Dr Nicola Small PhD, MSc, BA (Hons)

NIHR SPCR Fellow, Research Only

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Research interests

Nicola is a health services researcher based in the Division of Population Health, Health Services Research and Primary Care at the University of Manchester with research interests in understanding patient experience. Nicola's NIHR SPCR Fellowship is currently exploring how best to utilise patient reported outcome measure (PROM) feedback in older people with multiple long-term conditions in primary care.

Nicola's doctoral research involved the understanding and measurement of empowerment in patients with long-term conditions in primary care. She led on the development and preliminary validation of the Empowerment Scale (ES) - a patient reported outcome measure (PROM) freely available to use. 

The ES has recieved huge International research and commercial interest since it was first preliminary validated in a sample of eldery multimorbid patients in the United Kingdom in 2012, and validation papers are underway. The PROM is being cross-culturally validated globally with different long-term condition populations:

  • Spain: elderly patients with heart failure
  • Portugal: elderly patients with long-term conditions
  • Canada (Quebec): elderly patients with myotonic dystrophy
  • United States: obese, African adolescents and parents in underserved populations
  • Belgium, Sweden and Denmark: adolescents with congenital heart disease
  • China: elderly patients with long-term conditions

Scale reduction and refinement development work is currently underway. This study is using Rasch Analysis, and cognitive interviewing techniques, to shorten and refine the items in the 47-item ES, and to test it's psychometric properies in a UK empowerment feasability study to refine the measurement properties of the ES for acceptable future use in trials.

Methodological knowledge

Health services research

Health psychology


Scale development

Systematic review

Mixed method

Randomised controlled trial

SWAT (study-within-a-trial)

Patient and public involvement


Ethics and research governance


Research and projects

No past projects are available for public display