What shapes research and research capacity building in rural health services? Context matters

Abstract

Objective: To determine the contextual factors influencing research and research capacity building in rural health settings.Design: Qualitative study using semi-structured telephone interviews to collect data regarding health professionals' research education and capacity building.Analysis involved inductive coding using Braun and Clark's thematic analysis; and deductive mapping to the Consolidated Framework for Implementation Research (CFIR). Setting: Victorian rural health services and university campuses. Participants: Twenty senior rural health managers, academics and/or research coordinators. Participants had at least three years' experience in rural public health, health-related research or health education settings. Main outcome measures: Contextual factors influencing the operationalisation and prioritisation of research capacity building in rural health services. Results: Findings reflected the CFIR domains and constructs: intervention characteristics (relative advantage); outer setting (cosmopolitanism, external policies and incentives); inner setting (implementation climate, readiness for implementation); characteristics of individuals (self-efficacy); and process (planning, engaging). Findings illustrated the implementation context and the complex contextual tensions, which either prevent or enhance research capacity building in rural health services. Conclusions: Realising the Australian Government's vision for improved health service provision and health outcomes in rural areas requires a strong culture of research and research capacity building in rural health services. Low levels of rural research funding, chronic workforce shortages and the tension between undertaking research and delivering health care, all significantly impact the operationalisation and prioritisation of research capacity building in rural health | 411 WONG SHEE et al.

Rural health service leaders co‐design state‐wide research addressing an emerging health issue: A case report

“…13,14 This is particularly important to consider in rural health where research either led from a metropolitan setting or without specific consideration of the rural context may result in reduced applicability to rural end-users. 12 Co-design is described by Vargas et al 15 as 'active collaboration between stakeholders in designing solutions to a prespecified problem'. Research co-design includes the meaningful involvement of research users during the study planning phase and is an increasingly adopted strategy to avoid or limit such research waste.…”

“…It is increasingly recognised that factors such as poor research design and incomplete reporting can reduce the relevance of research evidence to end‐users and contribute to research waste 13,14 . This is particularly important to consider in rural health where research either led from a metropolitan setting or without specific consideration of the rural context may result in reduced applicability to rural end‐users 12 . Co‐design is described by Vargas et al 15 as ‘active collaboration between stakeholders in designing solutions to a prespecified problem’.…”

Perceptions of specialists in the public sector, on the role and value of family medicine

“…1,3 The World Health Organization (WHO) reports that 'primary health care (PHC) -now more than ever' has identified excessive specialisation of healthcare providers and the narrow focus of many disease programmes as contributing to the fragmentation of healthcare services and poor health outcomes. 4,5 The report observed that a better balance between specialised curative care, first contact care and health promotion has contributed to significant improvements in health outcomes. 4 In 2009, at the 62nd World Health Assembly, a resolution on PHC (including health system strengthening) recommended, among other things, the need to train and retain adequate numbers of health workers with an appropriate skills mix, including primary healthcare nurses, midwives, allied health professionals and FPs, in order to ensure universal access to healthcare.…”

“…The World Health Organization (WHO) reports that ‘primary health care (PHC) – now more than ever’ has identified excessive specialisation of healthcare providers and the narrow focus of many disease programmes as contributing to the fragmentation of healthcare services and poor health outcomes. 4 , 5 The report observed that a better balance between specialised curative care, first contact care and health promotion has contributed to significant improvements in health outcomes. 4…”

“…In addition, in 2019 the HPCSA, after acknowledgement and recognition of the role of FM, changed the internship requirements for newly qualified medical doctors to a compulsory 6 months rotation in FM while reducing the other speciality rotations, re-emphasising its important role. 5 , 16 However, despite the NDOH’s obvious commitment to FM through the Green Paper, the re-engineering of PHC, the additional time allocated to FM in the internship programme, as well as the evidence that supports the effectiveness of well-trained generalist, it has been an ongoing struggle to convince the provincial DOHs to commit resources to the creation of FP posts. This was highlighted in the human resources for health 2030 document, which estimated that the country was short of 888 FPs.…”