Mock Viva Questions Flashcards
PhD Mock Viva
Tell us about your thesis - What are the key findings?
We found that mHealth interventions are an acceptable, informative and supportive streategy that appears to help people with physical disabilities improve their physical activity levels. MHealth is cost-effective, does not require too much expertise, can be tailored towards the individuals needs, can be used anywhere and can help people with disabilities overcome many PA barriers.
Tell us about your thesis - What does it add to the literature?
Why does it matter/why do we care?
The reason we care is people with physical disabilities are physically inactive, they are not meeting recommended guidelines due to numerous barriers that exist and our thesis adds to the literature because we are the first to evaluate the Accessercise application in terms of it’s theoretical underpinning, usability and feasibility before we proceed into a full-scale trial.
David: Yes, so you are doing that preparatory work before you go into a full-scale trial, which takes away some of that risk and uncertainty.
The Accessercise application is a novel application. So, current application that exist mainly focus on a singular disability. However, more recently apps that focus on multiple disabilities struggle to tailor the content around the users disability. Accessercise is unique because you can tailor the content around the disability you select.
Summarise your approach, why did you opt for the MRC and not an alternative? (think about the MRC framework, mixed methods)
The MRC framework has been widely used to develop and evaluate behaviour change interventions.
As we know we need to develop more interventions in this population, it’s recommended because it’s a systematic, logical and reliable framework to help develop and evaluate interventions because it goes through the development, feasibility, evaluation and implementation..
What motivated you to look at disability/SCI, physical activity, and mHealth?
- I undertook my MSc dissertation looking at the barriers and facilitators to PA in young adults with physical/sensory disabilities. Based on these barriers, I noticed that there is a need to develop suitable interventions that can help improve physical activity in this population, which can help overcome sedentary behaviours
- Going into my PhD, I wanted to develop an intervention. Unfortunately, this plan changed because of COVID etc but we got approached by the Accessercise team, which developed a novel intervention and they seeked us to evaluate their intervention. Therefore, based on the expertise of the PHC and my supervisors, we thought that SCI were a suitable population to work on.
- Talk about my Care Jobs
- Dyslexia
Overall, I have a wealth of experience when it comes to working with people with disabilities in a physical activity context.
I said that Accessercise is the only app that looks at multiple disabilities. Is this true?
No. So, the SUPERHEALTH targets multiple disabilities (e.g., arthritis, SCI etc), WHEELS focuses on several different SCI disabilities.
However, the tailoring part of the Accessercise app is what makes it unique. So, Accessercise allows you to select disability and the content of the application changes and is tailored towards the individuals impairment. Other apps don’t really have that function!
The SUPERHEALTH and WHEELS app are not really highlighted much in my PhD thesis but if I mention it to my examiners it will show my wider understanding of the literature
I mention about the recommended guidelines. Which ones do I refer to?
I mainly talk about SCI related guidelines (e.g., 40-minutes of moderate to vigorous PA once per week).
However, I need to be mindful that my PhD doesn’t just look at SCI but I could use the WHO guidelines because they do have specific guidelines for physical disabilities, which are quite similar to non-disabilities.
PA guidelines (SCI): 40 minutes of moderate to vigorous aerobic PA once per week
PA Guidelines (Disabled): 150-300 moderate intensity PA once per week
The examiners may ask you a real life question like we have a new government and imagine you are speaking to the minister of disability. You have two minutes so what would you say to them, what do they need to know?
Think about the key points from my PhD thesis!
Avoid my answers always being around Accessercise. Instead, say mobile enabled health (mHealth apps) are accessible and useable for this demographic. Therefore, we should invest more money and time into developing these.
I need to think much bigger here.. So, we found that mHealth is an accessible way, can help overcome barriers for people with disabilities, acceptable mode of delivery for people with physical disabilities to increase physical activity and we really should be investing more time and money into delivering these.
Think about the advantages of mHealth apps… (1) Cost effective, (2) Can help overcome barriers, (3) provide real time feedback, (4) other modes present barriers to this population, (5) mHealth can be tailored towards individual needs..
Why did I opt to use the Medical Research Council framework and not another framework? Are there any other ones that I could have used?
Not that I am aware of but I feel like the MRC framework has been widely used in this population because looking at existing literature it seems to be a useful way to evaluate interventions, it’s robust and universally accepted (David really liked this answer because I said I wasn’t aware of anything and because I said the MRC framework has been widely used)
Chapter 1 (Introduction): You describe in detail the different models of disability. Why did you do this and how did they inform your research? Do you have a favoured model, and why?
The reason I spoke about the models of disability is because at the beginning of the thesis I wanted the readers to understand exactly what disability is before we jump into SCI, Physical Disabilities and so on. So, overall I wanted them to understand what is the definition of disability.
Based on the literature and what I wrote, it’s still difficult to define what disability is because everyone has different perspectives of what disability is. To help us understand what disability is, there are different models can help us define what disability is. Within my literature review, I only used the Medical Model, Social Model and the ICF model because these are the most prominent ways of understanding disability.
The Social Model builds on the limitations of the Medical Model and then followed by the ICF model which uses a combination of the Medical and Social Model to give us a better understanding of disability.
Did these models help inform my research I did throughout my PhD rather then just help to define/understand disability?
No, they didn’t feed into my research but they gave me a wider perspective on understanding disability which helped me to form and structure my thesis (David liked this answer- He said perfect) These models helped develop my understanding of disability.
Do you have a favoured model of disability and if so why?
I would say the ICF model.
The reason for selecting the ICF model is because I feel like disabilities can be a social problem as well as a medical problem. The ICF helps us to understand that it isn’t one or the other but it’s a combination of both and I feel that the society that we live in today is that it’s a combination of social barriers (e.g., accessibility issues, stigma) but also internal because the individual is disabled because of their condition, which makes them disabled.
So, I think if we view it from that view its better to understand disability as a collective problem rather then one or the other. It helps us to understand from a bigger picture.
Are you aware of any limitations of the ICF model?
The ICF model incorporates over 1,400 categories which can make it time-consuming and labour intensive for any new researchers to apply this framework to their research.
So, you mentioned that the ICF has a lot of categories so then how can we use this then? How is it usable?
It has been widely used in the literature now.
It has been summarised and there is a suitable manual which can help researchers to use it.
Even though it has a lot of these categories, there is a manual which does split it up by conditions (e.g., SCI etc) to make it more usable.
So, let’s talk about your paradigms and philosophies. What is your underlying approach to science, how does it underpin your PhD?
So, my philosophical underpinning is pragmatism. I selected pragmatism because of the key reasons.
We applied the MRC framework, which consists of different stages so it has a combination of qualitative/quantitative approaches, so therefore my overall methodology based on my view of research paradigms is that I am more of a mixed-methods pragmatist researcher going into this PhD because I wasn’t just an interpretivist or a positivist but I felt that I was in the middle with a pragmatic view to help answer the research question on how to understand how to increase PA in people with disabilities.
Overall, the pragmatist approach aligns closely with the MRC framework, a triangulated approach by using the two together because they both have their advantages and disadvantages.
We agreed to use pragmatist approach as a supervisory team because it follows the MRC framework which is key to my PhD!
So, you describe SCI in my literature review at length. Why did you initially focus on that condition but you then focus on physical disability more generally?
- So, among the physical disability population, SCI is the least physically active and are at the lower end of the PA spectrum.
- Additionally, based on the expertise of colleagues at Loughborough, Peter Harrison Centre and my supervisors, we felt it would be a good population to address in terms of developing PA interventions. (Perfect answer)
Why did you jump from SCI to Physical Disabilities?
The reason for this comes down to 2 key reasons..
- When we were recruiting participants for our study, we found it quite difficult to recruit participants with SCI, so we then extended out the recruitment to more people with physical disabilities (Perfect Answer)
- As my thesis developed and the intervention that I had available to me incorporated multiple disabilities.
- To make my research/findings to be more inclusive, establish equality and to ensure our work is more generalisable to a wider population within the UK.
Overall, this is why I have jumped from SCI to Physical Disabilities.
Why did I focus my PhD around using the Behaviour Change Wheel (BCW) and what about other theories of behaviour change
We know changing behaviour is challenging and requires a lot of work.
Even though there are many theories that exist, it’s always difficult to work out which theory to use because they overlap. However, I think the majority of the theories exist don’t always consider the interpersonal, intrapersonal and environmental factors. So, therefore recently the BCW has been developed, which overcomes some of the limitations of the theories that I mentioned before (e.g., Health Belief Model, SDT).
Some of the benefits of the BCW it can helps us to understand the barriers and facilitators to PA in this population, helps us to understand the behaviour.
The BCW is a super theory, it incorporates 19 frameworks into one. Additionally, the BCW has a further advantages such as it allows you to develop and/or evaluate interventions. The BCW is very much intervention focused. Also, we chose the BCW because my supervisor has extensive experience with the BCW.
The majority of theories that exist only look at predicting behaviour and DO NOT look at understanding behaviour.
You hone in on mHealth in the introduction chapter but what about other modes of delivery (e.g., in-person/telephone). Why have you only focused on mHealth? Are you aware of any other literature that assesses other modes in this population?
So, the majority of literature that looks at in-person, telephone counselling are mainly around strength training, which are effective at increasing PA in this population.
However, we know that in-person interventions are difficult for participants to attend in terms of transportation, time, cost and other barriers. The reason why I have gone straight into mHealth is because we know that since COVID individuals with disabilities had to do physical activity at home and mHealth is a suitable intervention approach to overcoming many barriers, can be undertaken in any location, is cost-effective, is easy to use, can be tailored towards the end-users needs and is ACCESSIBLE to a wider population.
We now know that people with disabilities are increasing the amount of smartphone use compared to previous years. Even though that some people with disabilities may struggle with accessing this technology, we know it’s a suitable information.
So, the MRC framework that you describe in Figure 1.8 is not the latest version. Are you aware that it’s been updated and why did you not include that?
I’m not aware that there is a new framework.
My answer to this question is that I started my PhD in January 2021, I used the older version when I started my journey and the newest version (2021) had not been published yet.
Also, when I looked at the newer version, there wasn’t much difference between the two so I continued using the older approach throughout the thesis as it didn’t make sense to change. So, when I started my thesis the newest version had not yet been published.
It was published in 2021 during COVID and I had already started my thesis before that. Therefore, to ensure consistency in my work I followed the older version through to the end of my PhD but when I reviewed the newest there wasn’t much difference.
How did I generalise my research questions? What were the reasoning’s and justifications for these?
Based on the systematic review, we know that theory is effective at increasing physical activity for people with SCIs when it comes to interventions. We know that only a couple of studies included in the systematic review used theory.
Therefore, we attached on the next study the BCW to assess the theoretical underpinning of a novel intervention, so that’s how I developed my first and second study
The first study was mainly around that interventions needed to be developed, we know our systematic review is based on the MRC framework.
For study 3, we know despite Accessercise appearing to be a promising intervention in this popualtion based on the findings from Study 2 unfortunately not much usability testing has been done on mHealth interventions for people with disabilities, so that’s the rationale for doing my 3rd study
For my feasibility study, when we were looking at the existing research for mHealth interventions, we know that the effectiveness of these interventions haven’t really been undertaken and we know that Accessercise has yet to be investigated.
(David says that for this answer I can also link back to the MRC framework - because my aims are very much structured around those aims)
Which steps of the MRC framework did I address in my PhD?
2
Step 1 (Development)
- Systematic Review
- Theoretical Underpinning stidy
- Usability
Step 2 (Feasibility)
- Feasibility RCT study
How did you ensure the integrity of the evaluation of the Accessercise app when working with the app developers? In other words how did you know that the developers did not influence the research?
We had a collaboration agreement with the app developers.
They approached us because they wanted an independent evaluation where they weren’t involved, so although we worked closely with to gain access to the app, and understand the app and we had meetings with them to understand the design ultimately the decisions were ours.
They cannot embargo anything that we publish. They have 30 days to comment/provide feedback.
However, they were not involved in the study design, I was not involved in the development of the app etc, they were not involved in the study design, it was very much looking at independently evaluating the app.
The app developers had an involvement but
Why did I undertake a systematic review?
- I wanted to understand what is out there already
- I followed the MRC framework which suggests undertaking a systematic review first.
Why did you only focus on manual wheelchair users and why adults?
Previous sytematic reviews (e.g., Kathleen Martin Ginis) looked at a range of different physical disabilities and Watson et al (2023) looked at a range of different SCIs
However, we know this sample is heterogenous with their requirements being different.
However, Manual Wheelchair Users with SCI are the most physically inactive spinal cord injured population and therefore we wanted to address this issue by developing/evaluating interventions in this population.
So, several similar systematic reviews exist that have been published in this area. Are you aware of these and why have you replicated these. Did you not check this before starting your review? What are the similarities/differences between your reviews?
Differences: Ma and Ginis only used RCTs. Whereas, we used RCTs, non-RCTs, before and after etc!
Ma and Ginis (2018) and Watson et al (2023) focus on a range of different physical disabilities or SCIs. Whereas, I just focus on a singular disaiblity.
However, the Watson et al (2023) paper which is quite similar to mine (SCI specific) they registered their systematic review after ours on PROSPERO, so actually they copied you. We registered our review on PROSPERO and then subsequently 2 months later the Watson (2023) paper registered their review.
So, at the time of my registration of my review there was nothing else out there on this specific/unique topic! They must of likely seen my review and then registered it and then quickly published it before I had the option to publish it.
I thoroughly checked PROSPERO and there was no other records there that showed the same thing and it wasn’t until this one was published that I came across it and saw that it was registered on PROSPERO, 2 months after my registration.
It was disappointing that they didn’t contact me regarding it. We could have worked together on it.
Given that your literature review focuses on mHealth, why didn’t you focus on this exclusively for your intervention? (e.g., systematic review - Behaviour Change Intervention)..
There is currently limited research on mHealth intervention research for people with SCI.
So, if I did mHealth as the intervention it could have just been an empty review..
I am aware that there is limited evidence on mHealth. Instead, I wanted to look at everything (all interventions).
Why did I choose those specific outcomes for your systematic review (e.g., self-reported PA, Behavioural PA, Adverse effects)? Were there any others you could have included? Why did you not include these?
- Physiological - We wanted to look at heart rate, blood pressure because these are obviously health outcomes related to PA
- Adverse effects (e.g., pain, injury) are commonly experience in people with SCI and adverse effects is good practice to include in systematic review according to Cochrane, which is a gold standard systematic review process.
- Self-reported PA and Behavioural PA is obvious
- Functional fitness is related to Self-reported PA and Behavioural PA because PA makes you fitter.
- Health-related QoL related to PA
All these outcomes are associated with PA. If you see improvements in PA you are likely to see improvements in General-Health Related QoL, reductions in adverse effects etc.
Overall, we wanted to include a lot of outcomes, a lot of research designs because we didn’t want to have an empty review.
You searched a lot of databases for your systematic review. Why did you select these and not others? Were there any criteria that you used to inform your decisions?
I think based on previous systematic reviews in the area they have only included several, so I wanted to provide an holistic approach to really search databases for new and existing research and really help us in answering the research question.
Great, so you used a lot of databases which is great but all of your databases are health based. Why did you only focus on health databases?
As we are only looking at health conditions, I was only looking into health.
I did not include any Arts or Humanities because you really diged down into health
I also have two supervisors which are experts in systematic reviews, so I went on their guidance.
How did you divide your search strategy? Did you get any additional support and were you confident that your search strategy was comprehensive and included all the correct terms? Do you think it’s possible that any relevant literature could have been missed?
I received support from my supervisors as well as the academic librarian from my school.
In terms of missing any relevant research, we can never be certain but I ensured that I did the searches all within one day, overseen by my supervisory team, searched each database clearly using each database, I used Covidence (gold standard software) for storing papers for my systematic review.
However, a strength of the search strategy is that they can be replicated. So, I can always do them again to ensure if I am happy with how I am done it. If needed, my supervisors can also double check too!
I followed the highest support provided from my supervisory team and obviously it’s possible I could miss something but I used the most rigorous approaches to avoid that.
Why did you include Risk of Bias 2, GRADE, Downs and Black for risk of bias, study quality Why do you think it’s important to do that?
I think every study incorporates some risk of bias and I think it’s important to know the quality of each paper you include in a review.
The reason I used RoB2 is basically I originally used RoB1, which looks at a range of different study designs but I obviously wanted to follow the most up to date research.
For GRADE, I used this because I wanted to know the quality of each study.
Lasty, Downs and Black (1998) checklist was chosen because it provides 27 clear questions on the studies (e.g., does it provide a hypothesis, are participants randomised). Overall, Downs and Black is good because it’s suitable for any study design
RoB2 non-RCTs score very low because it’s all about randomisation. So, Downs and Black gives you that variability in terms of a list of different questions it asks.
RoB1 is simpler to use and I liked it more but I wanted to ensure my research was up to do date and used suitable approaches. Also, the RoB2 was selected because the reviewers asked me to do it.
Why did you use standard mean differences and random effects?
We used Standard Mean Differences and Random Effects because we assumed there would be variability.
Fixed Effect you would use if the studies all used the same outcome measure and their interventions and populations were very similar. It means very little difference.
Standard mean difference: Always used when the outcome measures are measured slightly differently, which I expected would be because of the heterogeneity in outcome measures and research designs and that’s why I also used a random effect model.
We determined at apriori (before we did the meta-analysis) because we knew there would be loads of variations in our outcomes, how interventions were implemented. WE KNEW THERE WOULD BE HIGH HETEROGENEITY!
Mean Difference is only used when the outcome measure is the same and is measured in the same way (units of measurements are identical), so we can make that comparison.
However, we didn’t expect to find that so we used the Standardised Mean Difference because it doesn’t matter how something is measured (e.g., differerent questionnaire) it’s STANDARDISED.
Random Effect: We expect there to be heterogeneity in the sample, study designs and therfore that’s why we did a RANDOM EFFECT.
Why did you do moderator analyses and how did you do those?
We did moderator analyses to assess whether the study characterstics, intervention characteristics, mode of delivery, BCTs and Theory were more effective in the intervention relative to the control groups.
We did it using RevMan, we worked out which studies used BCTs vs studies that didn’t.
OVERALL, WE SPLIT THE STUDIES FROM THE META-ANALYSIS INTO SUB-GROUPS AND WE THEN RE-RAN THE ANALYSIS BASED ON STUDIES THAT DID/DIDN’T USE THEORY IN THE INTERVENTIONS VS THE CONTROL GROUPS TO HELP COMPARE THE DIFFERENCES BETWEEN THE GROUPS.
We did the moderator analyses based on the recommendations from Ma and Ginis and Watson et al (2023) also did it and was recommended by a reviewer!
How/why did you focus on intervention characteristics, study interventions, use BCTs and theory for my moderator analyses? Why did you not look at anything else like gender, ethnicity or level of disability?
Overall, we were looking at the overall effectiveness of the interventions in terms of mode of delivery, who delivered the interventions etc was helpful!
The use of theory - We know some interventions that use theory are more effective then other theories so we wanted to test that claim.
I initially had a lot of records to screen for the systematic review. How did I accomplish that task because it was very detailed with over 11,000 papers? What did you use to inform your judgments for including inclusion, did you get any help and why didn’t you have an additional screener?
- Completed the searches all within one day.
- Supervisors/librarian saw everything I did and ensured they were involved in the screening process.
- Searched each database 1 by 1, downloaded the files onto my PC and then imported them onto Covidence.
- To ensure I screened each paper correctly, I had the methods next to with the PICOS in view of my eye so that I knew I was accepting/removing the most suitable studies.
- Adam Dickinson and David Maidment were involved in screening and provided input when it was most necessary.
Were meta-analyses were not possible, how did you undertake your narrative synthesis, what strategies did you use and why?
I looked through each study and their results for what they found and I descriptively summarised what they found.
So, did they find a statistically significant finding/or not and then I basically just grouped them all together based on the studies that found an improvement and the ones that didn’t.
Why do you think your moderator analyses were not statistically significant?
This is mainly due to a small sample of studies included in my review and possibly because I focused on a singular disability rather then grouped (e.g., tetraplegia/paraplegia/manual wheelchair users).
If I had a bigger number of studies (rather then 6) this may have led to a bigger and more reliable finding.
Study 1: Given your null results, do you think your review actually adds anything substantial to the literature?
Yes, I would say the review was a timely piece of work and it was done at a time where it needed more understanding of the effectiveness of existing interventions in this specific population.
We also know that the use of theory is not as effective compared to similar studies.
Overall, I think the study is still contributing something because the majority of systematic reviews focus on multiple disabilities whereas this focuses on a novel area of just one.
We are highlighting the gaps in the literature which supported the rest of my PhD.
For Study 2, Summarise your approach and steps undertaken for this research?
We followed the Behaviour Change Wheel (BCW) guidance for developing/evaluating Behaviour Change Interventions.
We also did this study during COVID-19, so it considered a helpful study while I couldn’t collect data. A lot of the work I did at the beginning of my PhD were all done during lock down.
