A Systematic Review of the Literature on the Validity, Reliability, and Utility of the NHS Friends and Family Test as a Method for Gathering Feedback on and Improving the Experiences of Patients

The NHS Friends and Family Test (FFT) is widely used across the National Health Service to collect patient feedback on care experiences. Given its scale and cost, there is strong public and organisational interest in the validity, reliability, and utility of the FFT. This study aimed to systematically review the literature on the validity, reliability, and utility of the FFT as a method for gathering feedback on and improving patient experiences. PubMed and ProQuest databases were searched in September 2024. Studies were included if they met the inclusion criteria. Information extracted included study information (e.g., title, authors, publication year, research objectives, country), inclusion/ exclusion criteria (e.g., study design, population, concept, context) and evidence on validity, reliability, and utility. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. Out of 33 articles screened, fifteen studies were identified for inclusion. Twelve studies provided evidence on the validity of the FFT, mainly showing limited associations between FFT scores and other quality indicators. Twelve studies explored utility, with mixed findings: positive responses motivated staff but offered limited value for quality improvement. Reliability was underexplored, addressed in only two studies. The limited and inconsistent evidence base raises concerns about the FFT’s effectiveness in supporting quality improvement and prompts questions about the robustness of existing findings. PROSPERO registration number: CRD42025650825