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Article Title

Building Research Capacity in Regional, Rural and Remote Allied Health Services: Lessons from Evidence and Experience

In the previous editorial, I reflected on allied health in my country of birth, India. I reflected on the unique challenges that many allied health professionals in India faced and how evidence-based practice (EBP) may act as unique vehicle to address some of these challenges. In this editorial, I reflect about allied health in my adopted country, Australia. I vividly remember the day when I arrived in Australia in late summer of 1995 as a teenager about to embark on a university education. What struck me the most was the magnitude of this vast brown land and its relatively small population. I remember asking my father, who had accompanied me to Australia, "Where is everyone?” Coming from one of the most populous country in the world, the contrast could not be starker. Australia was, and is, one the wealthiest country in the world, and its health care is the envy of many. And despite this, there remains inequity within the Australian health care system (just like India).

One glaring area of inequity is in the rural and remote regions of Australia where research has identified that health outcomes for people living outside of urban centres (in rural and remote regions) are consistently worse than that of their metropolitan counterparts, with this continuing to worsen with the degree of remoteness[1]. As there is an uneven distribution of health workforce in rural and remote settings, this places enormous challenges on the health workforce in terms of their practice (diverse range of clients, lack of support and adequate resources, poor communication), profession (professional isolation, issues of self-care due to high workload, limited support and mentoring, limited access to professional development) and person (social isolation, risk of burnout, lack of rural incentives, blurring of professional and personal boundaries)[1,2]. It is in this context that I have been working with colleagues at Cunningham Centre and the Darling Downs Hospital and Health Service in regional Queensland with a view to support allied health professionals working in these settings. The Cunningham Centre and the Darling Downs Hospital and Health Service, among other things, aim to build research capacity, capability and culture in regional and rural health services as means of supporting rural and remote allied health professionals. In this editorial, my colleague and I outline the definition and summarise the current research on Research Capacity Building (RCB); we speak from experience as a public servant and researcher (Ducat) and academic (Kumar) based on our involvement in research in the public health setting as well as presenting ways forward based on evidence and experience[3,4].

Definition of Research Capacity Building (RCB)

While there is no universally agreed definition of research capacity, key common elements across all definitions include shared goals, collaboration and partnership, education and training, organisational support and leadership, evaluation and monitoring. It has been reported that may be a continuum of clinician research capacity development from research consumer, to research active to research leader. Trostle[5] from the United Kingdom define RCB as the

Process of individual and institutional development which leads to higher levels of skills and greater ability to perform useful research.

In Australia, Albert and Mikan propose that RCB is

An approach to the development of sustainable skills, organisational structures, resources and commitments to improvement in health and other sectors to multiply health gains many times over.

What the Research Says

The literature identifies multiple strategies to build research capacity, including funding through grants, scholarships and bursaries, education, networking and forums for support as well as the implementation and evaluation of dedicated research positions to enhance linkages and partnerships[3]. As outlined by Cooke[7], the focus of RCB is to

…develop skills and confidence, support linkages and partnerships, ensure the research is close to practice, develop appropriate dissemination, invest in infrastructure, and build elements of sustainability and continuity

Cooke advises a sole focus on research outputs is too narrow:

Traditional outcomes of publications in peer reviewed journals and successful grant applications may be important outcomes to measure, but they may not address all the relevant issues to highlight progress, especially amongst novice researchers[7]

Research capacity is about producing ability through enabling individuals and departments to undertake these activities, through creating the necessary infrastructure, environment, culture and credibility[8]. Sitthi-amorn and Somrongthong[9] present a global perspective that details the multidimensional nature of health research capacity including capacities that translate from traditional research settings into health settings. These include an ability to build sustainability; to set objectives, priorities, define problems and systematically identify solutions to key national health issues.

Similarly, the National Research Forum in the United Kingdom[10] specify that RCB is not simply about undertaking research projects, rather, the entire research process including specifying, accessing, interpreting and applying research needs to be considered. Leitch (2009) highlights the importance of focussing on the end user to be engaged, to understand and draw on research and to inform the formulation of future research priorities.

Research capacity building is not simply the acquisition of skills and capacities of educational researchers ….it is also about the capacity of users of research to understand and draw on existing research and to formulate effective demands for further research[11].

While the literature focuses on defining methods to build research capacity, there is minimal clarity or discourse around the organisational strategies or proposed evaluation of such strategies to enable or support research capacity building[3].

As part of an industrial relations agreement, the Department of Health, Queensland Government implemented new research positions and grant funding throughout the state as part of a research capacity building framework. Preliminary findings of this initiative were published this year, and showed that this framework has been associated with increased health practitioner research engagement[3]. Hulcombe and colleagues[3] report that 75% to 89% of grant funding has been awarded to major capital city hospitals. As discussed by these authors, there is a low representation of research participation and outcomes in regional, rural and remote health settings demonstrating the need to focus efforts on building research capacity in these settings.

What Experience Says

The experience of building research capacity, including, supporting regional, rural and remote allied health professionals to become evidence based, teaching evidence based practice and coordinating education sessions around evidence based practice, actively engaging in research and evaluation has formed our understanding of key aspects that are critical to building research capacity in a public health setting.

  • Mentoring in terms of availability and approachability of a mentor to work with clinicians. This person needs to be a champion and actively work on building confidence and capability in the research space. Confidence and encouragement appears to be critical
  • Resources including access to journals, databases and a good health service librarian, and/or journal club
  • Building a research culture including people actively discussing and talking about (approaching) research and seeing it as part of their role. This is counteracting the culture of I’m too busy, I don’t have time, that’s not core business
  • Collaborations with Universities including engaging as external contractors and collaborating on research initiatives.

Other successful strategies include

  • Starting small including simple research designs and a step-by-step approach, gradually adding the evidence base, building novice research capability and rigour and quality in research endeavour
  • Engaging with internal stakeholders and ensuring appropriate endorsement during all phases of the research endeavour
  • Training, education and up skilling for interested parties who have demonstrated commitment and motivation – including utilising online resources which are plentiful as well as coordinated, strategic provision of education
  • Clear policy and guidelines that communicate processes and commitment from the organisation.

Moving Forward

The desired outcome of translatable and rigorous research activity and publications in non-metropolitan health settings is a worthwhile pursuit. However, persistent barriers need continued attention in order to increase research capacity in these settings. Difficulties with confidence, finding time off line and accessing necessary resources to participate in research are consistently reported to impact on research capacity by allied health professionals. Continued communication of a clear vision around staff participation in research, including further development of guidelines and processes for increasing research capacity, and a sustainable mentoring model to foster and encourage research needs to continue. Continuation, as well as further development and evaluation of a research capacity building framework provides a path for future, high quality research endeavours in non-university settings and provides clear pathways for collaboration between government and research organisations.

A multidimensional focus on building structures, processes and outcomes is important to move forward. Continued development of structures includes building collaboration between clinical leaders, clinician researchers, allied health practitioner research positions and universities and strategically applying for health service grant funding to support relevant research activity. Continued focus on processes includes building confidence, mentoring, regular interest groups, liaising with management, development and approval of processes and policies to support research. Key implementation (process) variables need to be appropriately defined and investigated, with impacts on professional practice and health outcomes appropriately assessed. Finally, continued support of research outputs including obtaining grant funding and publication of research findings to build a rigorous evidence base for allied health practice across regional, rural and remote contexts is needed. Together, these key strategies will lead to an enhanced, evidence based understanding and application of effective practices for allied health professionals in non-metropolitan contexts.

References

  1. Health Workforce Australia 2011, Rural and remote health workforce innovation and reform strategy: summary of draft background paper, https://www.hwa.gov.au
  2. SARRAH 2009, Challenges of remote & rural practice, http://www.sarrahtraining.com
  3. Hulcombe, J., Sturgess J., Souvlis,T., Fitzgerald, C. An approach to building research capacity for health practitioners in a public health environment: an organisational perspective. Australian Health Review 2014; 38: 252–258.
  4. Kumar & Johnston Building Allied Health Capacity, International Centre for Allied Health Evidence (ICAHE), South Australia Http://www.unisa.edu.au/cahe
  5. Trostle J. Research capacity building in international health: definitions, evaluations, and strategies for success. Social Science Medicine 1992; 35(11): 1321-1324.
  6. Albert E, Mickan S: Closing the gap and widening the scope. New directions for research capacity building in primary health care. Australian Family Physician 2002, 31:1038 -10341.
  7. Cooke J. A framework to evaluate research capacity building in health care. BMC Family Practice 2005; 6: 44. doi:10.1186/1471-2296-6-44.
  8. D’Auria, D. Building a research capacity for occupational medicine. Occupational Medicine 2000; 50(2): 79.
  9. Sitthi-amorn, C., Somrongthong, R. Strengthening health research capacity in developing countries: a critical element for achieving health equity. British Medical Journal 2000; 321(7264): 813–817.
  10. National Educational Research Forum 2000, UK. http://www.eep.ac.uk Accessed 14th July 2014.
  11. Leitch, R. Harnessing the slipstream: building educational research capacity in Northern Ireland. Size matters. Journal of Education for Teaching: International research and pedagogy 2009; 35(4): 355-371.

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