Research and development for interactive digital health interventions requires multi-disciplinary expertise in identifying user needs, and developing and evaluating each intervention. Two of the central areas of expertise required are Health (broadly defined) and Human–Computer Interaction. Although these share some research methods and values, they traditionally have deep differences that can catch people unawares, and make interdisciplinary collaborations challenging, resulting in sub-optimal project outcomes. The most widely discussed is the contrast between formative evaluation (emphasised in Human–Computer Interaction) and summative evaluation (emphasised in Health research). However, the differences extend well beyond this, from the nature of accepted evidence to the culture of reporting. In this paper, we present and discuss seven lessons that we have learned about the contrasting cultures, values, assumptions and practices of Health and Human–Computer Interaction. The lessons are structured according to a research lifecycle, from establishing the state of the art for a given digital intervention, moving through the various (iterative) stages of development, evaluation and deployment, through to reporting research results. Although our focus is on enabling people from different disciplinary backgrounds to work together with better mutual understanding, we also highlight ways in which future research in this interdisciplinary space could be better supported.

BackgroundMultidisciplinary team (MDT) meetings have been endorsed by the Department of Health as the core model for managing chronic diseases. However, the evidence for their effectiveness is mixed and the degree to which they have been absorbed into clinical practice varies widely across conditions and settings. We aimed to identify the key characteristics of chronic disease MDT meetings that are associated with decision implementation, a measure of effectiveness, and to derive a set of feasible modifications to MDT meetings to improve decision-making.MethodsWe undertook a mixed-methods prospective observational study of 12 MDTs in the London and North Thames area, covering cancer, heart failure, mental health and memory clinic teams. Data were collected by observation of 370 MDT meetings, completion of the Team Climate Inventory (TCI) by 161 MDT members, interviews with 53 MDT members and 20 patients, and review of 2654 patients’ medical records. We examined the influence of patient-related factors (disease, age, sex, deprivation indicator, whether or not their preferences and other clinical/health behaviours were mentioned) and MDT features (team climate and skill mix) on the implementation of MDT treatment plans. Interview and observation data were thematically analysed and integrated to explore possible explanations for the quantitative findings, and to identify areas of diverse beliefs and practice across MDT meetings. Based on these data, we used a modified formal consensus technique involving expert stakeholders to derive a set of indications of good practice for effective MDT meetings.ResultsThe adjusted odds of implementation were reduced by 25% for each additional professional group represented [95% confidence interval (CI) 0.66 to 0.87], though there was some evidence of a differential effect by type of disease. Implementation was more likely in MDTs with clear goals and processes and a good team climate (adjusted odds of implementation increased by 7%; 95% CI 1% to 13% for a 0.1-unit increase in TCI score). Implementation varied by disease category (with the lowest adjusted odds of implementation in mental health teams) and by patient deprivation (adjusted odds of implementation for patients in the most compared with least deprived areas were 0.60, 95% CI 0.39 to 0.91). We ascertained 16 key themes within five domains where there was substantial diversity in beliefs and practices across MDT meetings. These related to the purpose, structure, processes and content of MDT meetings, as well as to the role of the patient. We identified 68 potential recommendations for improving the effectiveness of MDT meetings. Of these, 21 engendered both strong agreement (median ≥ 7) and low variation in the extent of agreement (mean absolute deviation from the median of < 1.11) among the expert consensus panel. These related to the purpose of the meetings (e.g. that agreeing treatment plans should take precedence over other objectives); meeting processes (e.g. that MDT decision implementation should be audited annually); content of the discussion (e.g. that information on comorbidities and past medical history should be routinely available); and the role of the patient (e.g. concerning the most appropriate time to discuss treatment options). Panellists from all specialties agreed that these recommendations were both desirable and feasible. We were unable to achieve consensus for 17 statements. In part, this was a result of disease-specific differences including the need to be prescriptive about MDT membership, with local flexibility deemed appropriate for heart failure and uniformity supported for cancer. In other cases, our data suggest that some processes (e.g. discussion of unrelated research topics) should be locally agreed, depending on the preferences of individual teams.ConclusionsSubstantial diversity exists in the purpose, structure, processes and content of MDT meetings. Greater multidisciplinarity is not necessarily associated with more effective decision-making and MDT decisions (as measured by decision implementation). Decisions were less likely to be implemented for patients living in more deprived areas. We identified 21 indications of good practice for improving the effectiveness of MDT meetings, which expert stakeholders from a range of chronic disease specialties agree are both desirable and feasible. These are important because MDT meetings are resource-intensive and they should deliver value to the NHS and patients. Priorities for future work include research to examine whether or not the 21 indications of good practice identified in this study will lead to better decision-making; for example, incorporating the indications into a modified MDT and experimentally evaluating its effectiveness in a pragmatic randomised controlled trial. Other areas for further research include exploring the value of multidisciplinarity in MDT meetings and the reasons for low implementation in community mental health teams. There is also scope to examine the underlying determinants of the inequalities demonstrated in this study, for example by exploring patient preferences in more depth. Finally, future work could examine the association between MDT decision implementation and improvements in patient outcomes.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

IntroductionThe coronavirus (COVID-19) pandemic has caused significant global mortality and impacted lives around the world. Virus Watch aims to provide evidence on which public health approaches are most likely to be effective in reducing transmission and impact of the virus, and will investigate community incidence, symptom profiles and transmission of COVID-19 in relation to population movement and behaviours.Methods and analysisVirus Watch is a household community cohort study of acute respiratory infections in England and Wales and will run from June 2020 to August 2021. The study aims to recruit 50 000 people, including 12 500 from minority ethnic backgrounds, for an online survey cohort and monthly antibody testing using home fingerprick test kits. Nested within this larger study will be a subcohort of 10 000 individuals, including 3000 people from minority ethnic backgrounds. This cohort of 10 000 people will have full blood serology taken between October 2020 and January 2021 and repeat serology between May 2021 and August 2021. Participants will also post self-administered nasal swabs for PCR assays of SARS-CoV-2 and will follow one of three different PCR testing schedules based on symptoms.Ethics and disseminationThis study has been approved by the Hampstead National Health Service (NHS) Health Research Authority Ethics Committee (ethics approval number 20/HRA/2320). We are monitoring participant queries and using these to refine methodology where necessary, and are providing summaries and policy briefings of our preliminary findings to inform public health action by working through our partnerships with our study advisory group, Public Health England, NHS and government scientific advisory panels.

The acceptability and feasibility of large-scale testing with lateral flow tests (LFTs) for clinical and public health purposes has been demonstrated during the COVID-19 pandemic. LFTs can detect analytes in a variety of samples, providing a rapid read-out, which allows selftesting and decentralized diagnosis. In this Review, we examine the changing LFT landscape with a focus on lessons learned from COVID-19. We discuss the implications of LFTs for decentralized testing of infectious diseases, including diseases of epidemic potential, the 'silent pandemic' of antimicrobial resistance, and other acute and chronic infections. Bioengineering approaches will play a key part in increasing the sensitivity and specificity of LFTs, improving sample preparation, incorporating nucleic acid amplification and detection, and enabling multiplexing, digital connection and green manufacturing, with the aim of creating the next generation of high-accuracy, easy-to-use, affordable and digitally connected LFTs. We conclude with recommendations, including the building of a global network of LFT research and development hubs to facilitate and strengthen future diagnostic resilience. Sections• Bioengineering approaches, such as the use of nano-and quantum materials, nucleic-acid-based LFTs, CRISPR and machine learning, will improve the sensitivity, specificity, multiplexing and connectivity features of LFTs.• We recommend investing in an international LFT research and development hub network to spearhead the development of a pipeline of innovative bioengineering approaches to design next-generation LFTs.