At the NIHR Innovation Observatory, understanding how healthcare innovation, evidence, and decision-making can better serve diverse populations is central to our mission. Through initiatives including “MedTech for All: Breaking Barriers to Equity in Healthcare Innovation”, alongside wider engagement across the health inequalities landscape, Patience has played an important role in advancing conversations around equity, inclusion, and representation in health research.
Her work has also extended into national policy discussions, including reflections following attendance at the APPG on Black Health meeting focused on improving diversity in clinical trials. More recently, Patience has been shortlisted for the Black Healthcare Awards 2026 in the Health Research & Life Sciences category, recognising her contributions to improving how health research and healthcare decision-making consider inequality and inequity.
Against this backdrop, we’re delighted to share that Patience has successfully completed her PhD, passing her viva with no corrections. Her research explored how health inequalities and inequities are considered within evidence synthesis, helping to support more inclusive and equitable healthcare research and decision-making. We spoke to Dr Patience Kunonga about her research journey, inspirations, and this fantastic achievement.
Thank you! It still feels slightly surreal. Completing a PhD is a major milestone in itself, and I feel very grateful to have passed with no corrections. The PhD brought together several years of methodological, applied, and policy-focused research, so it was really rewarding to see the work recognised through the viva process.
My PhD focused on how health inequalities and inequities are considered within evidence synthesis, which is the process of bringing together findings from multiple studies to inform healthcare and policy decisions. Often, this research focuses on whether something works overall, without fully examining who benefits most, who benefits least, or who may be left out altogether.
Through my research, I developed the Kunonga Framework, which is a structured approach to helping researchers think more carefully about inequality and inequity within evidence synthesis. It encourages researchers to look beyond differences between groups and consider the wider social and structural factors that shape health outcomes.
Part of the inspiration came from my own experiences during the COVID-19 pandemic. At the time, much of my healthcare moved online while I was managing existing health conditions. Although the changes worked well in some ways, they also relied on assumptions about people having access to technology, being able to afford equipment, and feeling comfortable using remote care.
That experience made me think more broadly about how we decide whether healthcare interventions are truly effective, and whether we pay enough attention to who may be excluded.
For example, a digital health intervention might appear successful overall, but that can hide important differences between people who can easily access the technology and those who cannot. If those differences are not examined, healthcare decisions can unintentionally widen existing inequalities.
Working across the NIHR Innovation Observatory and the NIHR Healthy Ageing Policy Research Unit gave me the opportunity to engage with both methodological research and real-world policy discussions. That broader experience strongly shaped the direction of the PhD because it highlighted how evidence moves from research into policy decisions and ultimately into patient care.
It also reinforced the importance of asking who is represented within the evidence we rely on to make healthcare decisions. Through projects, events, and wider policy discussions around equity and representation in healthcare innovation, I became increasingly interested in how research evidence can unintentionally overlook certain populations if inequality and inequity are not actively considered.
Medical evidence is only as reliable as the populations included in the research that produces it. If certain groups are underrepresented within research, there is a risk that important differences in health outcomes, treatment responses, or access to care may be missed.
One example discussed at the APPG on Black Health meeting was how standard HbA1c tests used to diagnose type 2 diabetes can give misleading results for some Black men because of genetic variation affecting the readings. It’s a powerful example of how evidence gaps can translate into gaps in care.
As healthcare increasingly incorporates artificial intelligence, advanced diagnostics, and data-driven decision-making, representation within health data becomes even more important. Systems built on incomplete or unrepresentative data risk reproducing existing inequalities rather than reducing them.
One of the biggest moments was realising that inequalities and inequities are not always absent from research evidence, they are often overlooked because of the way studies are designed and analysed.
For example, in one study I found that only 19 out of more than 8,600 studies underpinning selected NICE guidelines examined outcomes by socioeconomic status. Developing the Kunonga Framework was really about responding to that gap and creating a more structured way of examining inequality and inequity within evidence synthesis.
It has also been rewarding to see parts of the research gain recognition during the journey itself. One publication from the PhD was featured in a Journal of Clinical Epidemiology Editors’ Choice article, and the work led to invitations to present at Cochrane events, including a Cochrane Equity webinar.
I hope the work supports fairer and more inclusive approaches to health research and policymaking. More broadly, I hope it encourages researchers and decision-makers to think more carefully about whose experiences are reflected in the evidence, and whose may be missing, when making healthcare decisions.
I also hope the research contributes to wider conversations around inclusive healthcare innovation and equitable evidence generation, particularly as health technologies and data-driven systems continue to evolve.
Probably balancing a part-time PhD by publication alongside full-time research and policy roles. The work developed over several years, so it required a lot of persistence, patience, and learning how to manage competing priorities.
The research itself was also challenging because I was exploring an area where there were not always clear methods or answers. A big part of the process involved trying to make sense of complex issues and develop a more structured approach to studying inequality and inequity within evidence synthesis.
I’m most proud that the work contributes both methodologically and practically. The Kunonga Framework was designed not only to advance theoretical discussions around inequality and inequity, but also to be applied within real-world evidence synthesis and policymaking contexts.
It has also been very rewarding to see individual parts of the research gain recognition during the journey itself. One of the publications from the PhD was featured in a Journal of Clinical Epidemiology Editors’ Choice article, and the work also led to invitations to present at Cochrane events, including a Cochrane Equity webinar. Seeing the research resonate internationally, contribute to wider policy discussions, and more recently being shortlisted for the Black Healthcare Awards 2026 in the Health Research & Life Sciences category has been especially meaningful.
I’ve been very fortunate to have support from supervisors, collaborators, colleagues, friends, and family throughout the process. Working within the NIHR Healthy Ageing Policy Research Unit and NIHR Innovation Observatory also gave me the opportunity to work across both methodological and policy-focused environments, which strongly shaped the direction of the research.
One of the most important things is to accept that research is rarely linear. Some of the papers within my PhD took years to develop, revise, and refine. Progress can feel slow at times, but consistency and resilience matter a great deal.
I would also encourage people to remain intellectually curious and not be afraid to question assumptions within their field. Some of the most valuable research contributions come from identifying things that others may have overlooked or taken for granted.
I’m looking forward to building on the PhD and continuing to develop the Kunonga Framework further. One of the next steps is exploring how it can be applied across different types of evidence synthesis and extended to earlier stages of the review process, including how studies are identified and selected for inclusion.
I’m also interested in involving a wider range of contributors in the framework’s future development, including people with lived experience, practitioners, and third-sector organisations, to help strengthen its relevance for research, policy, and practice.
I’m still processing it all at the moment! But I’m looking forward to celebrating with family, friends, colleagues, and everyone who supported me throughout the journey. It’s been a long process, so it definitely feels like a milestone worth taking time to appreciate.
