Research papers published by our team



Elizabeth Taylor Buck et al (2020) Use of a modified World Café process to discuss and set priorities for a Community of Practice supporting implementation of ReQoL a new mental health and quality of life Patient Reported Outcome Measure (PROM)

Authors - Elizabeth Taylor Buck, Christine M. Smith, Amanda Lane, Anju Devianee Keetharuth, Tracey Young & Jo Cooke


Patient reported outcome measures (PROMs) are a means of assessing the quality and effectiveness of care from the patient’s perspective. However, the routine use of PROMs in clinical practice can be difficult to implement. New challenges arise at different stages of the implementation process and organisations need to invest time and financial resources into designing an appropriate strategy, information systems, providing technical support and preparing staff.

Recovering Quality of Life (ReQoL) is a PROM that was specifically designed to measure mental health service users’ perspectives of recovery and quality of life. It is a co-produced, service user-centred outcome measure tested by over 6000 mental health service users. It is able to detect change across a broad spectrum of mild to severe mental health conditions.

In May 2016 a licence to use the ReQoL measures became freely available to the NHS and publicly funded research. At the time of publication, 149 licences had been issued worldwide and eleven official translations had been made available. The team that developed ReQoL has continued to collaborate with mental health trusts across the country to support the implementation of ReQoL. The National Institute for Health Research and Applied Research Collaboration (NIHR ARC YHFootnote1), and the preceding NIHR CLAHRC-YH, along with the ReQoL development team have helped to guide and fund this work. The NIHR CLAHRC-YH supported two national events, the first of which was the launch of ReQoL at the Houses of Parliament in October 2016. More recently in November 2018, over 70 people, from 23 organisations, attended a second event focused on the development of a ReQoL Community of Practice.

Community of Practices (CoPs) have existed in sectors such as education and business for over 30 years [9], operating as networks and support groups for people who share a common set of problems or interests. Members of CoPs maintain and build links with each other for the purposes of social interaction, knowledge sharing, knowledge creation and identity building.

Matthew Frankin et al (2020) Conducting Value for Money Analyses for Non-randomised Interventional Studies Including Service Evaluations: An Educational Review with Recommendations

Authors - Matthew Franklin, James Lomas, Gerry Richardson


This article provides an educational review covering the consideration of conducting ‘value for money’ analyses as part of non-randomised study designs including service evaluations. These evaluations represent a vehicle for producing evidence such as value for money of a care intervention or service delivery model. Decision makers including charities and local and national governing bodies often rely on evidence from non-randomised data and service evaluations to inform their resource allocation decision-making. However, as randomised data obtained from randomised controlled trials are considered the ‘gold standard’ for assessing causation, the use of this alternative vehicle for producing an evidence base requires careful consideration. We refer to value for money analyses, but reflect on methods associated with economic evaluations as a form of analysis used to inform resource allocation decision-making alongside a finite budget. Not all forms of value for money analysis are considered a full economic evaluation with implications for the information provided to decision makers. The type of value for money analysis to be conducted requires considerations such as the outcome(s) of interest, study design, statistical methods to control for confounding and bias, and how to quantify and describe uncertainty and opportunity costs to decision makers in any resulting value for money estimates. Service evaluations as vehicles for producing evidence present different challenges to analysts than what is commonly associated with research, randomised controlled trials and health technology appraisals, requiring specific study design and analytic considerations. This educational review describes and discusses these considerations, as overlooking them could affect the information provided to decision makers who may make an ‘ill-informed’ decision based on ‘poor’ or ‘inaccurate’ information with long-term implications. We make direct comparisons between randomised controlled trials relative to non-randomised data as vehicles for assessing causation; given ‘gold standard’ randomised controlled trials have limitations. Although we use UK-based decision makers as examples, we reflect on the needs of decision makers internationally for evidence-based decision-making specific to resource allocation. We make recommendations based on the experiences of the authors in the UK, reflecting on the wide variety of methods available, used as documented in the empirical literature. These methods may not have been fully considered relevant to non-randomised study designs and/or service evaluations, but could improve and aid the analysis conducted to inform the relevant value for money decision problem.

Siobhan Kathleen McHugh et al (2020) Does team reflexivity impact teamwork and communication in interprofessional hospital-based healthcare teams? A systematic review and narrative synthesis

Authors - Siobhan Kathleen McHugh, Rebecca Lawton, Jane Kathryn O'Hara and Laura Sheard


Teamwork and communication are recognised as key contributors to safe and highquality patient care. Interventions targeting process and relational aspects of care may therefore provide patient safety solutions that reflect the complex nature of healthcare. Team reflexivity is one such approach with the potential to support improvements in communication and teamwork, where reflexivity is defined as the ability to pay critical attention to individual and team practices with reference to social and contextual information.


To systematically review articles that describe the use of team reflexivity in interprofessional hospitalbased healthcare teams.


Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six electronic databases were searched to identify literature investigating the use of team reflexivity in interprofessional hospital-based healthcare teams. The review includes articles investigating the use of team reflexivity to improve teamwork and communication in any naturally occurring hospital-based healthcare teams. Articles’ eligibility was validated by two second reviewers (5%).


Fifteen empirical articles were included in the review. Simulation training and video-reflexive ethnography (VRE) were the most commonly used forms of team reflexivity. Included articles focused on the use of reflexive interventions to improve teamwork and communication within interprofessional healthcare teams. Communication during interprofessional teamworking was the most prominent focus of improvement methods. The nature of this review only allows assessment of team reflexivity as an activity embedded within specific methods. Poorly defined methodological information relating to reflexivity in the reviewed studies made it difficult to draw conclusive evidence about the impact of reflexivity alone.


The reviewed literature suggests that VRE is well placed to provide more locally appropriate solutions to contributory patient safety factors, ranging from individual and social learning to improvements in practices and systems.

Raabia Sattar et al (2020) The views and experiences of patients and health‐care professionals on the disclosure of adverse events: A systematic review and qualitative meta‐ethnographic synthesis

Authors - Raabia Sattar, Judith Johnson and Rebecca Lawton


To synthesize the literature on the views and experiences of patients/family members and health‐care professionals (HCPs) on the disclosure of adverse events.


Systematic review of qualitative studies. Searches were conducted in MEDLINE, Embase, PubMed, CINAHL and PsycINFO. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Qualitative data were analysed using a meta‐ethnographic approach, comprising reciprocal syntheses of ‘patient’ and ‘health‐care professional’ studies, combined to form a lines‐of‐argument synthesis embodying both perspectives.


Fifteen studies were included in the final syntheses. The results highlighted that there is a difference in attitudes and expectations between patients and HCPs regarding the disclosure conversation. Patients/family members expressed a need for information, the importance of sincere regret and a promise of improvement. However, HCPs faced several barriers, which hindered appropriate disclosure practices. These included difficulty of disclosure in a blame culture, avoidance of litigation, lack of skills on how to conduct disclosure and inconsistent guidance. A lines‐of‐argument synthesis is presented that identified both the key elements of an ideal disclosure desired by patients and the facilitators for HCPs, which can increase the likelihood of this taking place.


Although patients/family members and HCPs both advocate disclosure, several barriers prevent HCPs from conducting disclosure effectively. Both groups have different needs for disclosure. To meet patients’ requirements, training on disclosure for HCPs and the development of an open, transparent culture within organizations are potential areas for intervention.

Sebastian Hinde et al. (2020) Quantifying the impact of delayed delivery of cardiac rehabilitation on patients’ health

Authors -Sebastian Hinde, Alexander Harrison, Laura Bojke, Patrick Doherty


Despite its role as an effective intervention to improve the long-term health of patients with cardiovascular disease and existence of national guidelines on timeliness, many health services still fail to offer cardiac rehabilitation in a timely manner after referral. The impact of this failure on patient health and the additional burden on healthcare providers in an English setting is quantified in this article.


Two logistic regressions are conducted, using the British Heart Foundation National Audit of Cardiac Rehabilitation dataset, to estimate the impact of delayed cardiac rehabilitation initiation on the level of uptake and completion. The results of these regressions are applied to a decision model to estimate the long-term implications of these factors on patient health and National Health Service expenditure.


We demonstrate that the failure of 43.6% of patients in England to start cardiac rehabilitation within the recommended timeframe results in a 15.3% reduction in uptake, and 7.4% in completion. These combine to cause an average lifetime loss of 0.08 years of life expectancy per person. Scaled up to an annual cohort this implies 10,753 patients not taking up cardiac rehabilitation due to the delay, equating to a loss of 3936 years of life expectancy. We estimate that an additional £12.3 million of National Health Service funding could be invested to alleviate the current delay.


The current delay in many patients starting cardiac rehabilitation is causing quantifiable and avoidable harm to their long-term health; policy and research must now look at both supply and demand solutions in tackling this issue.

Sebastian Hinde et al. (2020) Complex programme evaluation of a ‘new care model’ vanguard: a shared commitment to quality improvement in an integrated health and care context

Authors -Sebastian Hinde, Sally Fowler Davis, Steven Ariss


NHS vanguards, under-pressure to perform, required better contracting and data management arrangements with evaluation teams, to ensure that integrated service outcomes could be reported effectively. This communication reflects the experience of evaluating an NHS vanguard and suggests how academic teams can improve capacity for complex programme evaluation of rapid improvements in integrated services. This should be based on a shared commitment to data collection and management. Also, robust knowledge exchange processes can enable systems change and sustainability. The identifying features of the particular site have been withheld.

Andy Daly-Smith et al (2020) Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

Authors - Andy Daly-Smith, Thomas Quarmby, Victoria S. J. Archbold, Nicola Corrigan, Dan Wilson, Geir K. Resaland, John B. Bartholomew, Amika Singh, Hege E. Tjomsland, Lauren B. Sherar, Anna Chalkley, Ash C. Routen, Darren Shickle, Daniel D. Bingham, Sally E. Barber, Esther van Sluijs, Stuart J. Fairclough & Jim McKenna


UK and global policies recommend whole-school approaches to improve childrens’ inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective interventions, which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure ‘systems’ change, a framework is required that identifies all components of a whole-school PA approach. The study’s aim was to co-develop a whole-school PA framework using the double diamond design approach (DDDA).


Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n = 9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n = 6) stakeholder groupings. Six draft frameworks were created before stakeholders voted for one ‘initial’ framework. Next, stakeholders reviewed the ‘initial’ framework, proposing modifications. Following the workshop, stakeholders voted on eight modifications using an online questionnaire.


Following voting, the Creating Active Schools Framework (CAS) was designed. At the centre, ethos and practice drive school policy and vision, creating the physical and social environments in which five key stakeholder groups operate to deliver PA through seven opportunities both within and beyond school. At the top of the model, initial and in-service teacher training foster teachers’ capability, opportunity and motivation (COM-B) to deliver whole-school PA. National policy and organisations drive top-down initiatives that support or hinder whole-school PA.


To the authors’ knowledge, this is the first time practitioners, policymakers and researchers have co-designed a whole-school PA framework from initial conception. The novelty of CAS resides in identifying the multitude of interconnecting components of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, CAS presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives ‘with’ schools, while abandoning outdated traditional approaches of implementing interventions ‘on’ schools.


Sebastian Hinde et al. (2019) The Relevant Perspective of Economic Evaluations Informing Local Decision Makers: An Exploration in Weight Loss Services

Authors - Sebastian Hinde, Louise Horsfield, Laura Bojke, Gerry Richardson


Since 2013, obesity services in the UK National Health Service (NHS) have focused on a tiered structure, with tiers 3 (specialist weight management services) and 4 (primarily bariatric surgery) commissioned by Clinical Commissioning Groups (CCGs) and widely reported as cost effective and recommended by national guidelines. However, CCGs have been reluctant to fully conform to the guidance. We explore how the different evaluative perspective of those generating evidence from local decision makers has contributed to this failure of the CCGs to provide services considered cost effective. We explore four elements where the conventional economic evaluation framework, as applied by the National Institute for Health and Care Excellence (NICE), differ from the reality faced by local decision makers: the cost-effectiveness threshold, the implications of decision uncertainty and budgetary excess, the valuation of future costs and outcomes, and the scope of included costs. We argue that the failure of the conventional framework to reflect the reality faced by local decision makers is rendering much of the existing literature and guidance inappropriate to the key commissioners. Our analysis demonstrates that it is not reasonable to assume that the framework of economic evaluation used to inform national guidance applies to local decision makers, such as in the commissioning of weight loss services. This failure is likely to apply to the majority of cases where evidence is generated to inform national decision makers but commissioning is at a local level.

Sebastian Hinde et al. (2019) Understanding and addressing the challenges of conducting quantitative evaluation at a local level: a worked example of the available approaches

Authors - Sebastian Hinde, Laura Bojke and Gerry Richardson


In the context of tightening fiscal budgets and increased commissioning responsibility, local decision-makers across the UK healthcare sector have found themselves in charge of the implementation and evaluation of a greater range of healthcare interventions and services. However, there is often little experience, guidance or funding available at a local level to ensure robust evaluations are conducted. In this paper, we evaluate the possible scenarios that could occur when seeking to conduct a quantitative evaluation of a new intervention, specifically with regards to the availability of evidence.


We outline the full set of possible data scenarios that could occur if the decision-maker seeks to explore the impact of the launch of a new intervention on some relevant quantifiable outcomes. In each case we consider the implicit assumptions associated with conducting an evaluation, exploring possible situations where such scenarios may occur. We go on to apply the scenarios to a simulated dataset to explore how each scenario can result in different conclusions as to the effectiveness of the new intervention.


We demonstrate that, across the full set of scenarios, differences in the scale of the estimated effectiveness of a new intervention and even the direction of effect are possible given different data availability and analytical approaches.


When conducting quantitative evaluations of new interventions, the availability of data on the outcome of interest and the analytical approach can have profound effects on the conclusions of the evaluation. Although it will not always be possible to obtain a complete set of data and conduct extensive analysis, it is vital to understand the implications of the data used and consider the implicit assumptions made through its use.

Masuma Pervin Mishu et al. (2019) Factors associated with regular physical activity participation among people with severe mental ill health

Authors - Masuma Pervin Mishu, Emily J. Peckham, Paul N. Heron, Garry A. Tew, Brendon Stubbs, Simon Gilbody

Mishu, M.P., Peckham, E.J., Heron, P.N. et al. Factors associated with regular physical activity participation among people with severe mental ill health. Soc Psychiatry Psychiatr Epidemiol 54, 887–895 (2019).


People with severe mental ill health (SMI) are less physically active and more sedentary than the general population. There is limited research investigating the correlates of physical activity (PA) in people with SMI impeding the development of successful interventions. This study aimed to assess the factors associated with regular participation of PA among a large sample of people with SMI.


The data for this study were collected from the ‘Closing the Gap: Lifestyle Health and Wellbeing’ (HWB) cohort that collected data through self-administered questionnaire from participants with SMI. Self-reported participation in regular PA was the main outcome variable. Potential predictors of PA were grouped as demographic, biological, psychological and behavioural variables. Multivariable logistic regressions were conducted considering PA participation as the dependent variable adjusted for possible correlated predictors.


In total, 3287 people with SMI [mean (SD) age 47.7 (14.58) years, 59% male] were included; 38% reported undertaking regular PA and 61% wanted to undertake more physical activity. Multivariable logistic regressions showed that the following factors were associated with undertaking more regular PA: being male, aged 18–65 years, having a body mass index between 18.5 and 30 kg/m2, having better self-perceived general health condition, not having a health problem that limits activity, giving higher importance to maintain a healthy lifestyle, and eating more fruit and vegetables.


Having a better self-perceived general health and placing importance on maintaining a healthy lifestyle were important predictors of regular PA. Lifestyle interventions targeting increased PA among people with SMI should be shaped by their health perception and informed by their needs.

Gemma Louch et al. (2019) Validation of revised patient measures of safety: PMOS-30 and PMOS-10

Authors - Gemma Louch, Caroline Reynolds, Sally Moore, Claire Marsh, Jane Heyhoe, Abigail Albutt, Rebecca Lawton, on behalf of the Yorkshire Quality and Safety Research Group


There is growing evidence that patients can provide feedback on the safety of their care. The 44-item Patient Measure of Safety (PMOS) was developed for this purpose. While valid and reliable, the length of this questionnaire makes it potentially challenging for routine use. Our study aimed to produce revised, shortened versions of PMOS (PMOS-30 and PMOS-10), which retained the psychometric properties of the longer version.


To produce a shortened diagnostic measure, we analysed data from 2002 patients who completed PMOS-44, and examined the reliability of the revised measure (PMOS-30) in a sample of 751 patients. To produce a brief standalone measure, we again analysed data from 2002 patients who completed PMOS-44, and tested the reliability and validity of the brief standalone measure (PMOS-10) in a sample of 165 patients.


The process of shortening the questionnaire involved a combination of secondary data analysis (eg, Standard Deviation and inter-item correlations) and a consensus group exercise to produce PMOS-30 and examine face validity. Analysis of PMOS-30 data examined reliability (eg, Cronbach’s alpha). Further secondary data analysis (ie, corrected item-total correlations) produced PMOS-10, and primary data collection assessed its reliability and validity (eg, Cronbach’s alpha, analysis of variance).


Fourteen items were removed to produce PMOS30 and the percentage of negatively worded items was reduced from 57% to 33%. PMOS-30 demonstrated good internal reliability (α=0.89). The 10 items with the highest corrected item-total correlations across both PMOS-44 and PMOS-30 composed PMOS-10. PMOS-10 had good internal reliability (α=0.79), demonstrated convergent validity; however, discriminant validity was not established.


Two revised, shortened versions of the original PMOS-44 (PMOS-30 and PMOS-10) were produced to capture patient feedback about safety in hospital. The measures demonstrated good reliability and validity, and preserved the psychometric properties of the original measure.

Jane Heyhoe et al. (2019) The early diagnosis of cancer in primary care: A qualitative exploration of the patient's role and acceptable safety-netting strategies

Authors - Jane Heyhoe, Caroline Reynolds and Rebecca Lawton


The study had two aims—to assess the components considered important for patient involvement in diagnosing cancer earlier in primary care and to assess the acceptability, feasibility, cost and burden of three safety-netting interventions in terms of their potential to become a sustainable component of standard care and improve diagnostic outcomes for cancer in a primary care setting.


Fifteen interviews were conducted with patients and GPs/Nurse Practitioners. Findings were fed back at a workshop with 18 stakeholders who helped to conceptualise an intervention. Interviews were analysed using thematic analysis. Stakeholder discussions were captured through group feedback sessions.


Three key themes around stakeholders' views on patient involvement emerged from the interviews. These were keeping the door open, roles and responsibilities and fear of cancer. Interview findings and workshop feedback identified the intervention should include a verbal discussion and plan, written information and a patient prompt option.


Patient involvement in diagnosing cancer in primary care is considered acceptable to patients and HCPs. Factors that facilitate or hinder involvement have been identified. Components deemed important in a safety-netting intervention, and potential costs and benefits were established. This knowledge can direct future research and the development of safety-netting interventions.