Development and implementation of training for interdisciplinary research in primary health care

Complex skills are required for new primary health care researchers: a training program responds

BACKGROUND

Current dimensions of the primary health care research (PHC) context, including the need for contextualized research methods to address complex questions, and the co-creation of knowledge through partnerships with stakeholders - require PHC researchers to have a comprehensive set of skills for engaging effectively in high impact research.

MAIN BODY

In 2002 we developed a unique program to respond to these needs - Transdisciplinary Understanding and Training on Research - Primary Health Care (TUTOR-PHC). The program's goals are to train a cadre of PHC researchers, clinicians, and decision makers in interdisciplinary research to aid them in tackling current and future challenges in PHC and in leading collaborative interdisciplinary research teams. Seven essential educational approaches employed by TUTOR-PHC are described, as well as the principles underlying the curriculum. This program is unique because of its pan-Canadian nature, longevity, and the multiplicity of disciplines represented. Program evaluation results indicate: 1) overall program experiences are very positive; 2) TUTOR-PHC increases trainee interdisciplinary research understanding and activity; and 3) this training assists in developing their interdisciplinary research careers. Taken together, the structure of the program, its content, educational approaches, and principles, represent a complex whole. This complexity parallels that of the PHC research context - a context that requires researchers who are able to respond to multiple challenges.

CONCLUSION

We present this description of ways to teach and learn the advanced complex skills necessary for successful PHC researchers with a view to supporting the potential uptake of program components in other settings.

Capacity building and mentorship among pan-Canadian early career researchers in community-based primary health care

AIM

To describe activities and outcomes of a cross-team capacity building strategy that took place over a five-year funding period within the broader context of 12 community-based primary health care (CBPHC) teams.

BACKGROUND

In 2013, the Canadian Institutes of Health Research funded 12 CBPHC Teams (12-Teams) to conduct innovative cross-jurisdictional research to improve the delivery of high-quality CBPHC to Canadians. This signature initiative also aimed to enhance CBPHC research capacity among an interdisciplinary group of trainees, facilitated by a collaboration between a capacity building committee led by senior researchers and a trainee-led working group.

METHODS

After the committee and working group were established, capacity building activities were organized based on needs and interests identified by trainees of the CBPHC Teams. This paper presents a summary of the activities accomplished, as well as the outcomes reported through an online semistructured survey completed by the trainees toward the end of the five-year funding period. This survey was designed to capture the capacity building and mentorship activities that trainees either had experienced or would like to experience in the future. Descriptive and thematic analyses were conducted based on survey responses, and these findings were compared with the existing core competencies in the literature.

FINDINGS

Since 2013, nine webinars and three online workshops were hosted by trainees and senior researchers, respectively. Many of the CBPHC Teams provided exposure for trainees to innovative methods, CBPHC content, and showcased trainee research. A total of 27 trainees from 10 of the 12-Teams responded to the survey (41.5%). Trainees identified key areas of benefit from their involvement in this initiative: skills training, networking opportunities, and academic productivity. Trainees identified gaps in research and professional skill development, indicating areas for further improvement in capacity building programs, particularly for trainees to play a more active role in their education and preparation.

Promoting the creation of R&D intentions in primary healthcare measured by a validated instrument

BACKGROUND

Primary healthcare has a long and successful patient care history in Sweden. Nevertheless, a research-oriented attitude has been more or less absent in this context. In society today, access to information has significantly influenced the nature of patients' demand for up-to-date healthcare. A prerequisite for this new demand is health professionals who are interested in novel ways of thinking and view a change of work practices as necessary. One way to achieve this goal is by means of strategic communication, which is a relatively new interdisciplinary field. The aim of this study was to analyse the role of strategic communication in the creation of intentions in Research and Development (R&D) among primary healthcare staff as measured by a validated instrument.

METHODS

An intervention study on staff was performed. A 15-item questionnaire was validated and implemented. All primary healthcare staff from the southwestern Swedish province of Halland were included. In total, 846 employees (70%) agreed to participate in the measurements. After 12 years, 352 individuals who had participated in the intervention and remained in the organisation were identified and followed up. The intervention comprised established communication channels. The measurements were performed after 7 and 12 years. A questionnaire was designed for this purpose. The questions were validated by a factor analysis, and the degree of reliability was measured with Cronbach's alpha coefficient. χ² and Fisher's exact tests were used as statistical tests in comparisons.

RESULTS

Factor analysis identified five pure factors (most Cronbach's alpha > 0.70). Strategic communication contributed to a significant improvement in the staff members' interest in R&D and willingness to change in both the short (P < 0.05) and long (P < 0.05) term. The positive attitude was stable over time.

CONCLUSIONS

Strategic communication seems to be a significant tool for creating a stable positive attitude towards R&D in the primary healthcare context. The creation of a positive attitude towards a scientific approach is a relevant finding that deserves special attention in a context as complex as healthcare. Using a validated instrument seems to contribute to pure results in this case.

Capacity development among academic trainees in community-based primary health care research: The Aging, Community and Health Research Unit Experience

Health care system capacity and sustainability to address the needs of an aging population are a challenge worldwide. An aging population has brought attention to the limitations associated with existing health systems, specifically the heavy emphasis on costly acute care and insufficient investments in comprehensive primary health care (PHC). Health system reform demands capacity building of academic trainees in PHC research to meet this challenge. The Aging, Community and Health Research Unit at McMaster University has purposefully employed a capacity building model for interdisciplinary trainee development. This paper will describe the processes and outcomes of the model, outlining how the provision of funding, mentorship, and a unique learning environment enables capacity building in networking, collaboration, leadership development, and knowledge mobilization among its trainees. The reciprocal advancement of the research unit through the knowledge and productivity of trainees will also be detailed.

Do we need more training for interdisciplinary and interprofessional collaboration prior to implementing any primary care research action?

There has been a continuously increasing focus and discussion on interdisciplinary collaboration in primary care, across various settings and in different forums, during the past few years. Interprofessional and interdisciplinary collaboration should be a cornerstone of daily practice and context-relevant research. We considered it important for this manuscript to attempt to address some of the key issues linked to the recognised need for competence-based training, focusing on interdisciplinary and interprofessional collaboration, so as to promote and enhance context-relevant research in primary care. This article provides a general introduction and an overview of this topic, along with some key concepts and operational definitions. These key definitions and their interrelated nature are examined in detail, including those of practice-based research network, patient-centred primary care research, and interdisciplinary partnership for research. Furthermore, this paper outlines the reasons for the strong focus on composition and the development of strategies to enhance the research capacity of interdisciplinary partnerships throughout training. Workforce training, retention and academic collaboration are considered, with a particular focus on primary care, and existing interprofessional relationships and perceptions thereof. Organizational aspects influencing relationships and practice are considered along with their contribution in terms of practice, research and discourse. Finally, conclusions and recommendations, formed under the prism of rapidly changing population needs, person-centred values and the imperative need of bringing innovation to the patient in an effective and efficient manner, are presented for further discussion.

Providing Hands-on Experiences in Health Care Research to Mentor New Research Scholars

AIM

This article describes the benefits of integrating students into a National Institutes of Health-funded research project.

BACKGROUND

Research is important in all academic disciplines for increasing knowledge and determining the effectiveness of currently used interventions. Educating nursing students to read, evaluate, and use research in practice is essential for solving complex health care challenges and achieving better patient outcomes

METHOD

The students were involved at all levels of the research process: project development, site acquisition, recruitment of participants, data collection and analysis, and manuscript development. Interviews of the student researchers were conducted to understand the students' experience of participation in the research study.

RESULTS

Three themes were identified: creating new knowledge is worthwhile, research is interesting and meaningful, and research can shape practice.

CONCLUSION

Promoting knowledge and experience by involving students in research projects can create a bridge to the development of evidence-based practice.

Impact of the organisational culture on primary care staff members’ intention to engage in research and development

Purpose

– The purpose of this paper is to understand how organisational culture influences the intentions of primary care staff members (PCSM) to engage in research and development (R&D).

Design/methodology/approach

– The participants (n=30) were PCSM employed in a care centre in south-western Sweden. The study had an observational design with an ethnographic approach. The data were collected by means of observations, interviews and analysis of documents.

Findings

– The results revealed the perceptions of PCSM in two domains, research and clinical practice, both of which existed at three different cultural levels: visible (structures and policy), semi-visible (norms and values) and invisible (taken-for-granted attitudes).

Research limitations/implications

– It is difficult to conduct a purely objective ethnographic study because the investigation is controlled by its context. However, it is necessary to highlight and discuss the invisible level to improve understanding of negative attitudes and preconceptions related to the implementation of R&D in the clinical setting.

Practical implications

– By highlighting the invisible level of culture, the management of an organisation has the opportunity to initiate discussion of issues related to concealed norms and values as well as attitudes towards new thinking and change in the primary health context.

Originality/value

– This paper is one of the very few studies to investigate the influence of organisational culture on the intentions of PCSM to engage in R&D.

Development of a student-mentored research program between a complementary and alternative medicine university and a traditional, research-intensive university

The global need to develop clinician-scientists capable of using research in clinical practice, translating research knowledge into practice, and carrying out research that affects the quality, efficacy, and efficiency of health care is well documented. The complementary and alternative medicine (CAM) professions embrace the call to develop physician-researchers to carry out translational and applied research for CAM modalities. CAM universities face unique challenges when implementing research training compared with traditional, research-intensive (TRI) universities and medical centers where the majority of medical research is carried out.The authors present the development and outcomes of a mentored research program (MRP) between a CAM and a TRI institution, the National University of Health Sciences and the University of Illinois at Chicago School of Public Health, between 2006 and 2012. CAM predoctoral students engaged in a full-immersion semester at the TRI, including didactic courses and active research with a TRI faculty research mentor. Half of the participating doctor of chiropractic (DC) students continued on to PhD programs, and half established integrative medicine, primary care clinical careers.Establishing rigorous criteria for mentors and mentees, communicating expectations, developing solid relationships between the mentor, mentee, and home school advisor, responding quickly to impediments, and providing adequate support from CAM and TRI investigators were key to the MRP's success. To sustain research opportunities, coordinated degree programs for the DC and master of public health and master of clinical and translational research were established.

Creating an interest in research and development as a means of reducing the gap between theory and practice in primary care: an interventional study based on strategic communication

Today, healthcare professionals are faced with the challenge of implementing research results in an optimal way. It is therefore important to create a climate that is conducive to research and development (R&D). For this reason, new strategies are required to enhance healthcare professionals’ interest in innovative thinking and R&D. Strategic communication with roots in sociology, psychology and political science was employed as a means of achieving long-term behavioural change. The aim of this study was to describe, follow up and evaluate a primary care intervention based on strategic communication intended to increase healthcare professionals’ interest in R&D over time. An interventional cohort study comprising all staff members (N = 1276) in a Swedish primary care area was initiated in 1997 and continued for 12 years. The intention to engage in R&D was measured on two occasions; at 7 and 12 years. Both descriptive statistics and bivariate analyses were employed. The results demonstrated that the positive attitude to R&D increased over time, representing a first step towards new thinking and willingness to change work practices for the benefit of the patient. Strategic communication has not been previously employed as a scientific tool to create a long-term interest in R&D within primary care.

Scientometric trends and knowledge maps of global health systems research

BACKGROUND

In the last few decades, health systems research (HSR) has garnered much attention with a rapid increase in the related literature. This study aims to review and evaluate the global progress in HSR and assess the current quantitative trends.

METHODS

Based on data from the Web of Science database, scientometric methods and knowledge visualization techniques were applied to evaluate global scientific production and develop trends of HSR from 1900 to 2012.

RESULTS

HSR has increased rapidly over the past 20 years. Currently, there are 28,787 research articles published in 3,674 journals that are listed in 140 Web of Science subject categories. The research in this field has mainly focused on public, environmental and occupational health (6,178, 21.46%), health care sciences and services (5,840, 20.29%), and general and internal medicine (3,783, 13.14%). The top 10 journals had published 2,969 (10.31%) articles and received 5,229 local citations and 40,271 global citations. The top 20 authors together contributed 628 papers, which accounted for a 2.18% share in the cumulative worldwide publications. The most productive author was McKee, from the London School of Hygiene & Tropical Medicine, with 48 articles. In addition, USA and American institutions ranked the first in health system research productivity, with high citation times, followed by the UK and Canada.

CONCLUSIONS

HSR is an interdisciplinary area. Organization for Economic Co-operation and Development countries showed they are the leading nations in HSR. Meanwhile, American and Canadian institutions and the World Health Organization play a dominant role in the production, collaboration, and citation of high quality articles. Moreover, health policy and analysis research, health systems and sub-systems research, healthcare and services research, health, epidemiology and economics of communicable and non-communicable diseases, primary care research, health economics and health costs, and pharmacy of hospital have been identified as the mainstream topics in HSR fields. These findings will provide evidence of the current status and trends in HSR all over the world, as well as clues to the impact of this popular topic; thus, helping scientific researchers and policy makers understand the panorama of HSR and predict the dynamic directions of research.

Factors influencing attrition from a researcher training program

Purpose

– This study explored attrition from a novice health researcher training program. The aim of this paper was to identify factors contributing to attrition from the RRCBP that if understood could decrease attrition from this standalone researcher training program.

Design/methodology/approach

– Using a capacity building framework, this case-control study compared demographic characteristics and features of 30 withdrawn research trainees to 68 graduated trainees from the Rural Research Capacity Building Program, run by the Health Education and Training Institute of New South Wales, Australia between 2006 and 2010. Data were analysed using Exact Logistic Regression, Chi-square and Fisher's Exact tests.

Findings

– An attrition rate of 29 per cent was associated with a range of individual, organisational and supra-organisational factors. Withdrawals occurred prior to ethics submission (n=13, 43 per cent), after unsuccessful ethics submission (n=8, 27 per cent), or after receiving ethics approval (n=9, 30 per cent). Clinicians were less likely to withdraw than non-clinical staff (p=0.03). Profession, project ownership, funding sources and type of research were not significant factors in attrition, while the effect of location was mixed indicating a potential impact of peer support networks in areas with high numbers of trainees.

Practical implications

– This research demonstrates attrition from a research training program is associated with trainees receiving appropriate and timely support. In the formative stages researchers require support, particularly those working in professional or geographical isolation.

Originality/value

– This study is the first of its kind in examining in detail reasons for withdrawal from a standalone research training program and will allow coordinators of similar programs to target support to vulnerable research trainees at critical time points.

Excellence in Radiation Research for the 21st Century (EIRR21): description of an innovative research training program

PURPOSE

To describe and assess an interdisciplinary research training program for graduate students, postdoctoral fellows, and clinical fellows focused on radiation medicine; funded by the Canadian Institutes for Health Research since 2003, the program entitled "Excellence in Radiation Research for the 21st Century" (EIRR21) aims to train the next generation of interdisciplinary radiation medicine researchers.

METHODS AND MATERIALS

Online surveys evaluating EIRR21 were sent to trainees (n=56), mentors (n=36), and seminar speakers (n=72). Face-to-face interviews were also conducted for trainee liaisons (n=4) and participants in the international exchange program (n=2).

RESULTS

Overall response rates ranged from 53% (mentors) to 91% (trainees). EIRR21 was well received by trainees, with the acquisition of several important skills related to their research endeavors. An innovative seminar series, entitled Brainstorm sessions, imparting "extracurricular" knowledge in intellectual property protection, commercialization strategies, and effective communication, was considered to be the most valuable component of the program. Networking with researchers in other disciplines was also facilitated owing to program participation.

CONCLUSIONS

EIRR21 is an innovative training program that positively impacts the biomedical community and imparts valuable skill sets to foster success for the future generation of radiation medicine researchers.

Researcher development program of the primary health care research, evaluation and development strategy

The Research Development Program (RDP) was initiated in 2004 under the Primary Health Care Research, Evaluation and Development (PHCRED) Strategy to increase the number and range of people with knowledge and skills in primary health care research and evaluation. RDP Fellows were invited to participate in an online survey about the effect the program had on their research knowledge, attitudes and practice. The response rate was 42% (105/248). Most were female (88%) with 66% aged between 31 and 50 years. Over two-thirds (72%) were health practitioners. Activities undertaken during the RDP ranged from literature reviews, developing a research question, preparing ethics submissions, attending and presenting at conferences and seminars, preparing papers and reports, and submitting grant applications. Despite the fact that only 52% agreed that the RDP time was adequate, 94% agreed that the RDP was a valuable experience, with 89% expressing interest in undertaking further research. These results indicate that this program has had a positive effect on the RDP Fellows in terms of their knowledge about research, their attitude to research, and the way they use research in their work.