Delivering the digital ambition: Exploring how we can design, implement and evaluate digital technologies in healthcare.

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Digital health technologies (DHT) comprise a broad range of applications such as telehealth, wearable devices and smart-phone and tablet applications (apps). However, whilst national and international policies present ambitious plans for DHT to revolutionise healthcare, there has been little consideration of how they can be successfully integrated into healthcare systems and processes. This is important as many reports show that even well designed DHT fail to be adopted or are quickly abandoned in clinical practice, meaning that their potential to transform healthcare is lost.Stroke rehabilitation presents an ideal opportunity to use DHT to improve patient outcomes. Pressures on services mean that the amount of rehabilitation that can be directly delivered by staff, particularly for the arm, falls far short of that known to be beneficial resulting in sub-optimal outcomes for many people and reduced quality of life. With the numbers of people surviving a stroke set to double in the next 15 years, DHT provides an attractive, innovative, practical and engaging way for staff to prescribe additional rehabilitation and improve recovery for people after stroke, within current service constraints. However, DHT are not widely used in rehabilitation and the factors that influence their use in clinical practice are not known. This project seeks to identify and understand the factors that will influence the use of DHT in healthcare. It will employ this knowledge to design, implement and evaluate a DHT intervention, using rehabilitation after stroke as a case example.The project has 3 initial phases. In phase 1, the evidence considering if and how DHT are used in healthcare will be reviewed, to explore the factors influencing their use. A national survey, observations of practice, questionnaires and interviews will describe current practice and explore the behaviours and beliefs of people after stroke, rehabilitation staff and service managers about using DHT. This information will be used to develop a theory about, and framework of, the factors influencing the use of DHT in healthcare rehabilitation.In phase 2, the theory and framework will be used to co-design, create and undertake initial testing of an app and intervention to supplement routine rehabilitation for the arm after stroke with rehabilitation staff, stroke survivors and DHT developers from our in-house innovation lab. In phase 3, the initial feasibility, acceptability and costs of the app and intervention to supplement stroke rehabilitation at a single NHS trust will be evaluated. Data from interviews, questionnaires and generated by the app will investigate how it was used in practice. These findings will be used to further refine the theory and framework developed in Phase 1 and the app and intervention developed in Phase 2. In the second period of the fellowship (Phase 4), a multi-site feasibility study of the app and intervention will be conducted. The project outputs will also be used to guide and assess the use of other forms of DHT (e.g. virtual reality) in stroke rehabilitation and their transferability to support and evaluate DHT in other healthcare settings will be evaluated.This project will transform how DHT can be used in healthcare by generating a clear theory and framework and providing practical tools which detail the factors that must be considered in the design, implementation and evaluation of DHT. It will provide guidance on how patients and healthcare staff can co-design DHT and design a future trial of the effectiveness of the app and intervention. Its results will benefit technology developers and researchers by helping them design and utilise DHT to improve patient outcomes and enable healthcare organisations and policy-makers to consider the vital processes and resources required to realise the vision of a truly innovative and DHT-enabled healthcare service.