Professor Natalie Armstrong

I am a medical sociologist and my work uses sociological ideas and methods to understand health and illness and to tackle problems in the delivery of high-quality healthcare. I completed my first degree in Politics & Sociology at the University of Warwick, my MSc in Medical Sociology at Royal Holloway, University of London, and my PhD at the University of Nottingham. Following postdoctoral positions at the London School of Hygiene and Tropical Medicine and the University of Warwick, I took up my first academic post in 2008 as Lecturer in Social Science Applied to Health at the University of Leicester. I have remained here ever since, being promoted to Senior Lecturer/Associate Professor in 2014, and to Professor of Healthcare Improvement Research in 2017.

I am a member of the Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, which I jointly led from 2016-2018. I was subsequently Head of Department of Health Sciences from 2018-2021, and am now the Deputy Head of College for the College of Life Sciences. I am the Implementation Theme Lead for the NIHR Applied Research Collaboration (ARC) East Midlands and until recently acted as Co-Director and Theme Lead for the Wellcome Trust PhD Programme in Genomic Epidemiology and Public Health Genomics.

My work uses sociological ideas and methods to understand health and illness and tackle problems in the delivery of high-quality healthcare. Originally trained in sociology departments, I am committed to applied research and the practical impact of social science learning within healthcare and healthcare improvement. To date I have been awarded ~£23m of external research funding, including grants and direct commissions from various NIHR programmes, the Health Foundation, and NHS England.

I have worked across a range of healthcare contexts, but have long-standing interests in women’s and children’s health and preventative healthcare. I have a particular interest in population-based screening. In 2012 I co-edited a special issue of the journal Sociology of Health and Illness “The Sociology of Medical Screening: Critical Perspectives, New Directions”. In 2020, I co-edited a further special issue on “Understanding and Managing Uncertainty in Healthcare: Revisiting and Advancing Sociological Contributions”.

In 2017, I was awarded a Health Foundation Improvement Science Fellowship, in which I applied social science theory to the topic of overdiagnosis, by investigating the potential for system change to mitigate overdiagnosis and overtreatment within the UK health system, and how this can be balanced with interventions to prevent under-treatment.

Zubair M, Bown MJ, Armstrong N. (accepted, available online) Introducing multi-component cardiovascular health screening into existing Abdominal Aortic Aneurysm (AAA) screening programmes in the UK: A qualitative study of programme staff views. BMC Health Services Research

Martin G, Armstrong N. (in press, available online) Speaking up in resource-constrained settings: how to secure safe surgical care in the moment and in the future? BMJ Quality & Safety

Hoare S, Powell A, Modi R, Armstrong N, Griffin S, Mant J, Burt J. (in press, available online) Why do people take part in atrial fibrillation screening? Qualitative interview study in English primary care. BMJ Open

Harrad-Hyde F, Armstrong N, Williams C. (in press, available online) Using advance and emergency care plans during transfer decisions: a grounded theory interview study with care home staff. Palliative Medicine

Chew S, Armstrong N, Martin GP. (2022) Understanding knowledge brokerage and its transformative potential: a Bourdieusian perspective. Evidence & Policy 18(1): 25-42

Doe G, Clanchy J, Wathall S, Chantrell S, Edwards S, Baxter N, Jackson D, Armstrong N, Steiner M, Evans RA. (2021) A protocol for a feasibility study of a multi-centre cluster randomised control trial to investigate whether a structured diagnostic pathway in primary care is clinically and cost effective for adults presenting with chronic breathlessness. BMJ Open 11:e057362

Cupit C, Armstrong N. (2021) A win-win scenario? Restrictive policies from alternative standpoints. Journal of Health Organization & Management 35(9): 378-384

Brown KJ, Armstrong N, Potdar N. (in press, available online) Fertility preservation discussions in young women with breast cancer: a qualitative study of health care professionals' views and experiences. Human Fertility

Doe G, Chantrell S, Williams M, Steiner MC, Armstrong N, Hutchinson A, Evans RA. (2021) Breathless and awaiting diagnosis in UK lockdown for COVID-19…We’re stuck. npj Primary Care Respiratory Medicine 31, 21 

Cupit C, Rankin J, Armstrong N. (2021) Taking sides with patients using institutional ethnography. Journal of Organizational Ethnography 10(1): 21-35

Armstrong N. (2021) Overdiagnosis and overtreatment: A sociological perspective on tackling a contemporary healthcare issue. Sociology of Health & Illness 43(1): 58-64

Paton A, Armstrong N, Smith LK, Lotto R. (2020) Parents' decision-making following diagnosis of a severe congenital anomaly in pregnancy: practical, theoretical and ethical tensions. Social Science & Medicine 266: 113362

Mackintosh N, Armstrong N. (2020) Understanding and managing uncertainty in healthcare: revisiting and advancing sociological contributions. Sociology of Health & Illness 42(S1): 1-20

Hinton L, Armstrong N. (2020) "They don't know themselves, so how can they tell us?": Parents navigating uncertainty at the frontiers of neonatal surgery. Sociology of Health & Illness 42(S1): 51-68

Cupit C, Rankin J, Armstrong N, Martin G. (2020) Overruling uncertainty about preventative medications: the social organisation of healthcare professionals’ knowledge and practices. Sociology of Health & Illness 42(S1): 114-129

Armstrong N. (2019) Navigating the uncertainties of screening: the contribution of social theory. Social Theory & Health 17(2): 158-171

Armstrong N. (2018) Overdiagnosis and overtreatment as a quality problem: insights from healthcare improvement research. BMJ Quality & Safety 27: 571-574

Lotto RR, Smith LK, Armstrong N. (2018) Diagnosis of a severe congenital anomaly: a qualitative analysis of parental decision-making and the implications for healthcare encounters. Health Expectations 21:678-684

Armstrong N, Brewster L, Tarrant C, Dixon R, Willars J, Power M, Dixon-Woods M. (2018) Taking the heat or taking the temperature? A qualitative study of a large-scale exercise in seeking to measure for improvement, not blame. Social Science & Medicine 198: 157-164

Brewster L, Tarrant C, Willars J, Armstrong N. (2018) Measurement of harms in community care: a qualitative study of use of the NHS Safety Thermometer. BMJ Quality & Safety 27: 625-632

I am an experienced PhD supervisor and have supervised eight students to completion to date, three of whom were awarded their degrees without revisions. 

I am able to supervise students working in the area of healthcare improvement research who wish to use social science theory and/or methods in their work.  

My current students are working on the following topics:

• Deprescribing within the care home setting for patients with limited capacity: Achieving a person-centred approach
• Navigating perceived overdiagnosis and overtreatment - a sociological analysis of the experiences of people who decline treatment for anomalies identified through screening
• The challenges of seeking to avoid overdiagnosis and overtreatment - exploring defensive practice
• Diagnostic pathways for chronic breathlessness
• How do complex, professionally dominated organisations successfully implement quality and safety initiatives?

I provide teaching to the following courses/modules:

• MSc Quality and Safety in Healthcare
• MRes in Applied Health Research 
• Population and Social Science (PASS) module for the MBChB
• Intercalating medical student project supervision

I can be contacted by journalists as an expert on the following:

• Healthcare quality and safety
• Critical public health
• Population based screening
• Women's health
• Health policy

• Associate Editor, BMJ Quality and Safety (2012 to present)
• Member of the UK National Screening Committee Adult Reference Group (2017 to present)
• Member of NHS England National Overprescribing Review Short Life Working Group (2019-2020)
• Health Foundation Improvement Science Fellow (2017 to 2021)
• Associate Editor, Family Practice (2017 to 2018)
• Member of the East Midlands Regional Advisory Committee for the NIHR Research for Patient Benefit scheme (2012 to 2017)
• Member of the Wellbeing of Women Research Advisory Committee (2013 to 2017)
• Member of the ESRC Peer Review College (2010-2014)
• ESRC Knowledge Transfer Fellow with UK Cabinet Office (2009)
• Elected Committee Member, Behavioural and Social Sciences Teaching in Medical Education Group (2009-11)
• Regular peer review for a range of leading journals across both the social and health sciences.
• Regular expert review of funding applications and final reports for key funding bodies, including: Economic and Social Research Council, UK National Institute of Health Research (various funding streams, including Health Services and Delivery Research, Programme Grants for Applied Health Research, Health Technology Assessment. 

Invited Keynotes and Presentations

• Doing less in healthcare: the challenges of recognizing and tackling overuse. Yorkshire Quality and Safety Research Group, Bradford, 2020
• Navigating the uncertainties of screening. Problems of overdiagnosis and overtreatment, Symposium: Screening across the Life Span, Linkoping, Sweden, 2019
• A Sociological Perspective on Overdiagnosis and Overtreatment. School of Healthcare Sciences, Cardiff University, 2018
• Doing Less: Overdiagnosis and Overtreatment - Keynote, The Cost of (NO) Improvement: Launch of the Betsi Cadwaladr University Health Board Quality Improvement Hub, Bangor, 2018
• Using ethnography to study improving healthcare: reflections on the ‘ethnographic’ label’. Invited contribution to panel session, Health Services Research UK, Nottingham, 2018
• Fidelity or flexibility: An ethnographic study of the implementation and use of the Patient Activation Measure. Cardiff Business School, Cardiff University, 2017
• Navigating the uncertainties of screening. Keynote, European Society for Health and Medical Sociology, Geneva, 2016

• Senior Fellow of the Higher Education Academy, 2016
• Fellow of the Higher Education Academy, 2008
• Postgraduate Certificate in Academic and Professional Practice, 2008 (Centre for Academic and Professional Development, University of Warwick)
• PhD (awarded with no revisions), 2005 (Cervical Screening: Women’s Resistance to the Official Discourse, School of Sociology and Social Policy, University of Nottingham) (Supported by MRC Health Services Research Studentship)
• MSc Medical Sociology, 2001 (Royal Holloway, University of London) (Supported by ESRC Advanced Course Studentship)
• BA (Hons) Politics and Sociology (Upper Second), 2000 (University of Warwick)