Shaping research and research capacity building in rural health services: Context matters.

Abstract

Background/aim: To address the disconnect between rural healthcare service delivery and health and medical research, research capacity and capability should be embedded in rural health services. The Australian Government’s vision for ‘Better Health Through Research’ considers health services research as a key driver to improve health outcomes and increase health service efficiency, sustainability and productivity. However, the involvement of the healthcare workforce in research to drive evidence-based practice is yet to be substantially realised for rural health services. Aim is to determine contextual factors influencing research and research capacity building in rural health settings. Population/setting: Senior rural health managers, academics and/or research coordinators at Victorian rural health services and university campuses. Methods: Qualitative study involving semi-structured telephone interviews with senior rural health managers, academics and/or research coordinators to explore factors influencing health professionals’ research education and capacity building (RCB). Analysis involved inductive coding and thematic analysis; and mapping to the Consolidated Framework for Implementation Research (CFIR). Results: Findings reflected the CFIR domains and constructs: intervention characteristics (relative advantage of building RCB in rural health services compared to fly-in-fly-out or urban-based researchers); outer setting (cosmopolitanism – networks between rural health services/health professionals and research bodies, external policies and incentives); inner setting (implementation climate, readiness for implementation); characteristics of individuals (self-efficacy); and process (planning, engaging). Notably, low levels of rural research funding, chronic workforce shortages, tension between undertaking research and delivering healthcare, and the absence of organisational planning and research culture, were all considered to significantly impact the operationalisation and prioritisation of RCB in rural health services. Conclusion: A strong culture of research and research capacity building in rural health services is required to realise the Australian Government’s vision for improved healthcare service delivery and health outcomes in rural areas. Findings illustrated the implementation context and the complex contextual tensions either prevent or enhance research capacity building in rural health services; effective government policy and investment are critical for addressing these factors. Translational impact/implications for future practice: This project has informed the development of a comprehensive RCB program for regional and rural health services in Western Victoria. Additional recommendations include: development of workforce and rural research funding policies; identifying rural health services’ research priorities; and investing in researchers embedded rurally.