Understanding the contribution of UK public health research to clinical guidelines: a bibliometric analysis

Background: There is an increasing need to understand the wider impacts of research on society and the economy. For health research, a key focus is understanding the impact of research on practice and ultimately on patient outcomes. This can be challenging to measure, but one useful proxy for changes in practice is impact on guidelines. Methods: The aim of this study is to map the contribution of UK research and UK research funders to the National Institute for Health and Clinical Excellence (NICE) public health guidelines, understanding areas of strengths and weakness and the level of collaboration and coordination across countries and between funders. The work consisted of two main elements: analysis of the references cited on NICE guidelines and interviews with experts in public health. Results: Across the papers cited on 62 NICE public health guidelines, we find that 28% of the papers matched include at least one UK affiliation, which is relatively high when compared to other health fields. In total, 165 unique funders were identified with more than three acknowledgements, based in 20 countries. 68% of papers which acknowledge funding cite at least one UK funder, and NIHR is the most highly cited funder in the sample. Conclusions: The UK makes an important contribution to public health research cited on NICE PH guidelines, although the research does not appear to be bibliometrically distinct from other research sectors, other than having a relatively low level of international collaboration. However, the extent to which NICE public health guidelines reflect practice at the local authority level is less clear. More research is needed to understand the sources of evidence to support public health decision making at the local level and how NICE guidance can be made more applicable, timely and accessible in this new context.


Introduction
There is an increasing need to understand the wider impacts of research on society and the economy. In the UK, this is reflected in the introduction of impact case studies into the national assessment system, the Research Excellence Framework, through which core funding is allocated to universities. More widely, there are moves to understand and demonstrate the impact of research outside the academic sphere. This reflects the wider political climate. Economic austerity and increased demands on public expenditure to provide direct services put pressure on research budgets and there is an increased need to show why investment in research is worthwhile.
For health research, a key focus is understanding the impact of research on practice and ultimately on patient outcomes. This can be challenging to measure, but one useful proxy for changes in practice is impact on guidelines. In the UK in particular, evidence that influences NICE guidelines can make a strong case for an impact on patient treatment in the NHS. This is an approach that has been used previously to analyse the way research affects practice in a number of fields [1][2][3] . However, the picture for public health is more nuanced, partly since interventions may often not be delivered through the NHS. In this study, we explore the impact of UK public health research on NICE public health guidelines.
The aims of this article are: to understand the importance of UK research and UK research funders in developing the evidence for the guidance provided, relative to other fields and across areas of public health; to compare the body of evidence that underpins NICE guidelines in this field to other areas; to consider the appropriateness of this approach in the public health context; and to consider the extent and way in which guidelines shape practice in this field.

Methods
The aim of this study is to map the contribution of UK research and UK research funders to NICE public health guidelines, understanding areas of strength of weakness and the level of collaboration and coordination across countries and between funders. The work consisted of two main elements: analysis of the references cited on NICE guidelines and interviews with experts in public health. We discuss each of these methods in more detail in the remainder of this section.

Analysis of references cited on NICE guidelines
We identified 62 currently active NICE public health guidelines from the NICE website (data extracted on 26/09/2016 ). The guidelines included are listed in Table 1. These guidelines were grouped into ten field categories, as indicated in Table 1, by two members of the team (GC, SG) based primarily on their titles, though a brief review of content was also conducted where necessary (e.g. if the title was ambiguous).
The references were extracted from the guidelines manually into a database, producing a total of 31,409 references across all guidelines. It should be noted that many of these guidelines do not include all or, in some cases, any of the references for the evidence that underpinned their development directly. Often, separate evidence summaries are provided (also on the NICE website) for the guidelines -sometimes several for one guideline -which provide references for the underpinning evidence. We extracted the references from these evidence summaries as well as directly from the guidelines themselves.
The references were matched in the Web of Science (WoS) database. Once duplicates were removed and documents which were not journal articles excluded, we were able to produce a set of 12,706 papers from the guidelines matched in Web of Science. This is a low proportion of the total references extracted, but reflects a high level of policy documents and other non-journal material referenced in the guidelines.
For each of these papers matched in WoS, we were able to analyse the institutional affiliations of the contributing authors, based on the address information provided. We used this to look at the countries in which the research was conducted. We used a full counting approach, to allow for comparisons with previous studies in the area.
We also have the date of publication of each of the articles matched in WoS. By comparing this to the publication date of the relevant guideline, we are able to produce an estimate of the 'knowledge cycle time' -that is, the time between the publication of a paper and its citation on the guideline.
Finally, for a number of the publications, we were also able to extract the names of the funders supporting the research from the funding body acknowledgements (FBAs) on the publications. This is only available in WoS for publications from 2008, and even since 2008 the data is not complete, partly because authors do not always cite their funding sources completely and accurately (and sometimes not at all). These data were available for 15% of the papers matched in WoS.
Using these data sets we were able to analyse the contributions and levels of collaboration across funding bodies, countries and between institutions on the publications cited on public health guidelines, by area of public health and as a whole. Analysis was carried out using Microsoft Excel and R.

Interviews
Interviews were conducted with eleven stakeholders engaged in public health-related decision-making and public health research in the UK. Interviewees were selected to ensure a mix of geographical settings and experiences. At the time of the interview, seven of the interview participants were directors of public health at the local authority level, tasked with responsibility for delivering public health interventions in the UK since 2013 4 . Four interview participants were either senior academics or researchers with significant experience of public health in the UK. In accordance with the terms of interview participation, any quotes or attributions have been anonymised where applicable.
Interviews were typically 30-60 minutes long and were conducted by telephone in a semi-structured format, based on the interview protocol provided in Table 2. An anonymised list

Background
We are conducting research looking at the contribution of UK public health research to NICE public health guidelines. However, we are aware that these guidelines may not always reflect policy and commissioning at a local level, because of different needs and priorities in different contexts. Therefore, we are conducting a series of interviews with relevant informants with expertise in public health at the local level to understand how far these guidelines reflect policy and practice, and whether there are other important sources of evidence that are used or other documentation that reflects practice that we could analyse as part of our research. Do you have any questions about the project?
We would like to record the interview, solely for our own internal use within the project team. We will not quote you or identify you directly without your permission. Are you happy for us to record the interview?

Introductory questions
• I know you have many roles which might be relevant to us here, from your research to your work with NICE -could you start by telling us a little about your background and interest in this area?
• What do you know about how PH priorities are developed at the local authority level, so far as those process are common?
• How do those priorities then feed into commissioning decisions?
• We understand that Directors of PH have overall responsibility for this process, but who else is involved from LAs, CCGs etc? How does this interaction and the process overall work -or does this vary? of interviewees, along with their designation and expertise, is included in Table 3. Interviews were recorded, subject to the consent of the individuals, and summary notes written up after each interview (not full transcripts). Interviews were conducted under the principle of informed consent with interviewees informed that the recordings and notes would only be used by the study team for the purposes of the study. These files are stored on secure servers and recordings will be destroyed one year after study completion. The interview notes were analysed, and key themes and common messages extracted to generate some of the insights and the underlying context described, taking a thematic analysis approach. The emergent themes from the interviews are covered in more detail in the Discussion section of this paper.

Ethics and consent
The need for ethical approval was waived for this study by the RAND Human Subjects Protection Committee since interviews were conducted by individuals in their professional capacity only. Oral consent was sought from interviewees to record the interviews, with the interview recording and accompanying notes/transcripts solely for the use of the study team. Oral, rather than written, consent was sought as interviews were conducted by telephone. All participants are anonymised in the discussion in the article and we have ensured all quotes used could not identify the contributor.

Results
In this section, we discuss the findings from the bibliometric analysis of the citation data included in the NICE guidelines. We discuss this in two main sections: (1) contribution of the UK as a provider of research, through an analysis of the institutional affiliations associated with cited papers; (2) contribution of the UK as a funder of research through an analysis of the funding body acknowledgements associated with cited papers.

Contribution of the UK as a provider of research
The first level of analysis was to assess the distribution and co-occurrence of institutional affiliations from publications cited in the guidelines. This allows us to look at the contribution of the UK and other countries to the research conducted that underpins this set of guidelines.
We found that 28% (2,627/9,391) of the papers matched include at least one UK affiliation. Of the 2,627 papers with UK institutions, 2,114 papers (80%) contained only UK based affiliations, suggesting the proportion of international collaboration to be around 20% with non-UK based institutions. This is below the general average for international collaboration in research across the UK 5,6 .
We can also look at the contribution from other countries. Across the 9,391 papers, we identified 5,617 institutions across 93 countries. Figure 1 shows the distribution of institutions affiliated with the papers.
However, though many countries make some contribution, the majority of the research comes from a more limited set of countries. As shown in Figure 1, there are four countries (UK, US, Canada and Australia) who have contributed to over 500 papers, and collectively, these four countries have contributed to 90% of the papers. The largest contributor is the US -47% of papers have a US institution affiliation (4,419). This is likely to reflect the scale of public health research conducted in the US, relative to other countries 7,8 .
Dividing the papers by subject area, we see that the contribution of UK research to the evidence used in guidelines is broadly similar for each subject area. Figure 2 shows the total number of papers for UK, US, Canada and Australia by public health subject area. The US accounts for the majority of papers in each subject area, with the exception of diabetes and oral health, where the UK accounts for the majority of papers (40% and 29% respectively). Papers from non-Anglophone countries account for less than 4% of papers in each subject area with the exception of: oral health, where 9% of papers are from Sweden; mental health, where 6% of papers are from the Netherlands; cardiovascular, where 4% of papers are from Finland.
We can also look at the contribution of specific institutions, which provides some scope to identify 'centres of excellence' in public health research. In the UK, 1,181 institutions were identified, featuring on 2,627 papers. Table 4 shows the top ten institutions from the UK in the dataset, also mapped in Figure 3. Figure 4 outlines the network of institutional affiliations on papers with a UK address. In the network, each node represents an institution and the connecting lines indicate these institutions' co-acknowledgement on papers (a thicker line indicates a greater number of co-acknowledgements). The size of a node is proportional to the number of papers with a UK corresponding address affiliated to the institution. Institutions with fewer than 4 papers with an associated UK address are not included in the network. Nodes are coloured by the location of the institutions.
Aside from the top UK institutions in the network (see Table 4), institutions from other Anglophone countries, such as Australia, US, New Zealand and Canada, tend to be the most prominent non-UK institutions in the network.     Overall, the UK is an important contributor of research to the evidence base supporting NICE public health guidelines, contributing to 28% of papers, alongside other Anglophone countries. This may partly reflect biases in the WoS towards English language publications but may also reflect the strength of these countries in the field. Clarke et al.'s bibliometric overview of public health research in Europe 7 found that only 3.5% of research papers were published in non-English languages. This does not differ significantly by field of research within public health.

Contribution of the UK as a funder of public health research
The second level of analysis was to assess the distribution and co-occurrence of recorded funding body acknowledgements (FBAs) from publications cited in the guidelines. This bottom-up approach has been used in various studies to map the funding landscape of a particular field, explore interactions among research funders and assess trends in research funding 9-12 .
1,420 papers contain FBAs with an average of 2.98 acknowledgements per paper. This represents 15% of the dataset, which is lower than other studies 12 but may reflect the fact that 67% of the papers in the dataset were published before 2008the year WoS began collecting data on FBAs.
Across these papers, 165 unique funders were identified with more than three acknowledgements, based in 20 countries. Table 5 shows the total number of papers and FBAs by funder location.
While there are significantly more US-based institutions affiliated with papers in the dataset, there are more papers with UK-based funders acknowledged than the US. NIHR is the most acknowledged funder in the dataset, accounting for 11% of papers with FBAs. Taken together with the UK Department of Health, it accounts for 226 papers (16% of papers with FBAs). Table 5 shows the top ten most acknowledged funders in the dataset, which account for 60% of the papers with FBAs.
Along with the UK Department of Health, research councils (such as MRC and ESRC) and disease-specific charities working in public health (such as British Heart Foundation and Cancer Research UK) are the most prominent UK funders in the dataset. In addition to UK funders, we see two US funders and one Australian funder in the top ten.
Government funders make up the majority of the 165 funders in our data set, accounting for eight of the top ten funders and around 72% of all funding acknowledgements ( Figure 5). While our previous study on the FBAs associated with global mental health research 12 found a similar distribution in the overall number of acknowledgements (with government funding accounting for 68%), the study found a significantly larger proportion of charities, foundations and non-profits in relation to the total number of funders. Figure 6 outlines the network of funders acknowledged in papers across the dataset. In the network, each node represents a funder and the connecting lines indicate these funders'  co-acknowledgement on papers (a thicker line indicates a greater number of co-acknowledgements). The size of a node is proportional to the number of papers in the network. Funders with fewer than ten papers are not included in the network. Nodes are coloured by the location of the funder.
The most prominent funders in the network are the most frequentlyacknowledged US and UK funders (see Table 5). There is also a relatively large contingent from Australia, multilateral funders such as the EU and the WHO, as well as a number of pharmaceutical companies, such as Pfizer, Merck, GSK and Sanofi. Government funders in Canada, the Netherlands and Scandinavia are also visible.
Of the 165 unique funders identified with more than three acknowledgements, 43 funders (26%) are based in the UK. We have split UK government funding, which make up 42% of the UK funders, into five funder groups for the purposes of analysis.    • Devolved government departments, in Scotland, Wales and Northern Ireland; • Non-health focussed central government departments, such as the Department for International Development (DFID); • Non-departmental public bodies, both with a health focus (e.g. British Health and Safety Executive) and nonhealth focus (e.g. UK Food Standards Agency, Higher Education Funding Council for England (HEFCE)). Figure 7 outlines the network of funders acknowledged on papers with an associated UK address. In the network, each node represents a funder and the connecting lines indicate these funders' co-acknowledgement on papers (a thicker line indicates a greater number of co-acknowledgements). The size of a node is proportional to the number of papers in the network. Funders with fewer than 3 papers with an associated UK address are not included in the network. Nodes are coloured by the location of the funder.
Breaking this down by subject area, we see that the contribution of research funders varies according to the subject area of the guideline. Figure 8 highlights the number of papers cited on the four main subject areas of NICE public health guidelines across the top ten research funders identified. For guidelines on addiction and substance abuse (of which the majority are primarily focussed on smoking), the US National Institutes of Health is acknowledged the most, followed by Cancer Research UK and NIHR. The US National Institutes of Health is also the most frequently acknowledged funder on mental health and wellbeing guidelines. However, for guidelines focussed on obesity and nutrition, the Australian National Health and Medical Research Council (NHMRC) is the most frequently acknowledged funder and for guidelines on physical activity, NIHR is the most acknowledged funder, with the top four funders all based in the UK. However, it is important to reiterate in interpreting this data that only 15% of papers in the dataset contain FBAs.

Discussion
Based on the analysis above, we can conclude that UK public health research and research funders make an important contribution to NICE guidelines. Of the publications matched in Web of Science, 28% have at least one UK author, which is relatively high compared to other fields where such analysis has been conducted, as shown in Table 6, suggesting that context is important to the application of research to policy in this field. In addition, 68% of papers which acknowledge funding cite at least one UK funder, and NIHR is the most highly cited funder in the sample. This suggests that UK funded research in particular is important here, perhaps since research priorities are likely to correspond to policy and practice needs in the UK context. However, there may be other reasons for this -for example, it may be that UK funders are more likely to require acknowledgement of their funding on publications, or that the more recent papers, which are more likely to have fund-ing acknowledgements, are more likely to be from UK sources. This may make sense, as this may correspond to more recent research that reflects the implementation of research in practice, building on a wider body of research which could come from a wider range of sources and countries, since the contextual factors are less crucial to the relevance of this broader underpinning body of knowledge.
Although we can make the case that UK public health research does make an important contribution to NICE guidelines, the extent to which this reflects practice, and hence the extent to which UK public health research can be said to be influencing practice in the UK, is less clear. Based on the interviews we conducted, the extent to which NICE guidelines are seen to reflect practice varies significantly, depending on the prevailing circumstances of each local authority area. NICE guidelines on some aspects, such as obesity, smoking cessation, children's health and cancer prevention, are considered relevant across the board. However, due to budgetary reasons, statutory requirements and geographical variations, local practice can differ significantly (INT01; INT03; INT04; INT08; INT10; INT11). Depending on how the local authorities understand and interpret the role of NICE guidelines, the perceptions of the extent to which NICE guidelines reflect practice varies. Multiple interviewees highlighted the need to communicate more clearly that NICE guidelines are only meant to help make a public health-related decision and not present a ready-made decision on the behalf of the authorities (INT02; INT03; INT04;  INT05; INT08; INT10). These interviewees contended that NICE guidelines are aimed at achieving national relevance and the extent to which some of the guidance can be implemented in the context of specific local challenges would need to vary accordingly. This is reflected in how local authorities with predominantly rural and semi-urban areas with sparse populations are likely to diverge in their approach when considering the guidelines to be implemented (INT04; INT05;  INT06; INT08). The following quote elaborates on how the needs of rural, semi-urban areas differ when compared to urban areas. The quote has been paraphrased to protect the anonymity of the interview participant: Given the constraints of budget cuts / austerity, more than one director of public health mentioned that they sought evidence from other (non-UK) countries in relation to their decision-making for local public health priorities (INT04; INT06). Since there is insufficient precedent for the use of such evidence, the interviewees also suggested that guidance on weighing the appropriateness of the evidence for a particular local authority context would be useful. Such guidance was perceived as being potentially useful to practice and decision-making at local authority area. The way NICE guidelines are perceived to consider hierarchy of evidence also forms an important part of their use in practice (INT11). The type of evidence (based on Randomised Control Trials i.e. RCTs, modelling in some cases) varies and some interviewees suggested that as part of recommendations, the level of evidence is not always identified. This can pose challenges to local authorities when deciding their needs for evidence or additional evidence synthesis. For evidence deemed high-level and not necessarily based on detailed case studies, the NICE guidelines were often considered to be less reflective of the actual practice by some of the interviewees (INT01; INT03; INT04; INT11).
An important document at the local authority level is the health and wellbeing strategy. In recognising that NICE guidelines focus on treatment and prevention measures, local authorities emphasise engagement with local stakeholders and locally produced intelligence when creating and updating health and wellbeing strategies. Given that the local authorities are best placed to gather and act upon local intelligence, multiple An alternative approach to look at the impact of research on practice in public health would be to analyse documentation at the local authority level. However, based on the interviews and desk research we conducted, there are likely to be many challenges with this alternative approach: • The local authorities follow different processes and approaches to document and store their approach and policies for public health-related decision-making. This makes it time-consuming to track and identify local authorities' public health-related documentation.
• Although there is a degree of consistency in terms of storing documentation related to the Joint Strategic Needs Assessment (JSNAs), the practices in terms of citations and referencing vary significantly. with many documents setting out strategy including no formal referencing of research or underpinning evidence.
• In addition to the different practices for referencing and citation of the evidence, the use of evidence at the local level (including local statistics, local survey data and local population data) varies significantly. The citation and referencing of local evidence in this form varies, which makes the analysis of local authorities' documentation a time-consuming task.
• Document sharing with local government associations varies and the processes can often be informal in nature, which makes it difficult to authoritatively establish the reach and impact of the documentation produced by the local authorities.
• Document sharing between local authorities varies based on local areas and extent of coordination and leadership approaches are also different. This has an influence on the documentation publicly available and the manner in which evidence is cited.
• Given the emphasis on evidence-based decisionmaking in case of some priorities, evidence gathered and analysed by the teams that support the DPH and the documentation is internally provided. This evidence may not be formally cited depending on the nature of documentation which may / may not be available publicly.
• The public availability of the documents is shaped by contracting decisions and whether recommissioning is necessary in relation to a public health service. Consequently, making a realistic assessment of the evidence included in documentation related to public health was not feasible in the timescales allocated for this research.
Limitations of the study As noted above, a key limitation of this analysis is the extent to which we can link citation on NICE guidelines to changes in practice. In some areas of health research there are reasonable grounds to assume that practice should, at least to some extent, reflect, or be moving towards, best practice, as set out in guidelines. However, this is less clear in public health, where implementation can take multiple routes and is very much local-context dependent. In addition, we can also add the usual caveats around the use of bibliometrics, some of which are clearly emphasised here. Firstly, only a relatively small proportion of the publications from the guidelines were matched in Web of Science, which may be because much of what is cited on guidelines are not journal publications. This means the analysis here is only a reflection of that portion of the evidence used to underpin guidelines. Secondly, there are a number of known biases in the coverage of bibliometric databases -notably in relation to language, where English language publications are more covered than other languages, which may bias towards publications from the UK and other Anglophone countries. Finally, it should be noted that a full counting approach is used in the analysis here, meaning we look at the number of papers to which researchers or funders from a particular country has contributed. For many of these, there will also be contributions from other countries, and this analysis cannot account for the extent of the contribution of the different authors and/or funders, which may differ substantially.
In terms of the interviews conducted, we are of course limited to the range of viewpoints provided by the set of individuals to whom we spoke. There may be perspectives which we did not capture, and there may be biases inherent of the sample of individuals willing to speak about their experience and knowledge of evidence supporting practice in public health. However, we conducted sufficient interviews that we reached 'saturation point', that is, additional interviews did not seem to be adding substantially to the range and nature of information captured. We also compared the interview findings to wider published evidence on the topic.

Conclusions
UK public health research makes an important contribution towards NICE guidelines, accounting for 28% of all cited papers.
Research is broadly collaborative and coordinated across funders within the UK and in this respect, public health as a research field does not appear to be bibliometrically distinct from other research sectors. As the largest health research funder in the UK, it is also not surprising that the NIHR is the most acknowledged funder on papers cited in NICE public health guidelines.
There is, however, a relatively low-level of international collaboration on UK papers cited in the guidelines. Given the nature of the dataset, this may be expected for two reasons. Firstly, 23% of the papers included in the guidelines were published before the year 2000, when levels of international collaboration were lower. Secondly, the interviews conducted with public health experts highlight the local nature of public health research, which may mean that international collaboration is less likely in these fields.
How far NICE public health guidelines reflect practice conducted at the local authority level is less clear. Therefore, the extent to which public health research truly drives practice is harder to determine. More research is needed to understand the sources of evidence to support public health decision making at the local level, and how NICE guidance can be made more applicable, timely and accessible in this new context.

Data availability
Underlying data Interviews were conducted under the principle of informed consent. Interview participants were informed that recordings, transcripts and notes from the interviews were solely for the use of the project team and therefore these cannot be made publicly available, even in an anonymised form. If researchers wish to access these notes for the purposes of further research, they may contact the corresponding study author, Dr Susan Guthrie, by email (sguthrie@rand.org), providing details of the information required and the intended use of the data. Subject to approval by the RAND Human Subjects Protection Committee, we will then contact the interview participant(s) in question to seek their permission to share the interview notes for the purpose specified.

Grant information
This is an independent study conducted by the PRiSM unit, commissioned and funded by the Policy Research Programme in the Department of Health.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Open Peer Review Introduction
The acronym NHS is not defined.

Methods -Analysis of references cited on NICE guidelines
There is no reference for software R; in scientific publications the following is usually used: ○ R Core Team (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/

Results -Contribution of the UK as a funder of public health research
The second reference to Table 5 (Page 8, line 21 of that paragraph: " Table 5 shows the top ten most acknowledged funders in the dataset, which account for 60% of the papers with FBAs") seems not pertinent, as in Table 5 there is not a list of funders.

Discussion
Page 14, penultimate line of left column: the acronym DPH is not defined.
○ Tables  Table 2: there are acronyms used without any previous definition, i.e. LAs, CCGs, PH. Figure 1: grey color is not defined in the legend; it is supposed to indicate countries counting zero contributing papers, but this is contradictory with the group represented by the lightest blue, which seems to include also the 0. ○ Figure 4 is really too complex and hard to understand! Thicker lines are difficult to distinguish. Moreover, it is also cut at the top and the bottom. ○ Figure 6 and 7 are less confuse than Figure 4, but thicker lines are still hard to distinguish.

If applicable, is the statistical analysis and its interpretation appropriate? Yes
Are all the source data underlying the results available to ensure full reproducibility? Yes

Are the conclusions drawn adequately supported by the results? Yes
Statistical Cybermetrics Research Group, University of Wolverhampton, Wolverhampton, UK This is a descriptive analysis of references in UK NICE guidelines using bibliometrics together with stakeholder interviews for context. Although clinical guideline citations have been investigated before, I think this is the first to match citations with the web of science and to analyse them in conjunction with interviews. The paper contains a lot of results, is well written and clearly explained. The interviews do not seem to have been systematically analysed with a recognised qualitative method but I think this is fine given that they are used to support and follow up from the bibliometric analysis, as well as to address pre-defined questions. It also does not have a literature review component summarising what is known about NICE guidelines from previous research but it does not really need it.
For the sentence, "This is below the general average for international collaboration in research across the UK", could you find from the Web of Science what the average is for public health? If not, the science-wide comparison is not very meaningful.

If applicable, is the statistical analysis and its interpretation appropriate? Yes
Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes