Nicky Britten

• MSc PhD FRCGP (Hon)
• Professor at University of Exeter

Background and aims Individuals living with severe mental illness such as schizophrenia and bipolar can have significant emotional, cognitive, physical and social challenges. Most people with severe mental illness in the United Kingdom do not receive specialist mental health care. Collaborative care is a system of support that combines clinical and...

Background: Individuals living with severe mental illness can have significant emotional, physical and social challenges. Collaborative care combines clinical and organisational components. Aims: We tested whether a primary care-based collaborative care model (PARTNERS) would improve quality of life for people with diagnoses of schizophrenia, bi...

Patient preference is very important for medication selection in chronic medical conditions, like type 2 diabetes, where there are many different drugs available. Patient preference balances potential efficacy with potential side effects. As both aspects of drug response can vary markedly between individuals, this decision could be informed by the...

Our previous work identified that nine leading guidance documents for seven different types of systematic review advocated the same process of literature searching. We defined and illustrated this process and we named it ‘the Conventional Approach’. The Conventional Approach appears to meet the needs of researchers undertaking literature searches f...

Introduction Patient and public involvement in research is anchored in moral and epistemological rationales. Moral rationales relate to the public having a right to influence how knowledge about them is generated. Epistemological rationales relate to how research design and implementation can improve when informed by experiential, as well as techni...

Background: Person-centred care is a growing imperative in healthcare, but the documentation of person-centred care is challenging. According to the Gothenburg Framework of Person-centred Care, care should be documented in continuously revised care plans and based on patients' personally formulated goals and resources to secure a continuous partne...

Over the last decade, there has been a proliferation of published meta-ethnographies. Yet, strategies and techniques for updating have not received the same attention, rendering answers to important methodological questions still elusive. One such question has to do with who can perform an update. Although it is not uncommon for quantitative system...

Background Increasing healthcare costs need to be contained in order to maintain equality of access to care for all EU citizens. A cross‐disciplinary consortium of experts was supported by the EU FP7 research programme, to produce a roadmap on cost containment, while maintaining or improving the quality of healthcare. The roadmap comprises two driv...

Evidence is emerging of the potential of person-centred approaches to create partnerships between professionals and patients while also containing healthcare costs. This is important for enhancing outcomes in individuals with complex needs, who consistently report poor experiences with care. The shift towards person-centred care (PCC) is, however,...

Background Rates of participation in centre (hospital)-cardiac rehabilitation by patients with heart failure are suboptimal. Heart failure has two main phenotypes differing in underlying pathophysiology: heart failure with reduced ejection fraction is characterised by depressed left ventricular systolic function (‘reduced ejection fraction’), where...

Background Up to 50% of medicines are not used as intended, resulting in poor health and economic outcomes. Medicines optimisation is ‘a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines’. The purpose of this exercise was to co-produce a prioritised research agenda f...

The increasing popularity of the term ‘person‐centred’ in the healthcare literature and a wide range of ideals and practices it implies point to the need for a more inclusive and holistic healthcare provision. A framework developed in a Swedish context suggested narrative elicitation as a key practice in transition to person‐centred care. Initiatin...

Background Surgical specialities use extensive amounts of antimicrobials, and misuse has been widely reported, making them a key target for antimicrobial stewardship initiatives. Interventions informed by, and tailored to, a clear understanding of the contextual barriers to appropriate antimicrobial use are more likely to successfully improve pract...

Background: Although there is trial evidence that complex interventions are effective for the self-management of heart failure, little evidence supports their effectiveness in routine practice. We used Social Practice Theory to guide a Type 1 Hybrid Trial: a mixed methods process evaluation of a complex intervention for heart failure. The objectiv...

Background Surgical specialities use extensive amounts of antimicrobials, and misuse has been widely reported, making them a key target for antimicrobial stewardship initiatives. Interventions informed by, and tailored to, a clear understanding of the contextual barriers to appropriate antimicrobial use are more likely to successfully improve pract...

Background Surgical specialities use extensive amounts of antimicrobials, and misuse has been widely reported, making them a key target for antimicrobial stewardship initiatives. Interventions informed by, and tailored to, a clear understanding of the contextual barriers to appropriate antimicrobial use are more likely to successfully improve pract...

This study aimed to address the question: what does “effectiveness” mean to researchers in the context of literature searching for systematic reviews? We conducted a thematic analysis of responses to an e‐mail survey. Eighty‐nine study authors, whose studies met inclusion in a recent review (2018), were contacted via e‐mail and asked three question...

The COST CARES project aims to support healthcare cost containment and improve healthcare quality across Europe by developing the research and development necessary for person-centred care (PCC) and health promotion. This paper presents an overview evaluation strategy for testing ‘Exploratory Health Laboratories’ to deliver these aims. Our strategy...

(1) Background: Applied health services research (AHSR) relies upon coordination across multiple organizational boundaries. Our aim was to understand how competing organizational and professional goals enhance or impede the conduct of high quality AHSR. (2) Methods: A qualitative study was conducted in two local health care systems in the UK, linke...

(1) Background: Applied health services research (AHSR) relies upon coordination across multiple organizational boundaries. Our aim was to understand how competing organizational and professional goals enhance or impede the conduct of high quality AHSR. (2) Methods: A qualitative study was conducted in two local health care systems in the UK, linke...

Background Public involvement in research is seen as a quality marker by funders. To understand the process and impact of involvement, more in‐depth studies are needed on how members of the public contribute in meetings with researchers. Objectives This study aimed to observe and reflect on what is said by public advisers in involvement. We wanted...

Background Revitalized interest in narrative has informed some recent models of patient and person‐centred care. Yet, scarce attention has been paid to how narrative elicitation is actually used in person‐centred care practice and in which ways it is incorporated into clinical routine. Aim We aimed to identify facilitators and barriers for narrati...

Background Over one billion prescription items are dispensed in the United Kingdom annually. Up to 50% of medicines are not used as intended, resulting in sub-optimal health outcomes and harm. Medicines optimisation is ‘a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medic...

Background Up to 50% of medicines are not used as intended, resulting in poor health and economic outcomes. Medicines optimisation is ‘a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines’. The purpose of this exercise was to co-produce a prioritised research agenda f...

Background Up to 50% of medicines are not used as intended, resulting in poor health and economic outcomes. Medicines optimisation is ‘a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines’. The purpose of this exercise was to co-produce a prioritised research agenda f...

Objective To identify and explore change processes explaining the effects of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention taking account of reach, amount of intervention received, delivery fidelity and patient and caregiver perspectives. Design Mixed methods process evaluation parallel to a randomised controlled t...

Evaluation of recovery-focused interventions for people with psychosis may be enhanced by the use of Interpersonal Process Recall (IPR). The aim of this study was to examine whether the inclusion of IPR alongside semi-structured interviews in the formative evaluation of a novel collaborative care intervention increased understanding about both prac...

Objective To explore whether a preconsultation web-based intervention enables patients with diabetes to articulate their agenda in a consultation in the hospital outpatient clinic with their diabetologist. Methods and design A qualitative study embedded in a pragmatic pilot randomised controlled trial. Setting Two city outpatient departments in E...

In this article, we present an exemplar of the initial theory-building phase of theory-driven evaluation for the PARTNERS2 project, a collaborative care intervention for people with experience of psychosis in England. Initial theory-building involved analysis of the literature, interviews with key leaders and focus groups with service users. The in...

Background: Caregivers frequently provide support to people living with long-term conditions. However, there is paucity of evidence of interventions that support caregivers in their role. Rehabilitation EnAblement in Chronic Heart Failure (REACH-HF) is a novel home-based, health-professional-facilitated, self-management programme for patients with...

Supplemental material for The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial

Aims The aim of this study was to provide guidance to improve the completeness and clarity of meta-ethnography reporting. Background Evidence-based policy and practice require robust evidence syntheses which can further understanding of people’s experiences and associated social processes. Meta-ethnography is a rigorous seven-phase qualitative evi...

Aims The aim of this study was to provide guidance to improve the completeness and clarity of meta‐ethnography reporting. Background Evidence‐based policy and practice require robust evidence syntheses which can further understanding of people's experiences and associated social processes. Meta‐ethnography is a rigorous seven‐phase qualitative evi...

The aim of this study was to provide guidance to improve the completeness and clarity of meta‐ethnography reporting. Evidence‐based policy and practice require robust evidence syntheses which can further understanding of people's experiences and associated social processes. Meta‐ethnography is a rigorous seven‐phase qualitative evidence synthesis m...

Background Many people diagnosed with schizophrenia, bipolar or other psychoses in England receive the majority of their healthcare from primary care. Primary care practitioners may not be well equipped to meet their needs and there is often poor communication with secondary care. Collaborative care is a promising alternative model but has not been...

Introduction As people get older, they often experience an increase in multiple long-term health problems. Managing these may involve the prescribing of a large volume of drugs, often involving multiple prescribers (Farmer, Fenu, O’Flynn, & Guthrie, 2016). In the United States in 2011–14, ten times as many people aged 65 and over used five or more...

Background: Cardiac rehabilitation improves health-related quality of life (HRQoL) and reduces hospitalizations in patients with heart failure, but international uptake of cardiac rehabilitation for heart failure remains low. Design and methods: The aim of this multicentre randomized trial was to compare the REACH-HF (Rehabilitation EnAblement i...

Background: Systematic literature searching is recognised as a critical component of the systematic review process. It involves a systematic search for studies and aims for a transparent report of study identification, leaving readers clear about what was done to identify studies, and how the findings of the review are situated in the relevant evi...

Background: We conducted a pilot study of an intervention to facilitate patients' agenda setting in clinical consultations. The primary aim of the study was to test the feasibility of running the randomized controlled trial. A secondary objective was to assess the extent to which patient and public involvement (PPI) could contribute to the process...

Our recent editorial discussing the future of QOF for General Practice.

i>Aims To provide guidance to improve the completeness and clarity of meta-ethnography reporting. Background Evidence-based policy and practice require robust evidence syntheses which can further understanding of people’s experiences and associated social processes. Meta-ethnography is a rigorous seven-phase qualitative evidence synthesis method...

Background: Reducing unnecessary prescribing remains a key priority for tackling the global rise of antibiotic-resistant infections. Aim: The authors sought to update a 2011 qualitative synthesis of GPs’ experiences of antibiotic prescribing for acute respiratory tract infections (ARTIs), including their views of interventions aimed at more pruden...

Introduction Evidence from systematic reviews and meta-analyses of randomised trials has led the National Institute of health and Care Excellence (NICE) and international guideline bodies to recommend centre-based cardiac rehabilitation (CR) as an effective and safe intervention for heart failure. CR reduces the risk of hospitalisations and improve...

Introduction Home-based cardiac rehabilitation may overcome suboptimal rates of participation. The overarching aim of this study was to assess the feasibility and acceptability of the novel Rehabilitation EnAblement in CHronic Hear Failure (REACH-HF) rehabilitation intervention for patients with heart failure with preserved ejection fraction (HFpEF...

Objective: To identify the metrics or methods used by researchers to determine the effectiveness of literature searching where supplementary search methods are compared to bibliographic database searching. We also aimed to determine which metrics or methods are summative or formative and how researchers defined effectiveness in their studies. Stu...

Background Many people now take multiple medications on a long-term basis to manage health conditions. Optimising the benefit of such polypharmacy requires tailoring of medicines use to the needs and circumstances of individuals. However, professionals report barriers to achieving this in practice. In this study, we examined health professionals’ p...

Patient and public involvement in health research and care has been repeatedly theorised using the metaphor of spaces, knowledge spaces and participatory citizenship spaces. Drawing on data from a three year qualitative study of people involved in health research with organisations across England, this article explores where these spaces fit in a w...

Background Fragmented care results in poor outcomes for individuals with complexity of need. Person-centred coordinated care (P3C) is perceived to be a potential solution, but an absence of accessible evidence and the lack of a scalable ‘blue print’ mean that services are ‘experimenting’ with new models of care with little guidance and support. Thi...

Background The purpose and contribution of supplementary search methods in systematic reviews is increasingly acknowledged. Numerous studies have demonstrated their potential in identifying studies or study data that would have been missed by bibliographic database searching alone. What is less certain is how supplementary search methods actually w...

Objectives This study explored the divergence and convergence between funded research about type 1 diabetes and the research agenda of people living with the condition and their carers. Design, method, setting A secondary analysis was undertaken of existing data from two UK organisations who regularly work with patients and carers to identify rese...

Background The introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice. This study has two aims: first, to analyse deliberate and emergent strategies adopted by healthcare professionals to overcome barriers to normalization of a specific framework of person-centred care (PCC)...

Objective Although conceptual definitions of person-centred care (PCC) vary, most models value the involvement of patients through patient-professional partnerships. While this may increase patients’ sense of responsibility and control, research is needed to further understand how this partnership is created and perceived. This study aims to explor...

Background Caregivers support self-management in heart failure but often experience stress, anxiety and ill health as a result of providing care. Aims 1. To identify the factors that contribute to the experience of anguish. 2. To understand how caregivers learn to live with what is frequently a challenging and demanding role. Methods Individual i...

Background: There is a growing literature on evaluating aspects of patient and public involvement (PPI). We have suggested that at the core of successful PPI is the dynamic interaction of different forms of knowledge, notably lay and professional. We have developed a four-dimensional theoretical framework for understanding these interactions. Aim...

Objective We sought to develop a simulation modelling method to help better understand the complex interplay of factors that lead to people with type 2 diabetes and asthma not taking all of their medication as prescribed when faced with multiple medications (polypharmacy). Research design and methods In collaboration with polypharmacy patients, ge...

We continue the conversation initiated by Sally Thorne’s observations about “metasynthetic madness.” We note that the variety of labels used to describe qualitative syntheses often reflect authors’ disciplines and geographical locations. The purpose of systematic literature searching is to redress authors’ lack of citation of relevant earlier work...

Background Guidelines and evidence-based drug treatment recommendations are usually based on the results of clinical trials, which have limited generalisability in routine clinical settings due to their restrictive eligibility criteria. These trials are also conducted in ideal and rigorously controlled settings. N of 1 trials, which are single pati...

Different discourses that co-exist within the world of patient and public involvement in health and social care mirror a tangle of historical, social, political and theoretical roots. These range from the radical activism, born of civil rights movements, to a more passive model in which patients are the recipients of information. This paper explore...

Objective To test the feasibility of running a randomised controlled trial of a preconsultation web-based intervention (Presenting Asking Checking Expressing (PACE-D)) to improve the quality of care and clinical outcomes in patients with diabetes. Design and setting A feasibility study (with randomisation) conducted at outpatient diabetes clinics...

In recent decades, the ‘tenacious assumptions’ of biomedicine regarding the neutrality and universality of its knowledge claims have been significantly challenged by the growth of new collaborative and patient-focused models of Healthcare delivery. In this article, we discuss and critically reflect upon one such alternative Healthcare model develop...

This article explores how people with progressive multiple sclerosis give meaning to their experiences. It builds upon the self-management literature, which has captured the tension between the desire for retaining normalcy and the increasing burden of self-management associated with chronic disease progression. This repeat interview study is empir...

Background: To empower patients and improve the quality of care, policy-makers increasingly adopt systems to enhance person-centred care. Although models of person-centredness and patient-centredness vary, respecting the needs and preferences of individuals receiving care is paramount. In Sweden, as in other countries, healthcare providers seek to...

Introduction The Rehabilitation EnAblement in CHronic Heart Failure in patients with Heart Failure (HF) with preserved ejection fraction (REACH-HFpEF) pilot trial is part of a research programme designed to develop and evaluate a facilitated, home-based, self-help rehabilitation intervention to improve self-care and quality of life (QoL) in heart f...

Background: There has been growing support in England for a policy of medicines optimisation as a response to the rise of problematic polypharmacy. Conceptually, medicines optimisation differs from the medicines management model of prescribing in being based around the patient rather than processes and systems. This critical examination of current...

Unfortunately, the original version of this article [1] contained an error in abstract S1. The corresponding author for the abstract ‘Gabriele Meyer’ was included in the 'Correspondence' section but accidentally omitted from the author list. The correct author list should be as below: Gabriele Meyer1*, Sascha Kopke2, Jane Noyes3, Jackie Chandler4...

Critical theorists have informed how we think about and undertake collaborative health services research, but while much attention has been given to how patients can participate in research design generally, less has been given to their role in the analysis of qualitative data specifically. Qualitative analysis is a labour intensive practice, typic...

Background: Person-centred care (PCC) is increasingly advocated as a new way of delivering health care, but there is little evidence that it is widely practised. The University of Gothenburg Centre for Person-Centred Care (GPCC) was set up in 2010 to develop and implement person-centred care in clinical practice on the basis of three routines. The...

Drug Utilisation Research is an eclectic discipline, focusing on all aspects of medicine, utilizing a wide array of qualitative and quantitative methods and bringing together many scientific spheres. Drivers of its future are: (i) the nature of the output of future pharma research and development (ii) the validity and quality of its methods (iii) h...

Patients view medicines and their risks and benefits differently from health professionals, which influences the way they use them and their attitudes towards them. Self-medication is the most common form of medicine use worldwide. It is mostly used for self-limiting conditions in high-income countries, but it can also be used for chronic condition...

Table of contents KEYNOTE PRESENTATIONS K1 Researching complex interventions: the need for robust approaches Peter Craig K2 Complex intervention studies: an important step in developing knowledge for practice Ingalill Rahm-Hallberg K3 Public and patient involvement in research: what, why and how? Nicky Britten K4 Mixed methods in health service res...

In this article we examine a risk management tool that was used in a pilot programme of applied health research in the south-west of England funded by the National Institute for Health Research (NIHR). During a wider internal evaluation of the NIHR Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, we bec...

Background: In 2008, the National Institute for Health Research (NIHR) began funding a major 5-year pilot research programme of translational research in England, establishing nine 'Collaborations for Leadership in Applied Health Research and Care' (CLAHRCs). A number of evaluations were carried out to examine whether or not the various collaborat...

Seventy six senior academics from 11 countries invite The BMJ’s editors to reconsider their policy of rejecting qualitative research on the grounds of low priority.They challenge the journal to develop a proactive, scholarly, and pluralist approach to research that aligns with its stated mission