
Trisha GreenhalghUniversity of Oxford | OX · Department of Primary Care Health Sciences
Trisha Greenhalgh
FMedSci
About
928
Publications
532,468
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Introduction
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My work website is here http://www.phc.ox.ac.uk/team/researchers/trish-greenhalgh
My publications are listed on Google Scholar here
http://scholar.google.co.uk/citations?sortby=pubdate&hl=en&user=8KQwEGcAAAAJ&view_op=list_works
Additional affiliations
January 2015 - present
April 2010 - present
January 2001 - March 2010
Publications
Publications (928)
Purpose:
The questions addressed by this review are: first, what are the guiding principles underlying efforts to stimulate sustained cultural change; second, what are the mechanisms by which these principles operate; and, finally, what are the contextual factors that influence the likelihood of these principles being effective? The paper aims to...
The idea that policy should be based on best research evidence might appear to be self-evident. But a closer analysis reveals a number of problems and paradoxes inherent in the concept of "evidence-based policymaking." The current conflict over evidence-based policymaking parallels a long-standing "paradigm war" in social research between positivis...
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
This chapter considers the usefulness and validity of public inquiries as a source of data and preliminary interpretation for case study research. Using two contrasting examples – the Bristol Inquiry into excess deaths in a children’s cardiac surgery unit and the Woolf Inquiry into a breakdown of governance at the London School of Economics (LSE) –...
Public Health England’s focus on individual behaviour change is unlikely to stem the epidemic of type 2 diabetes
A new Public Health England report on the rising prevalence of type 2 diabetes proposes targeting people with non-diabetic hyperglycaemia (defined as an HbA1c concentration of 42-47 mmol/mol) with behavioural interventions (diet and exe...
The study
Payne R, Clarke A, Swann N, et al. Patient safety in remote primary care encounters: multimethod qualitative study combining Safety I and Safety II analysis. BMJ Quality and Safety 2023;0:1–14.
To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/how-to-make-remote-consultations-safer/
Background
The introduction of remote and digital forms of working in UK general practice has driven the development of new routines and working styles.
Aim
To explore and theorise how new forms of work have affected general practice staff.
Design and setting
Multi-sited, qualitative case study in UK general practice.
Method
Using longitudinal e...
Background
The rapid shift to video consultation services during the COVID-19 pandemic has raised concerns about exacerbating existing health inequities, particularly for disadvantaged populations. Intersectionality theory provides a valuable framework for understanding how multiple dimensions of disadvantage interact to shape health experiences an...
This commentary on Sturmberg and Mercuri's paper ‘Every Problem is Embedded in a Greater Whole’ [1] argues that those authors have approached complexity from a largely mathematical perspective, drawing on the work of Sumpter. Whilst such an approach allows us to challenge the simple linear causality assumed in randomised controlled trials, it is it...
The World Health Organization declared COVID-19 to be a public health emergency of international concern on 30 January 2020 and then a pandemic on 11 March 2020. In early 2020, a group of UK scientists volunteered to provide the public with up-to-date and transparent scientific information. The group formed the Independent Scientific Advisory Group...
Background
The cause of acute paediatric hepatitis of unknown aetiology (2022) has not been established despite extensive investigation.
Objective
To summarise the evidence for and against a causal role for human adenovirus (HAdv), adeno-associated virus 2 (AAV-2) and SARS-CoV-2 in outbreaks of paediatric hepatitis in 2022.
Methods
We appraised a...
Muscle symptoms in long covid
Background General practice is facing an unprecedented challenge in managing the consequences of the pandemic. In the midst of a policy drive to balance remote and in-person service provision, substantial workload pressures remain, together with increasing prevalence of long-term conditions, and declining staff numbers and morale. To address these...
BACKGROUND
The rapid shift to video consultation services during the COVID-19 pandemic has raised concerns about exacerbating existing health inequities, particularly for disadvantaged populations. Intersectionality theory provides a valuable framework for understanding how multiple dimensions of disadvantage interact to shape health experiences an...
Background
Since 2022, general practice has shifted from responding to the acute challenges of COVID-19 to restoring full services using a hybrid of remote, digital, and in-person care.
Aim
To examine how quality domains are addressed in contemporary UK general practice.
Design and setting
Multi-site, mostly qualitative longitudinal case study, p...
The protracted form of COVID-19 known as ‘long covid’ was first described in 2020. Its symptoms, course and prognosis vary widely; some patients have a multi-system, disabling and prolonged illness. In 2021, ring-fenced funding was provided to establish 90 long covid clinics in England; some clinics were also established in Scotland and Wales. The...
Long covid (persistent COVID‐19) is a new disease with contested aetiology and variable prognosis. We report a 2‐year ethnography of UK long covid clinics. Using a preformative lens, we show that multidisciplinary teams (MDTs) built working knowledge based on shared practices, mutual trust, distributed cognition (e.g. emails, record entries), relat...
Reflexivity’, as used by Margaret Archer, means creative self‐mastery that enables individuals to evaluate their social situation and act purposively within it. People with complex health and social needs may be less able to reflect on their predicament and act to address it. Reflexivity is imperative in complex and changing social situations. The...
This narrative review and meta-analysis summarizes a broad evidence base on the benefits—and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts—of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of...
Background General practice is facing an unprecedented challenge in managing the consequences of the pandemic. In the midst of a policy drive to balance remote and in-person service provision, substantial workload pressures remain, together with increasing prevalence of long-term conditions, and declining staff numbers and morale. To address these...
Background
Long covid (post covid-19 condition) is a complex condition with diverse manifestations, uncertain prognosis and wide variation in current approaches to management. There have been calls for formal quality standards to reduce a so-called “postcode lottery” of care. The original aim of this study—to examine the nature of quality in long c...
Background
Social prescribing (SP) typically involves linking patients in primary care with a range of local, community-based, non-clinical services. While there is a growing body of literature investigating the effectiveness of SP in improving healthcare outcomes, questions remain about how such outcomes are achieved within the everyday complexity...
Qualitative social scientists working in medical faculties have to meet multiple expectations. On the one hand, they are expected to comply with the philosophical and theoretical expectations of the social sciences. On the other hand, they may also be expected to produce publications which align with biomedical definitions and framings of quality....
Background
Remote and digital services must be equitable, but some patients have difficulty using these services. Designing measures to overcome digital disparities can be challenging for practices. Personas (fictional cases) are a potentially useful tool in this regard.
Aim
To develop and test a set of personas to reflect the lived experiences an...
Few interventions that succeed in improving healthcare locally end up becoming spread and sustained more widely. This indicates that we need to think differently about spreading improvements in practice. Drawing on a focused review of academic and grey literature, the authors outline how spread, scale-up, and sustainability have been defined and op...
The abrupt shift from face-to-face general practitioner (GP) consultations to remote ones was one of the most radical changes to the UK National Health Service (NHS) since it was set up in 1948. Overnight, people were blocked from turning up at their GP’s surgery and instead offered telephone, video or email contacts. This chapter considers how the...
Background
The relationship between healthcare interventions and context is widely conceived as involving complex and dynamic interactions over time. However, evaluations of complex health interventions frequently fail to mobilise such complexity, reporting context and interventions as reified and demarcated categories. This raises questions about...
Context
Long covid (post covid-19 condition) is a complex condition with diverse manifestations and uncertain prognosis. There is wide variation in how patients are investigated and managed. There have been calls for formal quality standards so as to reduce a so-called “postcode lottery” of care. We aimed to examine the nature of quality in long co...
Background
Triage and clinical consultations increasingly occur remotely. We aimed to learn why safety incidents occur in remote encounters and how to prevent them.
Setting and sample
UK primary care. 95 safety incidents (complaints, settled indemnity claims and reports) involving remote interactions. Separately, 12 general practices followed 2021...
Background
The workload and wellbeing of support staff in general practice has been critically understudied. This includes reception, secretarial and administrative workers who are critical in the daily practice function. Currently, only reception staff are mentioned in the evidence base on general practice working conditions, and all support staff...
Background
Contemporary general practice includes many kinds of remote encounter. The rise in telephone, video and online modalities for triage and clinical care requires clinicians and support staff to be trained, both individually and as teams, but evidence-based competencies have not previously been produced for general practice.
Aim
To identif...
Continuity is a long-established and fiercely-defended value in primary care. Traditional continuity, based on a one-to-one doctor-patient relationship, has declined in recent years. Contemporary general practice is organisationally and technically complex, with multiple staff roles and technologies supporting patient access (e.g. electronic and te...
Policy Points
The concept of value complexity (complexity arising from differences in people's worldviews, interests, and values, leading to mistrust, misunderstanding, and conflict among stakeholders) is introduced and explained.
Relevant literature from multiple disciplines is reviewed.
Key theoretical themes, including power, conflict, language...
Holmström and co-authors argue for the value of integrating system dynamics into action research to deal with increasing complexity in healthcare. We argue that despite merits, the authors overlook the key aspect of normative complexity, which refers to the existence of multiple, often conflicting values that actors in healthcare systems have to pr...
This article argues for a more critical, transformative and philosophically-underpinned approach to teaching Sustainable Development Goals (SDGs). The standard approach presents the SDGs as uncontested and universally agreed-upon targets, which oversimplifies their complexity and inherent contradictions and engages only superficially with the centr...
Background
Guidance and reporting principles such as CONSORT (for randomised trials) and PRISMA (for systematic reviews) have greatly improved the reporting, discoverability, transparency and consistency of published research. We sought to develop similar guidance for case study evaluations undertaken to explore the influence of context on the proc...
Background: Care navigation refers to support for patients accessing primary care and other related services. The expansion of digitally enabled care in the UK since the coronavirus disease 2019 (COVID-19) pandemic has led to a greater need for digital care navigation: supporting people to access primary care digitally and, if necessary, to help th...
Background
Social prescribing (SP) usually involves linking patients in primary care with services provided by the voluntary and community sector. Preliminary evidence suggests that SP may offer a means of connecting patients with community-based health promotion activities, potentially contributing to the prevention of long-term conditions, such a...
Since the first wave of COVID-19 in March 2020 the number of people living with post-COVID syndrome has risen rapidly at global pace, however, questions still remain as to whether there is a hidden cohort of sufferers not accessing mainstream clinics. This group are likely to be constituted by already marginalised people at the sharp end of existin...
Background
The value of continuity in primary care has been demonstrated for multiple positive outcomes. However, little is known about how the expansion of remote and digital care models in primary care have impacted continuity.
Aim
To explore the impact of the expansion of remote and digital care models on continuity in primary care.
Design and...
Background: Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and...
Background
Young people with diabetes experience poor clinical and psychosocial outcomes, and consider the health service ill-equipped in meeting their needs. Improvements, including alternative consulting approaches, are required to improve care quality and patient engagement. We examined how group-based, outpatient diabetes consultations might be...
BACKGROUND
The COVID-19 pandemic has led to the rapid scale up in the use of video consultations in general practice across the UK, but the impact this has had on digital health disparities concerning certain disadvantaged groups of patients remains largely unknown.
OBJECTIVE
We set out to review the research on digital disparities in relation to...
Background:
Digital consultations between patients and clinicians increased markedly during the COVID-19 pandemic, raising questions about equity.
Objective:
To review the literature on how multiple disadvantage-specifically, older age, lower socio-economic status and limited English proficiency-has been conceptualised, theorised and studied emp...
BACKGROUND
Until COVID-19, implementation and uptake of video consultations in healthcare was slow. But the pandemic created a ‘burning platform’ for scaling up such services. As healthcare organizations look to expand and maintain the use of video in the ‘new normal’, it is important to understand infrastructural influences and changes that emerge...
Background:
Until COVID-19, implementation and uptake of video consultations in healthcare was slow. But the pandemic created a 'burning platform' for scaling up such services. As healthcare organizations look to expand and maintain the use of video in the 'new normal', it is important to understand infrastructural influences and changes that emer...
We studied video consulting in the National Health Service during 2020–2021 through video interviews, an online survey and online discussions with people who had provided and participated in such consultations.
Video consulting had previously been used for selected groups in limited settings in the UK. The pandemic created a seismic shift in the co...
Background
Following a large-scale, pandemic-driven shift to remote consulting in UK general practice in 2020, 2021 saw a partial return to in-person consultations. This occurred in the context of extreme workload pressures because of backlogs, staff shortages, and task shifting.
Aim
To study media depictions of remote consultations in UK general...
Background: Following a pandemic-driven shift to remote service provision, UK general practices offer telephone, video or online consultation options alongside face-to-face. This study explores practices’ varied experiences over time as they seek to establish remote forms of accessing and delivering care.
Methods: This protocol is for a mixed-metho...
Background: Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and...
Background
Our research was based on the expressed need to evaluate the potential for group clinics to enhance care within the NHS for people with long-term conditions.
Objectives
We aimed to explore the scope, feasibility, impact and potential scalability of group clinics for young adults with diabetes who have poor experiences of care and clinic...
Evidence-based medicine (EBM’s) traditional methods, especially randomised controlled trials (RCTs) and meta-analyses, along with risk-of-bias tools and checklists, have contributed significantly to the science of COVID-19. But these methods and tools were designed primarily to answer simple, focused questions in a stable context where yesterday’s...
Background
Accurate assessment of COVID-19 severity in the community is essential for patient care and requires COVID-19-specific risk prediction scores adequately validated in a community setting. Following a qualitative phase to identify signs, symptoms, and risk factors, we aimed to develop and validate two COVID-19-specific risk prediction scor...
In this conceptual paper, we argue that at times of crisis, what is sometimes called “evidence-based” or “science-driven” policymaking—establishing scientific truths and then implementing them—must be tempered by a more agile, deliberative and inclusive approach which acknowledges and embraces uncertainty. We offer pragmatism as one potential optio...
Background
Group consultations have been gaining ground as a novel approach to service delivery. When in-person care was restricted owing to COVID-19, general practice staff began delivering group consultations remotely over video.
Aim
To examine how multiple interacting influences underpinned implementation and delivery of video group consultatio...
Background:
The Covid-19 pandemic-related rise in remote consulting raises questions about the nature and type of risks in remote general practice AIM: To develop an empirically-based and theory-informed taxonomy of risks associated with remote consultations.
Design and setting:
Qualitative sub-study of data selected from the wider datasets of t...
Introduction
Long COVID, a new condition whose origins and natural history are not yet fully established, currently affects 1.5 million people in the UK. Most do not have access to specialist long COVID services. We seek to optimise long COVID care both within and outside specialist clinics, including improving access, reducing inequalities, helpin...
Background:
Long covid (LC) is defined as fatigue, breathlessness, cognitive dysfunction and a variety of other symptoms occurring after coronavirus-2019 disease (COVID-19). (1,2) Over a million people in the UK are estimated to have prolonged symptoms after COVID-19, with 60% of long covid patients reporting extended symptoms lasting months, and 2...
Background
The introduction of remote triage and assessment early in the pandemic raised questions about patient safety. We sought to capture patients and clinicians’ experiences of the management of suspected acute COVID-19 and generate wider lessons to inform safer care.
Setting and sample
UK primary healthcare. A subset of relevant data was dra...
Background
Most studies of long COVID (symptoms of COVID-19 infection beyond 4 weeks) have focused on people hospitalized in their initial illness. Long COVID is thought to be underrecorded in UK primary care electronic records.
Objective
We sought to determine which symptoms people present to primary care after COVID-19 infection and whether prese...
This article draws on research and clinical experience to discuss how and when to use video consultations in mental health settings. The appropriateness and impact of virtual consultations are influenced by the patient's clinical needs and social context, as well as by service-level socio-technical and logistical factors.
Background:
Fewer than 1% of UK general practice consultations occur by video.
Aim:
To explain why video consultations are not more widely used in general practice.
Design and setting:
Analysis of a sub-sample of data from three mixed-method case studies of remote consultation services in various UK settings from 2019-2021.
Method:
The datas...
Background:
Following COVID-19 up to 40% of people have ongoing health problems, referred to as “post-acute COVID-19” or long covid (LC). LC varies from a single persisting symptom to a complex multi-system disease. Research has flagged that this condition is under recorded in primary care record; and seeks to better define its clinical characteris...
Background:
Following COVID-19, up to 40% of people have ongoing health problems, referred to as "post-acute COVID-19" or 'long covid'. Long covid varies from a single persisting symptom to a complex multi-system disease. Research has flagged that this condition is under recorded in primary care record; and seeks to better define its clinical char...
Objective
To explore the lived experience of ‘brain fog’—the wide variety of neurocognitive symptoms that can follow COVID-19.
Design and setting
A UK-wide longitudinal qualitative study comprising online focus groups with email follow-up.
Method
50 participants were recruited from a previous qualitative study of the lived experience of long COVI...
A consensus statement from physicians and scientists with a range of expertise in the areas of respiratory infection and aerosols, to clarify the discussion surrounding a recent preprint (https://www.medrxiv.org/content/10.1101/2022.01.08.22268944v1) describing the aerosol dynamics of SARS-CoV-2 (the virus that causes COVID-19) which generated cont...
Background
Accurate assessment of COVID-19 severity in the community is essential for best patient care and efficient use of services and requires a risk prediction score that is COVID-19 specific and adequately validated in a community setting. Following a qualitative phase to identify signs, symptoms and risk factors, we sought to develop and val...