Dr Natalie Gil
Pronouns: She/Her
About
Dr Natalie Gil is a Research Fellow in Health Inequalities in the School of Health Sciences at the University of Surrey and a Trainee Practitioner Health Psychologist.
Natalie's research focuses on understanding and reducing inequalities across the cancer pathway, with particular interests in cancer diagnosis, treatment and healthcare access for people with learning disabilities and other underserved populations. She currently contributes to both the CancerLearn programme and the Can-Treat Fellowship, supporting research that seeks to improve equity in cancer treatment and outcomes across the UK.
A qualitative researcher at heart, Natalie has particular expertise in theory-informed health research and the development of conceptual and theoretical contributions that advance understanding of complex healthcare systems and inequalities. Whilst experienced in mixed-methods research, her primary methodological interests lie in qualitative inquiry, participatory research and ethnographic approaches, enabling her to explore how healthcare is experienced, delivered and shaped in real-world settings.
Natalie completed her PhD at the University of Surrey, where she examined inequities in cancer care experienced by people with a learning disability through a programme of qualitative and quantitative research. Her work drew on behavioural, social and health psychology theory to generate new insights into how structural, organisational and interpersonal processes influence equitable access to cancer care.
Alongside her academic role, Natalie is completing doctoral-level professional training in Health Psychology through the British Psychological Society's Stage 2 Qualification. Her clinical training has included an 18-month placement within an NHS bariatric psychology service, where she worked with adults living with complex obesity and multiple long-term conditions, delivering psychological assessments, low-intensity interventions and high-intensity group-based support. This integration of research and clinical practice provides an important perspective for her work, ensuring it remains grounded in the realities of healthcare delivery and focused on producing meaningful improvements for patients, practitioners and health systems.
Natalie works collaboratively with NHS organisations, policymakers, clinicians and people with lived experience to co-produce research that informs service development and policy. Her overarching research programme seeks to understand how healthcare systems create, reproduce and perpetuate inequalities, and how theory-informed, inclusive research can ultimately support the design of more equitable cancer services
My qualifications
Affiliations and memberships
Graduate Member of British Psychological Society
ResearchResearch interests
Health inequalities, inequalities in cancer care, early diagnosis, behavioural science and health, health psychology.
Research projects
Research projects
This project aims to understand why there are delays in diagnosing cancer in people with learning disabilities and make recommendations for how this could be improved.
Background: People with learning disabilities are not diagnosed with cancer as quickly as people without learning disabilities. This means that by the time they are diagnosed their cancer is more advanced and harder to treat. We do not have a lot of information about what happens when people with learning disabilities have cancer-related symptoms, or what can support a timely diagnosis. Design and methods: We have designed this research with experts by profession - academics and health care professionals specialising in cancer and/or learning disabilities - and experts by experience - people with learning disabilities, some who have experience of cancer diagnosis. Together, we have designed four linked work packages that will help us to understand why there are delays diagnosing cancer in people with learning disabilities and to identify interventions that support a timely diagnosis. We will:
1. Search all existing evidence of interventions that aim to support timely diagnosis of cancer for people with learning disabilities;
2. Analyse a large dataset drawing on patient's GP, hospital and cancer records (with people's names and personal details removed) to highlight where there are avoidable delays within the health system in the diagnosis of cancer for people with learning disabilities;
3. Observe and explore (through interviews) the experiences of people in three places in England to understand what prevents or helps a timely diagnosis of cancer for people with learning disabilities. We will observe and/or interview people with learning disabilities and those people who support them to find out if they have cancer, for example their family, carers, doctors and nurses, people from local healthcare and social care organisations and charity workers.
4. Feedback our results to key stakeholders (including people with learning disabilities) and work together to make recommendations for action to improve cancer diagnosis for people with learning disabilities across England. Public and patient involvement: Our research team includes two patient representatives and an experienced co-production manager who supports people with learning disabilities to contribute to research. She will lead public and patient engagement and has already identified people with lived experience to advise our research. We will make provision to ensure activities are accessible to people with learning disabilities. They will continue to challenge and shape the work packages from design to dissemination, through regular engagement.
Dissemination: Our plans to share findings are strengthened by a member of our research team who has lived experience, a man with learning disabilities who has experience of cancer diagnosis. He has received a British Empire Medal for his influence and commitment to improving the lives of people with learning disabilities. Benefitting from his connections and passion, we will deliver a stakeholder event as well as creative and effective summaries of our findings in a range of accessible formats (film, easy read, audio) in addition to academic papers and conference presentations. In preparation for this, we have already developed relationships with national learning disability and cancer policymakers and networks, professional colleges, charities, and a medical education provider.
Identifying, understanding and addressing inequalities in cancer treatment — CRUK (Co-Investigator))This project aims to identify who is not receiving treatment or is experiencing delays, understand the reasons for these inequalities, and help reduce them to improve cancer survival outcomes.
The aim is to reduce inequalities in cancer survival by ensuring that everyone, regardless of their background, can benefit from cancer care.
- Key activities:
- Identify who is not receiving treatment or is waiting longer for treatment to start.
- Understand the factors causing these inequalities.
- Develop a future research program to reduce these disparities.
Methodology: The research will build on previous work by using a causal framework, incorporating stakeholder and patient input to identify and explain the mechanisms driving inequality
Funding: The project has received over £700,000 from Cancer Research UK.
Inequity in cancer care for adults with learning disabilities — Doctoral College Studentship, University of Surrey (Principal Investigator)Natalie's doctoral research focuses on understanding and addressing inequities in cancer care for people with a learning disability. People with a learning disability face a significantly higher risk of late-stage cancer diagnosis, longer diagnostic intervals, and poorer outcomes than the general population.
Using the Model of Pathways to Treatment, Candidacy Theory and The Health Stigma and Discrimination Framework as conceptual frameworks, this research examines how inequalities emerge across the cancer diagnostic journey — from symptom appraisal and help-seeking to primary and secondary care referral and diagnosis. By exploring these processes from the perspectives of people with a learning disability, their paid and unpaid carers, and healthcare practitioners, the aim of this project is to highlight where delays occur and identify opportunities for earlier intervention.
To achieve this, Natalie is conducting a mixed-methods programme of research comprising:
(1) a scoping review of existing evidence on cancer symptom awareness among people with learning disabilities and their support networks,
(2) a large-scale case-controlled analysis of national primary and secondary care data to identify diagnostic interval inequalities for specific cancers, and
(3) qualitative interviews exploring real-world experiences of accessing cancer care. This work seeks to generate evidence that can inform targeted interventions, shape equitable cancer policy, and ultimately improve early cancer diagnosis and outcomes for people with a learning disability.
Research interests
Health inequalities, inequalities in cancer care, early diagnosis, behavioural science and health, health psychology.
Research projects
Research projects
This project aims to understand why there are delays in diagnosing cancer in people with learning disabilities and make recommendations for how this could be improved.
Background: People with learning disabilities are not diagnosed with cancer as quickly as people without learning disabilities. This means that by the time they are diagnosed their cancer is more advanced and harder to treat. We do not have a lot of information about what happens when people with learning disabilities have cancer-related symptoms, or what can support a timely diagnosis. Design and methods: We have designed this research with experts by profession - academics and health care professionals specialising in cancer and/or learning disabilities - and experts by experience - people with learning disabilities, some who have experience of cancer diagnosis. Together, we have designed four linked work packages that will help us to understand why there are delays diagnosing cancer in people with learning disabilities and to identify interventions that support a timely diagnosis. We will:
1. Search all existing evidence of interventions that aim to support timely diagnosis of cancer for people with learning disabilities;
2. Analyse a large dataset drawing on patient's GP, hospital and cancer records (with people's names and personal details removed) to highlight where there are avoidable delays within the health system in the diagnosis of cancer for people with learning disabilities;
3. Observe and explore (through interviews) the experiences of people in three places in England to understand what prevents or helps a timely diagnosis of cancer for people with learning disabilities. We will observe and/or interview people with learning disabilities and those people who support them to find out if they have cancer, for example their family, carers, doctors and nurses, people from local healthcare and social care organisations and charity workers.
4. Feedback our results to key stakeholders (including people with learning disabilities) and work together to make recommendations for action to improve cancer diagnosis for people with learning disabilities across England. Public and patient involvement: Our research team includes two patient representatives and an experienced co-production manager who supports people with learning disabilities to contribute to research. She will lead public and patient engagement and has already identified people with lived experience to advise our research. We will make provision to ensure activities are accessible to people with learning disabilities. They will continue to challenge and shape the work packages from design to dissemination, through regular engagement.
Dissemination: Our plans to share findings are strengthened by a member of our research team who has lived experience, a man with learning disabilities who has experience of cancer diagnosis. He has received a British Empire Medal for his influence and commitment to improving the lives of people with learning disabilities. Benefitting from his connections and passion, we will deliver a stakeholder event as well as creative and effective summaries of our findings in a range of accessible formats (film, easy read, audio) in addition to academic papers and conference presentations. In preparation for this, we have already developed relationships with national learning disability and cancer policymakers and networks, professional colleges, charities, and a medical education provider.
This project aims to identify who is not receiving treatment or is experiencing delays, understand the reasons for these inequalities, and help reduce them to improve cancer survival outcomes.
The aim is to reduce inequalities in cancer survival by ensuring that everyone, regardless of their background, can benefit from cancer care.
- Key activities:
- Identify who is not receiving treatment or is waiting longer for treatment to start.
- Understand the factors causing these inequalities.
- Develop a future research program to reduce these disparities.
Methodology: The research will build on previous work by using a causal framework, incorporating stakeholder and patient input to identify and explain the mechanisms driving inequality
Funding: The project has received over £700,000 from Cancer Research UK.
Natalie's doctoral research focuses on understanding and addressing inequities in cancer care for people with a learning disability. People with a learning disability face a significantly higher risk of late-stage cancer diagnosis, longer diagnostic intervals, and poorer outcomes than the general population.
Using the Model of Pathways to Treatment, Candidacy Theory and The Health Stigma and Discrimination Framework as conceptual frameworks, this research examines how inequalities emerge across the cancer diagnostic journey — from symptom appraisal and help-seeking to primary and secondary care referral and diagnosis. By exploring these processes from the perspectives of people with a learning disability, their paid and unpaid carers, and healthcare practitioners, the aim of this project is to highlight where delays occur and identify opportunities for earlier intervention.
To achieve this, Natalie is conducting a mixed-methods programme of research comprising:
(1) a scoping review of existing evidence on cancer symptom awareness among people with learning disabilities and their support networks,
(2) a large-scale case-controlled analysis of national primary and secondary care data to identify diagnostic interval inequalities for specific cancers, and
(3) qualitative interviews exploring real-world experiences of accessing cancer care. This work seeks to generate evidence that can inform targeted interventions, shape equitable cancer policy, and ultimately improve early cancer diagnosis and outcomes for people with a learning disability.
Publications
Highlights
Background Recent evidence suggests that faecal immunochemical testing (FIT) can rule out colorectal cancer (CRC) in symptomatic adults. To date, there has been little research exploring experiences of FIT for this population.Aim To explore patient experience and satisfaction with FIT in an ‘early adopter’ site in England.Design Explanatory sequential mixed-methods approach combining mailed quantitative surveys with semi-structured telephone interviews.Method Multivariate logistic regression was used to analyse quantitative data. Thematic analysis was used to assess qualitative transcripts.Results The survey had 260 responders, and it found that satisfaction with FIT was high (88.7%). Compared with test satisfaction, the proportion of responders satisfied with their GP consultation and how they received their results was lower (74.4% and 76.2%, respectively). Multivariate analysis showed that increased area-level deprivation and not receiving an explanation of the purpose of the test were associated with lower satisfaction with the GP consultation (both P-values <0.05), while increased area-level deprivation and not receiving results from the GP were associated with lower satisfaction with receiving results (both P-values <0.05). Interviews with responders (n = 20) helped explain the quantitative results. They revealed that ‘not knowing the purpose of the test’ caused ‘anxiety’ and ‘confusion’, which led to dissatisfaction. ‘Not receiving results from GP’ was considered ‘unacceptable’, as this left patients with a ‘niggling doubt’ and lack of diagnosis or assurance that they did not have cancer.Conclusion Patient satisfaction with symptomatic FIT is high. Efforts to improve satisfaction should focus on ensuring that patients understand the purpose of the test and always receive their test results.
Objective: People from ethnic minority backgrounds are less likely to attend colonoscopy, following faecal immunochemical test screening, and are more likely to be diagnosed with colorectal cancer at an advanced stage as a result. The aim of this research was to explore the barriers and facilitators to attending colonoscopy, perceived by ethnic minority groups living in the United Kingdom. Methods: Semi-structured online and telephone interviews were conducted with thirty men and women of Black-African(n=5), Black-Caribbean(n=5), South Asian(n=10) and White British(n=10) descent. Participants were eligible for screening, but had not necessarily been invited for colonoscopy. All interviews were conducted in the participant's first language and were assessed using Framework-analysis, in line with a conceptual framework developed from previous interviews with healthcare professionals. Results: Five thematic groups of barriers and facilitators were developed: 'Locus of control', 'Cultural attitudes and beliefs', 'Individual beliefs, knowledge and personal experiences with colonoscopy and cancer', 'Reliance on family and friends' and 'Health concerns'. Differences were observed, between ethnic groups, for: 'Locus of control', 'Cultural attitudes and beliefs' and 'Reliance on family and friends'. Black and South Asian participants frequently described the decision to attend colonoscopy as lying with 'God' (Muslims, specifically), 'the doctor', or 'family' (Locus of control). Black and South Asian participants also reported relying on friends and family for 'language, transport and emotional support' (Reliance on family and friends). Black-African participants, specifically, described cancer as 'socially taboo' (Cultural attitudes and beliefs). Conclusions: The results highlight several targets for culturally-tailored interventions to make colonoscopy more equitable.
Inequity in HPV vaccination, primary HPV screening, and sexual health education for people with learning disabilities, autism, and severe mental illness: A discussion.