Research capacity building frameworks for allied health professionals – a systematic review

There is a burgeoning interest in strategies to enhance research capacity building for healthcare professionals. The recent Strategic Review of Health and Medical Research in Australia (2013) recommended that research should be fundamentally embedded in the health system, and that the healthcare workforce should be involved in research to drive continuous improvement [1]. Research capacity building has been defined as “a process of developing sustainable abilities and skills enabling individuals and organisations to perform high quality research” [2], or “a process of individual and institutional development which leads to higher levels of skills and greater ability to perform useful research” [3].

While there is no single agreed upon definition of “allied health” in the international literature, allied health professions are commonly grouped together by exclusion from medical and nursing/midwifery, and include but are not limited to physiotherapy, occupational therapy, speech pathology, social work, psychology, podiatry and pharmacy [4]. The benefits of allied health professionals participating in research are manifold. At a clinician level, benefits include enhanced attitudes towards research [5], an increased uptake of research evidence into practice [6, 7], and the development of critical thinking skills and a culture of evidence-based practice [8]. Clinicians who participate in research are also more likely to experience greater job satisfaction [9, 10].

At a service level, having healthcare professionals involved in research may positively influence the infrastructure and processes of client care [11]. A sound base of high quality research evidence is needed to inform the delivery of evidence-based healthcare and strategic service planning and policy making [5, 8, 10, 12, 13]. An additional benefit is being able to evaluate and demonstrate the quality and efficiency of the healthcare services being provided [6]. This is especially a priority for the allied health workforce due to the relatively low level of evidence for many allied health interventions [8, 10, 14]. Allied health professionals need to produce research evidence to demonstrate the efficiency and cost-effectiveness of their interventions and models of service delivery, or else they will increase their vulnerability to having aspects of their work delegated to traditional medical and nursing professionals, not being able to maintain current roles, diversify into new areas or expand their scope of practice [6, 8].

At a broader societal level, benefits of clinicians engaging in research include the potential of more successful translation and impact of research findings into clinical practice, thereby enhancing patient outcomes [15‐17]. Indeed, having healthcare professionals involved in identifying research questions that arise from real-life problems and gaps in clinical practice and assisting with designing research methodologies may increase the likelihood that research projects will generate practical solutions which are readily translated into practice [17].

Previous research has demonstrated that allied health professionals are motivated to participate in research by intrinsic and extrinsic factors which align to these benefits. The most commonly reported motivators are to address problems in practice, build the evidence base to inform service delivery, provide the best possible care for patients and enhance their job satisfaction and career opportunities [6, 10, 18, 19].

The aim of research capacity building in a healthcare setting is to strengthen health professionals’ existing clinical expertise with complementary research skills [8]. This enables them to contribute to the production of high-quality research which advances the knowledge base of their profession, demonstrates the effectiveness of interventions, influences funding bodies, and enables evidence-based practice [8]. Building research capacity may be targeted across three different levels including foundational skills in using research (e.g. understanding how to search for, appraise and consciously apply research evidence to inform practice), participating in research (e.g. assisting with participant recruitment and data collection) and leading research (e.g. developing research protocols and applying for funding).

Allied health professionals have been reported to have a high level of interest in undertaking research [20‐22]. However, despite their interest and the recognised benefits, allied health research engagement remains limited due to a number of challenges and barriers including a lack of time and funding, other work roles taking priority, a lack of research skills and a lack of support from managers and colleagues [10, 19]. As building allied health research capacity has been recognised as a priority [10], a range of different research capacity building approaches have been recommended and implemented across publicly funded healthcare organisations in Australia [9, 23] and internationally [8, 24].

Most of the extant literature describes single-strategy research capacity building initiatives, interventions or programs. Some of these strategies have been focussed at the level of individuals and teams, such as identifying those clinicians who express motivation and intention to do research and those who are seeking a challenge, improved job satisfaction or increased professional development opportunities [10, 19, 22] and providing these clinicians with protected time, education and training, resources and mentoring from more experienced researchers [10, 18, 22, 25‐27]. For example, a research internship model for podiatrists resulted in increased research output, as measured by the number of abstracts, publications and further research training [28].

Dedicated research leadership/facilitator or conjoint positions have been found to be associated with increased organisation and team domain scores on the Research Capacity and Culture tool, as well as increased research skills and outputs [7, 29, 30]. Similarly, academic-practice partnerships have been reported as an important strategy for increasing research capacity, engagement and output [10, 27, 31, 32]. For example, a large proportion of research outputs by clinical staff within one large publicly funded health service were the result of work led by, or in collaboration with, academic partners [27].

Strategies which have been implemented at the level of the organisation include embedding research activities in strategic plans, visions, missions and values, developing targets or key performance indicators (KPIs) for research [19] and role descriptions to attract research interested and active applicants [10]. Organisation level strategies also include incorporating research into clinical roles, increasing funding for appropriate backfill of clinical positions, supporting staff with joint clinical and academic appointments [6] and creating opportunities to engage in research through secondment [6, 8, 12, 27]. It has been suggested that organisations may benefit from strategically prioritising funding for those projects which have the greatest potential to directly impact on patient care [8].

Some authors have recognised that a single strategy approach is not sufficient, but that a “whole of organisation approach” or “whole of system approach” is required for building research capacity and culture in allied health [10, 12, 33‐35]. A recent rapid review of allied health research frameworks has recommended multiple strategies across individual, organisational and policy levels to embed a culture of allied health research into healthcare services [36]. Authors have suggested that strategies are interlinked and interdependent, such that strategies implemented at one level can have an impact on other levels. Therefore, the use of coordinated and integrated multi-level strategies at individual, team, organisational and system levels has been recommended [18, 25, 33, 37]. However, there currently is no single framework, model or set of recommendations to guide research capacity building approaches for allied health professionals in publicly funded secondary or tertiary healthcare settings.

The aim of this systematic review was to identify, appraise and synthesise existing models and frameworks which describe integrated and practical approaches to research capacity building for allied health professionals in publicly funded secondary or tertiary healthcare organisations. This review intended to search for both models and frameworks, the most common methods of conceptualising combinations of strategies. A model usually describes and guides the process of implementing an intervention, including a temporal sequence of steps, stages or phases of the process. In contrast, a framework usually identifies the hypothesised factors which may influence an outcome without describing the process for achieving this outcome. A framework may also provide a structure for planning and evaluating interventions. Neither models or frameworks necessarily address the causal mechanisms of change [38]. The protocol for this systematic review has been registered with PROSPERO. The registration number is CRD42018087476.

A total of 8492 unique records were assessed for eligibility by screening titles and abstracts. Of these, 20 were reviewed in full-text and six were included in the review [9, 29, 33, 37, 40, 41]. Figure 1 illustrates the number of studies which were screened based on title/abstract and full-text, with reasons for exclusion documented.

A total of one quantitative and five qualitative studies were included. Studies originated in Australia (n = 4) and the UK (n = 2). All studies defined research capacity as the ability to engage in, perform or carry out quality research. All six studies met the definition of framework rather than model. The studies varied in terms of the composition of their frameworks and in the way that these had been developed, implemented and evaluated. Each framework describes number of research capacity building approaches. Refer to Table 2 for a description of the included studies.

The findings of this systematic review have been synthesised to develop a succinct and integrated framework for research capacity building which is relevant for allied health professionals working in publicly funded secondary and tertiary healthcare organisations. Three themes (‘supporting clinicians in research’, ‘working together’ and ‘valuing research for excellence) and 17 subthemes have been identified. Each subtheme is linked to a number of strategies which may be implemented at individual, team, organisational and policy levels as part of the ‘whole of system’ approach which has been recommended in the literature [12, 33, 36, 45]. Although attempts were made to categorise strategies according to these structural levels, it was subsequently recognised that many strategies are applicable at more than one level. For example, for research to be considered part of core business, it needs to be valued by individual clinicians and by all levels of management across teams and the organisation and recognised within policy. This new framework consolidates many single-strategy research capacity building initiatives, interventions or programmes described in the literature, and provides further evidence to suggest that they are interlinked and interdependent and therefore benefit from being delivered in an integrated way to ensure maximum impact.

Although this review searched for both models and frameworks, only frameworks were found. It seems that frameworks are inherently better suited to guide research capacity building, because they do not include a clear linear process for how research capacity building interventions should be implemented. A number of factors appear to influence the outcomes of research capacity, culture and engagement and are useful for guiding the design and evaluation of interventions. However, the way in which interventions are implemented is highly dependent on context, such as the specific strengths, weaknesses, interests, needs and priorities of each individual, team and organisation.

A fundamental concept which was identified across all three themes is the importance of commitment and multi-faceted support from all levels of leadership and management. A research culture has been described as “an environment within an organisation that enables and supports research to generate new knowledge and opportunities to translate evidence into practice” [18] and has been reported to be essential for building research capacity [19, 33]. Previous studies have found that senior management and leadership support for research appears to have a significant impact on an organisation’s research culture [7, 20, 35, 36, 46] and individual health professionals’ engagement in research [29, 31]. The findings of this review further emphasise that in order to build and sustain research engagement, leaders and managers should recognise the benefits of having research-active practitioners in the workforce and consider research to be part of their core business alongside clinical practice [8, 19, 27]. Another implication is the importance of investing in collaborations with internal and external partners, mentors and colleagues who can support clinicians to undertake research within their existing roles, which is consistent with previous recommendations in the literature [22, 25, 32].

This systematic review developed a succinct and integrated framework for allied health research capacity building. This framework may be used to inform and guide the design and evaluation of research capacity building strategies targeting individuals, teams, organisations and systems. This framework provides structure in terms of specific strategies which can be monitored using process and outcome measures to determine short- and long-term impacts. Future directions for research include using behaviour change and knowledge translation theories to guide the implementation and evaluation of this framework. Another opportunity is to evaluate the transferability of this framework to other healthcare professions and settings.