Profile
Dr Antoinette Davey
Research Fellow
2753
+44 (0) 1392 722753
Smeall building JS03
Smeall Building, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
Overview
Antoinette completed her PhD in Medical Sciences at the University of Exeter in 2021 examining cyclical variations in patient-reported outcome measures across three chronic conditions (depression, osteoarthritis and asthma). Prior to this she worked for the Department of Primary Care in the Medical School on several GP patient survey projects, then on a number of studies on the Improving Patient Experience Programme Grant, before working on the CADENCE trial in 2015. In March 2020 she took a postdoctoral position project managing a NIHR-HS&DR grant entitled: The Effectivenes and cost effectiveness of community perinatal Mental health servIces (ESMI-II) in the Department of Psychology.
Qualifications
- BA (Hons) Psychology
- MSc Psychological Research Methods
- MPhil Psychology
- PhD in Medical Studies
- Cert in Transactional Analysis
Research group links
Research
Research interests
Antoinette’s research interests include primary health care provision for young adults aged between 16 and 24; experience and provision of health care for offenders in the community; and how patients’ evaluations of a consultation compare with their GP’s evaluation of the same consultation. She also has a keen interest in mental health, specifically the various methods of therapy available to patients. More recently Antoinette has a keen interest in the effects of the human biological rhythms on how patients experience their chronic condition, which is the focus of her PhD research.
Research projects
Antoinette has worked on four projects within the NIHR-funded IMPROVE (Improving patient experience) study. One project involved video-recording GP-patient consultations with a view to comparing both the patient’s and GP’s evaluation of that consultation. Following on from that another project involved conducting video elicitation interviews with a selection of patients following their videoed consultation to explore their evaluations further. The most recent project she was involved with was an exploratory trial investigating whether real-time feedback might be a feasible and acceptable means (with or without facilitated reflection) of identifying ways in which practices can improve patient experience. Prior to her PhD, she worked alongside Dr Suzanne Richards and Professor John Campbell on the CADENCE trial which is a pilot RCT assessing the acceptability, clinical and cost-effectiveness of Enhanced Psychological Care in cardiac rehabilitation services.
She is currently a postdoctoral research fellow working with Professor O'Mahen in the Department of Psychology managing a NIHR-HSDR funded project. The focus of this project is producing evidence of what types of community perinatal mental health teams are effective in improving mother and infant outcomes, and in what circumstances. This project is due to finish in May 2023.
Research networks
ISOQOL
Research grants
- 2020 Researcher-Led Initiative, University of Exeter
EREA grant looking at developing relationships between support services for pregnant women in domestic abuse situations who are under the care of perinatal mental health services - 0 Department of Health and Social Care Health and Wellbeing Fund
The project is designed to bring about system change that enables better and more equal access for children and families to health services from pre-conception to post-partum across Devon and Torbay, particularly for families who are the most disadvantaged and/or who experience the most complex needs.
Publications
Key publications | Publications by category | Publications by year
Publications by category
Journal articles
Abstract:
Development of a conceptual model for research on cyclical variation of patient reported outcome measurements (PROMs) in patients with chronic conditions: a scoping review.
Abstract:
Routine provision of feedback from patient-reported outcome measurements to healthcare providers and patients in clinical practice.
Abstract:
STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis
. Background
. Drug-related problems and potentially inappropriate prescribing impose a huge burden on patients and the health-care system. The most widely used tools for appropriate prescription in older adults in England and in other European countries are the Screening Tool of Older People’s Prescriptions (STOPP)/Screening Tool to Alert to the Right Treatment (START) tools. STOPP/START tools support medicines optimisation for older adults.
.
.
. Objectives
. To identify, test and refine the programme theories underlying how interventions based on the STOPP/START tools are intended to work, for whom, in what circumstances and why, as well as the resource use and cost requirements or impacts.
.
.
. Design
. A realist synthesis.
.
.
. Setting
. Primary care, hospital care and nursing homes.
.
.
. Patients
. Patients aged ≥ 65 years.
.
.
. Interventions
. Any intervention based on the use of the STOPP/START tools.
.
.
. Review methods
. Database and web-searching was carried out to retrieve relevant evidence to identify and test programme theories about how interventions based on the use of the STOPP/START tools work. A project reference group made up of health-care professionals, NHS decision-makers, older people, carers and members of the public was set up. In phase 1 we identified programme theories about STOPP/START interventions on how, for whom, in what contexts and why they are intended to work. We searched the peer-reviewed and grey literature to identify documents relevant to the research questions. We interviewed experts in the field in our reference group to gain input on our list of candidate context–mechanism–outcome configurations, to identify additional context–mechanism–outcome configurations and to identify additional literature and/or relevant concepts. In phase 2 we reviewed and synthesised relevant published and unpublished empirical evidence and tested the programme theories using evidence from a larger set of empirical studies.
.
.
. Results
. We developed a single logic model structured around three key mechanisms: (1) personalisation, (2) systematisation and (3) evidence implementation. Personalisation: STOPP/START-based interventions are based on shared decision-making, taking into account patient preferences, experiences and expectations (mechanisms), leading to increased patient awareness, adherence, satisfaction, empowerment and quality of life (outcomes). Systematisation: STOPP/START tools provide a standardised/systematic approach for medication reviews (mechanisms), leading to changes in professional and organisational culture and burden/costs (outcomes). Evidence implementation: delivery of STOPP/START-based interventions is based on the implementation of best evidence (mechanisms), reducing adverse outcomes through appropriate prescribing/deprescribing (outcomes). For theory testing, we identified 40 studies of the impact of STOPP/START-based interventions in hospital settings, nursing homes, primary care and community pharmacies. Most of the interventions used multiple mechanisms. We found support for the impact of the personalisation and evidence implementation mechanisms on selected outcome variables, but similar impact was achieved by interventions not relying on these mechanisms. We also observed that the impact of interventions was linked to the proximity of the selected outcomes to the intervention in the logic model, resulting in a clearer benefit for appropriateness of prescribing, adverse drug events and prescription costs.
.
.
. Limitations
. None of the available studies had been explicitly designed for evaluating underlying causal mechanisms, and qualitative information was sparse.
.
.
. Conclusions
. No particular configuration of the interventions is associated with a greater likelihood of improved outcomes in given settings.
.
.
. Study registration
. This study is registered as PROSPERO CRD42018110795.
.
.
. Funding
. This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 23. See the NIHR Journals Library website for further project information.
.
Abstract:
Assessing Patient-Centred Outcomes in Lateral Elbow Tendinopathy: a Systematic Review and Standardised Comparison of English Language Clinical Rating Systems
Abstract:
Assessing the effectiveness of Enhanced Psychological Care for patients with depressive symptoms attending cardiac rehabilitation compared with treatment as usual (CADENCE): a pilot cluster randomised controlled trial.
Abstract:
Enhanced psychological care in cardiac rehabilitation services for patients with new-onset depression: the CADENCE feasibility study and pilot RCT.
Abstract:
Rating Communication in GP Consultations: the Association Between Ratings Made by Patients and Trained Clinical Raters.
Abstract:
The Evaluation of Physicians' Communication Skills from Multiple Perspectives.
Abstract:
Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience
Abstract:
Investigating the meaning of 'good' or 'very good' patient evaluations of care in English general practice: a mixed methods study
Abstract:
Patients' use and views of real-time feedback technology in general practice.
Abstract:
Assessing the effectiveness of enhanced psychological care for patients with depressive symptoms attending cardiac rehabilitation compared with treatment as usual (CADENCE): study protocol for a pilot cluster randomised controlled trial.
Abstract:
Capturing patient experience: a qualitative study of implementing real-time feedback in primary care.
Abstract:
Test–retest stability of patient experience items derived from the national GP patient survey
Abstract:
The role of patient experience surveys in quality assurance and improvement: a focus group study in English general practice.
Abstract:
Web-based textual analysis of free-text patient experience comments from a survey in primary care.
Abstract:
Understanding high and low patient experience scores in primary care: analysis of patients' survey data for general practices and individual doctors.
Abstract:
Accessing primary care: a simulated patient study
Abstract:
Accessing primary care: a simulated patient study
Abstract:
Challenges to the credibility of patient feedback in primary healthcare settings: a qualitative study
Abstract:
Priorities for young adults when accessing UK primary care: literature review.
Abstract:
Trust, negotiation, and communication: young adults' experiences of primary care services.
Abstract:
Trust, negotiation, and communication: young adults’ experiences of primary care services
Young adulthood is an important transitional period during which there is a higher risk of individuals engaging in behaviours which could have a lasting impact on their health. Research has shown that young adults are the lowest responders to surveys about healthcare experiences and are also the least satisfied with the care they receive. However, the factors contributing to this reduced satisfaction are not clear. The focus of our research was to explore the needs and experiences of young adults around healthcare services with an aim of finding out possible reasons for lower satisfaction.
Methods
Twenty young adults were interviewed at GP surgeries and at a local young adult advice agency, exploring their experiences and use of primary care services. Interviews were analysed using thematic analysis.
Results
The use of primary care services varied amongst the young adult interviewees. Many interviewees reported positive experiences; those who did not linked their negative experiences to difficulties in negotiating their care with the health care system, and reported issues with trust, and communication difficulties. Most of the interviewees were unaware of the use of patient surveys to inform healthcare planning and delivery and were not inclined to take part, mainly because of the length of surveys and lack of interest in the topic area.
Conclusions
In order to effectively address the health needs of young adults, young adults need to be educated about their rights as patients, and how to most efficiently use primary care services. GPs should be alert to effective means of approaching and handling the healthcare needs of young adults. A flexible, varied approach is needed to gathering high quality data from this group in order to provide services with information on the changes necessary for making primary care services more accessible for young adults.
Abstract:
Priorities for young adults when accessing UK
primary care: literature review
Primary Care Research Group, University of Exeter Medical School, St Lukes Campus,
Exeter EX1 2LU, UK
This literature review focuses on what matters to young adults when they access
primary care services in the United Kingdom.
Patients’ access to and experience of primary care services differs across
age groups. Existing research has largely focused on the needs and experiences of
children, adolescents, and adults. There is some evidence to suggest the views
of young adults (aged 18–25 years) that may differ from the views of other age groups,
and research has not previously reported specifically on the views of this group of
the population.
The literature was reviewed to identify the views and priorities of young UK adults
regarding primary healthcare provision, and furthermore, to identify those related topics
that would benefit from further research. Relevant academic publications and grey
literature published from 2000 onwards was reviewed and synthesised. We identified
and reported emerging themes that were of importance to young adults in respect of the
UK primary care provision. A total of 19 papers met our inclusion criteria.
Young adults access primary care services less frequently than other age groups;
this may be because of their experience of primary care throughout childhood and
adolescence. Five aspects of primary care provision emerged as being of importance to
young adults – the accessibility and availability of services, the confidentiality of healthrelated
information, issues relating to communication with healthcare professionals,
continuity of care, and behaviours and attitudes expressed towards young adults by
healthcare professionals.
There is a lack of focus of current research on the expectations, needs, and primary
healthcare experiences of young adults. Young adults may hold views that are distinct
from other age groups. Further research is needed to better understand the needs of a
young adult population as their needs may impact the future use of services.
Reports
Abstract:
Protocol for a qualitative metasynthesis on response shift.
Publications by year
In Press
2023
Abstract:
Protocol for a qualitative metasynthesis on response shift.
2021
Abstract:
Development of a conceptual model for research on cyclical variation of patient reported outcome measurements (PROMs) in patients with chronic conditions: a scoping review.
Abstract:
Intraindividual cyclical variation of patient reported outcome measurements in patients with chronic health conditions
Aim: the aim of this thesis is to explore the cyclical variation in patient reported outcome measurements (PROMs) in patients with chronic conditions. Specific objectives included: a) the development of a conceptual model for researching cyclical variation of PROMs, b) the elicitation of patient perspectives on cyclical variation in PROMs, and c) the mapping, selection and use of best methods for the statistical modelling of cyclical variation.
Method:. This thesis comprised of three sequential studies which informed each other to address the aims and objectives of the thesis. A mixed methods scoping review, considering both quantitative and qualitative research, was conducted to map out the knowledge on cyclical variation of patient reported outcome measurements in patients with chronic conditions. Findings from this scoping review informed the development of a conceptual model building up on established outcomes models. A longitudinal mixed methods study was conducted to understand the factors that were important in the cyclical variation of PROMs from the patients’ perspective, to test the concepts within the conceptual model and to refine it. Sixteen individuals recruited with varying combinations of asthma, depression and osteoarthritis and conducted a total of 3 interviews with each participant over a 9-month period, in order to account for seasonal changes. Finally, variation in outcome scores for a range of symptoms (aural fullness, tinnitus, dizziness, and hearing loss) in Meniere’s disease was modelled by applying Fourier transformation using quantitative longitudinal data on Meniere’s symptoms captured across time.
Results: the scoping review identified 33 articles which provided empirical evidence for cyclical variation in PROMs, in respiratory, musculoskeletal, mental health and neurological conditions. The hypotheses and findings in the documents were used to develop a conceptual model of cyclical variation of PROMs in chronic conditions which included the following concepts: determinants (biorhythms, timing and type of healthcare interventions), variation in outcomes (health conditions, outcomes, and time-period), a mediator (psychological health status), moderators (individual and environmental factors), and variation in scores (cognition, integration, measurement, recall and interpretation). Patient interviews confirmed both cyclical variations in outcomes as experienced by patients themselves as well as the relevance of the concepts included in the conceptual model and supported the inclusion of additional ones (sleep, partners interpretation of outcomes and salience of recent episodes and/or flare ups). Fourier analysis of the Meniere’s disease data showed that the severity of symptoms was reported differently across a 24-hour period. Individuals reported the morning to be the worst time of the day for hearing loss and dizziness, tinnitus, and aural fullness peaking around 1/2pm. However, all four symptoms presented a decline in symptom severity by the evening.
Conclusion: This thesis has laid the theoretical and methodological foundation for future research on the cyclical variation of PROMs in patients with chronic health conditions. It has confirmed its existence for selected conditions based on literature synthesis and a mixed methods study. The new conceptual model developed as part of this work, which identifies key sources of variation and hypothesises pathways that may explain intraindividual variation of PROMs, will facilitate further research. Findings from the, to my best knowledge, first longitudinal mixed methods study eliciting narratives of cyclical variation may benefit from replication in other patients and for other conditions. Finally, Fourier analyses, emerges as the analytical approach of choice to model cyclical variation of PROMs. Potential application of PROMs to monitor the impact of chronic conditions on patient’s health needs to take into account cyclical variation in the selection, administration and interpretation of PROMs scores.
Abstract:
Routine provision of feedback from patient-reported outcome measurements to healthcare providers and patients in clinical practice.
Abstract:
STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis
. Background
. Drug-related problems and potentially inappropriate prescribing impose a huge burden on patients and the health-care system. The most widely used tools for appropriate prescription in older adults in England and in other European countries are the Screening Tool of Older People’s Prescriptions (STOPP)/Screening Tool to Alert to the Right Treatment (START) tools. STOPP/START tools support medicines optimisation for older adults.
.
.
. Objectives
. To identify, test and refine the programme theories underlying how interventions based on the STOPP/START tools are intended to work, for whom, in what circumstances and why, as well as the resource use and cost requirements or impacts.
.
.
. Design
. A realist synthesis.
.
.
. Setting
. Primary care, hospital care and nursing homes.
.
.
. Patients
. Patients aged ≥ 65 years.
.
.
. Interventions
. Any intervention based on the use of the STOPP/START tools.
.
.
. Review methods
. Database and web-searching was carried out to retrieve relevant evidence to identify and test programme theories about how interventions based on the use of the STOPP/START tools work. A project reference group made up of health-care professionals, NHS decision-makers, older people, carers and members of the public was set up. In phase 1 we identified programme theories about STOPP/START interventions on how, for whom, in what contexts and why they are intended to work. We searched the peer-reviewed and grey literature to identify documents relevant to the research questions. We interviewed experts in the field in our reference group to gain input on our list of candidate context–mechanism–outcome configurations, to identify additional context–mechanism–outcome configurations and to identify additional literature and/or relevant concepts. In phase 2 we reviewed and synthesised relevant published and unpublished empirical evidence and tested the programme theories using evidence from a larger set of empirical studies.
.
.
. Results
. We developed a single logic model structured around three key mechanisms: (1) personalisation, (2) systematisation and (3) evidence implementation. Personalisation: STOPP/START-based interventions are based on shared decision-making, taking into account patient preferences, experiences and expectations (mechanisms), leading to increased patient awareness, adherence, satisfaction, empowerment and quality of life (outcomes). Systematisation: STOPP/START tools provide a standardised/systematic approach for medication reviews (mechanisms), leading to changes in professional and organisational culture and burden/costs (outcomes). Evidence implementation: delivery of STOPP/START-based interventions is based on the implementation of best evidence (mechanisms), reducing adverse outcomes through appropriate prescribing/deprescribing (outcomes). For theory testing, we identified 40 studies of the impact of STOPP/START-based interventions in hospital settings, nursing homes, primary care and community pharmacies. Most of the interventions used multiple mechanisms. We found support for the impact of the personalisation and evidence implementation mechanisms on selected outcome variables, but similar impact was achieved by interventions not relying on these mechanisms. We also observed that the impact of interventions was linked to the proximity of the selected outcomes to the intervention in the logic model, resulting in a clearer benefit for appropriateness of prescribing, adverse drug events and prescription costs.
.
.
. Limitations
. None of the available studies had been explicitly designed for evaluating underlying causal mechanisms, and qualitative information was sparse.
.
.
. Conclusions
. No particular configuration of the interventions is associated with a greater likelihood of improved outcomes in given settings.
.
.
. Study registration
. This study is registered as PROSPERO CRD42018110795.
.
.
. Funding
. This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 23. See the NIHR Journals Library website for further project information.
.
2019
Abstract:
Assessing Patient-Centred Outcomes in Lateral Elbow Tendinopathy: a Systematic Review and Standardised Comparison of English Language Clinical Rating Systems
2018
Abstract:
Assessing the effectiveness of Enhanced Psychological Care for patients with depressive symptoms attending cardiac rehabilitation compared with treatment as usual (CADENCE): a pilot cluster randomised controlled trial.
Abstract:
Enhanced psychological care in cardiac rehabilitation services for patients with new-onset depression: the CADENCE feasibility study and pilot RCT.
Abstract:
Rating Communication in GP Consultations: the Association Between Ratings Made by Patients and Trained Clinical Raters.
Abstract:
The Evaluation of Physicians' Communication Skills from Multiple Perspectives.
2017
Abstract:
Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience
Abstract:
Investigating the meaning of 'good' or 'very good' patient evaluations of care in English general practice: a mixed methods study
Abstract:
Patients' use and views of real-time feedback technology in general practice.
2016
Abstract:
Assessing the effectiveness of enhanced psychological care for patients with depressive symptoms attending cardiac rehabilitation compared with treatment as usual (CADENCE): study protocol for a pilot cluster randomised controlled trial.
Abstract:
Capturing patient experience: a qualitative study of implementing real-time feedback in primary care.
Abstract:
Test–retest stability of patient experience items derived from the national GP patient survey
2015
Abstract:
The role of patient experience surveys in quality assurance and improvement: a focus group study in English general practice.
Abstract:
Web-based textual analysis of free-text patient experience comments from a survey in primary care.
2014
Abstract:
Understanding high and low patient experience scores in primary care: analysis of patients' survey data for general practices and individual doctors.
2013
Abstract:
Accessing primary care: a simulated patient study
Abstract:
Accessing primary care: a simulated patient study
Abstract:
Challenges to the credibility of patient feedback in primary healthcare settings: a qualitative study
Abstract:
Priorities for young adults when accessing UK primary care: literature review.
Abstract:
Trust, negotiation, and communication: young adults' experiences of primary care services.
Abstract:
Trust, negotiation, and communication: young adults’ experiences of primary care services
Young adulthood is an important transitional period during which there is a higher risk of individuals engaging in behaviours which could have a lasting impact on their health. Research has shown that young adults are the lowest responders to surveys about healthcare experiences and are also the least satisfied with the care they receive. However, the factors contributing to this reduced satisfaction are not clear. The focus of our research was to explore the needs and experiences of young adults around healthcare services with an aim of finding out possible reasons for lower satisfaction.
Methods
Twenty young adults were interviewed at GP surgeries and at a local young adult advice agency, exploring their experiences and use of primary care services. Interviews were analysed using thematic analysis.
Results
The use of primary care services varied amongst the young adult interviewees. Many interviewees reported positive experiences; those who did not linked their negative experiences to difficulties in negotiating their care with the health care system, and reported issues with trust, and communication difficulties. Most of the interviewees were unaware of the use of patient surveys to inform healthcare planning and delivery and were not inclined to take part, mainly because of the length of surveys and lack of interest in the topic area.
Conclusions
In order to effectively address the health needs of young adults, young adults need to be educated about their rights as patients, and how to most efficiently use primary care services. GPs should be alert to effective means of approaching and handling the healthcare needs of young adults. A flexible, varied approach is needed to gathering high quality data from this group in order to provide services with information on the changes necessary for making primary care services more accessible for young adults.
2012
Abstract:
Priorities for young adults when accessing UK
primary care: literature review
Primary Care Research Group, University of Exeter Medical School, St Lukes Campus,
Exeter EX1 2LU, UK
This literature review focuses on what matters to young adults when they access
primary care services in the United Kingdom.
Patients’ access to and experience of primary care services differs across
age groups. Existing research has largely focused on the needs and experiences of
children, adolescents, and adults. There is some evidence to suggest the views
of young adults (aged 18–25 years) that may differ from the views of other age groups,
and research has not previously reported specifically on the views of this group of
the population.
The literature was reviewed to identify the views and priorities of young UK adults
regarding primary healthcare provision, and furthermore, to identify those related topics
that would benefit from further research. Relevant academic publications and grey
literature published from 2000 onwards was reviewed and synthesised. We identified
and reported emerging themes that were of importance to young adults in respect of the
UK primary care provision. A total of 19 papers met our inclusion criteria.
Young adults access primary care services less frequently than other age groups;
this may be because of their experience of primary care throughout childhood and
adolescence. Five aspects of primary care provision emerged as being of importance to
young adults – the accessibility and availability of services, the confidentiality of healthrelated
information, issues relating to communication with healthcare professionals,
continuity of care, and behaviours and attitudes expressed towards young adults by
healthcare professionals.
There is a lack of focus of current research on the expectations, needs, and primary
healthcare experiences of young adults. Young adults may hold views that are distinct
from other age groups. Further research is needed to better understand the needs of a
young adult population as their needs may impact the future use of services.
Antoinette_Davey Details from cache as at 2023-03-30 05:20:23
External Engagement and Impact
Committee/panel activities
- Co-chair of Mixed Methods Special Interest Group of International Society for Quality of Life Research
- Co-opted member of the TA Theory Development and Research Committee (TDRC) for the European Association for Transactional Analysis
- Chair of the Research Committee for United Kingdom Association of Transactional Analysis
Editorial responsibilities
Peer reviewer for
- International Journal of Offender Therapy and Comparative Criminology
- Pilot and Feasibility Studies
- Journal of Patient Reported Outcomes
Teaching
My teaching interests span the methodological aspects of conducting research including qualitative methods and carrying out literature reviews. I tutor on different modules in Psychology and Medical Sciences. I co-supervise on final year Medical Sciences projects, and MSc Health Research Methods.
CSC4020 - co-supervise final year research projects
PSY2216 - tutor on Qualitative Methods Practical