Background: Digital contact tracing is employed to monitor and manage the spread of COVID-19. However, to be effective the system must be adopted by a substantial proportion of the population. Studies of mostly hypothetical contact tracing apps show generally high acceptance, but little is known about the drivers and barriers to adoption of deployed systems. Objective: The aim of this study was to investigate adoption of and attitudes toward the NHS (National Health Service) COVID-19 smartphone app, the digital contact tracing solution in the United Kingdom. Methods: An online survey based on the extended Technology Acceptance Model with the added factor of trust was carried out with a representative sample of the UK population. Statistical analysis showed adoption rates, attitudes toward and trust in the app, and compliance with self-isolation advice and highlighted differences for vulnerable populations (ie, older adults aged 65 years and over and members of Black, Asian, and minority ethnic [BAME] communities). Results: A total of 1001 participants took part in the study. Around half of the participants who had heard of the NHS COVID-19 mobile phone app (490/963, 50.9%; 95% CI 47.8%-54.0%) had downloaded and kept the app, but more than one-third (345/963, 35.8%; 95% CI 32.8%-38.8%) either did not intend to download it or had deleted it. Significantly more BAME respondents than White respondents had deleted the app (16/115, 13.9%; 95% CI 11.8%-16.0%, vs 65/876, 7.4%; 95% CI 5.8%-9.0%), and significantly more older adults 65 years and over than those under 65 years did not intend to download it (44/127, 34.6%; 95% CI 31.7%-37.5%, vs 220/874, 25.2%; 95% CI 22.5%-27.9%). Broadly, one of the reasons for uptake was to help the NHS and other people, especially among older adults, although significantly fewer BAME participants agreed that they did so to help the NHS. Reported compliance with received notifications to self-isolate was high but was significantly lower than reported intended compliance without received notifications. Only one-fifth (136/699, 19.5%; 95% CI 17.0%-22.0%) of participants understood that the decision to send self-isolation notifications was automated by the app. There were a range of significantly more negative views among BAME participants, including lower trust in the NHS, while older adults were often significantly more positive. Respondents without the app reported significantly lower trust and more negative views toward the app and were less likely to report that they understood how the app works. Conclusions: While compliance on the part of the approximately 50% of participants who had the app was fairly high, there were issues surrounding trust and understanding that hindered adoption and, therefore, the effectiveness of digital contact tracing, particularly among BAME communities. This study highlights that more needs to be done to improve adoption among groups who are more vulnerable to the effects of the virus in order to enhance uptake and acceptance of contact tracing apps.

Mental health literacy is important as it relates to understanding mental illness, increasing help-seeking efficacy, and reducing mental illness-related stigma. One method to improve the mental hea...

A systematic review was conducted to identify and quality assess how studies published since 1999 have measured and reported the usage of hearing aids in older adults. The relationship between usage and other dimensions of hearing aid outcome, age and hearing loss are summarised. Articles were identified through systematic searches in PubMed/MEDLINE, The University of Nottingham Online Catalogue, Web of Science and through reference checking. Study eligibility criteria: (1) participants aged fifty years or over with sensori-neural hearing loss, (2) provision of an air conduction hearing aid, (3) inclusion of hearing aid usage measure(s) and (4) published between 1999 and 2011. Of the initial 1933 papers obtained from the searches, a total of 64 were found eligible for review and were quality assessed on six dimensions: study design, choice of outcome instruments, level of reporting (usage, age, and audiometry) and cross validation of usage measures. Five papers were rated as being of high quality (scoring 10–12), 35 papers were rated as being of moderate quality (scoring 7–9), 22 as low quality (scoring 4–6) and two as very low quality (scoring 0–2). Fifteen different methods were identified for assessing the usage of hearing aids. Generally, the usage data reviewed was not well specified. There was a lack of consistency and robustness in the way that usage of hearing aids was assessed and categorised. There is a need for more standardised level of reporting of hearing aid usage data to further understand the relationship between usage and hearing aid outcomes.

The objective of this study is to compare the efficacy and cost of specialised individually delivered parent training (PT) for preschool children with attention-deficit/hyperactivity disorder (ADHD) against generic group-based PT and treatment as usual (TAU). This is a multi-centre three-arm, parallel group randomised controlled trial conducted in National Health Service Trusts. The participants included in this study were preschool children (33–54 months) fulfilling ADHD research diagnostic criteria. New Forest Parenting Programme (NFPP)—12-week individual, home-delivered ADHD PT programme; Incredible Years (IY)—12-week group-based, PT programme initially designed for children with behaviour problems were the interventions. Primary outcome—Parent ratings of child’s ADHD symptoms (Swanson, Nolan & Pelham Questionnaire—SNAP-IV). Secondary outcomes—teacher ratings (SNAP-IV) and direct observations of ADHD symptoms and parent/teacher ratings of conduct problems. NFPP, IY and TAU outcomes were measured at baseline (T1) and post treatment (T2). NFPP and IY outcomes only were measured 6 months post treatment (T3). Researchers, but not therapists or parents, were blind to treatment allocation. Analysis employed mixed effect regression models (multiple imputations). Intervention and other costs were estimated using standardized approaches. NFPP and IY did not differ on parent-rated SNAP-IV, ADHD combined symptoms [mean difference − 0.009 95% CI (− 0.191, 0.173), p = 0.921] or any other measure. Small, non-significant, benefits of NFPP over TAU were seen for parent-rated SNAP-IV, ADHD combined symptoms [− 0.189 95% CI (− 0.380, 0.003), p = 0.053]. NFPP significantly reduced parent-rated conduct problems compared to TAU across scales (p values < 0.05). No significant benefits of IY over TAU were seen for parent-rated SNAP, ADHD symptoms [− 0.16 95% CI (− 0.37, 0.04), p = 0.121] or parent-rated conduct problems (p > 0.05). The cost per family of providing NFPP in the trial was significantly lower than IY (£1591 versus £2103). Although, there were no differences between NFPP and IY with regards clinical effectiveness, individually delivered NFPP cost less. However, this difference may be reduced when implemented in routine clinical practice. Clinical decisions should take into account parental preferences between delivery approaches.