Samantha Armitage – Describing and specifying pre-appointment written materials as an intervention: a survey of pre-appointment materials used by children’s therapy teams in England

“My advice to other AHP researchers applying for a CAHPR award is to maximise outcomes and impact. Consider not only the outcomes that are expected directly from the proposed project, but also how the award could develop skills and research capacity for yourself and others, strengthen your profile for leading future applications and projects, and benefit employing organisations and colleagues as well as you and your service users. Demonstrating outcomes and impact from sharing, networking and collaborating, as well as the research will align the application to the core values of CAHPR and improve the quality of the application.”

Research Details


Samantha Armitage

Profession & current role

I am a children’s occupational therapist working in an early years’ therapy team. I work with children under 5 years of age and their parents to provide early assessment and intervention to children living with health conditions that affect their development and participation in daily life.

Employer (at the time of the award)

Sheffield Children’s NHS Foundation Trust

Title of study

Describing and specifying pre-appointment written materials as an intervention: a survey of pre-appointment materials used by children’s therapy teams in England

Amount awarded


Will this research influence your future research activity?

The research project funded by CAHPR will describe and specify pre-appointment written materials (e.g. appointment letters, leaflets and questionnaires) as an intervention. Once the intervention is defined and specified, it can be formally tested and evaluated. The findings from the project will support future research funding applications to develop and pilot pre-appointment materials as an intervention to actively engage parents in their children’s health care.

The CAHPR research award has also provided opportunities for me to extend my research network, leading to the potential for future research collaborations.

The CAHPR small research award has supported me to progress as a clinical academic at a challenging point in my clinical academic career pathway. The award has allowed me to:

• Progress my own research project
• Build my clinical academic CV through a successful grant application, project management, application of research methods, and publications and dissemination
• Support research capacity building across AHP professions by bringing together a team of early stage clinical academic AHP’s to work on and learn from the project together, with expert supervision from academic partners
• Broaden my clinical research network and develop potential collaborations for future research projects

Contact Samantha

Samantha on Twitter 

Research Summary

In children’s therapy services, the first interactions between therapists and parents is a package of written materials, posted to parents before the children’s first appointment. Materials often include an appointment letter, questionnaire about the child, and a service information leaflet. Pre-appointment materials try to engage parents with therapy services, but we do not know if the materials are effective. Evidence suggests that the quality of pre-appointment materials is directly related to parent engagement e.g. parents and children attending their health appointment, and indirectly to parent and child health.

Whilst it is common practice for therapy services to send pre-appointment written materials, we do not know if the content of the materials e.g. what the materials say and what techniques are used to engage parents, are similar across therapy services. The content of the materials is locally determined by individual services, resulting in unknown variation across the NHS. It is therefore not currently possible to test the materials to see if they effectively engage parents in therapy services.

The research project funded by CAHPR is a survey of pre-appointment materials used by children’s therapy services in England. The survey collects data about the content of the materials, techniques used in the materials and how, when and why services use the materials. Data is collected by therapy service managers completing a questionnaire and providing samples of their pre-appointment materials. Similarities and differences between the materials will be recorded by quantitative descriptive analysis (questionnaires) and qualitative content analysis (samples) to see if current pre-appointment materials can be described as a standardised intervention across NHS therapy services in England.

Progress Report – January 2019


I was awarded the CAHPR / NIHR Devices for Dignity research award in 2017 to describe and specify pre-appointment written materials as an intervention in children’s therapy services. The project was designed with two strands: 1) an online questionnaire about the use of written

materials in children’s therapy services, completed by children’s occupational therapy, physiotherapy and speech and language therapy managers and clinical leads; and 2) the collection of samples of written materials from therapy teams. Descriptive statistical analysis was selected to analyse questionnaire data and qualitative content analysis

to analyse sample documents. Results from the two strands were planned to be combined and reported to describe and specify pre-appointment materials as an intervention.

Actions to Date

The study protocol was written with support from supervisors at Newcastle University and the research and innovation team at Sheffield Children’s NHS Trust. I completed training about questionnaire design and testing to learn theory and skills related to questionnaire development, and I familiarized myself with the survey software to be used for administering the questionnaire and collecting data. Study documents including participant information sheets, invitation emails and advertising materials were developed, and an application submitted to the Health Research Authority for approval to conduct the study. Following matched funding, the project was eligible for Clinical Research Network support as a portfolio study and the scope of the study was extended to collect data from children’s therapy services across the UK.


Data collection commenced in October 2018 and will continue until February 2019. To date, 64 managers, clinical leads and/or therapists from 34 NHS organisations across England, Wales, Scotland and Northern Ireland have completed the online questionnaire and 15 therapy services have submitted samples of their materials for analysis. Data cleaning, coding and entry has commenced in preparation for quantitative analysis of questionnaire data. The coding framework for qualitative content analysis of sample documents is in development.

Next Steps

Analysis will commence in March 2019, from which a detailed description of pre-appointment written materials as an intervention will be produced by June 2019.


A manuscript for publication is in development and will be submitted to a peer reviewed journal by September 2019. Abstracts will be submitted to regional and national conferences to present the study findings.

Future Plans for the Project

Findings from the study will be shared and discussed with children, young people and families for a service user perspective about pre-appointment materials as an intervention in children’s therapy services.

Impact of the Research on Practice

The output of the study will be a detailed description of current practice related to pre-appointment written materials as an intervention. Participating therapy teams will receive a summary of the findings and can use this to benchmark their service against what is happening across the country. The description of pre-appointment materials as an intervention sets a baseline for starting to develop improvements in pre-appointment written materials.

Clinical Research Career Development

The CAHPR / Devices for Dignity award has helped me:
• Strengthen my clinical academic CV and credibility as a researcher. Since the Devices for Dignity award I have been a named co-investigator on a successful grant application and currently have two days a week funded for research.
• Develop my knowledge and skills in qualitative and quantitative research design and methods, and managing a portfolio study.
In September 2018, I registered with Newcastle University as a PhD student. The research project funded by Devices for Dignity will contribute to my PhD qualification.