Theti Chrysanthaki

Dr Theopisti (Theti) Chrysanthaki

Lecturer in Integrated Care/ehealth
BA, MSc, PhD in Social Psychology
+44 (0)1483 682511
29 DK 04

Academic and research departments

School of Health Sciences.



Research interests

Research projects

Research collaborations


Postgraduate research supervision

My teaching

My publications


Hendriks J, Smith S, Chrysanthaki T, Black N (2016) Reliability and validity of a self-administration version of DEMQOL-Proxy: DEMQOL-Proxy (self-administered), International Journal of Geriatric Psychiatry
Sanders C, Rogers A, Bowen R, Bower P, Hirani S, Cartwright M, Fitzpatrick R, Knapp M, Barlow J, Hendy J, Chrysanthaki T, Bardsley M, Newman SP (2012) Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study., BMC Health Serv Res 12
BACKGROUND: Telehealth (TH) and telecare (TC) interventions are increasingly valued for supporting self-care in ageing populations; however, evaluation studies often report high rates of non-participation that are not well understood. This paper reports from a qualitative study nested within a large randomised controlled trial in the UK: the Whole System Demonstrator (WSD) project. It explores barriers to participation and adoption of TH and TC from the perspective of people who declined to participate or withdrew from the trial. METHODS: Qualitative semi-structured interviews were conducted with 22 people who declined to participate in the trial following explanations of the intervention (n = 19), or who withdrew from the intervention arm (n = 3). Participants were recruited from the four trial groups (with diabetes, chronic obstructive pulmonary disease, heart failure, or social care needs); and all came from the three trial areas (Cornwall, Kent, east London). Observations of home visits where the trial and interventions were first explained were also conducted by shadowing 8 members of health and social care staff visiting 23 people at home. Field notes were made of observational visits and explored alongside interview transcripts to elicit key themes. RESULTS: Barriers to adoption of TH and TC associated with non-participation and withdrawal from the trial were identified within the following themes: requirements for technical competence and operation of equipment; threats to identity, independence and self-care; expectations and experiences of disruption to services. Respondents held concerns that special skills were needed to operate equipment but these were often based on misunderstandings. Respondents' views were often explained in terms of potential threats to identity associated with positive ageing and self-reliance, and views that interventions could undermine self-care and coping. Finally, participants were reluctant to risk potentially disruptive changes to existing services that were often highly valued. CONCLUSIONS: These findings regarding perceptions of potential disruption of interventions to identity and services go beyond more common expectations that concerns about privacy and dislike of technology deter uptake. These insights have implications for health and social care staff indicating that more detailed information and time for discussion could be valuable especially on introduction. It seems especially important for potential rec
Hendy J, Chrysanthaki T, Barlow J (2014) Managers? Identification with and Adoption of Telehealthcare, Societies 4 (3) pp. 428-445
This paper presents managerial attempts at implementing telehealthcare. Our longitudinal, ethnographic case studies document both successful and failed implementations across five health and social care organisations in England. We draw on theories of organisational identity, sensemaking and sensegiving to highlight how managerial organisational identities can inhibit the uptake of digital health technologies. Managers who strongly identified with their current role at work felt threatened by the intended change; a telehealthcare mode of care delivery. When a strongly identified workforce agrees with this assessment, managerial and employee sensemaking and sensegiving coalesce, forming a united front of resistance that prevents further adoption of the innovation.
Chrysanthaki T, Fernandes B, Smith S (2017) Can Memory Assessment Services (MAS) in England be categorized? A national survey., Journal of Public Health
The effectiveness and efficiency of memory assessment services (MASs) is unknown. Our aim was to determine if a typology can be constructed, based on shared structural and process characteristics, as a basis for a non-randomized evaluation of their effectiveness and cost-effectiveness.
Survey of random sample of 73 MASs in 2015; comparison of characteristics and investigation of inter-correlation.
It was not possible to group characteristics to form the basis of a typology of MASs. However, there was considerable variation in staff numbers (20-fold), new patients per whole-time equivalent (WTE) staff (20-fold), skill mix and the nurse:doctor ratio (1?10).
The operational performance also varied: first appointments (50?120 minutes); time for first follow-up (2?12 weeks); frequency of follow-up in first year (1?5). These differences were not associated with the number of new patients per WTE staff or the accreditation status of the MAS.
Post diagnosis, all MASs provided pharmacological treatment but the availability of non-pharmacological support varied, with half providing none or only one intervention while others providing four or more.
In the absence of any clear typology, evaluation of MASs will need to focus on the impact of individual structural and process characteristics on outcomes.
Hendy J, Chrysanthanki T, Barlow J, Knapp M, Rogers A, Sanders C, Bower P, Bowen R, Fitzpatrick R, Bardsley M, Newman S (2012) An Organisational Analysis of the Implementation of Telecare and Telehealth: The Whole System Demonstrator,BMC Health Services Research 1472-6963/12/403 BioMed Central
Stanton N, Bardsley M, Barlow J, Beecham J, Beynon M, Billings J, Cartwright M, Chrysanthaki T, Dixon J, Fernandez JL, Fitzpatrick R, Henderson C, Hendy J, Knapp M, MacNeil V, Rixon L, Silva LA, Steventon A (2012) Whole System Demonstrator Programme WSD_Exec_Sum_,
Park MH, Smith S, Neuburger J, Chrysanthaki T, Hendriks J, Black N (2016) Sociodemographic Characteristics, Cognitive Function, and Health-related Quality of Life of Patients Referred to Memory Assessment Services in England, Alzheimer Disease and Associated Disorders
National policy in England is to encourage referral of people with suspected dementia to Memory Assessment Services (MAS). However, little is known about the characteristics of new referrals, which limits our capacity to evaluate these services. The objectives were to: describe the characteristics (age, sex, ethnicity, socioeconomic deprivation, and comorbidity) of referred patients, and examine the relationships between these characteristics and cognitive function (tertiles of Mini-Mental State Examination score) and health-related quality of life (HRQL) (DEMQOL, DEMQOL-Proxy). We used multivariable regression methods to analyze data from 1420 patients from 73 MAS, and their lay carers (n=1020). The mean age of patients was 78 years; 42% had cognitive function equivalent to Mini-Mental State Examination
Chrysanthaki T, Hendy J, Barlow J (2013) Stimulating whole system redesign: Lessons from an organizational analysis of the Whole System Demonstrator programme, JOURNAL OF HEALTH SERVICES RESEARCH & POLICY 18 pp. 47-55 SAGE PUBLICATIONS INC
Park MH, Smith S, Chrysanthaki T, Neuburger J, Ritchie C, Hendriks AAJ, Black N (2017) Change in Health-related Quality of Life After Referral to Memory Assessment Services, Alzheimer Disease and Associated Disorders
Despite strong support for the provision of memory assessment services (MASs) in England and other countries, their effectiveness in improving patient outcomes is uncertain. We aimed to describe change in patients' health-related quality of life (HRQL) 6 months after referral to MASs and to examine associations with patient characteristics and use of postdiagnostic interventions. Data from 883 patients referred to 69 MASs and their informal caregivers (n=569) were collected at referral and 6 months later. Multivariable linear regression was used to examine associations of change in HRQL (DEMQOL, DEMQOL-Proxy) with patient characteristics (age, sex, ethnicity, socioeconomic deprivation, and comorbidity) and use of postdiagnostic interventions (antidementia medications and nonpharmacological therapies). Mean HRQL improved, irrespective of diagnosis: self-reported HRQL increased 3.4 points (95% CI, 2.7-4.1) and proxy-reported HRQL 1.3 points (95% CI, 0.5-2.1). HRQL change was not associated with any of the patient characteristics studied. Patients with dementia (54%) receiving antidementia drugs reported greater improvement in their HRQL but those using nonpharmacological therapies reported less improvement compared with those note receiving therapy. HRQL improved in the first 6 months after referral to MASs. Research is needed to determine longer term sustainability of the benefits and the cost-effectiveness of MASs.
Barlow J, Curry R, Chrysanthaki T, Taher N (2011) Remote Care plc. Developing the capacity of the remote care industry to supply Britain?s future needs., 10.13140/RG.2.1.4277.9044
There are calls for widespread scaling up of remote care ? ?telehealth? and ?telecare?. These are driven by an ageing population, increasing numbers of people with chronic conditions and constrained resources available for health and social services. This report is concerned with the supply-side of remote care and its ability to meet anticipated future needs. This is an important, but overlooked, question in the debate, which usually concentrates on demand-side issues such as the fragmentation of the health and social care system, or commissioning and funding issues.
Pennington M, Gomes M, Chrysanthaki T, Hendriks J, Wittenberg R, Knapp M, Black N, Smith S (2016) The cost of diagnosis and early support in patients with cognitive decline, International Journal of Geriatric Psychiatry


Recent research indicates considerable heterogeneity in the provision of memory assessment services (MAS). However, little is known on the extent of variation in the costs of the services MAS provide. We investigated the costs of supporting patients with suspected dementia, including assessment and support over the following 6 months.

Clinic costs were estimated on the basis of an organisational survey reporting staff roll, grade and activities. Costs of primary health and social care were estimated from questionnaire data reported by carers of patients at baseline, 3 and 6 months after referral.

Mean monthly staff costs at MAS were £73 000. Imaging at assessment costs an additional £3500 per month. Monthly clinic cost per new patient assessed varied from £320 to £5400 across clinics. Additional primary health and social care costs of £130?220 a month between baseline and 6 months were reported by carers. Costs of pharmacological and non-pharmacological treatments reported by carers were small. Informal care costs dwarfed health and social care costs when valued at a modest unit cost. The overall mean cost of supporting a patient for 6 months varied from £1600 to £2500 dependent on assumptions regarding the proportion of MAS intervention and review costs accrued at 6 months.

There is considerable variation in the intensity and associated costs of services provided by MAS. Further research should ascertain to what extent such variation is associated with differences in patient outcomes.

Hendy J, Barlow J, Chrysanthaki T (2012) Scaling-up Remote Care in the United Kingdom: Lessons from a Decade of Policy Intervention., In: Glascock A, Kutzik DM (eds.), Essential Lessons for the Success of Telehomecare - Why It's not Plug and Play 30 IOS Press
Since 2006 a series of government sponsored initiatives in the United Kingdom have sought to increase the adoption of remote care ? telehealth and telecare. These aim to address the increased demand on health and social care services caused by an ageing population and rise in the number of people with long term chronic conditions. The scale of activity, including the world?s largest randomised controlled trial, have made the UK a test bed for learning about the potential of remote care, as well as the challenges in deploying it as a mainstream part of health and social care. The chapter discusses the scope of this activity and the lessons that can be learnt.
Abrahao A.R.R., da Silva P.F.C., Frohlich D.M., Chrysanthaki T., Gratão A., Castro P.C. (2018) Mobile digital storytelling in a Brazilian care home,Lecture Notes in Computer Science: HCI International 2018 - Conference Proceedings 10926 pp. 403-421 Springer
Digital stories are short personal films made up of a series of still images with voiceover, music and text. The technical barriers to creating such stories are falling with the use of mobile apps which make it easy to assemble story elements as audiophoto narratives on a smartphone or tablet. In this case study, we explored the potential of mobile digital storytelling in a care home context. It was used for four weeks as form of multimedia communication between formal and informal carers inside and outside the home, and a care home resident suffering from dementia. The home was located in São Carlos, Brazil as part of a larger international project called Time Matters (UK and Brazil), in which Time stands for ?This is me?. Fifteen digital stories were made by participants in the trial, which is about one for every visit of the researchers to the care home. Stories focused mainly on the resident; capturing aspects of everyday life discussed in Visit conversations (4), documenting Social events (3) inside or outside the home, recording Therapy sessions (3) with the resident or Health reports (3) by professional carers, and forming Media albums (2) of the residents? art or life. In general, the technology was most useful for facilitating richer conversations with the resident and other participants, and stimulating greater expressivity and creativity in the resident herself. The desire to document the resident?s current life and interests in the home for later reminiscence by their family, stands in contrast to conventional reminiscence therapy and related digital systems. These use media artefacts to stimulate reminiscence of residents? past life outside the home.


Despite sexual expression being recognised as a fundamental human need, sexuality in old age is often ignored and frequently misunderstood, with residents with dementia in a nursing home often viewed as asexual or incapable of being sexually active.


The current study aims to understand the views held by nursing care home staff towards dementia and sexuality and explore the roles they may adopt whilst responding and managing sexual needs and expression for residents with dementia.


Face to face, in-depth, semi structured interviews were conducted with eight staff members working in two nursing homes in Greater London, United Kingdom. Data were analysed using Interpretative Phenomenological Analysis.


The findings suggest that representations of sexuality in dementia held by nursing home staff ranged from the perception that sexual expression in old age was part of human nature and a basic human right to others that proposed that with the loss of memory, people with dementia may also experience loss of interest in sexuality and intimacy. Based on the representation of sexuality held (personhood versus biomedical model), nursing home staff adopted a role or a combination of roles (a facilitator, an informant, a distractor, an empathiser, a safeguarder) that legitimised past and anticipated responses in managing sexual expression in the nursing home setting. Nursing home staff?s responses varied depending on the severity of the condition, level of involvement of the resident?s family and their own personal views on their duty of care, old age, sexuality and dementia.


The simplified binary labelling and classification of sexual behaviour in dementia as appropriate or inappropriate often applied in institutional settings, fails to account for complex factors that may influence staff?s decisions on the ethical dilemmas raised by dementia. A role based continuum approach could help staff move away from rigid binary judgments and train them to adopt formal carer roles that promote a more contextualised rights based approach in the provision of dementia care.

Purpose ? Despite the fact that research in readiness is growing, there are gaps in the context of enacting readiness within healthcare. Adopting the complex adaptive systems theory, this thesis aimed to extend the theoretical understanding of the concept of organisational readiness for innovation in the context of healthcare. It examined the meanings and the processes involved in achieving and maintaining a state of readiness for innovation in the UK public healthcare services sector from the perspective of its senior leaders.

Methodological approach ? The thesis included three studies. First, a narrative systematic review was conducted across different bibliographic databases to explore the associated meanings and factors influencing organisational readiness for innovation. The search revealed that there were different meanings and processes associated with the development, implementation and sustainability of the construct. These included the stage vs. the process-based debate, the various disagreements amongst theorists on the multifaceted nature of the construct and its impact (i.e. behavioral, psychological and structural), and its relation to organisational change. This led to the adoption of a qualitative research method to further investigate the topic in the context of UK public healthcare services. Twenty semi-structured individual interviews in total were conducted. The data were collected in two phases. The first phase consisted of a total of ten senior managers working in NHS organisations. This first phase investigated from an internal point of view how organisational readiness for innovation was successfully managed within the National Health Service (NHS) ? it explored meanings, discrepancies between organisational change management and innovation, and identified contextual (pre) conditions and processes of how leadership may influence readiness for innovation, its enactment and sustainability. In the second phase, a total of ten semi-structured personal interviews were conducted with senior management representatives from the Academic Health Science Networks groups. This second phase provided information on the perspective and role of an external facilitator?s organisation in supporting and sustaining an innovation ?ready? culture in the NHS. Conducting the study in two phases allowed the researcher to see the level and reasons for alignment in the senior management?s views from different organisational perspectives ? internal and external.

Summary of results ? A significant distinction was found in the senior managers? opinion regarding the definition of innovation and organisational change. Successful innovation management was described as a much more complex and intricate process than organisational change management. Readiness was perceived as an iterative process of interaction between different stakeholders, their new ideas and the environment to enable innovation development and service improvement. Participants acknowledged that readiness for innovation was driven by collective engagement and intrinsic motivation from members of the NHS organisation. The findings presented, among others, some unique key contextual factors enabling organisational readiness for innovation which include: free spaces, communities of practice, and five types of leadership style: systems leadership, collective leadership, distributed leadership, lateral leadership, and transformational leadership.

Conclusions ? The study generated new understanding about the theoretical distinction of innovation from organisational change. It provided new rationale about the meaning of organisational readiness for innovation based on views from those managing the process internally and externally in the NHS. The study recommended a conceptual framework enabling scholars, practitioners, senior managers, and policy makers to understand the actions required in order to prepare the NHS for the long-term success, adaptability, and the susta

Frohlich David M., Corrigan-Kavanagh Emily, Campbell Sarah, Chrysanthaki Theopisti, Castro Paula, Zaine Isabel, Campos Pimentel Maria da Graça (2020) Assistive media for wellbeing,In: HCI and design in the context of dementia Springer International Publishing
Personal digital media such as photos, music and films play a pervasive part in
contemporary life by helping us to remember the past, communicate with each other and
represent our identity to others. In this chapter we explore the value of such media for
supporting wellbeing in older age, drawing on concepts from literatures on art,
reminiscence and music therapy. Theoretically we argue for a new category of assistive
technologies involving media creation and consumption to enhance wellbeing. We propose
a framework for understanding and designing such assistive media systems which highlights
the interaction between media item, author and audience. This framework is then
illustrated through early attempts to explore a new kind of digital story therapy for people
with dementia in a residential care setting. We conclude with recommendations for the
design of future ?assistive media? systems and experiences that might enhance not only the
lives of people with dementia, but also those around them.

Additional publications