Hi, everyone. It's my first lecture for a while, so please let me know if I am mumbling or coughing or doing much about it,
but yeah, I'm Ben and I'm going to talk about this intervention called Jen.
Defence isn't entitled by any respect and. It was a psychological tension during COVID 19.
And I'm going to talk, it's kind of I'm going to treat it like a big case study of the beginning to look back to the end.
But wherever we are now in the pandemic and including the development of it, the evaluation of it and the ongoing implementation and it's turned into,
is it I mean, it started before I I probably was just about started in my undergrad degree.
But how was he had nothing to do with it then? In people, the leader, the current team.
But we do like that people say and cope tomorrow, I don't know if they're going to know.
My role is in this green box health psychology.
I don't know if that's being talked about this week or not, if anyone's discussed health psychology.
Does anyone have any experience of it or can I know what it is? One thing I know is going to say, You know, I have experience, but not of my father.
OK, cool. So explain it anyway. So you probably heard loads about in the last 18 months about behaviour, medicine.
Certainly what I read in the news quite a lot.
And Susan McVie and Wilbur West and people like that saying this is what people should do, stuff like that.
So health psychology is most similar to behaviour, medicine, I think anyway.
And behavioural medicine is kind of getting people to do things through changing their behaviour.
Health psychology is very, very similar, except we are particularly concerned with the psychology of what people are doing in that change.
So that change is not behaviour. Medicine might be getting them to change their behaviour without them,
even knowing that they're doing it through changing a bridge that they walk along on
the way to work or something and giving them no option to walk or longer run rate.
But if we make them want to change to walk a different route, they have different options.
They will to make that kind of security. It's more concerned with what people are thinking and why they're doing what they're doing.
So how can we make them want to take that idea? That's one difference.
I have to say the very reason it is not the kind of typical psychology, anxiety, depression,
a cognitive behavioural therapy that the psychology that I wanted to do when I came to
do a psychology degree with no idea of what it was about any questions on that so far.
That's cool. OK, cool. So what this talk is about is that this intervention called gen defence.
I'll explain what that is.
It's about how we developed it and how we updated it and the challenges of working in behavioural medicine health psychology during COVID 19,
which obviously accelerated everything in that period.
Am I in the way, by the way? I can all. All right.
And then what I think is potentially the most interesting stuff,
which is the subsequent dissemination implementation of that intervention and working within the current UK.
I'm going to say health care, but public health, whatever the systems that we were, we were very pragmatic.
So whatever systems we were working within, it's about the time to do that.
So x the rationale behind it and this was started actually a long, long time ago in pre swine flu.
But I mean, it's just generally true for influenza and infectious diseases within the home is a key transmission pathway.
So even in lockdown, well, especially in lockdown, when people aren't travelling anywhere,
when people are staying at home, if someone has a virus again, we have to be coronavirus.
It can be anything and they bring it home. You know, you and you and you share your household with people.
If you don't live alone,
there's loads of different ways and there's multiple opportunities to transmit that virus or that infection to someone else in your household.
You're kind of in this group, but. Similarly, if there's a lot of movement going on, if you're going to work, if you're a healthcare professional,
you go to work, you know, you go to a lecture at the university and then you come home.
There's also opportunity to spread it to the people that you live with when you're out and about.
One of you is shielding and the other person is going to work at home.
As I am well aware, if you have a young child going to nursery and Nancy, we don't have no clue about infection control whatsoever.
It's as if they've been trained to spread infection. They, you know you're at risk because it's very, very hard within the home to.
Exposure to infected. Now the key thing, and this is something that was written about by the team in The BMJ.
This is so commentary I so funny is actually that infects your chances of developing symptoms of having a strong or
substantial infection increased by your viral load that you experience the more virus that you come into contact with.
It can kind of overwhelm your immune system so that humans are able to come into contact with very small amounts of virus,
whether it's a cold, whether it's things like that and not to get sick.
Basically, this is not, you know, many people don't know this and therefore don't bother reducing that viral load.
So for example, if you go into a small room with someone who's very sick, you're very likely because it gives them the virus.
Whereas if you're outside, it's very hard to have that extensive exposure to your muscles that much.
And you can reduce the chance of getting the infection, but also the subsequent severity of impact.
And you are overwhelmed. I would note that I am a psychologist thanks to the people that help me.
And yet I think the biggest fear is that people tend to be fatalistic. So they're like, Oh, well, I am very guilty of this.
If my little boy has a snotty nose and he is rubbing his face into my ear or something, I tend to be like, Oh, well, there's nothing I can do.
However, with that in mind,
I can reduce virus transmission in viral load and therefore have a less severe impact on factors that can increase my motivation, change my behaviour.
With that in mind, and around the capability of just the ability to buy and also live with an at risk grandparent,
it would be that sort of germ defence was originally trialled like or developed in this once that stuff.
And so I think it's funded by fund and we see it with the leaves that Professor Lucy Yardley,
who both stayed involved with the project throughout the week.
And now at the time we just focussed on hand-washing is no good evidence actually start to say, Wait, I was involved with that.
There was no good evidence at home, no scalable interventions to support hand-washing at the home.
It was kind of this paper, which is pretty much ignored. And so the germ defence team developed,
it was a really good virus and such back in the day developed to try and increase handwashing
digitally and 2005 2010 for digital whole digital thing was really novel as well.
That just wasn't how you will not be surprised when you look into what it looked like.
That's right. And we used what I'm sure you've been speaking about and maybe to adjust people's behaviour and evaluate the individual side.
I think with the data we print to meet you and I'm not going to go into detail about your theory, class behaviour,
common sense, but revealing that the most basic reason brought in all of these theories of infection control for everything.
And the main thing we did or they did was to focus on increasing well-being, emphasising.
Social consequences.
And this is evidence that they live in the that price of stature comes up to the minute that we did this qualitative interviews and questionnaires,
I found out actually where the key target, what things are possible to change, what motivations are possible to change.
So, for example, social health consequences was something that was particularly important to people.
Therefore, it could be effectively targeted in the kind of informative intervention,
increasing people's skills and confidence on how to reduce that exposure to the virus.
And again, it was primarily on hand washing at the primary point.
Importantly, if you like the fact that this tool invented that it was exactly the same as this mindset and personalised context
wanting to help people sort of set up having to ask them to put in their current behaviour over the last week.
I wash my hands this month in this situation to think about it.
And I mean, these are things that actually quite fit you don't think about.
Like, how often do you wash your hands before you see me over 40 Panopto now it might be more like that,
but we're not necessarily asking everyone to do this all the time.
What germ defence does? Because if you say if you give people an impossible behaviour to adhere to, then we do it.
Basically, you just think, Well, that's ludicrous. But what we're doing is trying to tap into, OK, what is your risk?
What do you mean if you live with someone who's vulnerable? If you do it, if someone has been to a crowded place,
so being to the point of being to get the vaccine and being surprised when they have been of the hospital,
well, perhaps then you'll be at more risk and you may want to do something.
And if you do it, then can you build a habit on it? So we had this whole plan about how often people do it.
We then gave people feedback, said, OK, that you don't do in this area, make your weapon.
We ask people to set an intention. How often are you going to do that over the next week?
And that individual trial? People then don't do it over the course of 16 weeks, so we really try to set an automatic habit.
And that was something that I could talk about that I will really just mention is that
we used what's called the person based approach to make it as effective as possible.
And this is really a hallmark of the research that the team does. And I know that there are many people out of it who are it.
In many situations, the health care debate and based approach aims to understand exactly what it is that stops people doing it,
but how you just get that whatever the behaviour is, whatever the population is in this case,
the behaviour in the public to make interventions acceptable.
So it might be that, you know, people don't like the look of it.
It might be that the words they don't like and might be this fundamental conceptual ideas that people need to understand.
For example, that issue about viral load helped me because I have family as possible and overcoming
various pursuit to really get people engaged in the event in slightly different ways and,
to be honest, will continue to update this person based approach and make it practical and acceptable possible side effects,
except that it involves extensive and get qualitative interviews with your target group users or PTI stakeholders.
In this case, they might be clinicians. It might be vulnerable people living at home.
It might be helpful. You know, anyone who uses the intervention.
We also did a qualitative quantitative data from the using where they're using it.
Who is dropping out of what state intervention and stuff like that.
And we just couldn't be. The picture of engagement, why people using it, how can we help people,
what happens if that's acceptable as possible and therefore how can we increase the uptake in the hearings?
And ultimately the aim is to make the outcomes? So the doctor who basically at the state level, but she's been working on defence since its inception,
and she really ultimately developed the only way in the beginning and that takes qualitative interviews in a questionnaire.
And she found some relatively boring kind of you just central one that people wanted to see that interaction to be engaged in prevention layout.
They wanted. And but the point that they detached from the standard that could lead to change and they want to illustrate it.
So that's kind of simple stuff. Fundamentally, more conceptually, there was that viral.
People really need. That was a key message we needed to understand in order to motivate them to engage in behaviour change.
And that was a key one to try and get them to this look like effect.
So you can see yet be that.
You know that we highlighted in Bow emphasises the naked photos and everything, I think Claire should know this was filed in primary minutes.
So actually, a lot of the demographic that we're using it and where it's really likely to make a difference to health care often is older people.
And so older people may want to keep this clear accessible.
And it was also as a note of that, and you can see we have messages on that message before the bill comes together.
And then, yeah, I do want to emphasise that the qualitative stuff, the to me,
the important messages are not that Typekit around the neck and the feel of it and highlight these fundamental but where to target your key messages.
Why are people not engaging with it? Do they fundamentally not believe in what it's saying?
You know, do they have a belief that you need to read?
So, for example, in the qualitative interviews, people thought again, this virus, but the virus can go airborne.
It was all that often there was no need to wash your hands at all.
I would say I don't want to be obsessive that this isn't about constantly washing my hands.
So we would put the messages to address that component, and then it dissipated.
I forgot to do it again in things like that to really get into the nuts and bolts of why people might see these behaviours.
The key behaviour that you have in terms of generating evidence over 20000 people and climbing in the pool while I was going The Lancet.
And there was a positive effect. I think effect size, whether it's a documentary, was about 10 15 percent.
Reducing respiratory infections reduced the frequency of them, the severity of them.
The people in the firm had less consultations with a.
We'll prescribe. And also there was a benefit for their family members,
so people there were less household infections and there were also less other infections that were the primary target and programme.
And we did some subgroup analysis that said is particularly effective.
And it was equally effective across most of household variances that we could find like gender, age and things like that.
So that was that was Bob. And of course, one of the questions what we got.
So we did this big trial. I don't know if you've been discussing this,
but where do you go with something like this outside of a trial outside of like a tremendous amount of funding that
it takes to run a trial like this and do a to people and have teams ringing up and reminding them to complete?
I have to say it wasn't being used by loads of people, so Sasha was happy to have adapted it to be useful outside of the swine flu pandemic.
And so it was pushed. We updated it to make it look a bit more modern, and this is when I got the call.
And then we're kind of hosting it and trying to implement it in there with the W.H.O. Handwashing Week, they had for a while.
So we tried to advertise it then and then we were in the process of getting it
up into nice guidelines that everything related barriers that that I mean,
we have some news.
So it was a resource that was being used, so it was making some difference, but it certainly didn't have loads of uptake outside of a chance.
For me, always being one of the big challenges of Western Hemisphere is even in, you know,
targeted and effective interventions that you might develop to be increased from asthma.
Inhaler use in primary care outside of a trial is incredibly hard to implement them at a scale that is useful for digital interventions.
If these interventions they don't like, I wonder what that motivation is when you have time to sit down and try to change that one person's behaviour.
They tend to work at scale with relatively modest behavioural effects that don't work for everyone.
But the idea is because it's a cheap and it cost literally nothing to do it on 10 people versus doing it with one person.
Over time, they will have a hopefully a phenomenal, and they can reach many more people for less cost.
But like you do need to have that support and you like how if you have a fantastic app, how do you apply that app in the real world?
It's incredibly challenging and it's so much fun to do it.
And so one of the things that we looked at was when does the effect come to people in this trial?
We're doing over 16 weeks and they do it in every four weeks to complete a questionnaire from that.
And what you can see is I don't have a laser pointer, but if you see this is the bottom,
this is like every week they knock it off and they've done an intervention.
They do the full intervention fully, but in intensive care.
So well, yeah. And so if you look to the green, this is what we did is we look at how many sessions people did.
Three or four? And what you can see is the effect basically the same, whether they did one to three or four sets or anything in their hands.
Now it's not, it's not massive. It goes, it goes from light.
It's about nought point five or something goes from three to four, but that's on a scale of zero to five.
So it's taking on average it takes to go from like quite good to very good.
Actually, that's quite impressive if you think the average people are quite good at playing
people who've been taking and taking from that one to five and what people think.
But is this something you look at its effect size change after one session effect size is huge.
Like the big 15 is big and then almost all of the changes in that first session.
So in terms of how do we apply this learnings, we've got to take the evidence of what happened.
Anyone. They don't have any idea how we might adapt and defence based on it from a full assessment function.
Yeah, exactly. Basically, if you ask me to log in and over a four week period, it's a massive hassle.
You have to like, sign in and put your email address in and like, remember a password?
And I mean, at the time, that was that was a hassle for people.
It's now not only a hassle, but also there's legit Typekit issues of anyone else.
But I'm always like, if people say, can you put in a fake occupant thinking like, I'm not yet great.
And then I think my problem better. So what we did there was we think we better update based on context the evidence we made in one session only.
So it didn't have to lock in and think about the extra information. And actually, we could make that first that much more than half that.
We don't have a trust issue and we can give people the key messages and.
That was an example and making it snappy.
Investing is quite handy because obviously beginning anything and he begins by funny how the 19
year old around and we got some funding to actually the funding was for this implementation,
really. I mean, we were going to do an evaluation of our job evaluation, but really the funding was to get it out there as much as possible.
And in fact, I would think that would do that.
So we had the free copy co-design evaluation and we had a big collaborative, restless to Public Health England.
Now UK HSA UK has great things and a few other people here just waiting because we basically, you know, you read, remember that.
So every all hands on deck there. So that because that was the thing, this PBI approach, this sort of really rigorous,
evidence based development updating approach that we did in getting hit a that came to
over a five year you spent two years updating to make sure we didn't have time to do that.
So what we did was we set out this process of really, really rapid adaptation.
So we've got a stakeholder panel which had kind of people who would be able to weigh in on how to get people to get comfortable.
And we met like once a week to email people all the time, and then we'd compromise and be willing to jam with people.
Using it means that people who completed those questionnaires and surveys, we looked at data.
So we had a constant iterative process to try and make it less invasive without any barriers.
We met with people and we continued to do that constantly, and so we updated it in March 2020.
We've kind of released it to the world when we were confident that were appropriate.
That type of nineteen point three generation that people 2020 and you can see like this is in its simplest version.
Now this business or infographic that lets people read into that.
So we really updated it and tried to make you. It's a lot more appropriate for the modern world compared to that by mistake.
And yeah, we like we we still kept updating it. So to be honest, the funding is just about finished now, so we don't have much capacity.
I think it's still kind of keeping it going.
But I would say that one of the key things at the beginning of the pandemic, everyone was very scared of COVID 19.
Like people were like, If I get it, I might die everyone.
We didn't really know the risks. So the key motivating risk was here is the risk.
If you get the virus, this is what will happen.
Is the risk to you and to your family and what are you trying to avoid it?
By the end of the pandemic, people were not worried about the risk.
To me, that was kind of a known quantity that some people were very concerned about some people.
We're not concerned about it.
On the whole, people knew that it wasn't going to be something that we could change their minds about and change their behaviour within that limit.
So actually, actually what people didn't know was like, how easy it was,
how much community transmission there was and how easy it was to catch the virus if you were out and about.
So our messaging changed from here is the risk of you catching the virus.
So here is the risk if you pass the virus to here is the risk of contracting the virus.
So it's changing that key risk message to try and fundamentally get people to engage in drought.
And you're not going to talk about this intimidation rabbiting on all of that time.
But we did like we added content to help people identify,
know we're not trying to get someone who is fit and healthy and had their vaccines and at low risk,
and then to stay at home and wear a mask in the house with their family.
We're trying to get people to do to be motivated to understand what the risks are and
then to be motivated to do the appropriate behaviours in the face of those risks.
Again, because if you ask someone to do something really, really inconvenient,
the most likely thing is they'll go, That's a waste of time and then just switch off. We really can't say this is how this like.
These are reasons why you might want to engage in these behaviours and give people
an active understanding of what adjusting their behaviour will do for them.
And then they might engage in some of the behaviours to a level which is appropriate for them.
So, for example,
one of the quotes one of the great crises to a night from from an early participant because to a ninety five year old Typekit and more importantly,
than worrying about whether you're going to die of a virus and this incredibly emotional.
So we actually ended up putting in content that was like, how can you get around?
How can you engage in behaviours or how can you do appropriate behaviours in the face of these risks?
It was stuff like setting out your living room so you could watch films with if someone
is more vulnerable in the same breath and how you can sit in the same type of far apart.
It all comes down to reducing that with that, and you can see that this is what it looks like now.
People log in. We've got like the first three pages on the app.
I like the fundamentals, the motivational stuff you then get.
The guy down when pathway, depending on your level of risk,
and it kind of gives you this advice according to how vulnerable you are, a vulnerable, your family and things like that.
And then we get it. So it's really trimmed down from like a stage website with about 50 pages and it takes, well, take about 10 minutes.
But then and this is the stuff about the rest of it.
How do we get it out to people? This has been for me.
This has been a real like. I really don't actually think that as any other country in the world,
we have a really good grip on this problem of dissemination and implementation of interventions like this.
So it has been basically what I'm going to talk about for the remainder of the talk
is the fact that we did everything we could to get it to as many people as possible.
And because it's digital, we can look at what comes and we can look at usage and see how it goes.
And so we have a fairly good grip on what works and what it is, mostly what it is.
So we had you can see we had like lots of members of the team run from the press, the yard.
He was on stage. So he was he would get wheeled out sometimes by the BBC when they could convince him to do it.
And we had a Daily Mail article which really took off.
And that was incredibly popular. We had it was mentioned on in the BMJ.
It was mentioned on social media. You could share it was on the radio, it was on it from the UK, stay at home guidance.
We were helping the message out. And the really great thing is we can and and it worked.
I mean, to some extent, over and another. So we had around 600000 youth since then by careful with my language there because we don't know whether.
We don't know whether one person you can more than one.
I mean, I'm fairly confident from our fees are fairly comparable feedback that they didn't people didn't tend to, you know,
find it hard and come back to it again and again, most of them in the UK, but it will be translated into louder, different languages.
We a great project with like fluent speakers who are willing to help out to do that and we have used all over the world.
Normally people take ten minutes on it and a new lighting up, and these are, to be perfectly honest, some of the best experiences inventions.
These are like great sporting events and like this,
nobody in often uses like one minute because people look on it and just think that something that cost the best part of this stuff.
So we're really happy with these numbers. And this is this is what that pretty cool.
As you can see, we get we get hit of like what where you can see like when I write the stuff,
these are legitimate talking on the internet or on the radio and see that there was an interview in the Guardian and stuff at the time,
but washing your hands. And then as time went on, when the power went out of town, when the press conference announced the funding fight,
when that BMJ article came out about the importance of viral load,
that was the biggest spike when the press release came out in the Daily Mail, which, by the way, they called it German defence.
And people were getting really cool.
And then and actually, that was really interesting because it spoke to the Daily Mail article with they just, well, the press guys picked out.
They thought this was an interesting thing. What's the catch here? And they picked that.
Part of the recommendations that we had was that the initial evidence suggested that the virus would die on a set after 72 hours.
So in the intervention, we said, no, we try not to tell people to leave your pizza for 72 hours when it's delivered,
but we try and say the don't leave something. And now all the evidence is ventilation.
But this is right at the start where there wasn't that evidence in this the surface.
And you know, trying these longer is better than not at all.
You can leave it for a day. That's great. Yeah, it's always fantastic.
Got no chance. But you know, 30 minutes is better than zero.
They write that message the huge fury to the Daily Mail, because people like people immediately said, Well, I'm going to eat my takeaway.
But actually, what it did do is get loads of people using it, and once they used it, they realised that wasn't the key message we were saying.
It's kind of an important lesson on working effectively with press releases.
And then there were BBC interview that going towards a huge spike before the press conference with that question.
Yeah. You know, you have someone to do that or do well because we're doing so many different methods.
No, and part of the I mean, part of the issue was this was before we did this project.
There's no real guidance on how to disseminate something like this. So it was I mean, it became the primary job of me,
Lisa and the team really to try and disseminate it for as many channels as possible and outside of a trial,
because a trial, you have a tremendous amount of resources. You have people employed to chase people up and complex and stuff like that.
You know, we didn't have anywhere near that amount of funding, and it was really about finding out different things to know.
It was kind of me. Hit me and try to dominate something we did in the pandemic, something I know, like a lot of people,
just stopped watching the news because they didn't want to hear about it every day. Like I muted a load of times on my third.
Yeah, I didn't want it all in my face. I wonder if that made it even harder.
Well, maybe I know, but I'm about to talk about another method which might be at his side and that that might be true.
I guess we never know it, but we did have another method in a bit.
We talked about that. Yes, this is one of the cool things as well.
I will whip through this. What we do get we in digital trends so we can kind of gather all the data that's going on so we can see like people fill
out this quiz and we can say we had a thing to do this before and we can see what current levels of behaviour are.
Of course, it is in a highly motivated subgroup. I mean, that's the thing about these interventions.
If you don't tell them that people who are already doing it, but we can see like how much people.
So this is analysis done last August, and you can see basically into these bars.
You get one two three four five.
And it's how many people say the further to the left that the population is weighted, the less people are doing the behaviour.
You can see very few people wearing face coverings at home, virtually none, which you would expect, right?
Because it's quite an intrusive target. Few people put packages inside.
Quite enough people are saying disinfecting, not that many people social distancing.
And this is probably lower than you would expect during a pandemic because it's not saying, you know, do you socially distance from your loved?
It's kind of you if you're vulnerable. And we look at this and we could look at this within different groups,
which pathway would go down if people selected that I'm living with someone who is vulnerable and living with them?
We had a pathway. I'm living with someone who's showing symptoms. I am showing symptoms.
And you could still be your average.
So you can still see this by a lot of these people being high risk or vulnerable or showing symptoms that people still aren't doing.
A lot of these behaviours, as you can see.
So we could look and we could find that people with a high risk household member were more likely to do the behaviours.
People who had someone showing symptoms would be more likely to self isolate.
Generally, things like that. So we did find people who thought that they might have symptoms were actually less likely to clean
and disinfect than people who thought that someone they were living with might have symptoms,
which is interesting. So it kind of shows maybe you're putting the burden on the person who is well to clean up so they don't get it.
And interestingly, all of these behaviours, these like classic behaviours and we've now,
by the way, this data analysis came before ventilation, so we now added ventilation.
I believe we've taken out putting passengers back into the side and adding ventilation.
Opening windows were performed much less frequently than hand-washing.
Hand-washing was because do you remember at the beginning, like last February and April, it really pushed.
It was like washing your hands any second. So people really don't do that.
And this is this is the best because it's all the one we don't have at the trial, follow up or anything like that.
If we look at current behaviours from the plan, what might be next?
You can see there's a decent effect, no small increases, but it's actually, interestingly, exactly the same data marker in the original trial.
In less of an effect, which is really nice because even though we don't have that hard clinical data yet,
we know we can think so best estimate that it might be doing something if you have like the infection.
So if we remember that reduced risk of like 10 percent,
there's no real reason to think well of scepticism and rightly sceptical about the fact that this is
the best marker that possibly we might expect a similar risk reduction effect of this infection.
In fact, we might even great it because the the virus is much more prevalent because the infection behaviours that you were targeting ventilation.
In case you didn't think are more likely to be more effective than just we can all say that,
I mean, I'm not going to to it because it takes a long time to it.
But what was cool was we could have a seven day rolling average of these back so you can get over any distance and you can find it.
By the way, even if you don't have a trial, you can start modelling what is going on with you.
And we were able to use that data to decipher the uptake data, things like that, to inform state papers.
And it currently is. It's the only way that encroachment, yes, we have.
Current infection behaviour we didn't really like,
it does still seem to be a slightly overlooked aspect of infection control and actually they the infections quite bit.
And my dry throat. So yeah, this is going to have a dissemination rate.
What we don't know. And so we need to have ad hoc talking to the press, talking to Janet at Twitter, social media, Facebook, stuff like that.
The OTP practise with the email out and one of our team emailed out and we could see a little spike of like 500 800 uses that day.
We know these patients do. We think that's a cool and what we end up doing with designing a trial with a human at risk?
Do we need health protection? Research Unit got marked there as an public health COVID 19 study.
Well, negotiations with the NIH are selected by Chris Whitty as this means that we've got to rapidly go through ethical approval,
which is really handy because again,
so we sort of managed to whip through a lot of stuff that might take you a year to do in order to get it up and running.
And we're going to do with nearly finished a really big trial where we got to be got the email addresses of
every single GP practise in England from NHS X randomise them to 50 percent of them were in the control group.
And we can tell them we're in the German defence group and sent an email to every single one of them in the intervention group,
saying his evidence for definitely have to take.
And then we can look at sort of freely available routine practise data was quite freely available,
but available routine practise data in the GP practises that you've done transverse the GP,
practises that did it and see whether the infection rate in those GP practises were slightly lower.
So I think actually, it's really exciting. It's a really exciting trial to be a part of.
So we haven't got that completed the analysis yet.
We have good data from it. But I think this is but you don't see each of these Charles normally involved,
like individual patients and a GP practise by having the randomisation level at the practise.
We certainly are able to a. Conduct a real world clinical trial and be implemented,
disseminate it to patients via text to their phone from their health care professional, which is really exciting.
Now the challenge with this was that like, I mean, how is that that generic GMP at any and even don't try to involve their GP?
They're not brilliant at replying thinkers because I'm sure they get 100000 emails a day and something that says,
hello, we're doing a research project. It's not very likely to get through to them.
So it was really, really hard.
And I think if we don't show any effect, it is 100 percent due to a lack of uptake because that email access didn't get through.
We said in three cent GP practise three emails, each of those emails we piloted and we trialled and we walk,
we talk them through with members of the practise and people who we try to find out in a given year we've got to would receive the email.
Would it be a kind of receptionist? Would it be a health care system?
Would it be a partner, anything like that? And we try to work out how to challenge it and how to get the most engagement with it.
And then we would even suggest behavioural behaviour change text that they sent to a patient right now.
But that may not seem to be really exciting.
But I mean, one thing takeaway is that this was by far the best way of disseminating germ defence.
When it did get to patients, it came from their health care professional.
It had that credibility, and it also had all of the world number three.
But I mean, we were kind of lucky to be able to do that.
We had that team. But this is by no means a guaranteed solution, you can't have an intervention that shows effectiveness and then say,
Well, I'll just run a national randomised controlled trial and disseminate it like incredibly hard.
And this is for me, this is the one thing that is missing in a kind of pandemic response.
A well in a public health response like this is I might have an intervention that works for anything beyond like a poster or a viral video.
How do I get that to people? We have this National Health Service like we have these communication systems, but there is no at the moment there isn't.
It's incredibly hard. I mean, even like, you know, a clear pathway on who you meet with, who you talk to to actually disseminate something like this,
like, I know you just have a bunch of lessons on mask wearing and discussions of mask wearing.
How do you like that? That's a behaviour, really cute behaviour that's going to be clear,
interventions that could be designed or have been designed on how to change people's behaviour around masks.
But again, there's no clear pathway on accessing everyone in England on getting that through.
And sometimes there, of course, is with the vaccines.
Right? So but again, it's an kind of ad hoc thing that is done and loads of loads of stars have to align in order to do anything.
And you've got this. Hopefully in the future, there will be a guaranteed way of life.
Stop us in order to make me think so.
Yes. To sum up,
this adaptation of Denver defence enabled us to develop really effective methods to get buy into the stakeholders to optimise these interventions.
Reducing these barriers to implementation of evidence based medicine is incredibly important.
I, for me, the best line, the most important learning will be what are the barriers that we faced and how can we not know?
How did we? But how can we hope to deal with them better in the future and not rely on, to some extent, being lucky, but anything?
What I would say is ad hoc and an opportunity comes up. What can we do for someone?
I mean, we we had to get it on the Shelf Duke website.
It's currently on the guidance for multi-generational households and reducing infection if someone has it to get it on that website.
It took almost the entire length of the project 18 months, despite the fact that we had, unlike almost everything else,
we had an evidence base rate for this stuff and we had people from the quite senior people from Public Health England working individuals,
and we still found it incredibly hard. And some of the learning we had sort of reflective discussion meeting actually last week,
and both Richard and Tim on the team were like, we thought this would be a lot easier than it was.
But this, even within Public Health England, there still wasn't a clear channel,
and we don't even know who the gatekeepers are to try and march forward, and it is just incredibly interesting.
And to that identifying and reducing barriers, hopefully all that will help them find the time.
And I really think they're able to be an innovative type of these great adaptations,
the constant updating how do we integrate people's views so effectively the changing context?
I know the pandemic was really rapidly changing, but actually anything digital is constantly being.
If you have any digital behaviour change components like the platform that firing people's habits,
what apps they plug into constantly updating and how can you keep that is some of the methods being developed with what they do.
So that's it for me. Thank you for listening.
And yeah, like you said, there were loads of people involved in it, and this is exactly the audience that they.