What Factors Influence the Production of Orthopaedic Research in East Africa? A Qualitative Analysis of Interviews

Abstract

Background Research addressing the burden of musculoskeletal disease in low-and middle-income countries does not reflect the magnitude of the epidemic in these countries as only 9% of the world's biomedical resources are devoted to addressing problems that affect the health of 90% of the world's population. Little is known regarding the barriers to and drivers of orthopaedic surgery research in such resource-poor settings, the knowledge of which would help direct specific interventions for increasing research capacity and help surgeons from high-income countries support the efforts of our colleagues in low-and middle-income countries. Purpose We sought to identify through surveying academic orthopaedic surgeons in East Africa: (1) barriers impeding research, (2) factors that support or drive research, and (3) factors that were identified by some surgeons as barriers and others as drivers (what we term barrier-driver overlap) as they considered the production of clinical research in resource-poor environments. Materials Semistructured interviews were conducted with 21 orthopaedic surgeon faculty members at four academic medical centers in Ethiopia, Kenya, Tanzania, and Uganda. Qualitative content analysis of the interviews was conducted using methods based in grounded theory. Grounded theory begins with qualitative data, such as interview transcripts, and analyzes the data for repeated ideas or concepts which then are coded and grouped into categories which allow for identification of subjects or problems that may not have been apparent previously to the interviewer. Results We identified and quantified 19 barriers to and 21 drivers of orthopaedic surgery research (mentioned n = 1688 and n = 1729, respectively). Resource, research process, and institutional domains were identified to This study was supported by private donations to the Institute for Global Orthopaedics and Traumatology (IGOT, San Francisco, CA, USA). No authors received payment or in-kind benefit for this study, nor are any authors members of a company that provided funding to IGOT. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. categorize the barriers (n = 7, n = 5, n = 7, respectively) and drivers (n = 7, n = 8, n = 6, respectively). Resource barriers (46%) were discussed more often by interview subjects compared with the research process (26%) and institutional barriers (28%). Drivers of research discussed at least once were proportionally similar across the three domains. Some themes such as research ethics boards, technology, and literature access occurred with similar frequency as barriers to and drivers of orthopaedic surgery research. Conclusions The barriers we identified most often among East African academic orthopaedic faculty members focused on resources to accomplish research, followed by institutional barriers, and method or process ba...

Barriers and incentives for conducting research amongst the Ophthalmologists in Sub-Sahara Africa

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“…However, the lack of willingness of senior scientists and surgeons, and the lack of protected time are major limitations that must be addressed for this to be successful. 5,21,22 Bennett et al have suggested that mentoring could also be achieved by training mentors in the developed world. 24 Finally the SA Orthopaedic Journal should be encouraged to apply to be indexed on Medline for worldwide dissemination of African-based research.…”

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