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P2: Preventing Crisis

The study will follow the MRC framework for developing and evaluating complex interventions, ensuring a robust, iterative, and co-designed approach to identifying, evaluating, and implementing patient-facing technologies (PFTs) for preventing crises. Those living with MLTCs experience multi-faceted, intersectional and contextual crises which could lead to:

  1. development and accrual of new physical/mental LTCs and acceleration and worsening of existing LTCs;
  2. failure to seek/pursue/receive appropriate care;
  3. neglect
  4. complications including a further crisis of health (e.g. emergency hospital admissions), housing (e.g. loss of secure accommodation), or employment (e.g. inability to continue working) all of which contribute to adverse outcomes. Such crises adversely impact quality of life and health of individuals and households, and place additional pressures on health and care systems.

Our methodology integrates scoping, rapid evaluation, feasibility testing, and stakeholder engagement to assess the acceptability and impact of patient-facing technologies (PFTs) within clinical practice.

1. Scoping Workshops

We have undertaken extensive research to understand the patterns of MLTC combinations in our populations and their effects on health-related quality of life. Our Stage 1 project generated actionable population insights from re-usable NHS data assets in Liverpool and Glasgow to ensure our innovation hub is tailored to our populations’ needs. From these, we arrived at the common MLTC phenotypes described in our Stage 2 bid and the data supporting these can be found on our digital commons under Health Intelligence. We were, for example, able to show the importance of combined mental/physical and painful conditions in those attending unscheduled care. These combinations were also identified repeatedly and reported to be the most troublesome, throughout participatory research with community groups.

Objective: To engage with patients, carers and healthcare professionals to conceptualise and define crises that are most relevant for people/households with MLTCs.

Methodology: * Participant recruitment: Individuals/households with one adult 18+ with mental and physical MLTCs recruited in community test-beds via patient advocacy groups and community organisations. * Workshop structure: * Workshop 1: Focus groups with community members to explore crises to arrive at a definition. * Workshop 2: Professionals and system-level stakeholders to identify crises and response/support for crises. * Workshop 3: Joint co-design session to map predictors of crises and priorities for supportive technological touchpoints.

  • Data collection: Audio-recorded discussions, thematic analysis of transcripts using NVivo.
  • Output: A community-driven definition of crises and a prioritised list potential supportive technological touchpoints.

2. Rapid Evidence Synthesis

Objective: To map existing crisis support and assess optimisation potential, adaptability and scalability.

Methodology: * Rapid evidence synthesis: Systematic search of databases (MEDLINE, EMBASE, CINAHL, Cochrane, IEEE Xplore) for crisis support * Search strategy using terms co-identified from scoping workshops * Inclusion criteria: * Population: Adults with mental and/or physical health conditions * Intervention: Crisis support for cascading health crises * Outcomes: Crisis avoidance. * Data extraction & synthesis: * Standardised data extraction form capturing study design, reported effectiveness, and implementation barriers. * Stakeholder ranking: PPIE members and clinical experts will rate and rank PFTs based on feasibility and potential impact.

3. Feasibility Study

Objectives: 1. to trial digital pathfinder approaches to identify households at risk of crises. 2. To test the acceptability and implementation potential of technological touchpoints for preventing and managing crises in real-world settings.

Study Design: Prospective observational feasibility study using a mixed-methods approach. 

Methodology: * Participant recruitment: Households/Adults aged 18+ with mental and physical MLTCs; trial ‘pathfinder approaches in community test bed to ascertain whether data mining can accurately identify households at risk of crises. Aim to recruit up to 20 households * We will use the STANDING Together framework (established in Liverpool and Glasgow) to ensure that health equity considerations are embedded within technical evaluations 1 . We host the WHO Collaborating Centre for Policy Research on Determinants of Health Equity.

  • Intervention: Co-designed technological touchpoints including:

    • Optimisation of Wearables to track prevention metrics (e.g. emotional stability, symptom exacerbation etc.
    • Ambient sensors (e.g., sleep).
    • Conversational AI (e.g., symptom tracking, experience reporting).

  • Outcome measures:

    • Primary: Acceptability, usability, equitable uptake, engagement levels.
    • Secondary: Accuracy of identification, utilisation of care, unscheduled care use.
    • Process evaluation: Semi-structured interviews with participants and healthcare professionals to explore experiences, barriers, and facilitators.

  • Analysis:

    • Quantitative: Descriptive statistics (engagement metrics, concordance rates), comparative analysis where appropriate.
    • Qualitative: Thematic analysis of participant interviews, triangulated with usage data.
    • Iterative testing:
    • Cyclical refinement of touchpoints based on user feedback.
    • Technologies demonstrating high acceptability and engagement will progress to larger-scale feasibility testing.

References

  1. https://doi.org/10.1016/S2589-7500(24)00224-3