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The development of the Canadian Rural Health Research Society: creating capacity through connection

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The organization of rural health research in Canada has been a recent development. Over the past 8 years, rural and remote researchers from more than 15 universities and agencies across Canada have engaged in a process of research capacity building through the development of a network, the Canadian Rural Health Research Society (CRHRS) among the scientifically and geographically diverse researchers and their community partners. The purpose of this article is to discuss the development of the CRHRS as well as the challenges and lessons learned about creating networks and building capacity among rural and remote health researchers. Key elements of network development have included identifying and developing multidisciplinary research groupings, maintaining ongoing connections among researchers, and promoting the sharing of expertise and resources for research training. The focus has been on supporting research excellence among networks of researchers in smaller centres. Activities include a national annual scientific meeting, the informal formation of several regional and national research networks in specific areas, and the development of training opportunities. Challenges have included the issues of sustaining communication, addressing a range of networking and capacity-enhancement needs, cooperating in an environment that rewards competition, obtaining resources to support a secretariat and research activities, and balancing the demands to foster research excellence with the needs to create infrastructure and advocate for adequate research funding. The CRHRS has learned how to begin to support researchers with diverse interests and needs across sectors and wide geographical areas, specifically by: (1) focusing on research development through creating and supporting trusting connections among researchers; (2) building the science first, followed by infrastructure development; (3) making individual researchers the nodes in the network; (4) being inclusive by accommodating a wide variety of researchers and researcher strengths; (5) emphasizing social exchange, knowledge exchange, and mentoring in annual scientific meetings; (6) taking opportunities to develop separate projects while finding ways to link them; (7) finding a balance between advancing the science and advocating for adequate funding and appropriate peer review; (8) developing a network organizational structure that is both stable and flexible; and (9) maintaining sustained visionary leadership.
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© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
1
R U R A L H E A L T H H I S T O R Y
The development of the Canadian Rural Health
Research Society: creating capacity through
connection
MLP MacLeod
1
, JA Dosman
2
, JC Kulig
3
, JM Medves
4
1
University of Northern British Columbia, Prince George, BC Canada
2
Institute of Agricultural Rural and Environmental Health/Canadian Centre for Health
and Safety in Agriculture Saskatoon, University of Saskatchewan, Canada
3
School of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
4
School of Nursing, Queens University, Kingston, ON, Canada
Submitted: 13 July 2006; Resubmitted: 4 January 2007; Published: 27 March 2007
MacLeod MLP, Dosman JA, Kulig JC, Medves JM
The development of the Canadian Rural Health Research Society: creating capacity through connection
Rural and Remote Health 7: 622. (Online), 2007
Available from: http://www.rrh.org.au
A B S T R A C T
Context: The organization of rural health research in Canada has been a recent development. Over the past 8 years, rural and
remote researchers from more than 15 universities and agencies across Canada have engaged in a process of research capacity
building through the development of a network, the Canadian Rural Health Research Society (CRHRS) among the scientifically
and geographically diverse researchers and their community partners. The purpose of this article is to discuss the development of
the CRHRS as well as the challenges and lessons learned about creating networks and building capacity among rural and remote
health researchers.
Issue: Key elements of network development have included identifying and developing multidisciplinary research groupings,
maintaining ongoing connections among researchers, and promoting the sharing of expertise and resources for research training.
The focus has been on supporting research excellence among networks of researchers in smaller centres. Activities include a
national annual scientific meeting, the informal formation of several regional and national research networks in specific areas, and
the development of training opportunities. Challenges have included the issues of sustaining communication, addressing a range of
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
2
networking and capacity-enhancement needs, cooperating in an environment that rewards competition, obtaining resources to
support a secretariat and research activities, and balancing the demands to foster research excellence with the needs to create
infrastructure and advocate for adequate research funding.
Lessons learned: The CRHRS has learned how to begin to support researchers with diverse interests and needs across sectors and
wide geographical areas, specifically by: (1) focusing on research development through creating and supporting trusting
connections among researchers; (2) building the science first, followed by infrastructure development; (3) making individual
researchers the nodes in the network; (4) being inclusive by accommodating a wide variety of researchers and researcher strengths;
(5) emphasizing social exchange, knowledge exchange, and mentoring in annual scientific meetings; (6) taking opportunities to
develop separate projects while finding ways to link them; (7) finding a balance between advancing the science and advocating for
adequate funding and appropriate peer review; (8) developing a network organizational structure that is both stable and flexible;
and (9) maintaining sustained visionary leadership.
Key words: Canada, capacity-building, network, research.
Context
Although there is a long history of research into the health of
rural Canadians, as well as a long history of international
research symposia and meetings on rural health issues
1
, the
rural health research community remains small and dispersed
across the country. Within the last decade, sparked largely
by the new research funding opportunities created by the
establishment of the Canadian Institutes of Health Research
(CIHR), there has been a concerted effort to develop more
substantial connections among rural health researchers from
many different disciplines and parts of Canada. The
Canadian Rural Health Research Society (CRHRS), created
by researchers as a means to establish a robust and well-
funded rural health research community, has developed as a
network of researchers in the four principal areas of rural
health research: (i) biomedical; (ii) clinical; (iii) health
services and policy; (iv)population and public health.
The development of this rural health research networked
community has not been without its challenges. The purpose
of this article is to discuss the development of the CRHRS as
well as the challenges and lessons learned about creating
networks and building capacity among rural and remote
health researchers.
Issue: research networks and
networking
Health research networks have been described as, ‘networks
of investigators who are equipped with tools to facilitate
collaboration and information sharing’
2
and whole systems
that ‘facilitate cultural change and grass-roots participation
in research’ that also enable ‘individual innovation, through
multidisciplinary participation’
3
. Approaches to research
networks differ, from highly coordinated endeavours to
loosely coupled connections of researchers and others who
maintain ‘various types of contacts, co-operation and
communication’
4
. Networks fulfil various purposes,
including overcoming fragmentation of research on a
particular topic
5
, improving multidisciplinary approaches to
pressing research problems
6
, linking researchers and
decisionmakers
7
, and increasing researcher competitiveness
nationally and internationally
6-10
.
Research networks are important in building research
capacity as well as influencing the development of
multidisciplinary teams to address complex research
questions
6,8
. It is not always clear what structures and
processes can best enhance and sustain researcher capacity
11
.
Key elements in successful networks include: a common,
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
3
clear vision with a modest number of goals
12
; proven,
charismatic leadership of an individual or individuals with a
deep understanding of all aspects of research in the field
6
; a
structure that suits the network’s goals and purpose
6,10,12
;
clear, effective processes of communication, coupled with
mechanisms to foster and sustain researcher engagement and
collaboration
11,12
; sufficient resources
12
provided in a
judicious and timely manner
8
; and ways of working that
reflect the intent and context of the network
9,11
. Networks
develop largely in response to contextual forces.
Rural health research
The pattern of rural health research development occurs in
relation to the role of rural health in the country’s health
agenda, the availability of national research funding, the
organization of health services, and the availability of
universities and researchers to rural communities. In the
USA, for instance, rural health research is largely health
policy driven and focuses on access issues
13
. As Hartley
notes, this is due primarily to three factors. First was the
establishment of the Federal Office of Rural Health Policy in
1987 that provided funding and capacity-building support for
research centres focused on rural issues. Second was the
National Rural Health Alliance, which began in 1978 as a
merger of two rural hospital and rural primary care
organizations, serves as an umbrella organization, and
advocates successfully for research dollars. Third was the
creation of issue networks, made up of federal/state
decisionmakers, clinicians and researchers, to lobby for
specific issues such as rural hospital policy.
In Australia, a number of rural health units were established
within state health departments in the late 1980s to focus on
policy related issues. The increase in regional universities,
the funding of university departments of rural health in each
state and the Northern Territory, as well as the establishment
of the rural clinical schools has resulted in an increase in
rural health research. Most research is focused on public
health and health services, however, and remains small in
scale
14
. At the same time, funding for research that is
specifically rural in nature remains limited
15,16
, and there are
continuing needs for capacity development and
communication among researchers dispersed over a vast
geographic area
16
.
In Canada, the development of rural health research has been
more researcher driven than policy driven, and hence is
uneven across the country. Provinces are responsible for the
provision of health and education, and interest in rural health
varies from province to province. Although there is an
increasing number and range of rural health research projects
and programs across the country
17
, there are few long-term
provincially-funded centres with a central mandate for rural
health research, such as Ontario’s Centre for Rural and
Northern Health Research (CRaNHR).
Developing a Canadian Rural
Health Research Network
By the late 1990s an increasing appreciation that specific
knowledge was required to address rural and remote health
needs in Canada
18
led to the emergence of a network that has
become the CRHRS. Developmental milestones, including
policy and organizational influences, are outlined (Fig 1).
Two rural health research conferences in 1998, one at the
University of Lethbridge
19
; the other at the University of
Saskatchewan
20
, provided opportunities for researchers from
a broad range of disciplines and research interests to meet
for the first time. Also in 1998, the national department of
health, Health Canada, formed the Office of Rural Health for
the purpose of putting a ‘rural lens’ on national health
issues
18
. Rural health research was the focus of two
proposals during the consultation phase of the development
of the Canadian Institutes of Health Research (CIHR)
21,22
.
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
4
Figure 1: Milestones in Canadian Rural Health Research Society networking.
University of Lethbridge
Alberta
September
“Health in Rural Settings
From the Ground Up
University of Saskatchewan
Saskatchewan
October
“Rural Health and Safety in a
Changing World”
Saskatoon
Saskatchewan
Rural He
alth Research
Consortium Meeting
Ottawa
Ontario
October
1
st
Annual Conference
Rural Health Research
Saskatoon
Saskatchewan
October
2
nd
Annual Conference
Rural Health Research
Health Canada
Office of Rural Health
Established
Prince George
British Columbia
October
“Rural and Remote
Health Research
The Quest for equitable
Health Status for all
Canadians”
MRC/CIHR
Funding obtained by
Consortium
Health Canada
Ministerial Advisory
Council on Rural
Health Established
1998
1999
2000
2001
Halifax
Nova Scotia
October
3
rd
Annual Conference Rural
Health Research Consortium
Saskatoon
Saskatchewan
October
4
th
Annual Conference
with International
Symposium “Future of
Rural Peoples”
Sudbury
Onatrio
October
5
th
Annual Conference
with International
Rural Nurses Congress
Quebec City
Quebec
October
6
th
Annual Conference
with Canadian Society
for Circumpolar
Health
CRRHS
Receives CIHR Workshop
Funding and CIHR Rural
Initiatives funding
Canadian Rural
Health Research
Society
Established
CIHR
Initiatives
Rural Health
Canada Rural and
Remote Health Studies
Meeting
CIHR
Centre for Research
Development Canadian
Centre for Health and
Safety in Agriculture
Thunder Bay
Ontario
March
Canada Rural and Remote
Health Study(ies) (CRRHS)
Investigator Workshop
2002
2003
2004
2005
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
5
In 1999, two national meetings served to accelerate
connectedness. The University of Saskatchewan hosted a
meeting of 129 researchers from a wide variety of disciplines
from across Canada to explore whether specific
interdisciplinary cross-university research groupings might
be formed to seek funding for new research projects from the
emerging CIHR and other funding venues. The outcome was
the Canadian Rural Health Research Consortium
(Consortium) and the emergence of research groups in
nursing, the physical environment, and rural children’s
health. A month later, Health Canada’s Office of Rural
Health and the University of Northern British Columbia
hosted the National Rural Health Research Summit at which
researchers, rural residents and government representatives
further defined the area and recommended means of
supporting rural and remote health research
18
.
With the support of a Medical Research Council/CIHR
Opportunities grant, the Consortium met in April 2000 to
establish its mission, goals and 5 year targets. The
Consortium held its first national scientific conference in
October 2000 with 75 scientific abstracts and presentations.
Workshops at this meeting resulted in the identification of
nine key research areas, and requests for closer scientific
connections and project development, and advocacy for
increased funding for rural and remote health research.
The Canadian Rural Health Research
Society: a network of networks
Rather than a single network, rural and remote health
researchers have developed what can be considered a virtual
network of networks, which is enabling research capacity
development. The Consortium has become the Canadian
Rural Health Research Society (CRHRS), annual national
scientific meetings have continued, an inventory of research
training in rural health research has been created
23
, new
research groupings have emerged, and network members
have worked with CIHR and other funding agencies to hold
workshops and institutes, as well as to extend funding
opportunities.
The Society
Between 2001 and 2003 the Consortium evolved into the
CRHRS. As a national not-for-profit incorporated society,
the CRHRS aims to build interdisciplinary,
multidisciplinary, mutually supportive and community-
focused research networks that are responsive to the needs of
people living in rural and remote communities. The
Society’s activities are focused on researcher capacity-
building, networking, increasing the availability of funding
for rural health research, as well as knowledge translation
24
.
Connections among researchers have been fostered through
annual scientific meetings. The number of abstracts and
range of disciplines has increased each year. Joint
conferences have identified new areas of research and
expanded networks: in 2003, with the International
Symposium on the Future of Rural Peoples; in 2004 with the
International Rural Nurses Congress; in 2005 with the
Canadian Society for Circumpolar Health (CSCH); and in
2006 with the Canadian Centre for Health and Safety in
Agriculture, the National Collaborating Centre on Aboriginal
Health, The National Collaborating Centre on Environmental
Health, and the British Columbia Rural and Remote Health
Research Network, among others. The conferences have
served as the venue for research priority-setting and
networking on topics such as rural women’s health,
definitions of rural and rurality
25
working with large
databases, rural health professional education, research
ethics and aboriginal knowledge translation.
Research groupings
From the Consortium’s earliest meetings, structured
opportunities have been provided for researchers with
similar interests, from various universities and disciplines to
get together to explore the questions: what are the major
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
6
research issues in this area? What research questions could
be worked on?
One of the earliest networking results was in health services
and policy research, with the nursing group’s study, ‘The
Nature of Nursing Practice in Rural and Remote Canada’
26
.
This Canada-wide study, was conceived when the principal
researchers first met at the 1999 Saskatoon meeting, and
were later supported by a Medical Research Council/CIHR
Opportunities grant in 2000
27
. The physical environment
group, which also met at the 1999 meeting, was successful in
its 2002 application to CIHR Strategic Training Initiative in
Health Research (STIHR) Program for a multicentre training
grant, Public Health and the Agricultural Rural Ecosystem
Training Program (PHARE)
28
. In 2004, two CIHR Centres
for Research Development were funded: the Centre on the
Changing Physical and Social Landscape in Atlantic Rural
Canada
29
, and the Canadian Centre for Health and Safety in
Agriculture
30
, with its researcher network now numbering 66
scientists in 14 Canadian universities and other national and
international organizations. Most research within these
centres is in the areas of population and public health, and
health services and policy research, although increasingly
projects cross into biomedical research and genomics, on
topics such as mechanisms of lung inflammation related to
swine barn air
31
.
In March 2002, with the support of 8 CIHR Institutes,
37 researchers met in Thunder Bay, Ontario. Five additional
research groupings, in addition to the ones on rural nursing,
environmental health and rural children’s health, were
created. Subsequent proposals included a project on the links
between health status and community resiliency
32
, and an
evaluation of national information sources for developing a
baseline data set on the health of rural Canadians
29
. Other
research groupings, including one on children’s mental
health and a clinical research-focused group on chronic
disease management have been unable to garner a sufficient
critical mass of researchers to proceed.
A grant received by the Society’s co-leaders
33
, which
enabled the provision of small grants ($4000 $5000), has
added substantial value. The grants allowed investigators of
varying levels of research maturity, and often with little
infrastructure available to them in their home universities, to
meet and prepare proposals for funding. Small grants, and
the networking they have funded, have enabled researchers
to achieve a critical mass across universities, to be successful
in national competition, and to compete on standards of
international excellence
34,35
.
Research training
Fostering research training has been a continuing theme.
During 2001 a Canada-wide survey of training opportunities
in rural and remote health research was undertaken
23
. The
relationships built among researchers through the CRHRS
and the research grant activities, have created new research
training opportunities, for example, the PHARE Program
through the rural health CIHR Centres for Research
Development located in Nova Scotia
29
and Saskatchewan
30
.
Summer institutes have been implemented in Ontario and
Newfoundland. No fewer than 22 students presented their
research at the 2005 conference and, with their mentors,
participated in a mentorship workshop.
Making supportive networks possible
CIHR funding has been central to fostering research
groupings, networking and capacity building among rural
and remote researchers
27,33
. The need for a Canada-wide scan
of research priorities, first raised by CRHRS researchers,
was taken up by the CIHR. In September 2001 a national
meeting organized by CIHR resulted in a proposed strategy
for rural and remote health in Canada within the context of
the CIHR
36,37
, and led to CIHR strategic competitions in
2002, 2003 and 2004. In 2002, the CIHR created a strategic
initiative across all 13 institutes, now the Special Joint
Initiative in Rural and Northern Health, to provide support
for the development of this strategic priority
38
. Funding for
this initiative was discontinued in 2006.
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
7
Challenges of network development and sustainability
The challenges faced by the CRHRS are characteristic of a
small research community with multiple disciplines, diverse
interests, and limited capacity, dispersed over a large
geographical area. Predominant among the challenges are
the following:
1. Sustaining communication among a small research
community with a range of disciplines and research
foci, spread over a vast geography.
2. Addressing a range of networking and capacity-
enhancing needs within the research community.
3. Engendering cooperation in a research environment
that rewards competition.
4. Resourcing a secretariat or service centre, and other
network supports.
5. Balancing the demands to foster research excellence
with the needs to build infrastructure and engage in
advocacy action to increase research funding for
rural health.
The rural health research community in Canada remains
small and widely dispersed, with few senior researchers. The
networking and capacity enhancing needs vary considerably
within the research community, and as excellence can be
defined in terms of competitive success, cooperation is
sometimes stifled.
Attempts to identify gaps and set priorities in rural health
research have met with limited success
36,37
. The list of
important topics for research has been far-ranging, and
researchers have been unable to reach consensus on focused
research priorities because of diverse needs, interests, and
disciplines. The broad range of research topics contrasts with
the approach in the USA or Australia, where health services
or health policy as drivers and funders of rural health
research have prompted more focused research priorities
13,14
.
In Canada, it is frequently challenging to create a critical
mass of researchers around a particular topic, or to offer
research training, except by finding non-traditional ways to
link with others across the country or internationally. A
Canadian strength however, is a multidimensional approach
to understanding the determinants of rural health taken by
groups of researchers examining complex issues related to
the health and economic sustainability of rural
communities
30
. The breadth of interests and disciplines
among the rural health research community has been central
to fostering larger multidisciplinary research groups.
Most rural and remote health researchers are located in small
universities where research resources are limited. Small
universities, often located in more rural or remote parts of
Canada, frequently have sustained, substantive linkages with
their surrounding communities. These links foster
community based research, alignment of research interests,
and the ability for research findings to directly impact health
programs and services
18,38,39
. It is these abilities that provide
groups of rural health researchers, often networking across
provinces, with the potential to compete successfully
nationally and internationally, particularly in the new
funding era which increasingly emphasizes the need to work
with the users of research for improved research uptake.
The targeted national support for rural health and rural health
research has been short-lived: Health Canada’s Office of
Rural Health has been dismantled and CIHR has ceased
strategic funding for rural health research. The decrease in
targeted funding has made networking and capacity-building
more challenging. Among the challenges is finding
appropriate publication outlets. CRHRS members have
edited special issues of other publications
40
, but efforts to
create a rural health research journal in Canada have not yet
been successful.
Finally, it is challenging for a small research community
with few resources to develop the necessary infrastructure,
while maintaining a balance between advancing the science
and advocating for adequate research funding. Network
members have been diligent in recommending colleagues to
serve on CIHR peer review committees, and institute
advisory boards, as well as regularly communicating with
CIHR about rural health research needs. The CRHRS, a non-
profit society funded by memberships, has sustained its
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
8
leadership, and maintained its secretariat and conference
planning endeavours by means of in-kind contributions by
members and their universities. Without a national focus on
rural health on the part of those responsible for research
funding and policy development, and a more central place of
rural health on provincial agendas across the country, the
sustenance and growth of research excellence and funding
opportunities cannot happen easily.
Lessons learned in network
development
In addressing the challenges, the CRHRS has learned how to
begin to support researchers with diverse interests and needs
across sectors and a wide geographical area, specifically by:
1. Focusing on research development through creating
and supporting trusting connections among
researchers.
2. Building the science first, followed by
infrastructure development.
3. Making individual researchers the nodes in the
network.
4. Being inclusive by accommodating a wide variety
of researchers and researcher strengths.
5. Emphasizing social exchange, knowledge
exchange, and mentoring in annual scientific
meetings.
6. Taking opportunities to develop separate projects
while finding ways to link them.
7. Finding a balance between advancing the science
and advocating for adequate funding and
appropriate peer review.
8. Developing a network organizational structure that
is both stable and flexible.
9. Maintaining sustained visionary leadership.
Unlike research networks, designed as infrastructures for
information and services
8
, the CRHRS has developed as a
fluid channel so that researchers may find best ways of
achieving their own goals of excellence in rural and remote
health research. In pursuing excellence, researchers have
created a variety of smaller, often overlapping knowledge
networks, communities of practice and soft networks
7
.
Building a network of networks has been an intertwined
process of researchers reaching out, taking the risk to trust
one another, building community-linked projects and
programs of excellence, receiving funding, developing new
knowledge, using the knowledge to train students, building
capacity, learning how to translate our knowledge to each
other and to our stakeholders and partners, and reaching out
in new ways.
Conclusions
The CRHRS has made strides in enabling inclusive networks
of researchers and communities to develop capacity
collectively. Challenges that remain are to find new ways to
link together population health, health promotion, and health
services researchers with clinical and biomedical researchers
to address the human and health ecosystem issues that are of
such importance in rural and remote communities. New
developments may see large, multidisciplinary research
teams working in partnerships with communities to address
the diverse health agenda of rural and remote Canada, while
being connected and competitive nationally and
internationally. The network of networks approach that has
characterized the development of rural and remote health
research in Canada may permit some innovative ways to
move to this next stage.
Acknowledgements
The authors would like to acknowledge the Canadian
Institutes of Health Research for funding the process leading
to the formation of the Canadian Rural Health Research
Society. The authors also wish to thank the efforts of
colleagues from across Canada who participated in and
supported the process that led to the formation and
incorporation of the Society.
© MLP MacLeod, JA Dosman, JC Kulig, JM Medves, 2007. A licence to publish this material has been given to ARHEN http://www.rrh.org.au
9
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... Lack of mentorship is one of the largest barriers for young practitioners to conduct research 2 . Some governmentand university-based research support programs for rural practitioners in which mentorship and other services are provided have been reported, mainly from Australia and Canada, but not from Asian countries [4][5][6][7][8] . ...
... Some medical schools and public sectors support research conducted by rural health professionals [4][5][6][7][8] . The support includes providing mentors, short courses such as research design and statistics, research funds, conferences, and arrangement of research groups [4][5][6][7][8] . ...
... Some medical schools and public sectors support research conducted by rural health professionals [4][5][6][7][8] . The support includes providing mentors, short courses such as research design and statistics, research funds, conferences, and arrangement of research groups [4][5][6][7][8] . Flinders University in South Australia, for example, utilizing government funding scheme, provided funds and mentoring to rural health professionals and achieved a substantial effect 7 . ...
Article
Context: Jichi Medical University (JMU) is the only medical school in Japan that is devoted solely to producing rural and remote doctors. To support research activities of its graduates, mainly young graduates under obligatory rural service, JMU established a voluntary team, Clinical Research Support Team (CRST)-Jichi. Issues: CRST-Jichi consists of current and past JMU faculty members; all of them are specialists of certain medical fields and many are also graduates of JMU who have completed rural service. A client who asks the CRST for advice on study design or editing a paper emails the CRST to ask for support in conducting a study. Then, core members of the CRST assign the job to a registered specialist of the corresponding topic, who becomes a 'responsible supporter' and continues to support the client until a paper has been published. During the 3 years from July 2010, 12 English papers have been published in international peer-review journals, two Japanese papers in domestic journals, and 13 studies are in progress. Ninety-one percent of clients were satisfied with the service, and eighty-two percent considered their papers would not have been published if they had not used the service. Sense of commitment, existence of JMU-graduated specialists, and quick response were reported by clients as major strengths of CRST-Jichi. Lessons learned: The experience of CRST-Jichi can potentially be transferred to not only other Japanese medical schools with rural doctor production programs, which are now rapidly increasing as part of a national policy, but also rural medical education systems in other countries.
... 8 National research networks have also been adopted by Canada as part of enhancing rural health research capacity. 9 However, it is possible that networks are only part of what should be a comprehensive and integrated strategy for sustainable rural health research at global, national or local levels. ...
... Firstly, a draft framework was developed by considering both the themes from the authors' 2020 published research about the field and its sustainability challenges 11,12 and the wider literature about research capacity-building theory and rural research development strategies. 9,10,13,14 This involved considering, what were the major strategies that could be applied to improve capacity? The research team agreed on a draft framework which included 15 strategies. ...
... However, understanding how to sustain rural health academic research is a significant issue given that these researchers may work in different ways to metropolitan-based academics, including working across a generalist skillset, in small teams and distributed sites, and their field is depicted by responding to high levels of community demand with limited funding [2] [14]. Australia, the United States and Canada are all countries that have formally sought to or embed rural health research capacity; however, none has evaluated the sustainability challenges of their models [14][15][16][17]. We aimed to evaluate the sustainability challenges of researchers in this field, specifically to identify how to sustain rural health research capacity. ...
... Other countries have used nationalised rural health research networks to foster rural health research capacity [7,17]. Our participants were already seeking their own networks or joining regionalised networks but access to these was inequitable depending on the researcher's region. ...
Article
Full-text available
Background The field of rural health research is critical for informing health improvement in rural places but it involves researching in small teams and distributed sites that may have specific sustainability challenges. We aimed to evaluate this to inform how to sustain the field of rural health research. Methods We conducted In-depth semi-structured interviews of 50-70 minutes with 17 rural early career researchers who were from different research sites across rural Australia. Data were thematically coded. Results Seven sustainability challenges were noted, namely recognition, workload, networks, funding and strategic grants, organisational culture, job security, and career progression options. Rural researchers were poorly recognised for their work and researchers were not extended the same opportunities enjoyed by staff at main campuses. Unpredictable and high workloads stemmed from community demand and limited staff. Strategic grant opportunities failed to target the generalist, complex research in this field and the limited time researchers had for grant writing due to their demands within small academic teams. Limited collaboration with other sites increased dissatisfaction. In the face of strong commitment to rural ‘places’ and their enthusiasm for improving rural health, fixed-term contracts and limited career progression options were problematic for researchers and their families in continuing in these roles. Conclusion A comprehensive set of strategies is needed to address the sustainability of this field, recognising its value for rural self-determination and health equity. Hubs and networks could enable more cohesively planned, collaborative research, skills sharing, senior academic supervision and career development. Targeted funding, fit to the context and purpose of this field, is urgent. Inaction may fuel regular turnover, starting after a researcher’s first years, losing rich academic theoretical and contextual knowledge that is essential to address the health of rural populations.
... The identified literature supports some of the challenges and barriers highlighted in this research, in terms of the implementation of interventions for RCB in primary care. Among the previously identified challenges are the lack of protected time, the limited research-related human resource capacity to mentor novice researchers [15][16][17], the issues of sustaining communication, a range of networking and capacity-enhancement needs, and balancing the demands to foster research excellence with the needs to create infrastructure and advocate for adequate research funding [18]. Collaboration with stakeholders is crucial for the success of interventions to improve research capacity [16]. ...
... RCB in countries without an organizational infrastructure is challenging, and it needs to be flexible and tailored to the context [9]. One central question is how to empower individual researchers to build enough relevant high-quality science and become central in their national practice-based network to enhance the necessary infrastructural development [5,17,18,24]. ...
Article
Full-text available
Background: The effectiveness of any national healthcare system is highly correlated with the strength of primary care within that system. A strong research basis is essential for a firm and vibrant primary care system. General practitioners (GPs) are at the centre of most primary care systems. Objectives: To inform on actions required to increase research capacity in general practice, particularly in low capacity countries, we collected information from the members of the European General Practice Research Network (EGPRN) and the European World Organization of Family Doctors (Wonca). Methods: A qualitative design including eight semi-structured interviews and two discursive workshops were undertaken with members of EGPRN and Wonca Europe. Appreciative inquiry methods were utilized. Krueger’s (1994) framework analysis approach was used to analyse the data. Results: Research performance in general practice requires improvements in the following areas: visibility of research; knowledge acquisition; mentoring and exchange; networking and research networks; collaboration with industry, authorities and other stakeholders. Research capacity building (RCB) strategies need to be both flexible and financially supported. Leadership and collaboration are crucial. Conclusion: Members of the GP research community see the clear need for both national and international primary care research networks to facilitate appropriate RCB interventions. These interventions should be multifaceted, responding to needs at different levels and tailored to the context where they are to be implemented.
... In light of this, recent research has identified a need for collaboration between academic institutions and health sectors, to improve access to research expertise to support capacity building of health care professionals and services [9]. Research capacity building in health services refers to the development of individual and organisational skill and abilities in order to conduct health research [10,11] and is an area which has seen numerous approaches trialed [9,[12][13][14][15][16][17][18][19][20][21][22]. These approaches include staff development programs [12,21,22], provision of grant funding to support research projects [23], short educational courses [16,24,25], mentoring [26] fellowships [27] and embedding researchers into health services [9,28]. ...
Article
Full-text available
Background Participation of health service staff in research improves health outcomes and adherence to clinical guidelines. To increase research participation, many health services seek to build research capacity which adds to the development of individual and organisational skills and abilities in order to conduct health research. Numerous approaches to research capacity building have been trialed with inter- and intra-institutional, or university-health service collaborative approaches being frequently described strategies. University-health service research collaborations have potential for high impact and mutual benefit, by harnessing respective strengths across both organisations. However, the range and scope of research capacity building approaches, including their relative value and success have not been consolidated. The aim of this review was to examine and describe the collaborative strategies employed by health services in conjunction with educational partners to enhance the research capability of health service staff. Methods The scoping review framework by Arksey and O’Malley was used to inform the review method. A systematic search was conducted of four major databases: Medline, CINAHL, Embase, and Cochrane, focusing on publications after 1995. Inclusion and exclusion criteria were established through iterative team discussions. The two-stage screening process and data extraction was managed in Covidence. Collaboration, Research Capacity, Health Services, and Health workforce were the primary concepts, contexts and populations guiding the search. Results Of the 1462 studies identified, 61 were selected for the review. These studies reported on partnerships between universities and health services with a specific focus on building research capacity of health service staff. Studies predominantly hailed from Australia, USA, UK, and Canada. Collaboration approaches varied and leveraged different activities to build research capacity included training, mentoring, shared funding, and networking. Training partnerships emerging as the most prevalent. Findings emphasised the importance of localisation in approaches, with some studies indicating the intrinsic value of such collaborations for both partners involved. Despite the emphasis on individual interventions like training and mentoring, team-level interventions were notably scarce. Conclusion This review highlights the diverse range of approaches in research capacity building collaborations between health services and educational partners. It advocates for a shared understanding of goals, highlighting the critical nature of relationship-building and the pivotal role of sustainable infrastructure in long-term collaboration success. Future directions should consider the tangible impacts of these models on clinical outcomes.
... found that Canada's executive federalism has not fostered the level of rural health policy innovation one might expect, largely due to provincial resistance to federal intervention. With the nexus of health policymaking situated at the provincial level, there is notable interprovincial variation in rural health interest(MacLeod et al. 2007). While some provincial governments have been in the vanguard, demonstrating a firm commitment to action on this issue, others have lagged behind(Sibley and Weiner 2011).The aversion of sub-national governments to federal intrusion is evident across both Canada and the United States. ...
Article
Full-text available
Single-payer health reform has secured its place in the mainstream American health policy debate, yet its implications for particular subpopulations or sectors of care remain understudied. Amidst many unanswered questions from policymakers and political pundits, rural health has emerged as one such area. This article explores rural Canada’s five-decade-long experience with a national publicly funded health insurance program as a valuable opportunity for cross-national learning. During March 2020, I conducted 13 semi-structured, elite stakeholder interviews with government officials, academic researchers, rural hospital executives, public health association leaders, rural health administrators, and representatives from provincial medical, hospital, and physician associations in Ontario. I found that a single-payer model confers notable advantages over a market-based model, including improved rural hospital viability and enhanced governmental authority to plan health services. However, despite these advantages, advances in Canadian rural health care have remained modest, and those that have occurred seem to be derived as much from a basic value commitment to tackling rural health issues as from the structure of Canada’s single-payer model itself. These results suggest that designing a national single-payer program in the United States that successfully ameliorates geographic health disparities will require a specific and concerted focus on addressing rural health issues. In the absence of such a focus, any single-payer program instituted in the U.S. risks inadequately meeting the pressing and unique health care needs of rural communities.
... [5,14] Key elements of health networks include promoting multidisciplinary knowledge, facilitating interdisciplinary collaboration, and sharing expertise and resources for research training. [15,16] To accomplish this in the subspeciality of psycho-oncology, the International Psycho-Oncology Society (IPOS) was created to foster international multidisciplinary collaboration about clinical, educational, and research issues pertaining to the psychosocial health of those affected by cancer, their families, and care providers. [17] The mission of this society is to promote global excellence in psychosocial care of people affected by cancer through partnerships, research, public policy, advocacy and education. ...
Article
Background: The International Psycho-Oncology Society (IPOS) is a multidisciplinary professional network that aims to improve psychosocial care for individuals impacted by cancer. IPOS encourages research activity, recognizing that a high-quality evidence base is essential to provide best-practice, data-driven clinical care. This study aimed to determine the barriers to research involvement and the training needs and priorities of IPOS members, with the goal of facilitating the development of training resources tailored to the needs of IPOS members. Methods: A link to an online, cross-sectional survey was disseminated to all registered members of IPOS via email. The online survey platform SimpleSurvey was used, and questions included demographic characteristics and items related to research interests, involvement, and training needs. High priority research training needs were identified as research tasks respondents rated as highly important, yet possessed a low perceived skill level in. Results: Thirty-two percent of IPOS members (n = 142) completed the survey. Participants represented 49 countries and were at a variety of career stages. Overall, participants reported spending an average of 17.3 hours per week on research (range 0-80 hours per week), with 69% of respondents wanting to increase their research involvement. The main barriers to research participation included lack of research funding (80%) and lack of protected time (63%). IPOS members identified 5 high-priority training needs: preparing successful grant applications; preparing research budgets; community-based participatory research; working with decision makers; and finding collaborators or expert consultants. Participants suggested funding access, statistical advisors, and networking and mentorship opportunities as ways to enhance research involvement. Members preferred online training modules (39%) and mentorship programs (19%) as methods by which IPOS could provide research support. IPOS was viewed as being able to contribute to many aspects of research capacity building such as networking, training, and dissemination of research findings. Conclusions: IPOS has an important role in encouraging research capacity building among members. This survey provides an agenda for workshops and training opportunities. Mainly, for respondents it was less about training in research methods and more about training in how to prepare successful grant applications, including budgets, and receiving mentorship on this as well as having opportunities to collaborate with other researchers.
... The virtual network is an online forum of nurses with an interest in research who have identified themselves through the WSPCR online Community Nursing Researcher Network form (http://tinyurl.com/pce98c8). Generally, virtual networks take a variety of forms ranging from highly coordinated groups to those which have members which are loosely connected (Macleod et al, 2007). This virtual network will serve as a communication tool to achieve the second aim of the strategy, to 'establish the existing support infrastructure and training available to researchers'. ...
Conference Paper
Symposium Title: Using Consensus methods to build research capacity within Community Nursing in Wales. The aim of this symposium is to describe how consensus methods have been used to build and sustain research capacity within community nursing in Wales. Community nursing is changing and in order to obtain best patient outcomes, practice needs to be underpinned by robust research based evidence. The Community Nursing Research Strategy for Wales aims to provide all community nurses and midwives in Wales with the opportunity to be involved in Research for the development of evidence based practice1. The term community nurse includes all nurses, midwives and health visitors working outside of the district general hospital including all areas of practice, research and education. This symposium will present three papers to illustrate how consensus methods have been used to build and sustain research capacity in order to obtain better outcomes for patients. Paper one, ‘Building and coordinating the Community Nursing Research strategy for Wales’ describes how nominal group technique was used to develop, build and coordinate the community nursing research strategy for Wales. As a result of the development of this strategy two further papers will be presented. Paper two, will illustrate Concept Mapping¹ in a mixed-method PhD study to develop a validated instrument for district nurses to identify community-based patients with complex needs. Finally, paper three ‘Using Consensus Methods to evaluate an Erasmus Intensive Learning Project’ uses consensus methods to evaluate an international Erasmus funded intensive learning project (February 16-March 1 2014) which developed different pedagogical models/practices to help students support patients/families become empowered, including empowerment photography. Paper one: ‘Building and coordinating the Community Nursing Research strategy for Wales using Nominal Group Technique’ This paper will demonstrate how the use of nominal group technique can be used to develop and coordinate a national community nursing research strategy (CNRS). The CNRS was developed in December 2011 and launched in March 2013. Its inception originated from Recommendation 22 of the Community Nursing Strategy for Wales2 which stated ‘The Welsh Assembly Government will invest in the funding of research that will develop the evidence base for community nursing interventions, evaluation methods and the appropriate numbers and skill mix for workforce planning’. Thirty two community nurse participants from practice, research, professional bodies, workforce planning and education attended a NGT workshop. The three key characteristics of nominal group technique were used, phase 1-prior discussions and decisions, phase 2- face to face contact with presentation of ideas, topic debate and topic rating, Phase 3- formal group feedback. The All Wales community nursing research priorities and themes were identified. This method has since been used repeatedly to identify ideas, pilot studies and future planning for example, Practices Nurses workforce needs. In August 2013 the CNRS coordinator was appointed and has developed the strategy into a model with four quadrants, an online virtual network, research portfolio database, application to practice, and leadership. The coordinator has developed this model and its standard operational policies including a Scorecard (metrix) to identify impact on practice and to ensure that the CNRS meets its outcomes. Measures include a target of 250 virtual members by March 2015, annual conference, publications, study income, national and international contacts, translating measures into new practices and products. This metrix will be presented at this conference. The Community Nursing Strategy for Wales was sponsored by the Marchioness of Bute and Lady St. David’s Fund. References: 1. Kenkre , J., Wallace, C., Davies, R., Bale, S., Thomas, S., (2013) Developing and implementing the community nursing research strategy for Wales. British Journal for Community Nursing 18(11) 561-566 [online] http://www.wspcr.ac.uk/resources/Developing%20and%20implementing%20the%20Community%20Nursing%20Research%20Strategy%20for%20Wales.pdf [accessed on 10/11/14] 2. Welsh Assembly Government (2009) A Community Nursing Strategy for Wales. Consultation Document. Paper authors: Principal Author: Dr Carolyn Wallace, Reader, USW UK/ Clinical Research Fellow, Wales School Primary Care Research, Cardiff, Wales; Prof. Joyce Kenkre Professor of Primary Care, USW. UK, Robyn Davies Manager of Wales School for Primary Care Research, Cardiff, Wales; Sue Bale is Visiting Professor, University of South Wales, Sue Thomas Primary Care and Independent Sector Adviser, RCN Wales, Cardiff, Wales and PhD Student, University of South Wales, UK. Paper Two : Using Concept Mapping in a mixed-method study to develop a patient assessment instrument for district nurses to identify community-based patient complexity Aim This describes the place of consensus methodology using Concept Mapping¹ in a mixed-method PhD study to develop a validated instrument for district nurses to identify community-based patients with complex need or who have changing need that may place them at risk of rapid deterioration. Background Complex patient need might impact on professional thinking and care provision2,3,4, whilst understanding patient complexity has important implications for the planning and design of community-based services5. Despite this, there is no validated instrument to capture the relationship between complexity of patient need and district nurse activity; neither is there currently a method to articulate the complexity of community-based patient care to managers or service planners. Concept Mapping enabled several stages of instrument development to be addressed, including; theory development, items design, and items selection6. Method 5 face-to-face consensus workshops were held and 29 nurses were asked “what specific information should a district nurse record as part of an assessment of patient complexity?” in order to identify the necessary items for inclusion in the instrument. The results were mapped to an existing taxonomy7 to establish whether this contained the identified items and would be suitable for use. Results Results demonstrate that it is inadequate to consider clinical features alone in an assessment of complex patient need. Amendments were made to the existing taxonomy to reflect gaps found during the mapping exercise and the amended instrument is now known as the Patient Complexity Instrument. Conclusion Concept Mapping offered a mixed-methods approach to identifying factors considered essential for district nursing assessment of patient complexity. The stage of scale development is currently being addressed by using Rasch analysis8 of patient assessment data collected by district nurses. References 1. Kane M & Trochim W (2007) Concept Mapping for Planning and Evaluation. Sage Publications 2. NHS Wales & Welsh Government (2012) Working differently - Working together: A workforce and organisational development framework. Welsh Government, Cardiff 3. Kathol R, Perez R & Cohen J (2010) The Integrated Case Management Manual; Assisting Complex Patients Regain Physical and Mental Health. Springer Publishing Company, New York 4. Wade D (2011) Complexity, case-mix and rehabilitation: the importance of a holistic model of illness (Ed). Clinical Rehabilitation. Vol. 25, 387-395 5. Shippee N, Shah N, May C, Mair F & Montori V (2012) Cumulative complexity: a functional, patient-centred model of patient complexity can improve research and practice. Journal of Clinical Epidemiology. Vol. 65, 1041-1051 6. Wilson M (2005) Constructing Measures: An Item Response Modelling Approach. Psychology Press. 7. Wyatt M (2012) ANGEL Taxonomy: a cognitive model for assessment, decision making and planning in complex care. Technical Briefing Document. www.complexcarewales.org. 8. Bond T & Fox C (2007) Applying the Rasch Model: Fundamental Measurement in the Human Sciences (2nd ed.) Routledge Principal Author: Sue Thomas. PhD Student & RCBC Fellow, University of South Wales; Dr Carolyn Wallace, Reader, USW UK; Dr Paul Jarvis, Research fellow, USW, UK ; Dr Ruth Davis, Independent Consultant, Cardiff, UK.
... Institutional mentoring -an institution-to-institution learning framework using an interactive, facilitative process -may be a useful model for building the capacity of local health departments (LHDs) to address emerging public health challenges (1). By introducing a framework for in-person and remote interaction between an experienced, knowledgeable mentor institution and a group of mentee organizations, the institutional mentoring model incorporates training and technical assistance (T/TA) methods that have proven useful for LHD staff (2)(3)(4)(5)(6)(7) in a peer learning, interactive, and supportive structure. ...
Article
Full-text available
Introduction Institutional mentoring may be a useful capacity-building model to support local health departments facing public health challenges. The New York City Department of Health and Mental Hygiene conducted a qualitative evaluation of an institutional mentoring program designed to increase capacity of health departments seeking to address chronic disease prevention. The mentoring program included 2 program models, a one-to-one model and a collaborative model, developed and implemented for 24 Communities Putting Prevention to Work grantee communities nationwide. Methods We conducted semi-structured telephone interviews to assess grantees’ perspectives on the effectiveness of the mentoring program in supporting their work. Two interviews were conducted with key informants from each participating community. Three evaluators coded and analyzed data using ATLAS.ti software and using grounded theory to identify emerging themes. Results We completed 90 interviews with 44 mentees. We identified 7 key program strengths: learning from the New York City health department’s experience, adapting resources to local needs, incorporating new approaches and sharing strategies, developing the mentor–mentee relationship, creating momentum for action, establishing regular communication, and encouraging peer interaction. Conclusion Participants overwhelmingly indicated that the mentoring program’s key strengths improved their capacity to address chronic disease prevention in their communities. We recommend dissemination of the results achieved, emphasizing the need to adapt the institutional mentoring model to local needs to achieve successful outcomes. We also recommend future research to consider whether a hybrid programmatic model that includes regular one-on-one communication and in-person conferences could be used as a standard framework for institutional mentoring.
Article
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This article seeks to contribute to a more nuanced understanding of the much neglected study of regional research networks (RRNs) and their influence on capacity building in Africa. As a point of departure some conceptual ambiguities and inconsistencies in the field are addressed, with emphasis on the concepts of networking, network and organisation. This discussion serves as an inroad the construction of four ideal types of RRNs in Africa: (i) regional research associations; (ii) regional research organisations; (iii) regional research centres; and (iv) regional research programmes and projects. Thereafter some links between various types of RRNs and capacity building are dicussed. Then some negative consequences for networking and capacity building of the way donors operate are also discussed. A main argument developed is that RRNs should be integrated within a holistic, systems-oriented approach to research capacity building. The challenge for future research is to uncover the comparative advantages of various types of RRNs per se but also when RRNs are promoting synergy effects with other levels of research capacity building.
Article
Full-text available
The Innovation Systems Research Network is a collaborative Canadian initiative to undertake and disseminate research results concerning the diverse nature of regional and local innovation systems across the country. The network was established on the premise that, because of their diversity, regional innovation systems in Canada could not be treated as similar, and that single nation-wide innovation policies would not be successful. This project is, itself, an experiment in research management, in that, because of its regional focus in a geographically diverse federation, it is organized as a federation of regional innovation studies networks. A consequence is that the network has been productive and has provided opportunities for graduate students to meet their peers (and future colleagues) across the country. Copyright , Beech Tree Publishing.
Article
Rural health research in Canada is at the crossroads. Jolted by the establishment of the Canadian Institutes of Health Research, rural health researchers are trying hard to overcome past benign neglect and the lack of cohesion and collaboration within the rural health research community. Although there is considerable catching-up to do, rural health research in Canada has a firm foundation. Backed by a growing network of rural health research centres, researchers are searching for ways to work together in order to advance rural health research and the health and wellbeing of rural Canadians.