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Abstract Purpose An immediate research priority recovering from the COVID-19 pandemic is well-being among some of our most vulnerable—people with chronic illness. We studied how mental health changed among people with and without chronic illness throughout the pandemic and the mediating role of social support. Methods We used the 3-waves of COVID-19 survey within the Millennium Cohort Study (MCS, age 19, N = 5522) and MCS Parent (MCSP, age > > 19, N = 7479) samples, with additional pre-pandemic measures of some outcomes and exposure. Using Structural Equation Panel Models with Full Information Maximum Likelihood estimation to address missing data, we studied differences between respondents with a chronic illness and without, regarding depressive symptoms and mental well-being, with social provision, social support, and loneliness as potential mediators. Results Mental well-being (SWEMWBS) and psychological distress (Kessler-6) worsened significantly during the pandemic relative to baseline for people with and without chronic illness, while the latter group had substantially better well-being at all waves and the baseline regarding both outcomes. When the lockdown was lifted during wave-2, mental well-being temporarily rebounded, and distress waned among people without chronic illness but continued to worsen among people with chronic illness. Social support partially mediated the link between chronic illness and mental well-being. Conclusions The large mental well-being gap between people with and without chronic illness persisted during the pandemic. However, social support and provision can partially narrow this gap, hence should be employed in future pandemic management.

A doctoral student is someone studying for a doctoral degree, which is generally considered to be the highest academic qualification a university can award. The student develops research experience, while making an in-depth and original contribution to knowledge. They are supervised by university staff members (usually there are two, or a small panel) who train, mentor, and support the doctoral student. Professional and career development refers to support that helps students to not only grow as individuals and independent researchers, but to also have the option to successfully pursue either academic or non-academic roles after graduation. While this entry considers some international contexts, it is particularly oriented to the United Kingdom (UK) model, and to the most common doctoral degree, the Doctor of Philosophy (PhD).

Objective This work contributed to the development of a core outcome set (COS) for heavy menstrual bleeding (HMB). The objective was to determine which research outcomes best reflect how HMB affects women’s lives and to identify additional research outcomes, not previously reported. It was important to explore and record participants’ reasoning for prioritising outcomes and use this information to reinforce the patients’ voice during later phases of the COS development.Design Patient workshop discussions and telephone interviews.Setting East London teaching hospital.Participants Inclusion criteria were that participants must be over 18 years old, that either they or their partner had a history of HMB and that they had a good understanding of written and spoken English.Results 41 participants were recruited for the study. 8 women and 1 man completed the study. The eight female participants were representative of the different underlying causes and treatments for HMB. Participants ranged in age from their early 20s to their 60s and represented a range of ethnic groups. The five main themes that were identified as being important to patients were: ‘restriction’, ‘relationships and isolation’, ‘emotions and self-perception’, ‘pain’ and ‘perceptions of treatment’. We identified eight coding nodes that did not correspond with our list of previously reported outcomes in studies of HMB. These nodes were consolidated and became five new outcomes for potential inclusion in the COS.Conclusions HMB stops women living their lives as they would wish. It affects their relationships, education, careers, reproductive wishes, social life and mental health. This is a condition of girls and women in the prime of their lives, but for many, the constant threat of a heavy period starting means that they sacrifice that freedom. The societal and economic costs of women being incapacitated every month has an effect on everyone.Trial registration The COS study is registered with the COMET (Core Outcome Measures in Effectiveness Trials) Initiative—project reference number 789.

BackgroundThe Care Quality Commission published a review in 2018 in England titled “Are We Listening,” which revealed that child and adolescent mental health services are not responsive to the specific needs of young Black people and other ethnic minorities even in areas with ethnically diverse populations. It found that commissioners and service planners failed to engage with these young people and their families to understand their needs and expectations. ObjectiveThe purpose of this study is to engage Nigerian and Ghanaian young people (NAGYP) with experiences of care for common mental disorders (CMDs) in London, to increase understanding of their needs, and to give voice to their views and preferences. Their parents’, caregivers’, and practitioners’ views will also be sought for service improvement. MethodsThree combined contemporary complementary methodologies—thematic analysis, interpretative phenomenological analysis (IPA), and intersectionality-based policy analysis (IBPA)—will be used across 3 comprehensive phases. First, a scoping review where relevant themes will be critically analyzed will inform further phases of this study. Detailed mapping of community and mental health care services in 13 inner London boroughs to investigate what professionals actually do rather than what they say they do. Second, IBPA will be used to scrutinize improving access to psychological therapies and other legislations and policies relevant to NAGYP to undertake an intersectional multileveled analysis of power, models, and constraints. Third, IPA will “give voice” and “make sense” of NAGYP lived experiences of CMDs via a representative sample of NAGYP participants’ (n=30) aged 16-25 years, parents or caregivers’ (n=20), and practitioners’ (n=20) perspectives will be captured. ResultsThe study has been approved by the UCL Institute of Education Research Ethics Committee (Z6364106/2022/02/28; health research) and University College London (Z6364106/2022/10/24; social research). Recruitment has begun in 13 inner boroughs of London. Data collection through observation, semistructured interviews, and focus groups are expected to be finalized by early 2024, and the study will be published by early 2025. ConclusionsCombining multiple qualitative methodologies and methods will enable rigorous investigation into NAGYP’s lived experiences of care received for CMDs in London. Findings from this study should enable a reduction in the negative connotations and harmful superstitions associated with mental health–related issues in this group, inform evidence-based interventions, and facilitate preventive or early access to interventions. There may also be an indirect impact on problems resulting from mental illness such as school dropout, antisocial behaviors, knife crimes, juvenile detention centers, and even death. International Registered Report Identifier (IRRID)PRR1-10.2196/42575

BackgroundPeople with intellectual disability are twice as likely to experience sexual abuse, unintended pregnancies, and sexually transmitted diseases as people in the general population. Despite this, very little is known about how to deliver relationships and sex education effectively to this vulnerable population, how to measure the impact of its delivery in schools, and what stakeholders perceive as important outcomes of this education. ObjectiveTo address these urgent issues, this study aims to develop a stakeholder consensus–based core outcome set of relationships and sex education for use in research and educational settings with students with intellectual disability. MethodsThe study will use a 2-stage mixed methods design. The first stage will involve a systematic review of relationships and sex education outcomes reported in the literature, followed by qualitative exploration with caregivers, teachers and school staff, policy makers, and researchers to investigate their perspectives of meaningful outcomes of this education. Students with intellectual disability will be enabled to take part to express their views on outcomes of importance to them. The second stage will use findings from stage 1 in a 2-round web-based Delphi study with caregivers, teachers and school staff, policy makers, and researchers to develop consensus on proposed outcomes for the evaluation of relationships and sex education with this population. ResultsAs of September 2022, we have completed a systematic review and recruited 56 stakeholders (n=53, 95%, adults and n=3, 5%, students with intellectual disability) for the first stage of the study. We are still recruiting students with intellectual disability. Data analysis has not started yet. Recruitment for the second stage will commence in November 2022. We expect to complete the study by October 2023 and publish the results by the end of 2024. ConclusionsThe development of a core outcome set of relationships and sex education will provide a significant first step to assist the implementation, delivery, evaluation, and sustainability of relationships and sex education for students with intellectual disability. Key audiences will be teachers, researchers, policy makers, and decision makers. Trial RegistrationCore Outcome Measures in Effectiveness Trials 1787; https://www.comet-initiative.org/Studies/Details/1787 International Registered Report Identifier (IRRID)PRR1-10.2196/39921

Abstract This is the protocol for a Campbell Evidence Gap Map. The main objectives of the EGM are: establish the nature and extent of the primary empirical evidence on informal social support interventions, identify interventions and clusters of evidence suitable for systematic review/evidence synthesis and identify gaps in the evidence on informal social support interventions.

BackgroundThe COVID-19 pandemic has inequitably impacted the experiences of people living with ill health/impairments or from minoritized ethnic groups across all areas of life. Given possible parallels in inequities for disabled people and people from minoritized ethnic backgrounds, their existence before the pandemic and increase since, and the discriminations that each group faces, our interest is in understanding the interplay between being disabled AND being from a minoritized ethnic group. ObjectiveThe overarching aim of the Coronavirus Chronic Conditions and Disabilities Awareness (CICADA) project, building on this understanding, is to improve pandemic and longer-term support networks, and access to and experiences of care, services, and resources for these underserved groups, both during the pandemic and longer term, thereby reducing inequities and enhancing social, health, and well-being outcomes. MethodsThis mixed methods study involves three “sweeps” of a new UK survey; secondary analyses of existing cohort and panel surveys; a rapid scoping review; a more granular review; and qualitative insights from over 200 semistructured interviews, including social network/map/photo elicitation methods and two subsequent sets of remote participatory research workshops. Separate stakeholder cocreation meetings, running throughout the study, will develop analyses and outputs. Our longitudinal study design enables the exploration of significant relationships between variables in the survey data collected and to the assessment of changes in variables over time, including consideration of varying pandemic contexts. The qualitative data will provide more granular detail. We will take a strengths and assets–based approach, underpinned by the social model of disability and by intersectional considerations to challenge discrimination. Our exploration of the social determinants of health and well-being is framed by the social ecological model. ResultsThe CICADA project was funded by the Health and Social Care Delivery Research (HSDR) Programme of the United Kingdom (UK) National Institute for Health and Care Research (NIHR) in March 2021 and began in May 2021. Further work within the project (84 interviews) was commissioned in March 2022, a substudy focusing on mental health, specifically in Northeast England, Greater Manchester, and the Northwest Coast of the United Kingdom. Data collection began in August 2021, with the last participants due to be recruited in September 2022. As of January 2022, 5792 survey respondents and 227 interviewees had provided data. From April 2022, the time of article submission, we will recruit participants for the substudy and wave 2 of the surveys and qualitative work. We expect results to be published by winter 2022. ConclusionsIn studying the experiences of disabled people with impairments and those living with chronic conditions who come from certain minoritized ethnic groups, we are aiming for transformative research to improve their health and well-being. International Registered Report Identifier (IRRID)DERR1-10.2196/38361

Background: Up to 28% of endometriosis patients do not get pain relief from therapeutic laparoscopy but this subgroup is not defined. Objectives: To identify any prognostic patient-specific factors (such as but not limited to patients’ type or location of endometriosis, sociodemographics and lifestyle) associated with a clinically meaningful reduction in post-surgical pain response to operative laparoscopic surgery for endometriosis. Search strategy: PubMed, Cochrane and Embase databases were searched from inception to 19 May 2020 without language restrictions. Backward and forward citation tracking was used. Selection criteria, data collection and analysis: Cohort studies reporting prognostic factors, along with scores for domains of pain associated with endometriosis before and after surgery, were included. Studies that compared surgeries, or laboratory tests, or outcomes without stratification were excluded. Results were synthesised but variation in study designs and inconsistency of outcome reporting precluded us from doing a meta-analysis. Main results: Five studies were included. Quality assessment using the Newcastle–Ottawa scale graded three studies as high, one as moderate and one as having a low risk of bias. Four of five included studies separately reported that a relationship exists between more severe endometriosis and stronger pain relief from laparoscopic surgery. Conclusion: Currently, there are few studies of appropriate quality to answer the research question. We recommend future studies report core outcome sets to enable meta-analysis.

Abstract Background Constrained budgets within healthcare systems and the need to efficiently allocate resources often necessitate the valuation of healthcare interventions and services. However, when a technological product is developed for which no market exists it is a challenge to understand how to place the product and which specifications are the most sought after and important for end users. This was the case for a dashboard we developed, displaying analyses of patient experience survey free-text comments. Method We describe a customisation and evaluation process for our online dashboard that addresses this challenge, using a Discrete Choice Experiment (DCE). We were not interested in the exact content of the dashboard, which was determined in previous stages of our larger study, but on the availability of features and customization options and how they affect individuals’ purchasing behaviours. Results Our DCE completion rate was 33/152 (22%). Certain features were highly desirable - the search function, filtering, and upload own data - and would contribute significant added value to the dashboard. Purchasing behaviour was dependent on the dashboard features, going from a 10 to 90% probability to purchase when we moved from a baseline to a fully-featured dashboard. The purchasing behaviour elicited in this study assumes individuals already have buy-in to the online dashboard, so we assessed only how the various features of our dashboard influence the probability of purchasing the product. Results were used to inform development of a generic checklist of desirable healthcare dashboard features as well as to refine the dashboard itself. Our study suggests the development of the online dashboard and its roll-out in the market would result in a positive net benefit in terms of utilities. The cost-benefit analysis offers a lower bound estimate of the net benefit as it does not acknowledge or incorporate non-monetary benefits that would result from the use of the online dashboard, such as from improved healthcare management. Conclusion DCEs can be successfully used to inform development of an online dashboard by determining preferences for particular features and customisation options and how this affects individuals’ purchasing behaviours. The process should be transferable to the development of other technologies.

Before the COVID-19 pandemic virtual clinics in gynecology were not commonplace in the United Kingdom or most other countries. Owing to the need to reconfigure health provision to caring for COVID-19 patients, reducing footfall in hospitals and restricted movement, telemedicine was rapidly introduced at scale in hospitals thought the United Kingdom. This happened without much consultation with service users and healthcare professionals. It is anticipated that after the pandemic, telemedicine will remain to some extent. The authors report how their hospital how their place of work, a large London teaching hospital, adopted virtual phone consultations in gynecology, along with a countrywide survey of 200 service users and healthcare professionals. Now it is important carry out a robust evaluation of outcomes (both clinician and patient experience) and also to take care that service users from disadvantaged backgrounds do not lose out.

Abstract Background NHS community pharmacies provide effective smoking cessation services; however, there is scope for increasing throughput and improving quit rates. This trial examines whether the Smoking Treatment Optimisation in Pharmacies (STOP) intervention can improve smoker engagement to increase service throughput, retention and quitting. Methods This study is a pragmatic, cluster randomised controlled trial in 60 pharmacies in England and Wales. All workers in intervention pharmacies are offered STOP training while control pharmacies provide usual care. The STOP intervention, based on behavioural and organisational theories, comprises educational sessions for staff and environmental prompts in the pharmacy. Intervention fidelity is assessed by actors visiting pharmacies posing as smokers. The primary outcome is throughput, defined as the number of smokers who join the programme, set a firm quit date and undergo at least one stop smoking treatment session, and is measured using routinely collected data. Secondary outcomes include retention and quit rates at 4 weeks and continuous abstinence at 6 months verified by salivary cotinine. Cost-effectiveness is estimated using quality-adjusted life years and the probability that the intervention is effective at different levels of willingness to pay is calculated. Discussion The trial will generate evidence to inform the public health smoking cessation strategy in England and Wales, and may help to shape service commissioning decisions. The STOP intervention model may help inform the undertaking of a range of health behaviour change tasks in community pharmacies. Trial registration ClinicalTrials.gov, ISRCTN16351033. Retrospectively registered on 21 March 2017.

Introduction Black-British communities are disproportionately affected by type 2 diabetes (T2D). Structured education programs are a core component of T2D healthcare but they are less successful in people from minority ethnic groups. Culturally tailored T2D education has demonstrated greater benefits than usual care. The aim of our study was to evaluate acceptability, fidelity and trial feasibility of the Healthy Eating and Active Lifestyles for Diabetes (‘HEAL-D’) culturally tailored T2D self-management education and support (DSMES) program.Research design and methods A mixed-methods randomized controlled feasibility trial in black-British adults with T2D was conducted. Participants were assigned to control (usual care) or intervention (HEAL-D; 7 sessions, 14 hours of group-based culturally tailored diet and lifestyle education, behavior change support and supervised physical activity), in a ratio of 1:1. Primary outcomes were recruitment and retention rates, intervention attendance and completion. Fidelity was assessed through observations and qualitative evaluation was undertaken with participants and educators.Results 102 patients responded to invitation letters (n=1335); 63 were randomized but 8 were subsequently deemed ineligible due to high baseline glycosylated hemoglogin (HbA1c) requiring intensive medical management or missing baseline HbA1c measurement. Of the remaining 55 participants (27 intervention, 28 control), 69% were female, 47% were of African and 51% were of Caribbean ethnicity. 93% completed the trial, providing end point data. Intervention attendance was high; 85% completed the program (attendance at ≥5 sessions), and 74% attended ≥6 sessions. The intervention was delivered with acceptable fidelity, although the qualitative evaluations identified some areas of structure and format in need of refinement.Conclusions We have shown it is feasible to recruit and randomize black-British adults with T2D to a trial of a culturally tailored DSMES program. We have shown the intervention is highly acceptable for both patients and healthcare providers. A future trial should assess clinical and cost-effectiveness of HEAL-D.Trial registration number NCT03531177.

Introduction Poor access to, and engagement with, diabetes healthcare is a significant issue for black British communities who are disproportionately burdened by type 2 diabetes (T2D). Tackling these inequalities is a healthcare priority. The purpose of this research was to explore the experiences of healthcare practitioners providing diabetes self-management education and support (DSMES) to African and Caribbean adults living with T2D to inform the development of a culturally tailored DSMES program.Research design and methods Semi-structured interviews were carried out with a range of healthcare practitioners including diabetes specialist nurses, dietitians and general practitioners based in primary care in inner London. Thematic content analysis was used to identify barriers and facilitators relating to the provision of effective DSMES.Results Ten interviews were conducted. There was a strong consensus among healthcare practitioners for the importance of DSMES in T2D healthcare. However, practitioners discussed this area of practice as overwhelmingly challenging and recognized a wide range of barriers that they face. Four themes were identified: (1) The tension between structural and responsive care needs, particularly with growing numbers of patients alongside incentivized targets driving a care agenda that does not meet the needs of diverse communities; (2) challenges posed by cultural beliefs and practices, particularly a distrust of conventional medicine, rejection of body mass index standards and a belief in ‘God’s will’; (3) building relationships through cultural understanding: insiders and outsiders, particularly the benefits of racial concordance and cultural knowledge/resources and (4) getting the messages across, particularly the need to address gaps in structured education.Conclusion Provision of culturally sensitive DSMES is a challenging area of practice for practitioners, who recognize the need for more training and resources to support them in developing cultural competence. Nonetheless, practitioners recognize the importance of DSMES and are striving to provide culturally sensitive care to their patients.

Objectives To evaluate the feasibility of a randomised trial of a modified, pre-existing, mindfulness meditation smartphone app for women with chronic pelvic pain.Design Three arm randomised feasibility trial.Setting Women were recruited at two gynaecology clinics in the UK. Interventions were delivered via smartphone or computer at a location of participants choosing.Participants Women were eligible for the study if they were over 18, had been experiencing organic or non-organic chronic pelvic pain for 6 months or more, and had access to a computer or smartphone. 90 women were randomised.Interventions Daily mindfulness meditation delivered by smartphone app, an active control app which delivered muscle relaxation techniques, and usual care without app. Interventions were delivered over 60 days.Primary and secondary outcome measures Outcomes included length of recruitment, follow-up rates, adherence to the app interventions, and clinical outcomes measured at baseline, two, three and 6 months.Results The target sample size was recruited in 145 days. Adherence to the app interventions was extremely low (mean app use 1.8 days mindfulness meditation group, 7.0 days active control). Fifty-seven (63%) women completed 6-month follow-up, and 75 (83%) women completed at least one postrandomisation follow-up. The 95% CIs for clinical outcomes were consistent with no benefit from the mindfulness meditation app; for example, mean differences in pain acceptance scores at 60 days (higher scores are better) were −2.3 (mindfulness meditation vs usual care, 95% CI: −6.6 to 2.0) and −4.0 (mindfulness meditation vs active control, 95% CI: −8.1 to 0.1).Conclusions Despite high recruitment and adequate follow-up rates, demonstrating feasibility, the extremely low adherence suggests a definitive randomised trial of the mindfulness meditation app used in this study is not warranted. Future research should focus on improving patient engagement.Trial registration numbers NCT02721108; ISRCTN10925965; Results.

Objectives To determine whether a pre-existing smartphone app to teach mindfulness meditation is acceptable to women with chronic pelvic pain (CPP) and can be integrated into clinical practice within the National Health Service (NHS) CPP pathways, and to inform the design of a potential randomised clinical trial.Design A prestudy patient and public involvement (PPI) group to collect feedback on the acceptability of the existing app and study design was followed by a three-arm randomised feasibility trial. In addition, we undertook interviews and focus groups with patients and staff to explore app usability and acceptability. We also obtained participant comments on the research process, such as acceptability of the study questionnaires.Setting Two gynaecology clinics within Barts Health NHS, London, UK.Participants Patients with CPP lasting ≥6 months with access to smartphone or personal computer and understanding of basic English.Intervention The intervention was mindfulness meditation content plus additional pain module delivered by a smartphone app. Active controls received muscle relaxation content from the same app. Passive (waiting list) controls received usual care.Main outcome measures Themes on user feedback, app usability and integration, and reasons for using/not using the app.Results The use of the app was low in both active groups. Patients in the prestudy PPI group, all volunteers, were enthusiastic about the app (convenience, content, portability, flexibility, ease of use). Women contributing to the interview or focus group data (n=14), from a ‘real world’ clinic (some not regular app users), were less positive, citing as barriers lack of opportunities/motivation to use the app and lack of familiarity and capabilities with technology. Staff (n=7) were concerned about the potential need for extra support for them and for the patients, and considered the app needed organisational backing and peer acceptance.Conclusion The opinions of prestudy PPI volunteers meeting in their private time may not represent those of patients recruited at a routine clinic appointment. It may be more successful to codesign/codevelop an app with typical users than to adapt existing apps for use in real-world clinical populations.Trial registration number ISRCTN10925965.

Background: Patient experience surveys (PESs) often include informative free-text comments, but with no way of systematically, efficiently and usefully analysing and reporting these. The National Cancer Patient Experience Survey (CPES), used to model the approach reported here, generates > 70,000 free-text comments annually. Main aim: To improve the use and usefulness of PES free-text comments in driving health service changes that improve the patient experience. Secondary aims: (1) To structure CPES free-text comments using rule-based information retrieval (IR) (‘text engineering’), drawing on health-care domain-specific gazetteers of terms, with in-built transferability to other surveys and conditions; (2) to display the results usefully for health-care professionals, in a digital toolkit dashboard display that drills down to the original free text; (3) to explore the usefulness of interdisciplinary mixed stakeholder co-design and consensus-forming approaches in technology development, ensuring that outputs have meaning for all; and (4) to explore the usefulness of Normalisation Process Theory (NPT) in structuring outputs for implementation and sustainability. Design: A scoping review, rapid review and surveys with stakeholders in health care (patients, carers, health-care providers, commissioners, policy-makers and charities) explored clinical dashboard design/patient experience themes. The findings informed the rules for the draft rule-based IR [developed using half of the 2013 Wales CPES (WCPES) data set] and prototype toolkit dashboards summarising PES data. These were refined following mixed stakeholder, concept-mapping workshops and interviews, which were structured to enable consensus-forming ‘co-design’ work. IR validation used the second half of the WCPES, with comparison against its manual analysis; transferability was tested using further health-care data sets. A discrete choice experiment (DCE) explored which toolkit features were preferred by health-care professionals, with a simple cost–benefit analysis. Structured walk-throughs with NHS managers in Wessex, London and Leeds explored usability and general implementation into practice. Key outcomes: A taxonomy of ranked PES themes, a checklist of key features recommended for digital clinical toolkits, rule-based IR validation and transferability scores, usability, and goal-oriented, cost–benefit and marketability results. The secondary outputs were a survey, scoping and rapid review findings, and concordance and discordance between stakeholders and methods. Results: (1) The surveys, rapid review and workshops showed that stakeholders differed in their understandings of the patient experience and priorities for change, but that they reached consensus on a shortlist of 19 themes; six were considered to be core; (2) the scoping review and one survey explored the clinical toolkit design, emphasising that such toolkits should be quick and easy to use, and embedded in workflows; the workshop discussions, the DCE and the walk-throughs confirmed this and foregrounded other features to form the toolkit design checklist; and (3) the rule-based IR, developed using noun and verb phrases and lookup gazetteers, was 86% accurate on the WCPES, but needs modification to improve this and to be accurate with other data sets. The DCE and the walk-through suggest that the toolkit would be well accepted, with a favourable cost–benefit ratio, if implemented into practice with appropriate infrastructure support. Limitations: Small participant numbers and sampling bias across component studies. The scoping review studies mostly used top-down approaches and focused on professional dashboards. The rapid review of themes had limited scope, with no second reviewer. The IR needs further refinement, especially for transferability. New governance restrictions further limit immediate use. Conclusions: Using a multidisciplinary, mixed stakeholder, use of co-design, proof of concept was shown for an automated display of patient experience free-text comments in a way that could drive health-care improvements in real time. The approach is easily modified for transferable application. Future work: Further exploration is needed of implementation into practice, transferable uses and technology development co-design approaches. Funding: The National Institute for Health Research Health Services and Delivery Research programme.

In this report we present a reflection on the Collaborative Poetics Network's first "Carnival of Invention" which was held on 15th June 2018 at the University of Brighton, England. Collaborative poetics is an arts-based research method that brings together expertise from artists, academics, and community participants, to share knowledge and promote social change through engaging and accessible ways. On the day of the Carnival over 40 contributors from around the world came to participate in a series of workshops, presentations, installations and displays. In this article we outline the themes addressed on the day and the media utilized in these interactive and experiential sessions. We argue that this event supported the benefits of arts-based research in developing, analyzing, and communicating rich data sets. Finally, we provide evaluation and reflections from the event (including in haiku, a traditional Japanese form of poetry), in an attempt to creatively capture the events of the day.

This Campbell systematic review assesses the effects of advocacy interventions on intimate partner violence and women's wellbeing. The review summarizes findings from 13 studies. Physical abuse: After one year, brief advocacy had no effect in two healthcare studies and one community study, but it reduced minor abuse in one antenatal care study. Another antenatal study showed reduced abuse immediately after brief advocacy, but women were also treated for depression, which may have affected results. Two studies provided weak evidence that intensive advocacy reduces physical abuse up to two years after the intervention. Sexual abuse was reported in four studies that found no effects. Emotional abuse: One antenatal care study reported reduced emotional abuse at 12 months after advocacy. Depression: Brief advocacy prevented depression in abused women attending healthcare services and pregnant women immediately after advocacy. Intensive advocacy did not reduce depression in shelter women followed up at 12 and 24 months. The moderate‐to‐low quality evidence came mostly from studies with a low risk of bias. Quality of life: Three trials of brief advocacy trials no benefit on quality of life. Intensive advocacy showed a weak benefit in two studies in domestic violence shelters/refuges, and a primary care study showed improved motivation to do daily tasks immediately after advocacy. Abstract BACKGROUND Intimate partner abuse is common worldwide, damaging the short‐ and long‐term physical, mental, and emotional health of survivors and children. Advocacy may contribute to reducing abuse, empowering women to improve their situation by providing informal counselling and support for safety planning and increasing access to different services. Advocacy may be a stand‐alone service, accepting referrals from healthcare providers, or part of a multi‐component (and possibly multi‐agency) intervention provided by service staff or others. OBJECTIVES To assess the effects of advocacy interventions within or outside healthcare settings in women who have experienced intimate partner abuse. SEARCH METHODS In April 2015, we searched CENTRAL, Ovid MEDLINE, EMBASE, and 10 other databases. We also searched WHO ICTRP, mRCT, and UK Clinical Research Network (UKCRN), and examined relevant websites and reference lists with forward citation tracking of included studies. For the original review we handsearched six key journals. We also contacted first authors of eligible papers and experts in the field. SELECTION CRITERIA Randomised or quasi‐randomised controlled trials comparing advocacy interventions for women with experience of intimate partner abuse versus no intervention or usual care (if advocacy was minimal and fewer than 20% of women received it). DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias and undertook data extraction. We contacted authors for missing information needed to calculate statistics for the review and looked for adverse events. MAIN RESULTS We included 13 trials involving 2141 participants aged 15 to 65 years, frequently having low socioeconomic status. The studies were quite heterogeneous in terms of methodology, study processes and design, including with regard to the duration of follow‐up (postintervention to three years), although this was not associated with differences in effect. The studies also had considerable clinical heterogeneity in relation to staff delivering advocacy; setting (community, shelter, antenatal, healthcare); advocacy intensity (from 30 minutes to 80 hours); and abuse severity. Three trials evaluated advocacy within multi‐component interventions. Eleven measured some form of abuse (eight scales), six assessed quality of life (three scales), and six measured depression (three scales). Countries and ethnic groups varied (one or more minority ethnic groups in the USA or UK, and local populations in Hong Kong and Peru). Setting was associated with intensity and duration of advocacy. Risk of bias was high in five studies, moderate in five, and low in three. The quality of evidence (considering multiple factors such as risk of bias, study size, missing data) was moderate to low for brief advocacy and very low for intensive advocacy. Incidence of abuse Physical abuse Moderate quality pooled data from two healthcare studies (moderate risk of bias) and one community study (low risk of bias), all with 12‐month follow‐up data, showed no effect on physical abuse for brief (< 12 hours) advocacy interventions (standardised mean difference (SMD) 0.00, 95% confidence interval (CI) ‐ 0.17 to 0.16; n = 558). One antenatal study (low risk of bias) showed an association between brief advocacy and reduced minor physical abuse at one year (mean difference (MD) change ‐ 1.00, 95% CI ‐ 1.82 to ‐ 0.18; n = 110). An antenatal, multi‐component study showed a greater likelihood of physical abuse ending (odds ratio (OR) 0.42, 95% CI 0.23 to 0.75) immediately after advocacy (number needed to treat (NNT) = 8); we cannot exclude impact from other components. Low to very low quality evidence from two intensive advocacy trials (12 hours plus duration) showed reduced severe physical abuse in women leaving a shelter at 24 months (OR 0.39, 95% CI 0.20 to 0.77; NNT = 8), but not at 12 or 36 months. Sexual abuse Meta‐analysis of two studies (n = 239) showed no effect of advocacy on sexual abuse (SMD ‐ 0.12, 95% CI ‐ 0.37 to 0.14), agreeing with the change score (MD ‐ 0.07, 95% CI ‐ 0.30 to 0.16) from a third study and the OR (0.96, 95% CI 0.44 to 2.12) from a fourth antenatal, multi‐component study. Emotional abuse One study in antenatal care, rated at low risk of bias, showed reduced emotional abuse at ≤ 12‐month follow‐up (MD (change score) ‐ 4.24, 95% CI ‐ 6.42 to ‐ 2.06; n = 110). Psychosocial health Quality of life Meta‐analysis of two studies (high risk of bias) showed intensive advocacy slightly improved overall quality of life of women recruited from shelters (MD 0.23, 95% CI 0.00 to 0.46; n = 343) at 12‐month follow‐up, with greater improvement in perceived physical quality of life from a primary care study (high risk of bias; MD 4.90, 95% CI 0.98 to 8.82) immediately postintervention. Depression Meta‐analysis of two studies in healthcare settings, one at high risk of bias and one at moderate risk, showed that fewer women developed depression (OR 0.31, 95% CI 0.15 to 0.65; n = 149; NNT = 4) with brief advocacy. One study at high risk of bias reported a slight reduction in depression in pregnant women immediately after the intervention (OR 0.51, 95% CI 0.20 to 1.29; n = 103; NNT = 8). There was no evidence that intensive advocacy reduced depression at ≤ 12‐month follow‐up (MD ‐ 0.14, 95% CI ‐ 0.33 to 0.05; 3 studies; n = 446) or at two years (SMD – 0.12, 95% CI – 0.36 to 0.12; 1 study; n = 265). Adverse effects Two women died, one who was murdered by her partner and one who committed suicide. No evidence links either death to study participation. AUTHORS' CONCLUSIONS Results suggest some benefits from advocacy. However, most studies were underpowered. Clinical and methodological heterogeneity largely precluded pooling of trials. Therefore, there is uncertainty about the magnitude of benefit, the impact of abuse severity, and the setting. Based on the evidence reviewed, intensive advocacy may improve short‐term quality of life and reduce physical abuse one to two years after the intervention for women recruited from domestic violence shelters or refuges. Brief advocacy may provide small short‐term mental health benefits and reduce abuse, particularly in pregnant women and for less severe abuse. Plain language summary LIMITED EVIDENCE AND LIMITED EFFECTS OF ADVOCACY TO REDUCE INTIMATE PARTNER VIOLENCE The Campbell review in brief Intensive advocacy may improve everyday life for women in domestic violence shelters/refuges and reduce physical abuse. There is no clear evidence that intensive advocacy reduces sexual, emotional, or overall abuse, or that it benefits women's mental health. It is unclear whether brief advocacy is effective. What is this review about? Partner abuse or domestic violence is common worldwide. It includes physical, emotional, and sexual abuse; threats; withholding money; causing injury; and long lasting physical and emotional health problems. Active support by trained people, which is called ‘advocacy‘, may help women make safety plans, deal with abuse, and access community resources. Advocacy may be a stand‐alone service, accepting referrals from healthcare providers, or part of a multi‐component, and possibly multi‐agency, intervention. It may take place in the community, a shelter, or as part of antenatal or other healthcare, and vary in intensity from less than an hour to 80 hours. Advocacy may contribute to reducing abuse, empowering women to improve their situation by providing informal counselling and support for safety planning and increasing access to different services. What is the aim of this review? This Campbell systematic review assesses the effects of advocacy interventions on intimate partner violence and women's wellbeing. The review summarizes findings from 13 studies. What studies are included in this review? This review summarizes evidence from 13 clinical trials comparing advocacy for 1,241 abused women with no care or usual care. Most studies followed up on the women for at least a year. Does advocacy reduce intimate partner violence and improve women's wellbeing? Physical abuse: After one year, brief advocacy had no effect in two healthcare studies and one community study, but it reduced minor abuse in one antenatal care study. Another antenatal study showed reduced abuse immediately after brief advocacy, but women were also treated for depression, which may have affected results. Two studies provided weak evidence that intensive advocacy reduces physical abuse up to two years after the intervention. Sexual abuse was reported in four studies that found no effects. Emotional abuse: One antenatal care study reported reduced emotional abuse at 12 months after advocacy. Depression: Brief advocacy prevented depression in abused women attending healthcare services and pregnant women immediately after advocacy. Intensive advocacy did not reduce depression in shelter women followed up at 12 and 24 months. The moderate‐to‐low quality evidence came mostly from studies with a low risk of bias. Quality of life: Three trials of brief advocacy trials no benefit on quality of life. Intensive advocacy showed a weak benefit in two studies in domestic violence shelters/refuges, and a primary care study showed improved motivation to do daily tasks immediately after advocacy. What do the results mean? Intensive advocacy may improve everyday life for women in domestic violence shelters/refuges in the short term and reduce physical abuse one to two years after the intervention. There is no clear evidence that intensive advocacy reduces sexual, emotional, or overall abuse, or that it benefits women's mental health. It is unclear whether brief advocacy is effective, although it may provide short‐term mental health benefits and reduce abuse, particularly in pregnant women and those suffering less severe abuse. Several studies summarised in this review are potentially biased because of weak study designs. There was little consistency between studies, with variations in the amount of advocacv given, the type of benefits measured, and the lengths of follow‐up periods, making it hard to combine their results. So it is not possible to be certain how much or which type of advocacy interventions benefit women. How up to date is this review? The search for this review was updated in April 2015, and the review published in January 2016. What is the Campbell Collaboration? The Campbell Collaboration is an international, voluntary, non‐profit research network that publishes systematic reviews. We summarise and evaluate the quality of evidence about programmes in social and behavioural sciences. Our aim is to help people make better choices and better policy decisions. About this summary This summary was prepared by Howard White (Campbell Collaboration) and is based on the Campbell Systematic Review 2016:02 ‘Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well‐being of women who experience intimate partner abuse’ by Carol Rivas, Jean Ramsay, Laura Sadowski, Leslie L Davidson, Danielle Dunne, Sandra Eldridge, Kelsey Hegarty, Angela Taft, Gene Feder. Anne Mellbye (R‐BUP) designed the summary, which was edited and produced by Tanya Kristiansen (Campbell Collaboration).

BackgroundLung cancer symptoms are vague and difficult to detect. Interventions are needed to promote early diagnosis, however health services are already pressurised. This study explored symptomology and help-seeking behaviours of primary care patients at 'high-risk' of lung cancer (≥50 years old, recent smoking history), to inform targeted interventions.MethodsMixed method study with patients at eight general practitioner (GP) practices across south England. Study incorporated: postal symptom questionnaire; clinical records review of participant consultation behaviour 12 months pre- and post-questionnaire; qualitative participant interviews (n = 38) with a purposive sample.ResultsA small, clinically relevant group (n = 61/908, 6.7%) of primary care patients was identified who, despite reporting potential symptoms of lung cancer in questionnaires, had not consulted a GP ≥12 months. Of nine symptoms associated with lung cancer, 53.4% (629/1172) of total respondents reported ≥1, and 35% (411/1172) reported ≥2. Most participants (77.3%, n = 686/908) had comorbid conditions; 47.8%, (n = 414/908) associated with chest and respiratory symptoms. Participant consulting behaviour significantly increased in the 3-month period following questionnaire completion compared with the previous 3-month period (p = .002), indicating questionnaires impacted upon consulting behaviour. Symptomatic non-consulters were predominantly younger, employed, with higher multiple deprivation scores than their GP practice mean. Of symptomatic non-consulters, 30% (18/61) consulted ≤1 month post-questionnaire, with comorbidities subsequently diagnosed for five participants. Interviews (n = 39) indicated three overarching differences between the views of consulting and non-consulting participants: concern over wasting their own as well as GP time; high tolerance threshold for symptoms; a greater tendency to self-manage symptoms.ConclusionsThis first study to examine symptoms and consulting behaviour amongst a primary care population at 'high- risk' of lung cancer, found symptomatic patients who rarely consult GPs, might respond to a targeted symptom elicitation intervention. Such GP-based interventions may promote early diagnosis of lung cancer or other comorbidities, without burdening already pressurised services.

Background Equity of service provision by age, ethnicity and sex is a key aim of Government policy in the UK. The prevalence, natural history and management of common chronic conditions, such as diabetes and hypertension, vary between ethnic groups. Developing and monitoring responsive local services requires accurate measures of ethnicity and language needs. Hence establishing the ethnic composition of GP populations is important. Objective To compare three methods of estimating the ethnic composition of GP registered populations in three east London primary care trusts (PCTs). Design Self-reported ethnicity, routinely collected at practice level (and considered the 'gold standard'), was compared with two indirect methods of attributing ethnicity. The indirect method currently used in the UK assigns ethnicity to GP populations based on geographical postcode attribution from the national census. A proposed alternative indirect method uses the ethnic breakdown of hospital admission data from practice lists to attribute ethnicity to the whole practice population. Comparisons were made between practice self-report recording and these two indirect methods. Bland_Altman plots were used to assess the agreement between methods of measurement. Results Data from 103 practices, covering 70% of the GP registered population, was used. The hospital admission method showed better agreement with practice self-report data than the census attributed method. For white populations Bland_Altman plots showed a mean difference of 1.4%(95% CI _14.9 to 17.7) between hospital admission and practice data, and a mean difference of 12.5% (95% CI _6.2 to 31.1) between census attributed and practice data. Differences were also found for south Asian and black populations. Conclusion Practice ethnicity measured using hospital attendance data is in closer agreement with practice recording of self-reported ethnicity than the census attribution method. Census attribution may provide misleading information on the ethnic composition of practice populations. We recommend that healthcare commissioners change to this method of measurement when practice self-report data is not available.

The World Health Organisation estimates that between 10% and 50% of women worldwide report having been assaulted physically or sexually by an intimate partner at some time in their lives, and when threats, financial and emotional abuse are included the prevalence rates are even higher. Abused women can suffer injury and long‐lasting physical and emotional health problems. One form of interventionto assist these women is advocacy. Advocacy interventions aim to help abused women directly by providing them with information and support to facilitate access to community resources. However, before recommending them to health policy makers we need to know whether they improve the health and well‐being of abused women. In other words, are advocacy interventions effective? After searching the world literature for randomised controlled trials evaluating advocacy programmes for abused women, we found ten trials, involving 1,527 women. The studies comparing advocacy with “usual care” were conducted in a variety of settings both within and outside of healthcare. Participants were recruited from diverse ethnic populations and across a wide age range (15‐61 years), but manyhad a relatively deprived socioeconomic status. Most were experiencing current, often severe, abuse. All of the interventions sought to empower the women by helping them to achieve their goals. They differed in: duration (from 30 minutes to 80 hours), the outcomes reported, and the length of time the women were followed up. The evidence is consistent with intensive advocacy decreasing physical abuse more than one to two years after the intervention for women already in refuges, but there is inconsistent evidence for a positive impact on emotional abuse. Similarly, there is equivocal evidence for the positive effects of intensive advocacy on depression, quality of life and psychological distress. There is evidence that brief advocacy increases the use of safety behaviours by abused women. Taken as a whole, we conclude that at present there is equivocal evidence to determine whether intensive advocacy for women recruited in domestic violence shelters or refuges has a beneficial effect on their physical and psychosocial well‐being. Further, we do not know if less intensive interventions in healthcare settings are effective for women who still live with abusive partners. Too few studies evaluated interventions of comparable intensity and duration, measured the same outcomes, or had comparable follow‐up periods.

The World Health Organisation estimates that between 10% and 50% of women worldwide report having been assaulted physically or sexually by an intimate partner at some time in their lives, and when threats, financial and emotional abuse are included the prevalence rates are even higher. Abused women can suffer injury and long‐lasting physical and emotional health problems. One form of interventionto assist these women is advocacy. Advocacy interventions aim to help abused women directly by providing them with information and support to facilitate access to community resources. However, before recommending them to health policy makers we need to know whether they improve the health and well‐being of abused women. In other words, are advocacy interventions effective? After searching the world literature for randomised controlled trials evaluating advocacy programmes for abused women, we found ten trials, involving 1,527 women. The studies comparing advocacy with “usual care” were conducted in a variety of settings both within and outside of healthcare. Participants were recruited from diverse ethnic populations and across a wide age range (15‐61 years), but manyhad a relatively deprived socioeconomic status. Most were experiencing current, often severe, abuse. All of the interventions sought to empower the women by helping them to achieve their goals. They differed in: duration (from 30 minutes to 80 hours), the outcomes reported, and the length of time the women were followed up. The evidence is consistent with intensive advocacy decreasing physical abuse more than one to two years after the intervention for women already in refuges, but there is inconsistent evidence for a positive impact on emotional abuse. Similarly, there is equivocal evidence for the positive effects of intensive advocacy on depression, quality of life and psychological distress. There is evidence that brief advocacy increases the use of safety behaviours by abused women. Taken as a whole, we conclude that at present there is equivocal evidence to determine whether intensive advocacy for women recruited in domestic violence shelters or refuges has a beneficial effect on their physical and psychosocial well‐being. Further, we do not know if less intensive interventions in healthcare settings are effective for women who still live with abusive partners. Too few studies evaluated interventions of comparable intensity and duration, measured the same outcomes, or had comparable follow‐up periods. Abstract BACKGROUND Intimate partner abuse is common in all societies and damages the health of survivors and their children in the short and long term. Advocacy may decrease the impact of this abuse on women's health. OBJECTIVES To assess the effects of advocacy interventions conducted within or outside of health care settings on women who have experienced intimate partner abuse. SEARCH METHODS We searched: CENTRAL and DARE (Cochrane Library Issue 3, 2008), MEDLINE (1966 to 31/7/08), EMBASE (1980 to 2008 week 30), and 11 other databases, to end July 2008. We also searched relevant websites, reference lists and forward citation tracking of included studies, and handsearched six key journals. We contacted principal investigators and experts in the field. SELECTION CRITERIA Randomised controlled trials comparing advocacy interventions for women with experience of intimate partner abuse against usual care. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and undertook data extraction. For binary outcomes we calculated a standardised estimation of the odds ratio (OR) and for continuous data we calculated either a standardised mean difference (SMD) or a weighted mean difference (WMD), both with a 95% confidence interval. RESULTS We included ten trials involving 1527 participants. The studies were heterogeneous in respect of: intensity of advocacy, outcome measures and duration of follow‐up (immediately post‐intervention to three years), permitting meta‐analysis for only a minority of outcomes. Intensive advocacy (12 hours or more duration) may help terminate physical abuse in women leaving domestic violence shelters or refuges at 12‐24 months follow‐up (OR 0.43, 95% CI 0.23 to 0.80), but not at up to 12 months follow‐up. The evidence indicates that intensive advocacy may improve quality of life at up to 12 months follow‐up, but the confidence intervals included zero (WMD 0.23, 95% CI 0.00 to 0.46). Depression did not improve following intensive advocacy at up to 12 months follow‐up (WMD ‐0.05, 95% CI ‐0.19 to 0.09), nor did psychological distress (SMD ‐0.16, 95% CI ‐0.39 to 0.06). Only two meta‐analyses of brief advocacy interventions (less than 12 hours duration) were possible; an increased use of safety behaviours was consistent with the receipt of brief advocacy both at up to 12 months (WMD 0.60, 95% CI 0.14 to 1.06) and at 12‐24 months (WMD 0.48, 95% CI 0.04 to 0.92) follow up. AUTHORS’ CONCLUSIONS Based on the evidence reviewed, it is possible that intensive advocacy for women recruited in domestic violence shelters or refuges reduces physical abuse one to two years after the intervention but we do not know if it has a beneficial effect on their quality of life and mental health. Similarly, there is insufficient evidence to show if less intensive interventions in healthcare settings for women who still live with the perpetrators of violence are effective.

Background: Gamification techniques are showing promise in promoting healthy behaviours and delivering health promotion advice, however, their use in Mobile-Health is relatively new. Gamification involves using ‘gaming’ elements such as badges, leader boards, health-related challenges, rewards, ability to ‘level up’ and use of avatars to motivate and engage people to change health behavior. Gamification techniques may also overlap with validated health behaviour change techniques (BCTs), however, few apps appear to apply the techniques systematically or to define the BCTs they include. Aim: We aimed a) to assess the number apps that incorporate gamification to modify health behaviors, b) to examine the BCT repertoire and combinations used in these apps c) to consider associations with user satisfaction. Methods: English-language health apps that contain gamification techniques were identified through a systematic search of the official Apple and Google Play store and the NHS health apps library. Top rated free and paid Medical, Health & Wellness, Health & Fitness apps as defined by Apple and Google Play stores were searched. Apps were coded for BCTs according to the Michie et al. taxonomy. The taxonomy comprises 16 categories and 93 individual BCTs. BCT coding was conducted by two trained researchers (EE, JL) who scored independently and then cross-checked for discrepancies. BCT numbers, user ratings and app pricing were compared. We explored the association between number of BCTs per app, user and NHS libraries’ ratings and price. We also investigated, which of the 16 BCT categories and the individual 93 BCTs and their combinations were most commonly used. Results: 1,680 Medical, Health & Wellness or Health & Fitness Apps were reviewed and seventy containing gamification techniques were identified. The mean number of BCTs used was 12.5 (range 1-24). There was no correlation between number of BCTs, customer ratings, NHS library app rating or pricing. Commonly used BCT categories were: feedback & monitoring, reward & threat, goals & planning and comparison of behaviour. Commonly used individual BCTs were: self-monitoring of behaviour, non-specific reward, social support unspecified and non-specific incentive. Common combinations of BCTs were a) goal setting, self-monitoring and focus on past success b) goal setting, self-monitoring, non-specific reward and non-specific incentive. Only four apps were included in the NHS library. Conclusion: Our systematic review of smartphone health apps from two major providers suggests that gamification in Mobile-Health is relatively underused and there was wide variation in the use of BCTs. Whilst our data suggest that app designers are making some use of BCTs, as all apps contained at least one technique, many health apps underutilize them thus limiting the potential to modify health behaviour. In addition, there appears to be no correlation between what users rate as a good app (a possible proxy for the app having health benefits), and the app’s content and potential ability to modify health behaviour. We suggest that app designers should work collaboratively with public health practitioners, health psychologists and with users to ensure that apps incorporate appropriate BCTs together with gamification in order to modify health behavior more effectively, to enhance user retention and to increase user enjoyment/ratings. Further research and clinical evaluation is needed for health care apps to evaluate their effectiveness in modifying actual health behavior and clinical outcomes. There is also a need for regulation of Health Care apps to ensure patients are given access to apps, which are safe and have proven benefit to health. Greater use of gamification and behavior change techniques could provide a potentially cost effective platform for health behaviour change and health promotion and have enormous Public Health impact.

Introduction: We investigated the effects on collaborative work within the UK National Health Service (NHS) of an intervention for service quality improvement: informal, structured, reciprocated, multidisciplinary peer review with feedback and action plans. The setting was care for chronic obstructive pulmonary disease (COPD). Theory and methods: We analysed semi-structured interviews with 43 hospital respiratory consultants, nurses and general managers at 24 intervention and 11 control sites, as part of a UK randomised controlled study, the National COPD Resources and Outcomes Project (NCROP), using Scott's conceptual framework for action (inter-organisational, intra-organisational, inter-professional and inter-individual). Three areas of care targeted by NCROP involved collaboration across primary and secondary care. Results: Hospital respiratory department collaborations with commissioners and hospital managers varied. Analysis suggested that this is related to team responses to barriers. Clinicians in unsuccessful collaborations told 'atrocity stories' of organisational, structural and professional barriers to service improvement. The others removed barriers by working with government and commissioner agendas to ensure continued involvement in patients' care. Multidisciplinary peer review facilitated collaboration between participants, enabling them to meet, reconcile differences and exchange ideas across boundaries. Conclusions: The data come from the first randomised controlled trial of organisational peer review, adding to research into UK health service collaborative work, which has had a more restricted focus on inter-professional relations. NCROP peer review may only modestly improve collaboration but these data suggest it might be more effective than top-down exhortations to change when collaboration both across and within organisations is required.