach is used to design, develop, implement, test and evaluate the lighting and sensing solution. The technology is deployed in a local care home for 16 weeks with the aim to understand how dynamic lighting can support parameters of wellbeing such as sleep/wake cycles, rest-activity patterns, mood, and social interactions. This study therefore aims to categorise and address the main lessons learned during the trial using a retrospective approach. We review the following obstacles faced in deploying the technology; 1) Technical, 2) Ethical, 3) Logistical, 4) Coordination and Communication. 1)We identify issues with networking and gateway communications, highlighting the potential for obstruction to sensor signals caused by building composition and layout. The need for ‘repeater’ modules to allow lighting and sensing devices to communicate became a requirement due to the density of heavily-attenuating materials such as concrete within the care home. 2)Discussions arise surrounding the declaration of ‘medical device status’ and whether a lighting technology to support wellbeing would fall within this category and thus require extra testing/licensing. Combined with the ethical processes surrounding consent, we discuss the rigour involved in this stage alongside the importance of maintaining the perspectives of people living with dementia. 3)We find that the importance of a structured and ordered site survey cannot be understated. This requires liaising with site managers for access to the property, access to electrical cupboards and roof spaces in order to map out the deployment area and reduce the risk of technical issues in the next steps. 4)We find that implementing a technical research protocol requires aligning the needs of the residents and care staff in an approach that best suits them in their daily routines. As such, an open discussion between care manager, care staff and researchers is explored to ease the ‘burden’ associated with data collection and observation. To conclude, an informal evaluation of the entire system is conducted between researchers and the care home manager. The study closes with an approach to recommending a step-by-step process for designing future trials from the lab to care home environment.

Background: Engaging in meaningful work has potential to improve our mental health and foster well-being, however, more than 15% of individuals currently in work are experiencing symptoms indicative of a common mental health condition, primarily mild to moderate anxiety and depression. There is evidence these conditions can be either prevented or effectively treated in the workplace. However, left untreated these conditions are associated with increased absenteeism, presenteeism, under performance and reduced productivity. Digital interventions implemented in the workplace are an efficient, effective, and scalable way to raise awareness and promote mental health and wellbeing initiatives to employees. Integrating digital interventions that have been generalised from clinical settings have displayed potential in the workplace, primarily those that employ cognitive behavioural therapy, stress-management or mindfulness-based stress reduction techniques. Despite this, there is a shortage of gold standard evidence to determine which interventions are effective for specific workforce populations alongside identifying those which may potentially cause harm. There is also a paucity of digital interventions integrated into real world care, prioritising the need for exploration of how they are implemented effectively with clinician buy in. This study was conducted with Inspire, a social enterprise that delivers a range of mental health and wellbeing interventions to organisations across the UK & Ireland. Aim: The overall aim of this study is to determine the acceptability and effectiveness of using a digital tool as a workplace wellbeing intervention, by investigating the perceived drivers of as well as barriers to use, benefits, and challenges and provide recommendations for future development. Methods: Semi structured interviews were conducted with 14 employees from five sectors, recruited from Inspire’s customer base. Interview questions were guided by current literature and transcripts were analysed using thematic analysis. This study was approved by Ulster University’s Ethics Filter Committee. Results: Digital interventions were considered most useful when implemented with an integrated care approach, where they are blended with face to face services. Time, lack of access to non-digital healthcare , and stigma surrounding face to face interventions were highlighted as potential drivers towards using a digital intervention. Benefits identified included 24/7 availability, ease of use, and how interventions can be used to support not only individual employees, but teams and colleagues. Challenges were associated with accessibility, particularly for non-office-based populations. Participants suggested the quality of digital interventions varies greatly, and barriers to use include connectivity problems, poor digital literacy and lack of equipment for non-office-based staff. When providing recommendations for improving digital interventions, participants suggested easy access to content delivered in short, “bite-sized” formats. Personalisation of content was also highlighted, including content tailored for specific workplace sectors, or personalised to their location, such as rural areas. Conclusion: Digital interventions were perceived to be most useful and accessible when integrated into workplace wellbeing programmes, that include traditional mental health services, such as counselling. Multiple drivers of usage, benefits, challenges, and recommendations were identified by employers. Further understanding of how these recommendations can impact the effectiveness of integrating digital interventions into workplace wellbeing programmes should be explored.

Integrative lighting considers light for both visual and non-visual impact and can therefore benefit human health and well-being. More specifically, it can benefit circadian-related well-being, an umbrella term which within dementia cohorts considers factors such as sleep, rest-activity, mood, agitation and activities of daily living. As people living with dementia experience disruptions to their circadian rhythms and spend large amounts of time indoors, the understanding of how integrative interior lighting could influence their body clock could help support their well-being. A review of 18 studies found that papers are difficult to compare due to unsystematic study designs and reporting of study characteristics, light characteristics and participant characteristics. The findings at most imply that indoor integrative lighting could be beneficial to these aspects of well-being. This review finds suggestion that for this cohort there may be a relationship between colour variation and mood and agitation, alongside a relationship between intensity variation and sleep, and that the influence on rest-activity may be more unpredictable. These findings are inferred and due to heterogeneous study designs they are inconclusive. The outcome of this review therefore recommends future studies that follow systematic checklists for study designs which seek to test these inferred hypotheses within this cohort.

Aim To identify and synthesise recommendations and guidelines for mental health chatbot conversational design. Design Integrative review. Methods Suitable publications presenting recommendations or guidelines for mental health conversational design were included. The quality of included publications was assessed using Joanna Briggs Institute Critical Appraisal Tools. Thematic analysis was conducted. Data sources Primary searches limited to last 10 years were conducted in PubMed, Scopus, ACM Digital Library and EBSCO databases including APA PsycINFO, CINAHL, APA PsycArticles and MEDLINE in February 2023 and updated in October 2023. A secondary search was conducted in Google Scholar in May 2023. Results Of 1684 articles screened, 16 publications were selected. Three overarching themes were developed: (1) explicit knowledge about chatbot design and domain, (2) knowing your audience and (3) creating a safe space to engage. Results highlight that creating pleasant and effective conversations with a mental health chatbot requires careful and professional planning in advance, defining the target group and working together with it to address its needs and preferences. It is essential to emphasise the pleasant user experience and safety from both technical and psychological perspectives. Conclusion Recommendations for mental health chatbot conversational design have evolved and become more specific in recent years. Recommendations set high standards for mental health chatbots. To meet that, co‐design, explicit knowledge of the user needs, domain and conversational design is needed. Implications for the Profession and/or Patient Care Mental health professionals participating in chatbot development can utilise this review. The results can also inform technical development teams not involving healthcare professionals directly. Impact Knowledge of developing mental health chatbot conversations appears scattered. In mental health chatbots, features that enhance the chatbot's ability to meet users' needs and increase safety should be considered. This review is useful for developers of mental health chatbots and other health applications used independently. Reporting Method This integrative review was reported according to PRISMA guidelines, as applicable. Patient or Public Contribution No patient or public contribution.