Developing a digital Ecological Momentary assessment tool for use with paediatric populations with chronic pain

This project aims to improve the assessment of paediatric chronic pain for five- to eleven-year-olds. By improving the assessment of pain in an under-researched age group better understanding, visibility, and importance can therefore be placed on their care. Better assessment also leads to better care meaning this project supports The Lancet Child & Adolescent Health Commissions areas to transform paediatric pain care of making pain matter, understood, visible and better. Problems with existing measures are that they are unidimensional and retrospective, affecting the quality and accuracy of data collection. Unidimensional measures often do not capture the complexity of biopsychosocial influences on pain. Retrospective tools introduce cognitive biases such as: recency effects, emotional salience and recall bias. Thereby these tools can lead to non-optimal treatment plans in clinical practice and inaccurate measures for clinical trials. To address uni-dimensionality this project will focus on the use of multidimensional tools and data triangulation. Multidimensional tools assess different facets of a painful experience such as: severity, intensity, location, and impact on quality of life. Data triangulation allows the collection of different data modalities and stakeholders perspective to produce a more meaningful output than a single self-report. The 5-11 age group is especially of interest for triangulation due to the higher level of care required from a parent/guardian and the same teacher throughout the day (rather than changing per subject). Ecological Momentary Assessment (EMA) is a methodology which aims to reduce cognitive biases by frequently sampling participants' experiences throughout their everyday lives. Research has shown potential use in routine care as well as in clinical trials due to its ability to capture inter-individual variability over time and thereby detailed evaluation of treatment effects. This project will focus on the digital implementation of EMA due to the improved adherence rate against non-digital alternatives such as paper diaries and the quality of data collection. The use of a digital tool also provides additional benefits in relation to adherence, data communication and scale-ability. However, the combination of these methods: multidimensional assessment, triangulation and EMA will produce a significant amount of data. It is therefore important that this project also focuses on how this data can be communicated with and understood by multiple stakeholders. Additionally to further this point it is important to understand how children can be motivated to engage in this process.

Impact on Health and Care
The CDT primarily addresses the most pressing needs of nations such as the UK - namely the growth of expenditure on long term health conditions. These conditions (e.g. diabetes, depression, arthritis) cost the NHS over £70Bn a year (~70% of its budget). As our populations continue to age these illnesses threaten the nation's health and its finances.

Digital technologies transforming our world - from transport to relationships, from entertainment to finance - and there is consensus that digital solutions will have a huge role to play in health and care. Through the CDT's emphasis on multidisciplinarity, teamwork, design and responsible innovation, it will produce future leaders positioned to seize that opportunity.

Impact on the Economy
The UK has Europe's 2nd largest medical technology industry and a hugely strong track record in health, technology and societal research. It is very well-placed to develop digital health and care solutions that meet the needs of society through the creation of new businesses.

Achieving economic impact is more than a matter of technology. The CDT has therefore been designed to ensure that its graduates are team players with deep understanding of health and social care systems, good design and the social context within which a new technology is introduced.

Many multinationals have been keen to engage the CDT (e.g. Microsoft, AstraZeneca, Lilly, Biogen, Arm, Huawei ) and part of the Director's role will be to position the UK as a destination for inwards investment in Digital Health. CDT partners collectively employ nearly 1,000,000 people worldwide and are easily in a position to create thousands of jobs in the UK.

The connection to CDT research will strongly benefit UK enterprises such as System C and Babylon, along with smaller companies such as Ayuda Heuristics and Evolyst.

Impact on the Public
When new technologies are proposed to collect and analyse highly personal health data, and are potentially involved in life or death decisions, it is vital that the public are given a voice. The team's experience is that listening to the public makes research better, however involving a full spectrum of the community in research also has benefits to those communities; it can be empowering, it can support the personal development of individuals within communities who may have little awareness of higher education and it can catalyse community groups to come together around key health and care issues.

Policy Makers
From the team's conversations with the senior leadership of the NHS, local leaders of health and social care transformation (see letters from NHS and Bristol City Council) and national reports, it is very apparent that digital solutions are seen as vital to the delivery of health and care. The research of the CDT can inform policy makers about the likely impact of new technology on future services.

Partner organisation Care & Repair will disseminate research findings around independent living and have a track record of translating academic research into changes in practice and policy.

Carers UK represent the role of informal carers, such as family members, in health and social care. They have a strong voice in policy development in the UK and are well-placed to disseminate the CDTs research to policy makers.

STEM Education
It has been shown that outreach for school age children around STEM topics can improve engagement in STEM topics at school. However female entry into STEM at University level remains dramatically lower than males; the reverse being true for health and life sciences. The CDT outreach leverages this fact to focus STEM outreach activities on digital health and care, which can encourage young women into computer science and impact on the next generation of women in higher education.

For academic impact see "Academic Beneficiaries" section.