Who should be in control when technology becomes part of how we look after ourselves? That question belongs at the centre of the digital self-care agenda. In my view, emerging technologies should be judged by the understanding and practical capability people gain, and by the control they retain over decisions affecting their lives.
The World Health Organization’s account of self-care includes maintaining health and coping with illness, with or without professional support. For me, the purpose of innovation is to make those activities more manageable within the realities of people’s lives.
Emerging technologies offer different ways to access information and assistance. Virtual reality (VR) creates an immersive digital environment; augmented reality (AR) adds digital information to a view of the physical world. Smart glasses offer functions that vary by device, including cameras, audio and, in some models, visual displays. Brain–computer interfaces (BCIs) translate brain signals into commands for external devices. Because their mechanisms and risks differ, each needs evaluation suited to its purpose.
Starting with the self-carer’s goals
My starting point is the self-carer’s goal. They may want an explanation they can understand, support with a difficult task or a way to communicate their needs. The design question is whether a particular technology helps them pursue that goal, under conditions they find acceptable. Our work on Self-Driven Healthcare proposed connecting people’s own health information and monitoring tools with professional care. That vision depends on accessible support and integration with health services, with people able to influence decisions about their care.
Our BMJ Open study of spatial computing in health and self-care explored these issues with UK adults, including healthcare professionals. Respondents identified possible value for self-care and patient education alongside barriers involving cost, training and privacy. These findings reflect perceptions rather than evidence of clinical benefit.
Smart glasses illustrate both the promise and the open questions. Be My Eyes connects blind and low-vision users of supported Meta glasses with sighted volunteers who can view the camera feed and provide spoken assistance. Its value, however, should be assessed against users’ goals and the alternatives available to them. This is why we launched the SMART EYES study to examine public views on AI-enabled smart glasses, including privacy, accessibility and possible support for health and self-care. To be meaningful, evaluations must start with people’s experiences, concerns and expectations. They should also account for the time needed to learn a tool, maintain it and resolve problems. The practical test is whether the overall experience becomes easier for the person using it.
In an earlier Prevention Lab article on health literacy, I argued that people need to understand information, judge its relevance and decide what to do next. Digital assistance should support those capabilities. Our UK symptom-checker survey found that respondents wanted help understanding symptoms and deciding whether to seek care, alongside concerns about privacy and losing face-to-face consultations. At the same time, our 2023 systematic review of symptom checkers found variable diagnostic and triage accuracy in the studies available at that time.
Earning public trust
Public trust also needs to be framed with care. SCARU’s RADIANT Voices research on AI and software as a medical device (SaMD) examined trust in clinical decision-making. We found higher trust in AI-assisted decisions than in AI-only decisions, alongside strong support for disclosure and professional oversight. These findings describe preferences, not evidence of safety or effectiveness.
Trust in individual pieces of advice matters as well. Our Trust in AI-Generated Health Advice (TAIGHA) scale and its four-item short form, TAIGHA-S, focus on trust in a specific piece of advice. Initially validated with 385 UK adults in a symptom-assessment scenario, they measure trust and distrust as related but distinct dimensions.
Our PLOS Digital Health study of community perspectives on BCIs likewise found concerns about implantation risks and cost, with participants emphasising regulation and public education. Those concerns belong in the decisions that set research priorities. Public engagement should give people a meaningful opportunity to influence development, including the option to question whether an application is desirable.
Because public trust has to be earned through evidence and accountability, developers and health services should explain the evidence for a proposed use, its limitations and who is accountable when something goes wrong. People should also have a practical way to challenge advice or report harm. The WHO’s guidance on generative AI in health supports clear tasks, appropriate accuracy and reliability, and involvement of patients and other affected groups in development.
Regulation and intended purpose
SaMD refers to software intended to perform a medical purpose without being part of a hardware medical device. Its increasing pervasiveness makes the intended purpose especially important. The MHRA’s guidance emphasises specifying that purpose and matching it to supporting evidence. Whether an application is accessed through a phone, headset or glasses, assessment should address its intended users, clinical function and setting. Determining regulatory status therefore requires attention to the specific features and claims of health-related software.
The developer’s experience deserves attention too. Our study of medical-software developers’ experiences of regulation, available as a preprint, describes participants’ difficulties obtaining reliable advice and navigating requirements. Clear guidance, accessible expertise and proportionate evidence requirements should form part of responsible innovation.
Autonomy in everyday use
Personal autonomy also needs to be built into everyday use. Who chooses the goal behind a reminder or recommendation? Who can change it? People should understand the purpose of the support they receive and be able to pause or decline it. Commercial interests should be visible, especially where advice is connected to the sale of a product or service. Delegating a task should leave the individual able to influence the terms of that delegation.
For smart glasses, autonomy also concerns the relationship between the wearer and people nearby. Using a camera to assist with a task, retaining a recording and sharing it are distinct activities. Each deserves a clear explanation and an appropriate decision about permission.
That discussion should also respect the dignity of people using assistive technology. Someone should not have to disclose a diagnosis to justify their device to a stranger. Equally, the people around them should have meaningful ways to understand and influence what happens to their information. Good safeguards need to address both concerns in practice.
Equity and shared responsibility
Equitable access should be considered from the outset and meaningful evaluations need to address affordability, language, disability-related requirements and the support needed to use a technology. People should retain an accessible route to care if a device is unsuitable or they choose not to use it. A service should also plan for interruptions, software changes and the point at which a product is no longer supported.
Health systems and wider society retain responsibilities of their own. A self-care strategy needs accessible professional advice and practical support, alongside attention to housing, working conditions and other constraints on daily choices. Digital tools should be assessed within that context and should not become a justification for transferring responsibilities to people without considering the resources available to them.
Evaluating what matters
For researchers and commissioners, this calls for evaluation beyond stated willingness to adopt a product. Relevant outcomes include understanding, appropriate action, wellbeing and harms, with results examined across different groups. We should measure the work expected of users and carers, compare realistic alternatives and study use over time. A successful demonstration is only the starting point for that work. Ultimately, the future of self-care must be shaped with the people expected to use these technologies. They should help define the problems worth solving, the evidence that matters and the boundaries they want respected. The measure of progress should be whether people have more meaningful choices, stronger capabilities and dependable support in looking after their health. These principles guide our work in practice. Through our patient and public involvement and engagement PPIE activities, self-carers regularly share their feedback with us, and their insights shape our projects. Their perspectives keep our research grounded in the realities of looking after one’s health, and we are grateful for the time and candour they bring. We will continue to build our work with them, rather than for them.
Building the future together
In my next blog, I will reflect on the importance of PPIE and adopting a team science approach in driving our work, and on what bringing together lived experience and diverse expertise contributes to research on self-care.