Trisha Greenhalgh
Dados Biográficos
| ID | 105816 |
|---|---|
| NOME | Trisha Greenhalgh |
| PRENOMES | Trisha |
| SOBRENOME | Greenhalgh |
| ASSINATURA | GREENHALGH T |
| AFILIAÇÕES | University of Oxford |
| ORCID | 0000-0003-2369-8088 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 93 |
| TOTAL DE CITAÇÕES | 391 |
| TOTAL COMO AUTOR | 93 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 1987 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2026 |
| ÍNDICE H | 11 |
The randomised controlled trial as cultural product
In the epistemic tradition of evidence-based medicine (EBM), the randomised controlled trial (RCT) is the best design for assessing the efficacy of an intervention. Other traditions question whether and for what questions the RCT is the “gold standard” and the extent to which the findings of other research designs should inform, complement or replace the RCT. These epistemic differences have played out in the controversy around the efficacy of fa…
Toxic experts in longevity business
In this paper, we introduce and theorize the concept of toxic experts as individuals who, by virtue of their perceived or actual expertise, systematically engage in behaviors characterized by professional and intellectual vices. Despite maintaining an appearance of legitimacy, toxic experts exploit public trust by disseminating unsubstantiated, misleading, or harmful claims for personal and commercial gain. Drawing on a multidisciplinary framewor…
Remote Access to Primary Care
The use of digital technology to facilitate remote access to care can increase inequalities, especially for people with complex health and social care needs. Care navigation, human input to support access, is one potential solution. We aimed to understand how care navigation is practised in the context of increasing remote access in primary care in the United Kingdom. We used the concepts of social navigation and infrastructure to analyse empiric…
When trial interventions are likely to reduce the impact of rape myths on juror decisions
Research suggests that there is, at least, a risk that problematic viewpoints about rape (and other serious sexual offences) (rape myths) are influencing decisions made by jurors in cases involving alleged sexual offending. Research has examined whether any impact of such viewpoints can be minimised through providing correct information to jurors, either through judicial directions or expert testimony. However, findings in this research appear in…
Reflexive Qualitative Research and Generative AI
Recent debates on generative artificial intelligence (AI) in qualitative research have been framed in increasingly polarized terms, positioning researchers as uncritical adopters or principled refusers. Drawing on recent position statements and editorial guidance, this article argues that such binary framing is unhelpful. While endorsing core concerns about meaning-making, reflexivity, bias, and environmental harm, it suggests that these concerns…
Trust in Transition
BACKGROUND: New drugs and vaccines usually come with the promise and hope of benefit. We explore stories about the variable and sometimes disappointing effects of Covid-19 vaccines in the context of post-Covid-19 syndrome ('long Covid'), aiming to understand how people with long Covid made sense of unexpected vaccine responses and how these experiences impacted their trust in vaccination. METHODS: We carried out 33 interviews with people who desc…
Missed SDG targets
This article explores a radical hypothesis: that our repeated failure to achieve the Sustainable Development Goals (SDGs) signals something inherently paradoxical within the current approach, suggesting that simply doing ‘more of the same’ will not transform the fortunes of the failing SDG mission. We examine four interrelated paradoxes – those of universality, implementation, information, and signification – that characterize the dominant approa…
Educating healthcare students in the Sustainable Development Goals
Healthcare courses typically approach Sustainable Development Goals (SDGs) education from a 'translational science' perspective. Students are taught about 'evidence-based' interventions, which are developed through scientific research (hence, assumed to be politically neutral), implemented with 'fidelity' (ie, in a standardised way in diverse contexts) and then 'rolled out'. Progress is measured using standardised indicators. We argue for a shift…
Daily stress and worry are additional triggers of symptom fluctuations in individuals living with Long Covid
BACKGROUND: Recent research has shown that exertion in physical, cognitive, social, and self-care activities triggers symptom severity in individuals with Long COVID. PURPOSE: The current study aimed to investigate whether daily emotional exertions (stress, worry, rumination) were associated with symptom exacerbation, over and above influences of effortful daily activities, in individuals with Long COVID. METHODS: In total, 376 participants were …
Airborne infection prevention and control implementation
There are many examples of poor TB infection prevention and control (IPC) implementation in the academic literature, describing a high-risk environment for nosocomial spread of airborne diseases to patients and health workers. We developed a positive deviant organisational case study drawing on Weick's theory of organisational sensemaking. We focused on a district hospital in the rural Eastern Cape, South Africa and used four primary care clinics…
Pragmatism and crisis
Theorising Support for Interdisciplinary Early-Career Researchers Using Communicative Genre and 'Rules of the Game
Qualitative social scientists working in medical faculties have to meet multiple expectations. On the one hand, they are expected to comply with the philosophical and theoretical expectations of the social sciences. On the other hand, they may also be expected to produce publications which align with biomedical definitions and framings of quality. As interdisciplinary scholars, they must handle (at least) two sets of journal editors, peer reviewe…
What does social prescribing look like in practice? A qualitative case study informed by practice theory
Access and triage in contemporary general practice
To access contemporary healthcare, patients must find and navigate a complex socio-technical network of human and digital actors linked in multi-modal pathways. Asynchronous, digitally-mediated triage decisions have largely replaced synchronous conversations between humans. In this paper, we draw on a large qualitative dataset from a multi-site study of remote and digital technologies in general practice to understand widening inequities of acces…
Working knowledge, uncertainty and ontological politics
Long covid (persistent COVID-19) is a new disease with contested aetiology and variable prognosis. We report a 2-year ethnography of UK long covid clinics. Using a preformative lens, we show that multidisciplinary teams (MDTs) built working knowledge based on shared practices, mutual trust, distributed cognition (e.g. emails, record entries), relational knowledge of what was at stake for the patient, and harnessing uncertainty to open new discurs…
The reflexive imperative in the digital age
Reflexivity', as used by Margaret Archer, means creative self-mastery that enables individuals to evaluate their social situation and act purposively within it. People with complex health and social needs may be less able to reflect on their predicament and act to address it. Reflexivity is imperative in complex and changing social situations. The substantial widening of health inequities since the introduction of remote and digital modalities in…
Towards evidence-based and inclusive models of peer support for long covid
A contemporary ontology of continuity in general practice
Ethnographic closeness
With the reflexive turn in the social sciences, emotional engagement is an inevitable and crucial part of data-gathering and analysis. However, there is a glaring gap in methodological discussions to this end. Presenting ethnographic research into end of life with people living at home in England with heart failure, we argue for a methodological blend of engagement and detachment that shifts throughout the research process, and that sensory exper…
Health worker experiences of implementing TB infection prevention and control
Implementation of TB infection prevention and control (IPC) measures in health facilities is frequently inadequate, despite nosocomial TB transmission to patients and health workers causing harm. We aimed to review qualitative evidence of the complexity associated with implementing TB IPC, to help guide the development of TB IPC implementation plans. We undertook a qualitative evidence synthesis of studies that used qualitative methods to explore…
What does the literature mean by social prescribing? A critical review using discourse analysis
Social prescribing (SP) seeks to enhance the role of the voluntary and community sector in addressing patients' complex needs in primary care. Using discourse analysis, this review investigates how SP is framed in the scientific literature and explores its consequences for service delivery. Theory driven searches identified 89 academic articles and grey literature that included both qualitative and quantitative evidence. Across the literature thr…
The science-policy relationship in times of crisis
In this conceptual paper, we argue that at times of crisis, what is sometimes called "evidence-based" or "science-driven" policymaking-establishing scientific truths and then implementing them-must be tempered by a more agile, deliberative and inclusive approach which acknowledges and embraces uncertainty. We offer pragmatism as one potential option, using examples from the UK to illustrate how such an approach might have changed particular crisi…
Theorising the shift to video consulting in the UK during the Covid-19 pandemic
We studied video consulting in the National Health Service during 2020-2021 through video interviews, an online survey and online discussions with people who had provided and participated in such consultations. Video consulting had previously been used for selected groups in limited settings in the UK. The pandemic created a seismic shift in the context for remote consulting, in which video transformed from a niche technology typically introduced…
Why doesn't integrated care work? Using Strong Structuration Theory to explain the limitations of an English case
Integrated care is an aim and a method for organising health and care services, particularly for older people and those with chronic conditions. Policy expects that integrated care programmes will provide person-centred coordinated care which will improve patient or client experience, enable population health, prevent hospital admissions and thereby reduce costs. However, empirical evaluations of integrated care interventions have shown disappoin…
Interrogating the promise of technology in epilepsy care
Technology development is gathering pace in epilepsy with seizure detection devices promising to transform self‐care and service provision. However, such accounts often neglect the uncertainties, displacements and responsibilities that technology‐supported care generates. This review brings together a heterogeneous literature, identified through systematic searches in 8 databases and snowball searching, to interrogate how technology becomes posit…
Theorising big IT programmes in healthcare
Drug prescription and self-medication in India
Communicative and strategic action in interpreted consultations in primary health care
What matters to older people with assisted living needs? A phenomenological analysis of the use and non-use of telehealth and telecare
Telehealth and telecare research has been dominated by efficacy trials. The field lacks a sophisticated theorisation of [a] what matters to older people with assisted living needs; [b] how illness affects people's capacity to use technologies; and [c] the materiality of assistive technologies. We sought to develop a phenomenologically and socio-materially informed theoretical model of assistive technology use. Forty people aged 60-98 (recruited v…
Long Covid - The illness narratives
Whose turn is it anyway? Latency and the organization of turn-taking in video-mediated interaction
Latency in video-mediated interaction can frustrate smooth turn-taking: it may cause participants to perceive silence at points where talk should occur, it may cause them to talk in overlap, and it impedes their ability to return to one-speaker-at-a-time. Whilst potentially frustrating for participants, this makes video-mediated interaction a perspicuous setting for the study of social interaction: it is an environment that nurtures the occurrenc…
Best research - For what? Best health - For whom? A critical exploration of primary care research using discourse analysis
Food beliefs and practices among British Bangladeshis with diabetes
In order successfully to promote 'healthier' food choices, health professionals must first understand how people classify and select the foods they eat. We explored the food beliefs and classification system of British Bangladeshis by means of qualitative interviews with 40 first-generation adult immigrants with diabetes. Methods included audiotaped, unstructured narrative interview in which participants were invited to 'tell the story' of how di…
The science-policy relationship in times of crisis
In this conceptual paper, we argue that at times of crisis, what is sometimes called "evidence-based" or "science-driven" policymaking-establishing scientific truths and then implementing them-must be tempered by a more agile, deliberative and inclusive approach which acknowledges and embraces uncertainty. We offer pragmatism as one potential option, using examples from the UK to illustrate how such an approach might have changed particular crisi…
Choose and Book
In 2004, the English Department of Health introduced a technology (Choose and Book) designed to help general practitioners and patients book hospital outpatient appointments. It was anticipated that remote booking would become standard practice once technical challenges were overcome. But despite political pressure and financial incentives, Choose and Book remained unpopular and was generally used reluctantly if at all. Policymakers framed this a…
Interpreted consultations as 'business as usual'? An analysis of organisational routines in general practices
UK general practices operate in an environment of high linguistic diversity, because of recent large-scale immigration and of the NHS's commitment to provide a professional interpreter to any patient if needed. Much activity in general practice is co-ordinated and patterned into organisational routines (defined as repeated patterns of interdependent actions, involving multiple actors, bound by rules and customs) that tend to be stable and to pers…
Realist RCTs of complex interventions - An oxymoron
Why doesn't integrated care work? Using Strong Structuration Theory to explain the limitations of an English case
Integrated care is an aim and a method for organising health and care services, particularly for older people and those with chronic conditions. Policy expects that integrated care programmes will provide person-centred coordinated care which will improve patient or client experience, enable population health, prevent hospital admissions and thereby reduce costs. However, empirical evaluations of integrated care interventions have shown disappoin…
Achieving and sustaining profound institutional change in healthcare
Plus ça change, plus c'est la même chose
The UK National Health Service (NHS) is regularly restructured. Its smooth operation and organisational memory depends on the insights and capability of managers, especially those with experience of previous transitions. Narrative methods can illuminate complex change from the perspective of key actors. We used an adaptation of Wengraf's biographical narrative life interview method to explore how 20 senior NHS managers (chief executives, director…
Looking for a better future
"I don't know how I'm still standing" a Bakhtinian analysis of social housing and health narratives in East London
The view from nowhere? How think tanks work to shape health policy
Think tanks seek to shape the business of government by offering policy expertise in a number of areas, including health care.This expertise tends to be presented as 'the view from nowhere'independent, value-neutral expertise that can inform policy.We challenge this view by examining what 'independence' means and how it is performed.We present an interpretive policy analysis of data collected from four UK-based think tanks that have sought to inf…
Care organising technologies and the post-phenomenology of care
Care organising technologies are software applications that are intended primarily for informal carers, to help organise, document and coordinate caring work. These may be purchased privately or provided as part of state support. Take-up to date remains low. Based on empirical case studies of three such technologies and drawing on post-phenomenology and political science, we examined people's experience of caring when caring technologies find a w…
Childhood obesity in transition zones
Childhood obesity is particularly prevalent in areas that have seen rapid economic growth, urbanisation, cultural transition, and commodification of food systems. Structuration theory may illuminate the interaction between population and individual-level causes of obesity. We conducted in-depth ethnographies of six overweight/obese and four non-overweight preschool children in Hong Kong, each followed for 12-18 months. Analysis was informed by St…
What does social prescribing look like in practice? A qualitative case study informed by practice theory
A contemporary ontology of continuity in general practice
Ethnographic closeness
With the reflexive turn in the social sciences, emotional engagement is an inevitable and crucial part of data-gathering and analysis. However, there is a glaring gap in methodological discussions to this end. Presenting ethnographic research into end of life with people living at home in England with heart failure, we argue for a methodological blend of engagement and detachment that shifts throughout the research process, and that sensory exper…
Theorising the shift to video consulting in the UK during the Covid-19 pandemic
We studied video consulting in the National Health Service during 2020-2021 through video interviews, an online survey and online discussions with people who had provided and participated in such consultations. Video consulting had previously been used for selected groups in limited settings in the UK. The pandemic created a seismic shift in the context for remote consulting, in which video transformed from a niche technology typically introduced…
Clinical guidelines and the pursuit of reducing epistemic uncertainty. An ethnographic study of guideline development panels in three countries
Guideline development panels apply multiple - often conflicting - understandings of knowledge, inference and truth in an attempt to reduce epistemic uncertainty. Guidelines makers, clinicians, scientists and students should engage critically and reflexively with the philosophical assumptions that underpin guideline development and inductive inference to build capability to deal with clinical complexity
Drug prescription and self-medication in India
Culture, Religion and Childbearing in a Multiracial Society
Judith Schott, Alix Henley Butterworth-Heinemann, £19.99, pp 384 ISBN 0 7506 2050 1 “At a hospital that recorded Roman Catholics as RC and Protestants as P, and in the days when student nurses served meals, a ward sister challenged a student nurse about the way she was giving out breakfasts. She replied, ‘I look at their notes. If they are P I give them porridge and the RCs get rice crispies.’” This is one of many apocryphal stories of cultural a…
How to read a paper
Education and debateShould we screen for gestational diabetes?R J Jarrett wrote to us arguing that gestational diabetes was a muddled concept that provided uncertain benefits for mother and infant.We invited Richard Beard and colleagues to put the other side of the argument and make the case for screening all pregnant women for gestational diabetes
Health beliefs and folk models of diabetes in British Bangladeshis
OBJECTIVE: To explore the experience of diabetes in British Bangladeshis, since successful management of diabetes requires attention not just to observable behaviour but to the underlying attitudes and belief systems which drive that behaviour. DESIGN: Qualitative study of subjects' experience of diabetes using narratives, semi-structured interviews, focus groups, and pile sorting exercises. A new qualitative method, the structured vignette, was …
Why study narrative?
points: The processes of getting ill, being ill, getting better (or getting worse), and coping (or failing to cope) with illness, can all be thought of as enacted narratives within the wider narratives (stories) of people's lives. Narratives of illness provide a framework forapproaching a patient's problems holistically, and may uncover diagnostic and therapeutic options. Taking a history is an interpretive act; interpretation (the discernment of…
Narrative based medicine
points: Even "evidence based" clinicians uphold the importance of clinical expertise and judgment. Clinical method is an interpretive act which draws on narrative skills to integrate the overlapping stories told by patients, clinicians, and test results. The art of selecting the most appropriate medical maxim for a particular clinical decision is acquired largely through the accumulation of "case expertise" (the stories or "illness scripts" of pa…
Food beliefs and practices among British Bangladeshis with diabetes
In order successfully to promote 'healthier' food choices, health professionals must first understand how people classify and select the foods they eat. We explored the food beliefs and classification system of British Bangladeshis by means of qualitative interviews with 40 first-generation adult immigrants with diabetes. Methods included audiotaped, unstructured narrative interview in which participants were invited to 'tell the story' of how di…
The challenge of complexity in health care
This is the first in a series of four articles Across all disciplines, at all levels, and throughout the world, health care is becoming more complex. Just 30 years ago the typical general practitioner in the United Kingdom practised from privately owned premises with a minimum of support staff, subscribed to a single journal, phoned up a specialist whenever he or she needed advice, and did around an hour's paperwork per week. The specialist worke…
Coping with complexity
This is the last in a series of four articles Recent high profile scandals in the United Kingdom have highlighted the changing values by which the National Health Service is judged.1 The public expects, and the government has promised to deliver, a health service that is ever safer, constantly up to date, and focused on patients' changing needs. Successful health services in the 21st century must aim not merely for change, improvement, and respon…
'Health for me'
In this paper, we address what many health professionals see as a common, increasingly uncontainable and personally stressful problem: the beliefs, behaviour and expectations of the articulate, health-aware and information-rich middle-classes. We describe some fictitious case scenarios, which reflect real-life problems that we have encountered in clinical situations as a general practitioner (Greenhalgh) and psychiatrist (Wessely). The scenarios …
Diffusion of Innovations in Service Organizations
This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence‐based model for considering the diffusion of innovation…
Realist review - a new method of systematic review designed for complex policy interventions
Evidence-based policy is a dominant theme in contemporary public services but the practical realities and challenges involved in using evidence in policy-making are formidable. Part of the problem is one of complexity. In health services and other public services, we are dealing with complex social interventions which act on complex social systems-things like league tables, performance measures, regulation and inspection, or funding reforms. Thes…
Effectiveness and efficiency of search methods in systematic reviews of complex evidence
Storylines of research in diffusion of innovation
Using the online environment in assessment for learning
The development of e-learning has opened up new opportunities for innovation in assessment practices in higher education. This descriptive case study draws upon staff and student experiences of teaching and learning on a web-based Masters programme in primary health care to explore how specific features of the online environment can be exploited to promote assessment as part of learning. It begins by identifying different ways of conceptualising …
Communicative and strategic action in interpreted consultations in primary health care
Looking for a better future
Interpreted consultations as 'business as usual'? An analysis of organisational routines in general practices
UK general practices operate in an environment of high linguistic diversity, because of recent large-scale immigration and of the NHS's commitment to provide a professional interpreter to any patient if needed. Much activity in general practice is co-ordinated and patterned into organisational routines (defined as repeated patterns of interdependent actions, involving multiple actors, bound by rules and customs) that tend to be stable and to pers…
Best research - For what? Best health - For whom? A critical exploration of primary care research using discourse analysis
Evidence-Based Policymaking
The idea that policy should be based on best research evidence might appear to be self-evident. But a closer analysis reveals a number of problems and paradoxes inherent in the concept of “evidence-based policymaking.” The current conflict over evidence-based policymaking parallels a long-standing “paradigm war” in social research between positivist, interpretivist, and critical approaches. This article draws from this debate in order to inform t…
Tensions and Paradoxes in Electronic Patient Record Research
Context: The extensive research literature on electronic patient records (EPRs) presents challenges to systematic reviewers because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Methods: Using the meta‐narrative method and searching beyond the Medline‐indexed literature, this review used “conflicting” findings to address higher‐order questions about how researchers had di…
How Do You Modernize a Health Service? A Realist Evaluation of Whole‐Scale Transformation in London
Context: Large‐scale, whole‐systems interventions in health care require imaginative approaches to evaluation that go beyond assessing progress against predefined goals and milestones. This project evaluated a major change effort in inner London, funded by a charitable donation of approximately $21 million, which spanned four large health care organizations, covered three services (stroke, kidney, and sexual health), and sought to “modernize” the…
The English Surgeon
Private equity investment in banking organizations presents a unique opportunity for the private-equity fund to diversify its investment portfolio through entry into the banking industry and for banking organizations to gain access to additional sources of capital. A properly structured investment transaction can result in tremendous benefits to the parties involved and can strengthen the financial position of both the private equity firm and the…
‘Never heard of it’– Understanding the public’s lack of awareness of a new electronic patient record
Background The introduction of electronic patient records that are accessible by multiple providers raises security issues and requires informed consent – or at the very least, an opportunity to opt out. Introduction of the Summary Care Record (SCR) (a centrally stored electronic summary of a patient’s medical record) in pilot sites in the UK was associated with low awareness, despite an intensive public information programme that included letter…
Theorising big IT programmes in healthcare
Sociology (51 obras) · Medicine (43 obras) · Political science (43 obras) · Psychology (40 obras) · Computer Science (30 obras) · Public relations (21 obras) · Law (20 obras) · Epistemology (18 obras) · Health care (18 obras) · Nursing (17 obras)