Imperial College London

DrMatthewHarris

Faculty of MedicineSchool of Public Health

Clinical Senior Lecturer in Public Health
 
 
 
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Contact

 

+44 (0)20 7594 7452m.harris

 
 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

107 results found

Cash-Gibson L, Harris M, Guerra G, Benach Jet al., 2020, A novel conceptual model and heuristic tool to strengthen understanding and capacities for health inequalities research, Health Research Policy and Systems, Vol: 18, Pages: 1-12, ISSN: 1478-4505

BackgroundDespite increasing evidence on health inequalities over the past decades, further efforts to strengthen capacities to produce research on this topic are still urgently needed to inform effective interventions aiming to address these inequalities. To strengthen these research capacities, an initial comprehensive understanding of the health inequalities research production process is vital. However, most existing research and models are focused on understanding the relationship between health inequalities research and policy, with less focus on the health inequalities research production process itself. Existing conceptual frameworks provide valuable, yet limited, advancements on this topic; for example, they lack the capacity to comprehensively explain the health (and more specifically the health inequalities) research production process at the local level, including the potential pathways, components and determinants as well as the dynamics that might be involved. This therefore reduces their ability to be empirically tested and to provide practical guidance on how to strengthen the health inequalities research process and research capacities in different settings. Several scholars have also highlighted the need for further understanding and guidance in this area to inform effective action.MethodsThrough a critical review, we developed a novel conceptual model that integrates the social determinants of health and political economy perspectives to provide a comprehensive understanding of how health inequalities research and the related research capacities are likely to be produced (or inhibited) at local level.ResultsOur model represents a global hypothesis on the fundamental processes involved, and can serve as a heuristic tool to guide local level assessments of the determinants, dynamics and relations that might be relevant to better understand the health inequalities research production process and the related research capacities.ConclusionsThis type of

Journal article

Harris M, Tobias R, Schweikhardt J, 2020, Healthcare Public Health in Extreme Environments: the case of primary care in the Amazon., Healthcare Public Health, Editors: Gulliford, Jessop, Publisher: Oxford University Press

Book chapter

Harris M, Bhatti Y, Prabhu J, Frugal Innovation for Today’s and Tomorrow’s Crises, Stanford Social Sciences Review

Journal article

Harris M, Bhatti Y, Buckley J, Sharma Det al., 2020, Fast and frugal innovations in response to the COVID-19 pandemic., Nat Med, Vol: 26, Pages: 814-817

Journal article

Haines A, de Barros EF, Berlin A, Heymann DL, Harris MJet al., 2020, National UK programme of community health workers for COVID-19 response, The Lancet, Vol: 395, ISSN: 0140-6736

Journal article

Harris M, Dadwal V, Syed SB, 2020, Review of the reverse innovation series in globalization and health - where are we and what else is needed?, Globalization and Health, Vol: 16, ISSN: 1744-8603

Following advances in industrial strategy and organizational behaviour, as well as post-development debates in international relations, Globalization and Health launched the Reverse Innovation series in 2012, in order to forge an agenda to promote not just the innovativeness of low-income country health systems but to recognize current and advocate for future strengthened knowledge flow between the global south and global north. It was considered to be a timely antidote to a knowledge flow that has traditionally been characterised by unidirectionality of innovation and expertise. Since then, the series provides a repository of research, theory, commentary and debate through which a collective community of practice in Reverse Innovation might emerge and provide an evidence base to promote, support and mainstream this type of knowledge flow. In this Commentary, we review the series as a whole, explore what has been learnt and what needs to come next in terms of empirical research, business models, processes and theoretical contributions to inform reverse innovation.

Journal article

Al-Saffar M, Hayhoe B, Harris M, Majeed A, Greenfield Get al., Children as frequent attenders in primary care: a systematic review, BJGP Open, ISSN: 2398-3795

Background: Frequent paediatric attendances make up a large proportion of the general practitioner (GP) workload. Currently no systematic reviews on frequent paediatric attendances in primary care exists. Aim: To identify the socio-demographic and clinical characteristics of children who attend primary care frequently. Design and setting: A systematic review.Methods: The electronic databases MEDLINE, EMBASE and PsycINFO were searched up to January 2020, using terms relating to frequent attendance in primary care settings. Studies were eligible if they considered children frequently attending in primary care (0-19 years). Relevant data were extracted and analysed by narrative synthesis.Results: Six studies, of overall fair quality, were included in the review. Frequent attendance was associated with presence of psycho-social and mental health problems, younger age, school absence, presence of chronic conditions, and high level of anxiety in their parents.Conclusions: Various sociodemographic and medical characteristics of children were associated with frequent attendance in primary care. Research on interventions needs to account for the social context and community characteristics. Integrating GP services with mental health and social care could potentially provide a response to medical and psycho-social needs of frequently attending children and their families.

Journal article

Skopec M, Issa H, Reed J, Harris Met al., 2020, The role of geographic bias in knowledge diffusion: a systematic review and narrative synthesis, Research Integrity and Peer Review, Vol: 5, Pages: 1-14, ISSN: 2058-8615

Background: Descriptive studies examining publication rates and citation counts demonstrate a geographic skew towards high-income countries (HIC) and research from low- or middle-income countries (LMICs) is generally underrepresented. This has been suggested to be due in part to reviewers’ and editors’ preference toward HIC sources, however, in the absence of controlled studies it is impossible to assert whether there is bias or whether variations in the quality or relevance of the articles being reviewed explains the geographic divide. This study synthesizes the evidence from randomized and controlled studies that explore geographic bias in the peer review process. Methods: A systematic review was conducted to identify research studies that explicitly explore the role of geographic bias in the assessment of the quality of research articles. Only randomized and controlled studies were included in the review. Five databases were searched to locate relevant articles. A narrative synthesis of included articles was performed to identify common findings.Results: The systematic literature search yielded 3,501 titles from which twelve full texts were reviewed, and a further eight were identified through searching reference lists of the full texts. Of these articles, only three were randomized and controlled studies that examined variants of geographic bias. One study found that abstracts attributed to HIC sources elicited a higher review score regarding relevance of the research and likelihood to recommend the research to a colleague, than did abstracts attributed to LIC sources. Another study found that the predicted odds of acceptance for a submission to a computer science conference was statistically significantly higher for submissions from a “Top University.” Two of the studies showed the presence of geographic bias between articles from “high” or “low” prestige institutions. Conclusions: Two of the three included studie

Journal article

Harris M, Skopec M, Issa H, 2020, REVERSE INNOVATION Global spread of innovations-direction is important Reply, BMJ-BRITISH MEDICAL JOURNAL, Vol: 368, ISSN: 1756-1833

Journal article

Skopec M, Issa H, Harris M, 2019, Delivering cost effective healthcare through reverse innovation., BMJ, Vol: 367, Pages: 1-5, ISSN: 1759-2151

Journal article

Skopec M, Issa H, Harris M, Reverse Innovation in healthcare, BMJ: British Medical Journal, ISSN: 0959-535X

Journal article

Rocha T, da Silva N, Amaral P, Barbosa A, Vissoci J, Thomaz E, Queiroz R, Harris M, Facchini Let al., 2018, Geolocation of hospitalizations registered on the Brazilian National Health System’s Hospital Information System: a solution based on the R Statistical Software, Epidemiologia e Serviços de Saúde, Vol: 27, ISSN: 1679-4974

Goal:present a solution to allow the geolocation of hospitalizations processed together with the Hospital Information System of the Brazilian National Health System.Methods:with the purpose of spatializing the AIHs, a script was elaborated in language R, based on the microdatosus and CepR packages; the script was applied to all AIHs made in the state of Goiás referring to 2015; after downloading and pre-processing the data, the procedure for the spatialization of AIHs was detailed.Results:of the 361,213 AIHs processed, it was possible to extract 24,220 different postal codes (CEP); of this set of postal codes, 23,910 (98.7%) were geolocalized; these geolocalized CEPs allowed the spatialization of 97.7% of the AIHs registered in Goiás.Conclusion:it is possible to spatialize the AIHs with a high success rate; the method detailed in this document opens up a new range of possibilities for the design of evaluative studies, the formulation of policies and the planning of health actions.

Journal article

Hayhoe BWJ, Cowling T, Pillutla V, Garg P, Majeed FA, Harris Met al., 2018, Integrating a nationally scaled workforce of community health workers in primary care: a modelling study, Journal of the Royal Society of Medicine, Vol: 111, Pages: 453-461, ISSN: 1758-1095

ObjectiveTo model cost and benefit of a national community health worker workforce.DesignModelling exercise based on all general practices in England.SettingUnited Kingdom National Health Service Primary Care.ParticipantsNot applicable.Data sourcesPublicly available data on general practice demographics, population density, household size, salary scales and screening and immunisation uptake.Main outcome measuresWe estimated numbers of community health workers needed, anticipated workload and likely benefits to patients.ResultsConservative modelling suggests that 110,585 community health workers would be needed to cover the general practice registered population in England, costing £2.22bn annually. Assuming community health workerss could engage with and successfully refer 20% of eligible unscreened or unimmunised individuals, an additional 753,592 cervical cancer screenings, 365,166 breast cancer screenings and 482,924 bowel cancer screenings could be expected within respective review periods. A total of 16,398 additional children annually could receive their MMR1 at 12 months and 24,716 their MMR2 at five years of age. Community health workerss would also provide home-based health promotion and lifestyle support to patients with chronic disease.ConclusionA scaled community health worker workforce integrated into primary care may be a valuable policy alternative. Pilot studies are required to establish feasibility and impact in NHS primary care.

Journal article

Joseph L, Ismail S, Prior D, Gunst M, Jarman K, Harris M, Abbara Aet al., 2018, Barriers to healthcare access for refugees in Greece, Publisher: OXFORD UNIV PRESS, Pages: 407-407, ISSN: 1101-1262

Conference paper

saddi F, Harris M, coelho G, pego R, parreira R, perreira W, santos A, almeida H, costa Det al., 2018, Perceptions and evaluations of front-line health workers regarding the Brazilian National Program for Improving Access and Quality to Primary Care (PMAQ): a mixed-method approach, Cadernos de Saúde Pública, Vol: 34, ISSN: 0102-311X

Although it is well known that a successful implementation depends on the front-liners’ knowledge and participation, as well as on the organizational capacity of the institutions involved, we still know little about how front-line health workers have been involved in the implementation of the Brazilian National Program for Improving Access and Quality to Primary Care (PMAQ). This paper develops a contingent mixed-method approach to explore the perceptions of front-line health workers - managers, nurses, community health workers, and doctors - regarding the PMAQ (2nd round), and their evaluations concerning health unit organizational capacity. The research is guided by three relevant inter-related concepts from implementation theory: policy knowledge, participation, and organizational capacity. One hundred and twenty-seven health workers from 12 primary health care units in Goiânia, Goiás State, Brazil, answered semi-structured questionnaires, seeking to collect data on reasons for adherence, forms of participation, perceived impact (open-ended questions), and evaluation of organizational capacity (score between 0-10). Content analyses of qualitative data enabled us to categorize the variables “level of perceived impact of PMAQ” and “reasons for adhering to PMAQ”. The calculation and aggregation of the means for the scores given for organizational capacity enabled us to classify distinct levels of organizational capacity. We finally integrated both variables (Perceived-Impact and Organizational-Capacity) through cross-tabulation and the narrative. Results show that nurses are the main type of professional participating. The low organizational capacity and little policy knowledge affected workers participation in and their perceptions of the PMAQ.

Journal article

Majeed FA, Harris M, 2018, Importance of accessibility and opening hours to overall patient experience of general practice: analysis of repeated cross-sectional data from a national patient survey in England, British Journal of General Practice, Vol: 68, Pages: e469-e477, ISSN: 0960-1643

Background The UK government aims to improve the accessibility of general practices in England, particularly by extending opening hours in the evenings and at weekends. It is unclear how important these factors are to patients’ overall experiences of general practice.Aim To examine associations between overall experience of general practice and patient experience of making appointments and satisfaction with opening hours.Design and setting Analysis of repeated cross-sectional data from the General Practice Patient Surveys conducted from 2011–2012 until 2013–2014. These covered 8289 general practice surgeries in England.Method Data from a national survey conducted three times over consecutive years were analysed. The outcome measure was overall experience, rated on a five-level interval scale. Associations were estimated as standardised regression coefficients, adjusted for responder characteristics and clustering within practices using multilevel linear regression.Results In total, there were 2 912 535 responders from all practices in England (n = 8289). Experience of making appointments (β 0.24, 95% confidence interval [CI] = 0.24 to 0.25) and satisfaction with opening hours (β 0.15, 95% CI = 0.15 to 0.16) were modestly associated with overall experience. Overall experience was most strongly associated with GP interpersonal quality of care (β 0.34, 95% CI = 0.34 to 0.35) and receptionist helpfulness was positively associated with overall experience (β 0.16, 95% CI = 0.16 to 0.17). Other patient experience measures had minimal associations (β≤0.06). Models explained ≥90% of variation in overall experience between practices.

Journal article

Prime M, Attaelmanan I, Imbuldeniya A, Harris M, Darzi A, Bhatti Yet al., 2018, From Malawi to Middlesex – The case of the Arbutus Drill Cover System as an example of the cost saving potential of frugal innovations for the UK NHS, BMJ Innovations, Vol: 4, Pages: 103-110, ISSN: 2055-642X

Background Musculoskeletal disease is one of the leading clinical and economic burdens of the UK health system, and the resultant demand for orthopaedic care is only set to increase. One commonly used and one of the most expensive hardware in orthopaedic surgery is the surgical drill and saw. Given financial constraints, the National Health Service (NHS) needs an economic way to address this recurring cost. We share evidence of one frugal innovation with potential for contributing to the NHS’ efficiency saving target of £22 billion by 2020.Methods Exploratory case study methodology was used to develop insights and understanding of the innovations potential for application in the NHS. Following a global search for potential frugal innovations in surgery, the Arbutus Drill Cover System was identified as an innovation with potential to deliver significant cost savings for the NHS in the UK.Results The Arbutus Drill Cover System is up to 94% cheaper than a standard surgical drill available in the UK. Clinical and laboratory tests show that performance, safety and usability are as good as current offerings in high-income countries and significantly better than hand drills typically used in low-and-middle-income countries. The innovation meets all regulatory requirements to be a medical device in the Europe and North America.Conclusions The innovation holds promise in reducing upfront and life span costs for core equipment used in orthopaedic surgery without loss of effectiveness or safety benchmarks. However, the innovation needs to navigate complicated and decentralised procurement processes and clinicians and healthcare leaders need to overcome cognitive bias.

Journal article

Cowling T, Majeed F, Harris M, Cowling TE, Majeed FA, Harris Met al., 2018, Patient experience of general practice and use of emergency hospital services in England: regression analysis of national cross-sectional time series data, BMJ Quality and Safety, Vol: 27, Pages: 643-654, ISSN: 2044-5415

Background The UK Government has introduced several national policies to improve access to primary care. We examined associations between patient experience of general practice and rates of visits to accident and emergency (A&E) departments and emergency hospital admissions in England. Methods The study included 8,124 general practices between 2011-12 and 2013-14. Outcome measures were annual rates of A&E visits and emergency admissions by general practice population, according to administrative hospital records. Explanatory variables included three patient experience measures from the General Practice Patient Survey: practice-level means of experience of making an appointment, satisfaction with opening hours, and overall experience (on 0-100 scales). The main analysis used random-effects Poisson regression for cross-sectional time series. Five sensitivity analyses examined changes in model specification. Results Mean practice-level rates of A&E visits and emergency admissions increased from 2011-12 to 2013-14 (310.3 to 324.4 and 98.8 to 102.9 per 1,000 patients). Each patient experience measure decreased; for example, mean satisfaction with opening hours was 79.4 in 2011-12 and 76.6 in 2013-14. In the adjusted regression analysis, a standard deviation increase in experience of making appointments (equal to nine points) predicted decreases of 1.8% (95% CI: -2.4% to -1.2%) in A&E visit rates and 1.4% (95% CI: -1.9% to -0.9%) in admission rates. This equalled 301,174 fewer A&E visits and 74,610 fewer admissions nationally per year. Satisfaction with opening hours and overall experience were not consistently associated with either outcome measure across the main and sensitivity analyses. Conclusions Associations between patient experience of general practice and use of emergency hospital services were small or inconsistent. In England, realistic short-term improvements in patient experience of general practice may only have modest effects on A&E

Journal article

Jimenez G, Harris M, 2017, Published evidence about bias against research from lower income countries: can we do something about it?, Revista Chileana de Dermatologia, Vol: 33, Pages: 6-7, ISSN: 0719-9406

We have always suspected it. Many colleagues, doctor friends and researchers from Latin American countries keep mentioning how di cult it is for them to publish articles in international journals, especially in high im- pact factor ones. Was this because their research came from lower-income countries (LICs)? Maybe. Is it ea- sier for research coming from higher-income countries (HICs) to be accepted in journals? Probably. We never knew for sure whether this was true but nally there is research demonstrating that there is indeed bias aga- inst research from lower-income countries.

Journal article

Prime M, Bhatti Y, Harris M, Darzi Aet al., 2017, Frugal innovations for healthcare: a toolkit for innovators, Academy of Management conference, Publisher: Academy of Management, ISSN: 2151-6561

Global health systems face significant challenges over the coming years to meet the increasing demands of ageing populations, the growing burden of chronic disease and the exponential cost of healthcare delivery. In response innovators from around the world are beginning to develop solutions that focus on reducing the cost of care; widen access to care; and challenge the dogma that more is better. So-called frugal innovations are defined as “means or ends, to do more with less, for the many” (Bhatti, 2014). This paper seeks to ask, “How can we identify frugal innovations for healthcare and how are they achieving frugality?” with the specific objective of developing a frugal innovation toolkit for healthcare. An emergent, embedded, mixed-methods research strategy was employed. A pilot study was used to develop the Frugal Innovation for Healthcare - Identification Tool (FIH-ID tool). A larger study was undertaken to identify a cohort of frugal innovations, evaluate the application of the FIH-ID tool, and assess the processes and strategies employed by frugal innovators. 56 semi-structured interviews were undertaken with 90 representatives of 28 healthcare innovations exhibiting at the World Innovation Summit for Health (WISH) 2015. 15 frugal innovations for healthcare were identified. Inter-observer agreement for application of the FIH-ID tool demonstrated a high proportion of agreement (Po = 0.714), and a “fair” Cohen’s Kappa score (K = 0.499). A thematic analysis identified key strategies applied by individuals or organizations to produce frugal innovations. These include: the application of new information & communication technologies; harnessing existing networks; simplification; changing the location of care; and task-shifting. This paper presents a toolkit of strategies for identifying and creating frugal innovations for healthcare. This research suggests that the FIH-ID tool is a reliable means of identifying exampl

Conference paper

Harris M, Bhatti Y, Prime M, Del Castillo J, Parston Get al., 2017, Low-cost innovation in healthcare: what you find depends on where you look, Journal of the Royal Society of Medicine, Vol: 111, Pages: 47-50, ISSN: 1758-1095

Journal article

Harris MJ, macinko J, jimenez G, mullachery Pet al., 2017, Measuring the bias against low-income country research: an Implicit Association Test, Globalization and Health, Vol: 13, ISSN: 1744-8603

BackgroundWith an increasing array of innovations and research emerging from low-income countries there is a growing recognition that even high-income countries could learn from these contexts. It is well known that the source of a product influences perception of that product, but little research has examined whether this applies also in evidence-based medicine and decision-making. In order to examine likely barriers to learning from low-income countries, this study uses established methods in cognitive psychology to explore whether healthcare professionals and researchers implicitly associate good research with rich countries more so than with poor countries.MethodsComputer-based Implicit Association Test (IAT) distributed to healthcare professionals and researchers. Stimuli representing Rich Countries were chosen from OECD members in the top ten (>$36,000 per capita) World Bank rankings and Poor Countries were chosen from the bottom thirty (<$1000 per capita) countries by GDP per capita, in both cases giving attention to regional representation. Stimuli representing Research were descriptors of the motivation (objective/biased), value (useful/worthless), clarity (precise/vague), process (transparent/dishonest), and trustworthiness (credible/unreliable) of research. IAT results are presented as a Cohen’s d statistic. Quantile regression was used to assess the contribution of covariates (e.g. age, sex, country of origin) to different values of IAT responses that correspond to different levels of implicit bias. Poisson regression was used to model dichotomized responses to the explicit bias item.ResultsThree hundred twenty one tests were completed in a four-week period between March and April 2015. The mean Implicit Association Test result (a standardized mean relative latency between congruent and non-congruent categories) for the sample was 0.57 (95% CI 0.52 to 0.61) indicating that on average our sample exhibited moderately strong implicit association

Journal article

bhatti Y, taylor A, harris M, wadge H, escobar E, prime M, patel H, carter A, parston G, darzi Aet al., 2017, Global Lessons In Frugal Innovation To Improve Health Care Delivery In The United States, Health Affairs, Vol: 36, Pages: 1912-1919, ISSN: 0278-2715

In a 2015 global study of low-cost or frugal innovations, we identified five leading innovations that scaled successfully in their original contexts and that may provide insights for scaling such innovations in the United States. We describe common themes among these diverse innovations, critical factors for their translation to the United States to improve the efficiency and quality of health care, and lessons for the implementation and scaling of other innovations. We highlight promising trends in the United States that support adapting these innovations, including growing interest in moving care out of health care facilities and into community and home settings; the growth of alternative payment models and incentives to experiment with new approaches to population health and care delivery; and the increasing use of diverse health professionals, such as community health workers and advanced practice providers. Our findings should inspire policy makers and health care professionals and inform them about the potential for globally sourced frugal innovations to benefit US health care.

Journal article

Bhatti Y, Prime M, Harris M, Wadge H, McQueen J, Patel H, Carter A, Parston G, Darzi Aet al., 2017, The search for the Holy Grail -- frugal innovation in healthcare from developing countries for reverse innovation to developed countries, BMJ Innovations, Vol: 3, Pages: 212-220, ISSN: 2055-642X

The healthcare sector stands to benefit most from frugal innovation, the idea that more can be done for less for many more people, globally. As a first step for health systems to leverage new approaches to offset escalating health expenditures and to improve health outcomes, the most relevant frugal innovations have to be found. The Institute of Global Health Innovation was commissioned by the US-based Commonwealth Fund to identify frugal innovations from around the world that could, if transferred to the USA, offer approaches for expanding access to care and dramatically lower costs. Our global scan was motivated by the need to extend the list of frugal innovations in healthcare beyond the impressive but oft-repeated examples such as GE’s MAC 400, a US$800 portable ECG machine, Narayana’s US$1500 cardiac surgery and Aravind’s US$30 cataract surgery. Our search involved (1) scanning innovation databases, (2) refining frameworks to identify frugal innovations and evaluate their reverse potential and (3) developing in-depth case studies. From 520 possible innovations, we shortlisted 16 frugal innovations that we considered as frugal and with potential for reverse diffusion into high-income country health systems. Our global search was narrowed down to three care delivery models for case analysis: The Brazilian Family Health Strategy around community health workers; Singapore-based GeriCare@North use of telemedicine and Brazil’s Saude Crianca community involvement and citizenship programme. We share core features of the three frugal innovations and outline lessons for practitioners, scholars and policymakers seeking to lower healthcare costs while increasing access and quality.

Journal article

Cowling TE, Laverty AA, Harris MJ, Watt HC, Greaves F, Majeed Aet al., 2017, Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey, Journal of the Royal Society of Medicine, Vol: 110, Pages: 440-451, ISSN: 1758-1095

Objective: To examine associations between the contractand ownership type of general practices and patient experiencein England.Design: Multilevel linear regression analysis of a nationalcross-sectional patient survey (General Practice PatientSurvey).Setting: All general practices in England in 2013–2014(n ¼ 8017).Participants: 903,357 survey respondents aged 18 years orover and registered with a general practice for six monthsor more (34.3% of 2,631,209 questionnaires sent).Main outcome measures: Patient reports of experienceacross five measures: frequency of consulting a preferreddoctor; ability to get a convenient appointment; rating ofdoctor communication skills; ease of contacting the practiceby telephone; and overall experience (measured onfour- or five-level interval scales from 0 to 100). Modelsadjusted for demographic and socioeconomic characteristicsof respondents and general practice populations and arandom intercept for each general practice.Results: Most practices had a centrally negotiated contractwith the UK government (‘General Medical Services’54.6%; 4337/7949). Few practices were limited companieswith locally negotiated ‘Alternative Provider MedicalServices’ contracts (1.2%; 98/7949); these practices providedworse overall experiences than General MedicalServices practices (adjusted mean difference 3.04, 95%CI 4.15 to 1.94). Associations were consistent in directionacross outcomes and largest in magnitude for frequencyof consulting a preferred doctor (12.78, 95% CI15.17 to 10.39). Results were similar for practicesowned by large organisations (defined as having 20 practices)which were uncommon (2.2%; 176/7949).Conclusions: Patients registered to general practicesowned by limited companies, including large organisations,reported worse experiences of their care than otherpatients in 2013–2014.

Journal article

Harris MJ, Marti J, Watt H, Bhatti Y, Macinko J, Darzi Aet al., 2017, Explicit Bias Toward High-Income Country Research: A Randomized, Blinded, Crossover Experiment Of English Clinicians, Health Affairs, Vol: 36, Pages: 1997-2004, ISSN: 0278-2715

Unconscious bias may interfere with the interpretation of research from some settings, particularly from lower-income countries. Most studies of this phenomenon have relied on indirect outcomes such as article citation counts and publication rates; few have addressed or proven the effect of unconscious bias in evidence interpretation. In this randomized, blinded crossover experiment in a sample of 347 English clinicians, we demonstrate that changing the source of a research abstract from a low- to a high-income country significantly improves how it is viewed, all else being equal. Using fixed-effects models, we measured differences in ratings for strength of evidence, relevance, and likelihood of referral to a peer. Having a high-income-country source had a significant overall impact on respondents’ ratings of relevance and recommendation to a peer. Unconscious bias can have far-reaching implications for the diffusion of knowledge and innovations from low-income countries.

Journal article

van Schalkwyk MC, Harris M, 2017, Translational health policy: towards an integration of academia and policy., Journal of the Royal Society of Medicine, Vol: 111, Pages: 15-17, ISSN: 1758-1095

Journal article

Woringer M, Jones Nielsen J, Zibarras L, Evason J, Kassianos AP, Harris M, Majeed A, Soljak Met al., 2017, Development of a questionnaire to evaluate patients’ awareness of cardiovascular disease risk in England’s National Health Service Health Check preventive cardiovascular programme, BMJ Open, Vol: 7, ISSN: 2044-6055

BackgroundThe National Health Service (NHS) Health Check is a CVD risk assessment and management programme in England aiming to increase CVD risk awareness among people at increased risk of CVD. There is no tool to assess the effectiveness of the programme in communicating CVD risk to patients. AimsThe aim of this paper was to develop a questionnaire examining patients’ CVD risk awareness for use in health service research evaluations of the NHS Health Check programme. MethodsWe developed an 85 item questionnaire to determine patients’ views of their risk of CVD. The questionnaire was based on a review of the relevant literature. After review by an expert panel and focus group discussion, 22 items were dropped and 2 new items were added. The resulting 65 item questionnaire with satisfactory content validity (content validity indices >=0.80) and face validity was tested on 110 NHS Health Check attendees in primary care in a cross sectional study between May 21 and July 28, 2014. ResultsFollowing analyses of data, we reduced the questionnaire from 65 to 26 items. The 26 item questionnaire constitutes 4 scales: Knowledge of CVD Risk and Prevention, Perceived Risk of Heart Attack/Stroke, Perceived Benefits and Intention to Change Behaviour and Healthy Eating Intentions. Perceived Risk (Cronbach’s α = 0.85) and Perceived Benefits and Intention to Change Behaviour (Cronbach’s α = 0.82) have satisfactory reliability (Cronbach’s α >=0.70). Healthy Eating Intentions (Cronbach’s α = 0.56) is below minimum threshold for reliability but acceptable for a three item scale. ConclusionsThe resulting questionnaire, with satisfactory reliability and validity, may be used in assessing patients’ awareness of CVD risk among NHS Health Check attendees.

Journal article

Issa H, Kulasabanathan K, Darzi A, Harris Met al., 2017, Shared learning in an interconnected world: the role of international health partnerships., Journal of the Royal Society of Medicine, Vol: 110, Pages: 316-319, ISSN: 0141-0768

Journal article

Kulasabanathan K, Issa H, Bhatti Y, Prime M, del Castillo J, Darzi A, Harris Met al., 2017, Do international health partnerships contribute to reverse innovation? A mixed methods study of THET-supported partnerships in the UK, Globalization and Health, Vol: 13, ISSN: 1744-8603

BackgroundInternational health partnerships (IHPs) are changing, with an increased emphasis on mutual accountability and joint agenda setting for both the high- and the low- or middle-income country (LMIC) partners. There is now an important focus on the bi-directionality of learning however for the UK partners, this typically focuses on learning at the individual level, through personal and professional development. We sought to evaluate whether this learning also takes the shape of ‘Reverse Innovation’ –when an idea conceived in a low-income country is subsequently adopted in a higher-income country.MethodsThis mixed methods study used an initial scoping survey of all the UK-leads of the Tropical Health Education Trust (THET)-supported International Health Partnerships (n = 114) to ascertain the extent to which the IHPs are or have been vehicles for Reverse Innovation. The survey formed the sampling frame for further deep-dive interviews to focus on volunteers’ experiences and attitudes to learning from LMICs. Interviews of IHP leads (n = 12) were audio-recorded and transcribed verbatim. Survey data was analysed descriptively. Interview transcripts were coded thematically, using an inductive approach.ResultsSurvey response rate was 27% (n = 34). The majority (70%) strongly agreed that supporting LMIC partners best described the mission of the partnership but only 13% of respondents strongly agreed that learning about new innovations and models was a primary mission of their partnership. Although more than half of respondents reported having observed innovative practice in the LMIC, only one IHP respondent indicated that this has led to Reverse Innovation. Interviews with a sample of survey respondents revealed themes primarily around how learning is conceptualised, but also a central power imbalance between the UK and LMIC partners. Paternalistic notions of knowledge could be traced to partnership p

Journal article

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