Health organisations that have greater research capacity and activity are more likely to perform evidence-based practice and deliver evidence-informed health messages to patients. Many research capacity building (RCB) iniatives, however, assume a level of resourcing in health organisations that sometimes, is just not there.

In this article, I will highlight the importance of context and multi-level approaches for building research capacity, what a low resource setting looks like, and the strategies that can be used to build research capacity in these types of settings. This blog is relevant for individuals and organisations concerned with, or leading research capacity building initiatives in health settings.

 

Context matters for building research capacity

Effective RCB strategies focus on multiple levels of influence to promote individual clinicians’ research skills and to develop a research enabling context. These levels of influence include:

1. Individual-level: this includes clinicians and emerging or established clinician-researchers
2. Organisation-level: this encompasses factors within the environment including infrastructure, resource accessibility, research leadership and culture
3. Global-level: for example, research-supportive policy, health organisation-embedded research roles.

Focusing only on individual-level RCB is tempting—let’s face it, it’s a bit easier. This approach may lead to increased individual clinician knowledge, skills, and confidence to engage in research. However, without access to the supports and infrastructure to engage in research, it is difficult to achieve, let alone demonstrate impact. Another risk with this approach is that individuals with new-found research skills and capacity leave the organisation for better opportunities elsewhere.

What is a low resource setting?

Some of the characteristics of a low research resource health setting include:

• Geographic isolation (e.g., in rural and remote locations)
• Intermittent internet access
• Lack of access to library services and research databases for quality peer-reviewed research literature
• Perennial workforce shortages making it difficult (or impossible) to provide backfill for clinicians to engage in research
• Limited opportunities to collaborate with research partners (e.g., university partners)
• Absence of research strategy or overt organisational support for research
• No clear starting point or pathway for research-interested clinicians (e.g., a “go-to” research person or an ethics and governance pathway).

These are just some of the factors that hinder RCB efforts in some settings.

Strategies to build research capacity in low resource settings

I won’t sugarcoat it, building research capacity in low resource settings (e.g., in rural and remote health organisations) is hard work and a long game, but it is also really important. We know that health outcomes for people living in rural and remote communities are worse than those living in city-centric locations. What’s more, the directive to support health research that is close to practice and reflects the needs of health consumers, is clear.

Here are my top five strategies for building research capacity in low resource settings.

1. Focus on health managers, leaders, and executives

Yes, we need research capable clinicians to do research, but we also need supportive and enabling environments for them to do it in. We need managers that overtly support and celebrate research activity, are willing to endorse time allocation to research (which may mean time “off the floor”), and sign-off on research applications (e.g., for ethics approval, seed grant funding, etc.).

For RCB to be effective and impactful, managers, leaders, and executives must be engaged in the initiative. This is difficult for health organisations themselves to orchestrate, however individuals and organisations concerned with developing and delivering research capacity building strategies (e.g., embedded researchers and academic health science centres) can make deliberate efforts to engage and support these critical stakeholders. This may be done informally, by taking opportunities to provide ad hoc support, advice, and education or by developing formalised managerial and executive-level research support strategies.

2. Establish connections to build research capacity in low resource settings

When it comes to building individuals’ research skills and capacity, you cannot beat experiential learning or “learning by doing”. The best way to enable experiential learning is by providing opportunities for emerging clinician-researchers to connect and work with more established researchers. However, this may be difficult for those leading RCB activities to support considering their often busy and complex workloads.

Facilitating connections between emerging clinician-researchers and more established researchers in academic and other settings is a key RCB strategy. This may take some time, creative thinking, and effort to orchestrate, but will mean that emerging clinician-researchers can really consolidate their skills, develop their own research network, a clinician-researcher identity, and more feasibly manage their competing clinical demands.

To achieve this, RCB leaders must establish and nurture their own research networks and connections to understand the available research assets and where they are. They also need to be prepared to play strategic research “match-maker.” This won’t always be successful, or even possible, but networking and connecting must be recognised as a key component of RCB leaders’ roles in low resource settings.

3. Identify research priorities

Research is necessarily born of curiosity; however, research funders almost always place an explicit emphasis on impactful research that directly influences practice and policy. This is where health organisation and clinician-led research has the edge over university-led research. Clinicians are in tune with the needs of service users and are prime to identify gaps in knowledge to inform clinical care.

There are many gaps in knowledge that need to be filled by research activity. This is particularly the case for rural and remote health settings, where existing evidence supporting healthcare delivery tends to emanate from metropolitan settings and does not account for the challenges specific to more geographically isolated contexts.

To demonstrate the impact of clinician-led research and therefore promote recognition of and momentum around research, organisations must have a sense of their research priorities. In a perfect world, organisations would have a research strategy outlining their approach to RCB that considers individuals and the organisation more broadly. This is not a perfect world and indeed health workforce issues are acute amid the COVID-19 pandemic.

At a minimum, the identification of some research priorities emanating from local practice or clinical issues that impact multiple teams and disciplines will go a long way. This allows for research activity to be recognised as a core component of clinical practice, rather than considered secondary (at best), or a waste of time (at worst).

4. Back a winner to build research capacity

The decision between wide-spread, all-inclusive RCB activities (e.g., a bulk research training course) or narrowing the focus to a small number of individuals with great potential, can be difficult to make. However, investing in individuals that have an intrinsic interest in research can lead to greater impact in terms of productivity and the quality of research. This can also double as a strategy to retain research-interested, and ultimately research-capable staff.

5. Collaborate (yes!) but collaborate wisely

There is increasing pressure on academic researchers to demonstrate real world impact (see for example, the UK’s Research Excellence Framework and Australia’s Excellence in Research for Australia). This means that academic researchers are increasingly interested in partnering with health organisations and other end users to conduct their research (and rightly so!). This may also mean overwhelm for health organisations (particularly those with low resources) when approached by potential research partners.

There are advantages that come with collaborating with researchers, including shared access to research infrastructure (e.g., libraries, databases, software, data collection tools) and mentor support, just to name a few. However, organisations must be sure that the collaboration will be fruitful and impactful for them and for their service users. The last thing you want is for research-interested clinicians to be jaded by a research experience that is not meaningful or impactful.

Making decisions about whether to collaborate must be made with regard to identified priorities (see the third strategy). They must also consider the resources that will need to be contributed to the collaborative endeavour and the gains or benefits for the organisation (e.g., honorary positions, access to resources, research funding, authorship on papers, etc.).

In summary

Building research capacity in low resource settings is challenging, but important. It is tempting to focus limited resources on delivering services and neglecting research, however this may mean that the gap between knowledge and practice remains, or even widens. What’s more, the health disparity between low resource health organisations’ communities and those living closer to major cities also widens.

Strategies to promote research capacity and capability in low resource settings are not wildly different from those in higher resource settings. However, the key message here is to focus at least as much on organisational RCB, if not more, than individual RCB.

We also have resources to support clinical managers wanting to support research and manage competing priorities, available here.

We would love to hear about your experiences or thoughts on building research capacity in all kinds of settings. Please leave a comment below. 

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