SACM - United Kingdom
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9667
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Item Restricted EVALUATING THE EFFECTIVENESS OF THE SLEEPTRACKER APP FOR DETECTING ANXIETY AND DEPRESSION-RELATED SLEEP DISTURBANCES(University of Bristol, 2025-03-19) Alamoudi, Doaa; Nabney, Ian; Crawley, Esther; Bennett, SarahSleep is necessary for the proper functioning of our bodies and minds because it helps our bodies to recuperate and rebuild while our minds organise and evaluate memories. Poor sleep, on the other hand, can have a severe impact on both physical and emotional well-being, leading to a variety of health problems such as anxiety, depression, heart disease, obesity, dementia, diabetes, and cancer. University students, in particular, are at risk of poor sleep quality and mental health issues, which can exacerbate the risk of anxiety and despair. It is critical to treat sleep disorders and prioritise adequate sleep practises in order to ensure good health and well-being. Many individuals may be unaware they suffer from conditions like insomnia, depression, or anxiety, often because they fail to recognize the symptoms. These issues are typically diagnosed by medical professionals during consultations. While experts understand the connection between poor sleep patterns and mental health, this knowledge gap among the general population highlights the potential for technological intervention. Computer science, particularly through smartphone technology, can bridge this gap by enabling early detection and intervention, helping to preserve mental health. This thesis aims to explore and develop methods using current mobile technology specifically, built-in sensors to diagnose sleep issues and provide interventions for associated mental health problems, focusing on young adults. Existing literature on using mobile sensors to track sleep and mental health reveals several limitations, which this thesis seeks to address. While numerous mobile apps track behavioural signals, such as sleep, and correlate them with mental health, many rely on wearable or non-wearable sensors (e.g., accelerometers, microphones, GPS, light, and screen on/off sensors), but each has limitations in terms of accuracy and usability. This thesis centers on the development of SleepTracker, an app designed to go beyond basic sleep tracking to address mental health concerns like depression and anxiety often associated with insomnia. The SleepTracker app was developed with the goal of accurately detecting sleep duration and disturbances using mobile phone sensors, specifically screen on/off events and accelerometer data. Its development was structured in two distinct phases, each building on the last to progressively enhance the app’s functionality, data accuracy, and user experience. In the first phase, initial development efforts focused on refining the app’s core algorithms through iterative testing. This phase was supported by a Patient and Public Involvement (PPI) session, where users provided feedback on the app’s feasibility and potential benefits. Following this, two field tests were conducted to validate the app’s ability to detect sleep patterns accurately: the first test spanned six nights, while the second test ran for seven nights. The results from these field tests, along with post-test survey feedback, informed the subsequent steps in the app’s development. As the study progressed to the second phase, an enhanced algorithm was introduced to detect sleep disturbances based on screen on/off activity and accelerometer data. Prior to launching this phase, an additional PPI session was held to refine the study’s focus, gathering user insights specifically on the app's aim to investigate links between sleep disturbances and mental health concerns such as anxiety and depression. This 56-day phase involved ongoing data collection and analysis to explore these relationships further, enabling the app to evolve into a tool capable of identifying potential mental health risks associated with sleep issues. To ensure data security and privacy throughout both phases, two separate databases were created: one storing sensitive personal information (e.g., name, email, gender, ethnicity) and another for sleep and sensor data. In the first phase, Firebase was used for data storage; however, due to concerns raised by the ethics committee regarding enhanced data protection, the app transitioned to Amazon Web Services (AWS) in the second phase. This move, along with the separation of databases, was critical in maintaining data integrity and anonymity, providing a strong foundation for ethical compliance and secure data management. At the conclusion of the study, the SleepTracker app’s acceptability was evaluated using both quantitative and qualitative analyses. The quantitative analysis focused on numerical data collected through participant surveys, applying a theoretical framework based on the Technology Acceptance Model (TAM). The qualitative analysis used thematic analysis to explore participants’ experiences with the app, uncovering a range of insights regarding its usability and effectiveness. Together, these analyses provided a holistic understanding of the SleepTracker app’s feasibility and its potential for monitoring mental health. In summary, the SleepTracker app shows promise as a tool for monitoring sleep patterns and identifying potential mental health concerns among young adults. Its integration of advanced technology and data-driven algorithms offers the potential to yield significant insights into the intricate relationship between sleep disturbances and mental health. This research aims to contribute to improved mental well-being and address the challenges posed by sleep-related issues in future health interventions.3 0Item Restricted Patient portals in the National Health Service general practice (GP) practices: a systematic review and analysis of GP patient surveys and clinical practice research datalink(Imperial College London, 2024) Alturkistani, Abrar Saleh A; Costelloe, Ceire E; Greenfield, Geva; Beaney, ThomasIntroduction: Patient portals are online platforms for accessing healthcare records, prescriptions, and appointments, and are available in all General Practice (GP) practices providing National Health Service (NHS) services in England. This thesis aims to study the use and associations of patient portals in this context and explore healthcare-related outcomes, offering clinical and policy recommendations. Methods: A systematic review was performed to determine health and healthcare utilisation outcomes associated with patient portals among patients with diabetes. An analysis of the GP Patient Surveys (GPPS) of 2018-2020 was performed to explore characteristics associated with patient portal use in England. An analysis of Clinical Practice Research Datalink (CPRD), was performed to evaluate the number of consultations and statin prescription ordering adherence before and after patient portal registration. Results: The systematic review concluded that patient portal use is associated with health and healthcare utilisation outcomes. Analyses of the GPPS surveys indicated that respondents with long-term conditions (compared to those without), of the age groups 16 years old until 84 years old (compared to those aged 85 years and older), and of the lowest deprivation level (compared to those in the highest level) were more likely to use patient portals. The exploration of health utilisation indicated a reduced number of face-to-face consultations (incidence rate ratio (IRR): 0.93, 95% confidence interval (CI): 0.93, 0.94), but an increased number of remote consultations after portal registration (IRR: 1.16, 95% CI: 1.15, 1.18). Additionally, there was a reduction in statin prescription ordering adherence (of at least 80%) after portal registration (IRR: 0.84, 95% CI: 0.81, 0.86). Conclusion: Patient portals are useful tools, but there is a need to further explore and address any existing inequalities, and unintended outcomes associated with their use. Future research could explore inequalities and the mechanisms between patient portal use and outcomes.4 0Item Restricted Exploring Digital Self-Management Support for Chronic Knee Pain in Physiotherapy Clinics in Jeddah, Saudi Arabia: A Two Phased Sequential Mixed Methods Study(Cradiff University, 2024-04) Aljahdali, Shaima; Latchem-Hastings, Julie; Button, Kate; Hamana, KatyBackground and study aim: Chronic knee pain is a widespread issue globally, affecting individuals of all ages worldwide. This challenge is intensified by an aging population, sedentary lifestyles and increasing obesity rates. There is an international shift towards promoting active management approaches in line with clinical guidelines, including physical activity, dietary changes and the support of self-management. This shift has led to an evolution of digital initiatives designed to support people to self- manage their chronic knee pain. However, despite the high prevalence of chronic knee pain in Saudi Arabia, relevant research in the region remains scarce. This study aims to explore digital self-management support for knee pain within the current physiotherapy practices in Jeddah, a prominent city in Saudi Arabia. Methods: This study employed a sequential exploratory mixed-method design. It started with qualitative interviews involving 29 participants (15 physiotherapists and 14 individuals with knee pain), analysed using reflexive thematic analysis (Phase 1). The aim was to explore how existing physiotherapy practices for knee conditions align with self-management support principles and to explore the perceptions of potential users towards digital self-management support initiatives. Part of the findings informed the adaptation of the digital intervention "TRAK" into a Saudi-specific platform named "TRAK-Saudi". In Phase 2, 12 participants (6 physiotherapists and 6 individuals with chronic knee pain) participated in remote usability testing sessions for evaluating the usability of TRAK-Saudi. The perceived usability was assessed using the Arabic System Usability Scale (A-SUS), with usability issues identified through a concurrent think-aloud approach and analysed via quantitative content analysis. Additionally, the likelihood of substituting face-to-face sessions was assessed using a 5-point Likert scale. Qualitative and quantitative data from both phases were integrated at various points to address the study's overarching aim. Findings: In Phase 1, the findings highlighted a discrepancy between current physiotherapy practices and the foundational principles of self-management support, underscoring an essential transition towards patient-centred care. Participants generally favoured digital self-management support initiatives, advocating for their role as supplementary to in-clinic therapy rather than as replacements. TRAK-Saudi was rated highly for usability, with A-SUS scores of 77.5 by individuals with chronic knee pain and 83.3 by physiotherapists. During the navigation of TRAK-Saudi, participants initiated 53 inquiries, primarily seeking guidance and assurance. Participants also expressed strong willingness to substitute in-clinic sessions with TRAK-Saudi, reflected in median ratings of 4.5 for individuals with chronic knee pain and 5 for physiotherapists, with a mode of 5 for both type of participants. Conclusion: Both physiotherapists and individuals with chronic knee pain demonstrated competence and openness to digital solutions. While TRAK-Saudi was user-friendly for Saudi users, current physiotherapy practices lack the clinical foundation to fully embrace digital self-management support initiatives. Significant changes in current practices are necessary to promote patient-centred care. At this stage, it is advisable for Jeddah’s physiotherapy clinics, if interested, to integrate TRAK-Saudi or similar initiatives as supplement to existing practices. This strategy aims to elevate the quality of knee care by enriching individuals’ knowledge, strengthening patient-provider relationship and improving self-management skills.4 0Item Restricted Enhancing the Patient Journey and Reducing Waiting Times in the Referral Process from General Dentist to Speciaist Dental Clinics in the Riyadh Second Health Cluster(University College of London, 2024) Algwenim, Wafa; Davies, JulieAbstract Intermittent delays concerning dental referrals remain an ever-present problem in global health systems. These delays can negatively impact patient safety by worsening dental conditions, potentially leading to more complex and costly treatments and increasing the risk of complications. They also affect patients' experiences and the overall systems' performances. Although several strategies have been carried out to solve this problem such as growing the stock of specialists and efficient use of available resources, the problem could not be solved fully. Therefore, it becomes necessary to discuss integrated strategies that can address the demand and supply side as well as system imbalances producing these delays. This systematic literature review aims to obtain patterns of effective evidence-based treatments for streamlining the referral from general dentists to specialized dental units, especially concerning Riyadh Second Health Cluster. The review aims to bring together available evidence about the causes of referral delays, assessment of current interventions, and set up a framework to improve the referral process to minimize waiting time and patient outcomes in Riyadh. Aims The purpose of this report is to explore processes to streamline the patient referral pathway from GP dental clinics to specialist dental clinics. Specifically, it focuses on reducing waiting times and minimizing risks for patients by optimizing the referral process in Riyadh Second Health Cluster. Research Question: This research seeks to answer the following question: What strategies can streamline the dental referral process, reducing waiting times and minimizing patient risks in Riyadh's Second Health Cluster? Methodology This research adopts a case study method (Yin, 2018) to assess the dental referral process in Riyadh Second Health Cluster, establish the causes of delay, and recommend possible interventions. The research methodology of a systematic literature review based on operations management (Meredith & Shafer, 2019) principles are used to analyze the elements influencing demand, supply, and system factors of referral efficiency. The review also involved the use of sources in databases including PubMed, Web of Science, Scopus, and JSTOR, using keywords and terms including, “dental referral, waiting times, patient journey, healthcare efficiency, and digital pathways.” From this review, the generated conceptual framework shows the relationships between these aspects and their impact on the duration of time that waits for the patients, outcomes, and perceptions. It helps decide on the specific actions aimed at improving the referral process in Riyadh Second Health Cluster based on the specific characteristics of the area. Key Themes Key themes in an analysis of 40 articles revealed the importance of the multifactorial nature of referral delays (demand, supply, systems); the impact of waiting times on patient outcomes, experience, and system efficiency; the effectiveness of demand management, supply optimization, and system-level improvement strategies; as well as the potential for digital health technologies to enhance efficiency and communication. Theoretical Focus This report follows the structure of patient journey mapping, in conjunction with principles of service design (Stickdorn et al., 2018), where concepts of flowcharting business processes are in line with operations management (Slack, Brandon-Jones & Johnston, 2016). Demographically outlining the patient's journey towards the referred dentist helps in the following aspects: (1) Points to areas of delay and opportunities for improvement from the patient’s perspective; (2) Reveals non-value-added activities or stages; and (3) Provides a guide for the suggested solutions in redesigning the referral process. The present framework draws on insights from MBA Health by considering the patient as a consumer while also considering the processes of operation management. Implications for Practice Prolonging dental referrals disintegrates continuity of the care, complicates the treatment, makes it costly, and most importantly, leads to dissatisfied patients. Healthcare decision-makers and practitioners can use the findings of this review to enhance healthcare referrals, decrease the time clients spend waiting for dental compartments, and increase the quality of timely and appropriate dental care. These include an electronic referral system; referral of patients to specialists; enhancing communication & collaboration among PCPs by establishing clear referral guidelines and protocols, facilitating regular communication channels (e.g., secure messaging, EHRs, case conferences, direct consultations), implementing feedback mechanisms from specialists to general dentists, and promoting continuing education on collaborative care and referral management; purchasing of Health IT; and improving patient self-management regarding oral health. Findings: The literature review indicates that dental referral delays stem from the complex patient journey and healthcare system inefficiencies. These include poor communication between primary care providers and specialists, underutilization of health IT systems, and unnecessary referrals. Recommendation: The integration of digital health technologies, improved resource allocation, and enhanced communication strategies are essential to address these challenges. Additionally, increasing the number of dentists, particularly specialists, and streamlining the referral process through electronic systems and web-based platforms are crucial. Collaboration and integration among healthcare providers and strengthening the health IT framework are also important for an effective referral system. Limitations: This study has several limitations that should be considered when interpreting the findings. First, this study focused specifically on the Riyadh Second Health Cluster, and the findings may need to be more generalizable to other regions or healthcare systems with different organizational structures, resources, and cultural contexts. This limitation potentially restricts the broader applicability of the identified strategies to streamline the dental referral process, as proposed by the research question: "What strategies can be implemented to streamline the dental referral process from GP dental clinics to specialist dental clinics in Riyadh's Second Health Cluster, thereby reducing waiting times and minimizing risks for patients?" Second, since the number of quantifiable records concerning patient satisfaction and definite waiting time within the Riyadh Second Health Cluster is scarce, this work chiefly depends on the literature review and general tendencies as operating qualitative data. It has been an advantage, but it might have influenced the quantitative measurement of the effects of referral delays on the overall patients' satisfaction and safety. The precise measurement of the proposed strategies to the goal achieved according to the research question. Third, there was a broad literature search; therefore, it must be considered that other relevant studies needed to be identified. This may limit the number of strategies and best practices highlighted in improving the dental referral processes highlighted in the research question. Keywords: Dental referrals, waiting times, patient journey, healthcare efficiency, digital health, e-referral, teledentistry, demand management, supply optimization, integrated care, Saudi Arabia, Riyadh Second Health Cluster. Article classification: Research paper: A systematic review of strategies to improve dental referral efficiency.22 0