Background
Methods
Results
Mapping
Paper subject | Universities | Hospitals | NGOs | Total | ||||
---|---|---|---|---|---|---|---|---|
n | % | n | % | N | % | n | % | |
Hypertension | 128 | 83.1 | 20 | 13.0 | 6 | 3.9 | 154 | 24.4 |
Diabetes Mellitus | 107 | 82.9 | 17 | 13.2 | 5 | 3.9 | 129 | 20.4 |
Obesity | 104 | 85.2 | 10 | 8.2 | 8 | 6.6 | 122 | 19.3 |
Coronary Artery Disease | 70 | 62.0 | 31 | 27.4 | 12 | 10.6 | 113 | 17.9 |
Dyslipidemia | 37 | 74.0 | 5 | 10.0 | 8 | 16.0 | 50 | 7.9 |
Cerebro Vascular Disease | 22 | 78.6 | 5 | 17.9 | 1 | 3.5 | 28 | 4.4 |
Metabolic Syndrome | 16 | 70.0 | 5 | 21.5 | 2 | 8.5 | 23 | 3.6 |
Physical Activity | 13 | 100.0 | - | - | - | - | 13 | 2.1 |
Total
|
497
|
78.7
|
93
|
14.7
|
42
|
6.6
|
632
|
100
|
Judgements of Key Informants (KI)
“…Via a short presentation, we wanted our residents to share information they had learned from a course which had been conducted in English. There was a small problem. They said that they did not understand some parts of the course and therefore could not report back very well. ….Generally, most junior researchers are not fluent enough to follow a course in English. …The language problem is an important barrier.” Academician
“There is no interest in research, they want someone else to conduct research and they only want to read it. If they are interested in research, the reason is this: if they do not have publications, they will not be promoted as a professor or associate professor. A thesis for specialization is compulsory, because if they do not have a thesis, they will not be a specialist in medicine. Indeed, there is no curiosity.” Editor of a SCIE scientific journal
“The main problem for public health researchers is the heavy load of undergraduate education in medical schools. So, there is no time for research, really… We have a very heavy teaching commitment. It is too hard for a researcher to take a full-time role in a project, even if it is short-term.” Academician
“Academics who are focused on only one field bring the science more up to date and are more productive…. I mean, if there could be researchers working only on one area like heart disease, strokes, or diabetes and if there were no other expectations from them, we would have an opportunity to reach the level of Western countries … We have a problem of not focusing or concentrating enough on one subject…” Academician
“…….the General Directorate of Health Research has been newly established and has a history of only five or six months. ….Historically, our staff [of MoH] rarely conduct research, after all, it wasn’t planned this way…but we are hopeful for the future.” Senior Policymaker
“..There is no relationship between academia and the MoH. The MoH does not state a need for research in any particular field or a need for evaluation of any particular policy. The MoH does not want to have this kind of connection with universities. But people we trained go on to work in the MoH later. In fact, the MoH can give them this kind of responsibility. It can require them to conduct research or evaluate a policy. If there was such a connection during training, the junior researcher could do this more effectively when he goes there. ..There is a lack of collaboration, such as working together on implementation, or working towards solutions for real problems…” Academician
‘…….Conducting research is the duty of General Directorate of Health Research. We think that this makes our task easier. For instance, when we wonder about the effectiveness of our new interventions and want to evaluate this, the General Directorate of Health Research is the first place that we contact…’ Senior Policymaker
‘“… So the biggest problem is this: there is no way of keeping people at the high level of motivation that they have reached after these courses. So she came, learned and was very excited, but the day after the training she goes to her department and does nothing [related to the training she received]. Her position will not be adequate, and she will have no opportunities or access to a network. I mean, there is actually no national health research system to speak of…..” Academician
“Last year, we trained 250 people, who were staff of the MoH, in the field of epidemiology and expected that they would work in specific departments which were related to epidemiology and make a contribution as epidemiologists. But one third of them did not stay in those departments.” Academician
“… and in the end, there came the system of payments based on performance and whatever happened, people stopped bothering to undertake research. Every person is willing to see a patient rather than conducting research…” Editor of a SCIE scientific journal
“…The first is really a financial problem. … Formerly we have been receiving great support from pharmaceutical companies. Now, in order to increase their profit share they have become almost unable to support us. Furthermore, even when there is such a research project, namely if it is not prescribed [i.e. increase drug sales], they do not give the researcher anything…” NGO Representative
“Recently, we wanted to conduct a study about family medicine at the level of primary care, but we could not get permission from the MoH. Permission problems can occur elsewhere, too”. NGO Representative
“…Nobody knows how to access the information gathered by the MoH. There is a disconnect. We don’t know what the MoH wants, or areas of demand. We don’t even know if their data can meet their needs….” Academician
Training needs of junior researchers
(n = 46) | N | % | |
---|---|---|---|
Gender | Female | 28 | 61.0 |
Male | 18 | 39.0 | |
Highest level of education completed
|
University (Medical Faculty)
|
22
|
47.8
|
PhD (Public Health)
|
10
|
21.7
| |
Specialization in Medicine
|
9
|
19.6
| |
MPH (Master of Public Health)
|
5
|
10.9
| |
Institutional affiliation | University | 29 | 63.0 |
Ministry of Health | 15 | 32.6 | |
Ministry of Labor and Social Security | 1 | 2.2 | |
Private (Occupational Physician) | 1 | 2.2 | |
Job title
|
MD (Resident/Research Assistant)
|
22
|
47.8
|
MD (Specialist)
|
8
|
17.4
| |
Academician
|
8
|
17.4
| |
Nurse
|
2
|
4.3
| |
Anthropologist
|
2
|
4.3
| |
Dietician
|
1
|
2.2
| |
Psychologist
|
1
|
2.2
| |
Engineer
|
1
|
2.2
| |
Health Officer
|
1
|
2.2
| |
Mean | SD | ||
Age | 32.9 | 5.9 | |
Working years | 3.7 | 4.0 |
(n = 46)
|
Importance score mean ± SD
|
Performance score mean ± SD
|
Gap* (difference) mean ± SD
|
Training need %
|
---|---|---|---|---|
Research design & implementation
|
6.2 ± 0.9
|
4.5 ± 1.4
|
1.7 ± 1.4
|
66
|
Study Design: Qualitative | 5.9 ± 1.4 | 3.4 ± 1.8 | 2.6 ± 2.0 | 80 |
Qualitative Research tools | 5.8 ± 1.3 | 3.7 ± 1.7 | 2.1 ± 1.8 | 77 |
Writing research proposals | 6.4 ± 1.0 | 4.5 ± 1.6 | 1.9 ± 1.5 | 66 |
Data management | 6.5 ± 0.8 | 4.8 ± 1.7 | 1.8 ± 1.8 | 61 |
Study Design: Quantitative | 6.2 ± 1.2 | 4.5 ± 1.6 | 1.7 ± 1.6 | 70 |
Routine/secondary data use | 6.2 ± 1.2 | 4.5 ± 1.7 | 1.7 ± 1.8 | 68 |
Ethical guidelines & oversight | 6.3 ± 1.2 | 4.9 ± 1.5 | 1.4 ± 1.9 | 64 |
Questionnaire development | 6.1 ± 1.3 | 4.7 ± 1.7 | 1.3 ± 1.6 | 54 |
Conducting literature reviews | 6.5 ± 0.8 | 5.2 ± 1.4 | 1.3 ± 1.6 | 61 |
Analysis & writing
|
6.3 ± 0.9
|
3.8 ± 1.4
|
2.5 ± 1.6
|
80
|
Writing qualitative reports | 6.1 ± 1.2 | 3.1 ± 1.8 | 2.9 ± 2.0 | 82 |
Qualitative data analysis | 6.1 ± 1.2 | 3.2 ± 1.8 | 2.9 ± 1.9 | 84 |
Writing policy papers | 5.9 ± 1.4 | 3.3 ± 1.7 | 2.7 ± 2.0 | 89 |
Writing academic journal articles | 6.5 ± 0.9 | 3.9 ± 1.9 | 2.6 ± 2.0 | 79 |
Writing quantitative reports | 6.3 ± 1.0 | 4.1 ± 1.9 | 2.2 ± 1.9 | 75 |
Statistical analysis | 6.5 ± 0.8 | 4.4 ± 1.7 | 2.1 ± 1.6 | 77 |
Conference presentation skills | 6.4 ± 0.8 | 4.4 ± 1.7 | 1.9 ± 1.8 | 73 |
(n = 46)
|
Importance score mean ± SD
|
Performance score mean ± SD
|
Gap (difference) mean ± SD
|
Training need %
|
Familiarity %
|
---|---|---|---|---|---|
Health economics
|
5.8 ± 1.3
|
2.4 ± 1.3
|
3.4 ± 1.5
|
78
|
57
|
Statistical and econometric analysis | 5.8 ± 1.3 | 2.0 ± 1.3 | 3.8 ± 1.7 | 84 | 48 |
Microeconomics of health care | 5.7 ± 1.5 | 2.0 ± 1.3 | 3.6 ± 1.8 | 82 | 41 |
Health accounting | 5.8 ± 1.5 | 2.3 ± 1.2 | 3.5 ± 1.7 | 75 | 55 |
Economic evaluation | 5.9 ± 1.4 | 2.4 ± 1.5 | 3.4 ± 1.9 | 75 | 59 |
Health Financing functions | 5.9 ± 1.3 | 2.6 ± 1.5 | 3.2 ± 1.6 | 75 | 66 |
Economics of health systems | 6.1 ± 1.3 | 2.9 ± 1.7 | 3.2 ± 1.7 | 77 | 73 |
Provider payment mechanisms | 5.7 ± 1.6 | 2.6 ± 1.6 | 3.0 ± 1.7 | 77 | 57 |
Health policy
|
6.0 ± 1.3
|
2.9 ± 1.5
|
3.1 ± 1.6
|
84
|
72
|
Monitoring and evaluation methods | 5.9 ± 1.5 | 2.6 ± 1.6 | 3.3 ± 1.8 | 84 | 57 |
Health policy analysis frameworks | 5.8 ± 1.5 | 2.5 ± 1.6 | 3.3 ± 1.9 | 84 | 64 |
Policy processes in health care | 6.2 ± 1.3 | 3.1 ± 1.6 | 3.1 ± 1.7 | 82 | 77 |
Impact of policies on population | 6.1 ± 1.3 | 3.0 ± 1.6 | 3.0 ± 1.7 | 84 | 82 |
Political influence on resource alloc. | 5.9 ± 1.4 | 3.0 ± 1.6 | 3.0 ± 1.8 | 82 | 71 |
Organization, financing & health syst. | 6.2 ± 1.3 | 3.3 ± 1.7 | 2.9 ± 1.7 | 86 | 82 |
Environmental health
|
6.2 ± 0.9
|
3.2 ± 1.6
|
3.0 ± 1.6
|
76
|
74
|
Environmental epidemiology | 6.2 ± 1.0 | 2.9 ± 1.7 | 3.4 ± 1.7 | 82 | 64 |
Policies to mitigate env. hazards | 6.3 ± 1.1 | 3.0 ± 1.7 | 3.3 ± 1.8 | 75 | 73 |
Interaction of environ. determinants | 6.1 ± 1.1 | 2.9 ± 1.5 | 3.2 ± 1.8 | 80 | 75 |
Health & environ. risk assessment | 6.3 ± 1.0 | 3.2 ± 1.7 | 3.1 ± 1.7 | 80 | 75 |
Factors modifying impact of env. | 6.1 ± 1.1 | 3.1 ± 1.8 | 3.0 ± 1.8 | 75 | 71 |
Exposure assessment methods | 6.1 ± 1.1 | 3.2 ± 1.9 | 2.9 ± 1.8 | 77 | 71 |
Sources, pathways, of exposure | 6.3 ± 0.9 | 3.5 ± 1.9 | 2.8 ± 1.7 | 71 | 80 |
Major environ. & occup. hazards | 6.4 ± 1.0 | 3.6 ± 1.9 | 2.7 ± 1.8 | 68 | 82 |
Medical anthrop & sociology
|
5.9 ± 1.2
|
3.0 ± 1.5
|
2.9 ± 1.6
|
75
|
63
|
Ethnographic methods | 5.6 ± 1.5 | 2.4 ± 1.7 | 3.2 ± 1.8 | 77 | 34 |
Health seeking behavior | 6.2 ± 1.1 | 3.2 ± 1.8 | 3.0 ± 1.8 | 77 | 71 |
Historical & political dimensions | 5.9 ± 1.2 | 2.9 ± 1.8 | 3.0 ± 1.8 | 71 | 59 |
The clinic/hospital as social | 5.6 ± 1.6 | 2.7 ± 1.6 | 2.9 ± 1.7 | 75 | 59 |
Role of culture in health | 5.9 ± 1.3 | 3.1 ± 1.8 | 2.8 ± 1.9 | 77 | 66 |
Social inequalities in health | 6.3 ± 1.1 | 3.7 ± 1.8 | 2.6 ± 1.9 | 73 | 84 |
Understanding popular health | 5.8 ± 1.5 | 3.2 ± 1.7 | 2.6 ± 1.8 | 73 | 71 |
Epidemiology
|
6.3 ± 0.7
|
4.3 ± 1.4
|
2.0 ± 1.6
|
73
|
87
|
Mathematical modeling | 6.0 ± 1.2 | 3.0 ± 1.5 | 3.0 ± 1.9 | 89 | 66 |
Disease surveillance | 6.4 ± 0.8 | 4.0 ± 1.5 | 2.4 ± 1.6 | 82 | 86 |
Methods in epidemiology | 6.6 ± 0.7 | 4.5 ± 1.8 | 2.1 ± 1.7 | 64 | 93 |
Subjective health measures | 5.9 ± 1.1 | 3.8 ± 1.7 | 2.1 ± 1.7 | 73 | 84 |
Effect modification (confounding) | 6.2 ± 1.0 | 4.2 ± 1.7 | 2.0 ± 1.9 | 77 | 82 |
Risk factors and susceptibility | 6.5 ± 0.8 | 4.5 ± 1.7 | 2.0 ± 1.8 | 77 | 89 |
Validity and reliability | 6.4 ± 0.8 | 4.4 ± 1.7 | 2.0 ± 1.9 | 71 | 89 |
Association and causation | 6.4 ± 0.8 | 4.6 ± 1.8 | 1.9 ± 1.8 | 68 | 91 |
Statistical analysis of data | 6.5 ± 0.8 | 4.7 ± 1.7 | 1.8 ± 1.8 | 71 | 96 |
Measures of morbidity & mortality | 6.3 ± 1.0 | 4.8 ± 1.8 | 1.4 ± 1.8 | 61 | 96 |
Rank | Training areas and sources | |||
---|---|---|---|---|
Key informants (n:10) | Junior researchers (n:46) | |||
(n/total number) | First priority discipline (% ) | Willing to conduct research (%) | The gap* (mean) | |
1.
| Epidemiology (7/10) | Epidemiology (35%) | Epidemiology (85%) | Health economics (3.4) |
2.
| Medical anthropology and sociology (7/10) | Health policy (19%) | Health policy (72%) | Health policy (3.1) |
3.
| Health policy (5/10) | Health economics (11%) | Medical anthropology and sociology (72%) | Environmental health (3.0) |
4.
| Health economics (5/10) | Medical anthropology and sociology (6%) | Health economics (67%) | Medical anthropology and sociology (2.9) |
5.
| Environmental health (3/10) | Environmental health (6%) | Environmental health (54%) | Epidemiology (2.1) |