Professor Natalie Armstrong

Professor of Healthcare Improvement Research and Deputy Head of College of Life Sciences

Natalie Armstrong

School/Department: Population Health Sciences, Department of

Telephone: +44 (0)116 252 3197



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 Healthcare and 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, a Theme Lead within the NIHR Greater Manchester Patient Safety Research Collaboration,  and was previously 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 over £33m of external research funding as either lead or co-investigator. These awards include project grants, direct commissions, infrastructure awards, capacity building awards, and two personal fellowships. My work has been supported by a range of funders, including various NIHR programmes, the Health Foundation, NHS England, the Wellcome Trust, and the ESRC.

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.


Hoare S, Thomas GPA, Powell A, Armstrong N, Mant J, Burt J. (accepted, published online) Why do people choose not to take part in screening? Interview study of atrial fibrillation screening non-participation. Health Expectations  

Overton C, Emerson T, Evans RA, Armstrong N. (2023) Responsive and resilient healthcare? ‘Moments of Resilience’ in post-hospitalisation services for COVID-19 BMC Health Services Research 23:720 
Paton A, Cupit C, Armstrong N. (accepted, published online) Organising work in neonatal transfer: optimising place of care for babies born moderately preterm. Sociology of Health & Illness 
Sutton E, Armstrong N, Locock L, Conroy S, Tarrant C. (accepted, published online) Visual identifiers for people with dementia in hospitals: a qualitative study to unravel mechanisms of action for improving quality of care. BMJ Quality & Safety 
Houchen-Wolloff L, Overton C, Ibbetson A, Walters A, Hastie C, Gill R, Armstrong N, Singh S, Little P, Evans K, Pimm J, Marks M, Poinasamy K, Walker S, Briggs A, Evans RA. (2023) A typology of healthcare pathways for adults after hospitalisation for COVID-19 in the UK: towards understanding clinical and cost-effectiveness ERJ Open Research – European Respiratory Society 9(4): 00565-2022 
Thomas S, Machuel P, Foubert J, Nafilyan V, Bannister N, Colvin H, Routen A, Morriss R, Khunti K, Farooqi A, Armstrong N, Gray LJ, Gordon AL. (2023). A study protocol for the use of time series forecasting and risk analyses to investigate the effect of the coronavirus pandemic on hospital admissions associated with new-onset disability and frailty in a national, linked electronic health data setting. BMJ Open 13:e067786 
Doe GE, Williams M, Chantrell S, Steiner M, Armstrong N, Hutchinson A, Evans RA. (2023) Diagnostic delays for breathlessness: a qualitative study in primary care to understand current care and inform future pathways. British Journal of General Practice 73 (731): e468-e477 
Tarrant C, Lewis R, Armstrong N. (2023) Polypharmacy and continuity of care: medicines optimisation in the era of multidisciplinary teams. BMJ Quality & Safety 32:121-124 
Harrad-Hyde F, Armstrong N, Williams C. (2022) Hospital transfers from care homes: conceptualising staff decision-making as a form of risk work. Health, Risk & Society 24(7–8:317–335 
McCartney M, Armstrong N, Martin G, Nunan D, Richards O, Sullivan F. (2022) Delicate diagnosis: avoiding harms in difficult, disputed, and desired diagnoses. British Journal of General Practice 72(725): 580-581 
Williams K, Modi R, Dymond A, Hoare S, Powell A, Burt J, Edwards D, Lund J, Johnson R, Lobban T, Lown M, Sweeting M, Thom H, Kaptoge S, Fusco F, Morris S, Lip GYH, Armstrong N, Cowie MR, Fitzmaurice D, Freedman B, Griffin SJ, Sutton S, Hobbs FDR, McManus RJ, Mant J. (2022) A cluster randomised controlled trial of screening for atrial fibrillation in people aged 70 years and over to reduce stroke: protocol for the pilot study for the SAFER trial. BMJ Open 12:e065066 
Mackintosh N, Agarwal S, Gong Q, Briley A, Sandall J, Armstrong N. (2022) Curating the digital space: structural gate-keeping and boundary work in maternity care. SSM - Qualitative Research in Health 2:100145 
Harrad-Hyde F, Armstrong N, Williams C. (2022) “Weighing up risk”: A conceptual model of care home staff decision-making about potential resident hospital transfers. Age & Ageing 51(7) 
Cupit C, Paton A, Boyle E, Pillay T, Armstrong N. (2022) Managerial thinking in neonatal care: a qualitative study of place of care decision-making for preterm babies born at 27-31 weeks gestation in England. BMJ Open 12:e059428 
Zubair M, Bown MJ, Armstrong N. (2022) 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 22, 569  

Martin G, Armstrong N. (2022) Speaking up in resource-constrained settings: how to secure safe surgical care in the moment and in the future? BMJ Quality & Safety 31(9):631–633  

Hoare S, Powell A, Modi R, Armstrong N, Griffin S, Mant J, Burt J. (2022) Why do people take part in atrial fibrillation screening? Qualitative interview study in English primary care. BMJ Open 12:e051703 
Harrad-Hyde F, Armstrong N, Williams C. (2022) Using advance and emergency care plans during transfer decisions: a grounded theory interview study with care home staff. Palliative Medicine 36(1):200-207  

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 ten 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
  • The challenges of seeking to avoid overdiagnosis and overtreatment - exploring defensive practice
  • Accounting for and explaining ‘not doing’ within healthcare
  • Maternal and paternal futures: responsibilisation practices in the preconception period to ensure health outcomes for babies
  • Non-invasive prenatal testing in fetal anomaly screening: issues of informed choice and reproductive autonomy
  • A state of emergency: workforce wellbeing in the Emergency Department


I provide teaching and project supervision 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

Press and media

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


  • Member of Applied Partnership Awards Grant Selection Panel, Health Research Board, Ireland (2022 onwards)
  • Member of Research Collaborative in Quality and Patient Safety (Ireland) Grant Selection Review Panel (2021 onwards)
  • Associate Editor, BMJ Quality and Safety (2012 onwards)
  • Member of the UK National Screening Committee (2022 onwards)
  • Member of the UK National Screening Committee Adult Reference Group (2017-2022)
  • Member of NHS England National Overprescribing Review Short Life Working Group (2019-2020)
  • Health Foundation Improvement Science Fellow (2017 to 2021)
  • Member of HEE/NIHR Integrated Clinical Academic (ICA) Programme Pre-doctoral Clinical Academic Fellowship Scheme Selection Committee (2020)
  • Member of Forte, Swedish Research Council for Health, Working Life and Welfare Funding Review Committee (2020)
  • 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. 


Selected Invited Keynotes and Presentations

  • 'The importance of organisational contexts and how they influence what does (and doesn’t) happen within healthcare.' Preventing Overdiagnosis Conference, Copenhagen, August 2023
  • Panel Discussion: ‘Still Not Safe: Patient Safety and the Middle-Managing of American Medicine’. International Forum on Quality & Safety in Healthcare, Copenhagen, May 2023
  • '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.' 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’.' 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.' European Society for Health and Medical Sociology, Geneva, 2016


  • Elected Fellow of the Academy of Social Sciences, 2023
  • 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)
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