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Building capacity to use and undertake research in health organisations: survey of training needs and priorities

amongst staff

Journal: BMJ Open

Manuscript ID bmjopen-2016-012557

Article Type: Research

Date Submitted by the Author: 06-May-2016

Complete List of Authors: Barratt, Helen; UCL, Department of Applied Health Research Fulop, Naomi; University College London, Department of Applied Health Research

<b>Primary Subject Heading</b>:

Evidence based practice

Secondary Subject Heading: Medical education and training

Keywords: Knowledge translation, Evidence use, Research participation, Training

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml

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Building capacity to use and undertake research in health organisations: survey of training needs and priorities amongst staff

Helen Barratt,1 Naomi J Fulop

1

1NIHR CLAHRC North Thames, Department of Applied Health Research, University

College London, 1-19 Torrington Place, London WC1E 6BT, UK

Corresponding author:

Dr Helen Barratt

NIHR CLAHRC North Thames, Department of Applied Health Research, University


[email protected]

020 7679 8285

Keywords:

Knowledge translation

Evidence use

Research participation

Training

Word count: 4652

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Abstract

Objectives: Efforts to improve health care and population health depend partly on the

ability of health organisations to use research knowledge and participate in its

production. We report the findings of a survey conducted to prioritise training needs

amongst health care and public health staff, in relation to the production and

implementation of research, across an applied health research collaboration.

Design: A questionnaire survey using a validated tool, the Hennessy-Hicks Training

Needs Assessment Questionnaire. Participants rated 25 tasks on a five-point scale

with regard to both their confidence in performing the task, and its importance to their

role.

Setting: A questionnaire weblink was distributed to a convenience sample of 35

health care and public health organisations in London and South East England, with a

request that they cascade the information to relevant staff

Participants: 203 individuals responded, from 20 health care and public health

organisations

Interventions: None

Outcome measures: Training needs were identified by comparing median

importance and performance scores for each task. Individuals were also invited to

describe up to three priority areas in which they require training.

Results: Across the study sample, evaluation; teaching; making do with limited

resources; coping with change and managing competing demands were identified as

key tasks. Assessing the relevance of research and learning about new developments

were the most relevant research-related tasks. Participants’ training priorities included

evaluation; finding, appraising and applying research evidence; and data analysis. Key

barriers to involvement included time and resources, as well as a lack of institutional

support.

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Conclusions: We identify areas in which health care and public health professionals

may benefit from support to facilitate their involvement in and use of applied health

research. We also describe barriers to participation and differing perceptions of

research between professional groups.

Strengths and limitations of this study:

• Our study is the first of its kind to be conducted in England and extends the

existing literature exploring research use and participation in specific groups

by examining self-identified opportunities to improve research use and

comparing across professional groups.

• The findings may relevant to others looking to establish research training

programmes, because we received responses from staff in twenty separate

organisations, including large teaching hospitals, small district general

hospitals, and public health organisations.

• Several professional groups were underrepresented in our survey, and their

perspectives warrant further exploration, for example midwives and public

health staff.

• Our sample size was relatively small, but the survey was conducted in the first

few months of our five year research collaboration and it is encouraging to see

that there was clear interest in using and applying research, right across the

partnership.

• Results from a convenience sample are of unknown generalizability and staff

who completed the survey are likely to be those who are most interested in the

topic, but this sampling approach was appropriate for our purposes as we

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sought to prioritise our capability building efforts and reach those most

interested in research.

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BACKGROUND

The provision of high-quality, affordable, health services is a growing challenge in

many developed countries. In England, for example, the NHS Five Year Forward

View set out the case for major system change and new ways of working. [1] Staff in

health care and public health organisations have a key role to play in improving

patient care and population health through the implementation and co-production of

applied health research (AHR). [2] Emerging evidence suggests there is an association

between the engagement of health care organisations in research and improvements in

their overall performance. [3] However, such organisations frequently fail to use

research evidence to inform practice. [4,5] Similar findings have been reported

globally, in both primary and secondary care. [6] In order to improve care, research

findings therefore need to be better integrated into practice and organisational

routines, alongside efforts to promote the co-production of knowledge and build

organisational absorptive capacity.[7]

Over the last 10 to 15 years, increasing attention has been paid to reducing the ‘know-

do’ gap. [8] Ellen et al set out a framework of possible organisational level activities

that might be undertaken to facilitate access, dissemination, exchange, and use of

evidence within health organisations. [9] The framework builds on earlier work by

Lavis et al which classified approaches to communicating research to end users as

push, pull or exchange efforts [10]. It acknowledges that the path from research

creation to utilisation may not be logical or linear, as well as the influence that context

may have on decision making. It includes four major domains of activity: 1)

establishing a climate for research use; 2) research production efforts; 3) activities

used to link research to action; and 4) evaluation. [9] The third domain, activities to

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link research to action, consists of three parts. The first includes ‘push’ efforts, such

as activities undertaken by researchers or intermediaries to disseminate research

evidence. Second, ‘facilitating pull’ efforts aim to provide ‘easy access’ to research

evidence, by ensuring that the appropriate infrastructure is in place to make the

process straightforward for knowledge users (e.g. IT systems, websites). Finally,

‘pull’ efforts seek to develop the personal capacity and capability of staff within

health organisations. This includes, for example, training that focuses, for example, on

the skills needed to find or appraise research evidence. Our specific focus in this paper

is on this final component: training as a means of increasing participation in and use

of AHR by health professionals.

The 2006 Cooksey Report highlighted the gap that exists in the UK between the

conduct of research and its implementation. [11] Subsequently, in 2007, the High

Level Group on Clinical Effectiveness, chaired by Sir John Tooke, called on the

health service to harness better the capacity of higher education to help address this

problem. It recommended the development of new ‘academic health centres’ to

encourage the conduct of relevant research and help embed a culture more receptive

to change in the NHS.[12,13] Collaborations for Leadership in Applied Health

Research and Care (CLAHRCs) were established in England [13] to facilitate the co-

production of research by staff in the health service and public health departments,

working together with academic researchers. [14,15] Funded by the National Institute

for Health Research (NIHR), the first round of five CLAHRCs was established in

2009. Evaluation demonstrated that the first wave had differing capabilities with

respect to reducing the ‘know-do’ gap, partly because of differing interpretations and

enactments of their mission. [16] However, success in this area will inevitably require

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a long-term, sustained focus on relationship building, resource allocation and, in some

cases, culture change. [17] The second wave of thirteen CLAHRCs has been in

operation across England since January 2014.

This article describes an exercise carried out to assess research training needs and

priorities amongst health care and public health staff across England’s largest

CLAHRC, NIHR CLAHRC North Thames. Alongside our programme of research,

we have established an Academy to build capacity and capability to co-produce

research and apply its outputs in practice (http://www.clahrc-

norththames.nihr.ac.uk/academy/). This exercise was conducted to inform the

Academy’s priorities and the development of a programme of activities, including

short courses. Drawing on the framework proposed by Ellen et al, the aim of these

activities is to increase participation in and use of applied health research by health

professionals, to better link research and action. [9] This is the first such study

conducted in the UK. Because of the size and breadth of our partnership, our findings

may be relevant to others seeking to establish similar programmes, addressing the

training needs of a range of professional groups. They also contribute to a growing

literature on research use, at a time when there is a need for evidence to support new

ways of working in many health care systems. [1] To date, much of this research has

taken place outside of the UK and it has typically studied the different behaviours of

specific health professions, such as nursing [18] and allied health professionals. [19]

This literature suggests that training needs and priorities may differ between groups,

but few previous studies have formally compared professions or examined self-

identified opportunities to improve research use or participation.

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METHODS

We used a self-administered online survey to explore research training needs across

NIHR CLAHRC North Thames in June 2014. This approach was chosen to elicit a

high volume of feedback in a short amount of time, from participants in

geographically separated areas. [20] The Hennessy-Hicks Training Needs Analysis

Questionnaire is a validated tool, which offers a means of evaluating training

requirements and prioritising education and development opportunities to meet local

needs. [21] It is tailored for use specifically with health teams and designed to be

adapted, without compromising its validity and reliability.

Study population

Launched in January 2014, and funded for five years, NIHR CLAHRC North Thames

involves 55 partner organisations across North Central and East London, as well as

parts of Bedfordshire, Essex and Hertfordshire. It covers a diverse population of over

6 million residents; 10% of the UK population. Partner organisations include higher

education institutions, health care and public health organisations, as well as third

sector organisations and industry partners. The intended audience for our programme

of short courses is staff working in our 35 partner health care and public health

organisations. These include 21 NHS provider organisations responsible for acute

hospital services, mental health or community care (known as NHS Trusts); 8

organisations responsible for purchasing or commissioning care on behalf of patients

in a designated geographical area (known as Clinical Commissioning Groups); and 8

local government departments, responsible for public health (known as Local

Authorities).

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Administration

We used the web-based tool, Opinio, to collect the survey data from a convenience

sample (available at https://www.ucl.ac.uk/isd/services/learning-teaching/elearning-

staff/core-tools/opinio). We disseminated a weblink to named contacts in relevant

partner organisations, via the CLAHRC mailing list. Contacts were asked to forward

the link on to relevant staff in their organisation. Reminder emails were sent two

weeks later and the survey was live for four weeks in total.

Questionnaire development

The survey questions were developed in line with guidance set out in the

questionnaire manual. [21] The basic questionnaire comprises a list of 30 tasks,

relating to a range of areas, including research, communication/ teamwork, clinical

tasks, administration, and management. Each item is rated along a 7-point scale with

respect to how important the task is to the respondent’s job (Rating A); and how well

the task is currently performed (Rating B). Comparing scores for importance/

performance provides an assessment of where the greatest training needs lie. The

greater the difference in scores, the greater the training need. The questionnaire also

facilitates comparison between the different tasks, such as research and

administration.

The questionnaire is designed so that up to 25% of the original items (to a maximum

of 8) may be swapped for items of the researcher’s choice without compromising its

psychometric properties. Another 10 items may be added in.[21] We identified further

tasks for inclusion, related to both conducting research and using its findings from

interviews, with health care and public health staff from a range of backgrounds

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(n=7). Throughout the modification process, we considered design factors such as the

quality of the questions, survey format and the way questions were presented.[22]

Before releasing the survey, we pilot tested it with eight staff from a range of

professional backgrounds, drawn from across the CLAHRC.

Section 1 of the final survey included a list of 25 tasks, 13 of which were directly

related to research. These are listed in Table 1. In line with guidance about the use of

the questionnaire, we retained 22/30 of the original survey items. In Section 2,

participants were invited to list up to three areas in which they felt they would benefit

from training to better equip them either to conduct research or apply its findings in

practice. We also collected basic demographic information, including professional

group, age and gender.

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Table 1: Research training needs by profession

All respondents (n = 151)

Allied Health Professionals

(n = 39)

Doctors (n = 36)

Managers (n=22)

Nurses (n=27)

Importa

nce to

role

Curre

nt

Perfo

rmance

p value

Importa

nce to

role

Curre

nt

Perfo

rmance

p value

Importa

nce to

role

Curre

nt

Perfo

rmance

p value

Importa

nce to

role

Curre

nt

Perfo

rmance

p value

Importa

nce to

role

Curre

nt

Perfo

rmance

p value

1. Handling routine data 6.00 5.00 0.03 5.00 5.00 0.63 6.00 6.00 1.00 6.00 5.50 0.18 7.00 6.00 <0.01

2. Critically evaluating published research

5.00 4.00 <0.01 5.00 4.00 0.01 6.00 4.50 <0.01 4.00 4.00 0.87 6.00 4.00 <0.01

3. Evaluating your organisation’s performance

6.00 4.00 <0.01 6.00 4.00 <0.01 5.00 4.00 <0.01 7.00 5.00 <0.01 7.00 4.00 <0.01

4. Interpreting research findings

5.00 5.00 <0.01 5.00 4.00 <0.01 6.00 5.00 <0.01 5.00 4.00 0.88 6.00 4.00 <0.01

5. Applying research results to your own practice

6.00 4.00 <0.01 6.00 4.00 <0.01 6.00 5.00 <0.01 5.50 4.00 <0.01 6.00 4.00 <0.01

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6. Identifying viable research topics

4.00 3.00 <0.01 4.00 3.00 0.02 4.50 3.00 0.02 3.50 4.00 0.48 4.50 3.50 <0.01

7. Introducing new ideas at work

6.00 5.00 <0.01 6.00 4.00 <0.01 6.00 4.50 <0.01 7.00 5.00 <0.01 7.00 5.00 <0.01

8. Accessing relevant research literature to inform your work

6.00 5.00 <0.01 6.00 4.00 <0.01 6.00 4.50 <0.01 6.00 4.50 <0.01 6.00 5.00 <0.01

9. Giving information about research to patients/the public

5.00 4.00 <0.01 5.00 4.00 <0.01 5.00 4.50 0.01 4.50 4.00 0.07 5.50 4.00 0.08

10. Statistically analysing your own research data

4.00 3.00 <0.01 4.00 3.00 0.04 5.00 3.00 <0.01 4.00 3.00 0.02 5.00 2.50 <0.01

11. Teaching colleagues and/or students

6.00 5.00 <0.01 7.00 5.00 <0.01 6.00 5.00 <0.01 6.50 5.00 <0.01 7.00 6.00 0.03

12. Managing multiple demands on your time

7.00 5.00 <0.01 7.00 5.00 <0.01 7.00 5.00 <0.01 7.00 5.00 <0.01 7.00 5.00 <0.01

13. Writing up the findings of research studies or audits

5.00 4.00 <0.01 5.00 4.00 0.02 5.00 4.00 <0.01 3.00 4.00 0.64 5.50 4.00 <0.01

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14. Undertaking health promotion activities

5.00 4.00 <0.01 5.00 3.00 <0.01 5.00 3.00 <0.01 2.00 3.00 0.84 5.00 4.50 0.01

15. Making do with limited resources

6.00 5.00 <0.01 6.00 5.00 0.04 5.00 4.00 <0.01 6.00 5.00 <0.01 6.00 5.00 0.28

16. Assessing local health care needs

5.00 4.00 <0.01 4.00 3.00 <0.01 5.00 3.00 <0.01 5.00 3.00 <0.01 5.00 4.00 0.01

17. Collecting and collating relevant research

5.00 4.00 <0.01 4.50 3.00 <0.01 5.00 3.00 <0.01 5.00 4.00 0.27 5.00 4.00 0.09

18. Designing research studies

3.00 3.00 <0.01 3.00 3.00 0.01 4.50 2.50 <0.01 3.00 0.24 0.31 4.00 2.00 <0.01

19. Working as a member of a team doing research

4.00 4.00 0.03 4.00 3.00 0.14 5.00 4.00 0.35 3.00 3.00 0.34 6.00 5.00 0.06

20. Accessing resources to undertake research e.g. money, information, equipment

4.00 2.00 <0.01 3.00 2.00 <0.01 5.00 2.00 <0.01 4.00 3.50 <0.01 4.50 3.50 <0.01

21. Undertaking administrative activities

5.00 5.00 0.15 5.00 5.00 0.98 5.00 4.00 <0.01 6.00 5.50 0.54 5.00 5.00 0.83

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22. Personally coping with change in the health service

6.00 5.00 <0.01 6.00 5.00 <0.01 6.00 4.00 <0.01 6.00 5.00 0.02 6.00 4.00 <0.01

23. Securing time to undertake research

5.00 2.00 <0.01 4.00 2.00 <0.01 5.00 2.00 <0.01 4.00 3.00 0.04 5.00 2.00 <0.01

24. Learning about new research developments in your field

6.00 4.00 <0.01 6.00 4.00 <0.01 6.00 4.00 <0.01 6.00 4.00 <0.01 6.00 4.00 <0.01

25. Assessing the relevance of research to your organisation

5.00 4.00 <0.01 5.00 4.00 <0.01 5.00 4.00 <0.01 5.00 4.00 <0.01 5.00 4.00 <0.01

Numbers in bold and underlined represent the three most significant training needs for each profession

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Analysis

We used Microsoft Excel to manage the survey data and analyse the data from

Section 1, comparing importance and performance ratings for each task to identify

training needs. Given much of the existing literature focuses on individual

professional groups in isolation, we analysed results for the whole sample, but also

disaggregated the data to explore whether differences exist between the needs of

different professional groups. To establish whether differences between the

importance and performance scores given to each task were significant, and therefore

represented a training need, Wilcoxon signed ranks tests were conducted in Microsoft

Excel using the Real Statistics Resource Pack add in (available at http://www.real-

statistics.com). The survey tool authors have advocated the use of parametric tests to

analyse the data it generates. [21][23][24] However, because one cannot necessarily

assume that the intervals are equal between values in Likert-type scales, such as those

used to rate performance and importance, we have opted to use a non-parametric

approach.[25] We carried out qualitative content analysis of free text data from

Section 2 of the questionnaire to identify research training priorities, using the

systematic method set out by Mayring and others.[26] Categories were derived and

revised inductively from the data. Priorities were first identified for the whole sample,

and then compared to examine potential differences between professional groups.

Ethics approval

Completion of the NHS Health Research Authority’s decision tool indicated that NHS

ethics approval was not required for our needs assessment. [27] Local ethics approval

was also not required because the study only involved the use of survey methods to

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collect non-sensitive, anonymous information from participants who were not defined

as vulnerable.

RESULTS

In this section, we describe first the demographics of the survey respondents. We then

go on to examine the research training needs identified by comparing importance and

performance ratings for each task; the training priorities described by participants; and

finally the barriers to research that were highlighted by respondents.

Demographics

203 individuals completed at least one part of the questionnaire. 151 completed the

rating exercise and 125 also described at least one research-related training need in

the free text section.

Respondents were from 20 of the 35 CLAHRC health care and public health partner

organisations. This included a wide spread of different types of organisation: 14 NHS

provider organisations, including 4 teaching hospitals, 4 specialist mental health

organisations and 1 community care provider; 3 local government public health

departments; and 3 organisations responsible for commissioning or purchasing care

on behalf of a geographical population. The median number of responses per

organisation was 4.5 (IQR 1-7.25). As Table 2 shows, over 50% (n=105) of survey

respondents were staff in teaching or specialist hospitals. 74.8% of respondents were

female. 38.4% were aged 30-39 and 33.1% aged 40-49. Respondents’ professions are

outlined in Figure 1. The largest four groups were allied health professionals (AHPs,

25.8% of sample); doctors (23.8%); managers (14.6%) and nurses (16.6%). Other

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groups included administrators (0.7%), directors (1.3%), local authority/ public health

staff (7.3%) and scientific/ technical staff (1.3%).

Table 2: Types of health organisation represented

No. of organisations

Total no of respondents

Teaching Hospital 4 105

District General Hospital 5 31

Mental/ Community Health Provider 5 47

Local Government Public Health Department

3 15

Clinical Commissioning Group 3 5

Total 20 203

The training needs and priorities of the whole survey sample are described below. We

also highlight key differences between the four largest staff groups. The views of

other staff groups are not described in detail, because the relatively small number of

responses increases the risk that the data are not necessarily representative.

Research training needs

In this section, we first describe participants’ assessment of the importance of the 25

tasks included in the questionnaire. We then compare this with the performance

ratings assigned to each task, in order to assess research training needs. Information

about the relative importance and performance of each task is provided in Table 1.

Importance of tasks

Across the study population, participants rated the following as the most important

tasks: managing multiple demands on your time (median score = 7); teaching

colleagues and/or students; evaluating your organisation’s performance; making do

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with limited resources; and coping with change in the health service (median scores

all = 6). Of the 13 research-related tasks, participants considered applying research

results to practice and accessing relevant research literature to be the most important

(median scores both=6).

Designing research studies; accessing resources to undertake research (e.g. money,

information, equipment); securing time to undertake research; identifying viable

research topics and statistically analysing your own research data were the three least

important research tasks for study participants. Nevertheless, apart from designing

research studies, each of these tasks had a median importance score of more than 4.0

on the seven-point scale, suggesting that these tasks are still considered relatively

important the respondents’ jobs. In addition, around 20% of respondents gave each of

these tasks an importance score of 7.0 (‘very important’), which indicates that they

are highly relevant to a subset of participants. Indeed, with the exception of designing

research studies, all the 25 tasks included in the survey had a median importance

score of more than 4.0, with ten having a median score of 6.0 or more on the seven

point scale (Table 1).

There were minor differences between the four largest professional groups in terms of

the tasks identified as most important. Applying research results to practice; learning

about new research developments and accessing relevant research literature were

regarded as most important by doctors and AHPs. On the other hand, nurses and

managers selected managing multiple demands on your time as one of the tasks most

important to their role; introducing new ideas at work and evaluating organisational

performance were also important to both these groups.

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In line with the results for the whole study population, designing research studies was

regarded as one of the least important tasks by all four professional groups.

Identifying viable research topics was considered less important by both doctors and

nurses, whilst nurses and AHPs also considered accessing resources for research (e.g.

money, information, equipment) to be relatively unimportant. Finally, managers also

rated working as a member of a research team and writing up the findings of research

or audits as relatively less important to their particular role.

Training needs

Comparing the median importance and performance rating for each task across the

whole study population, we identified significant training needs for 24/25 tasks (p

≤0.05) (Table 1). The only task without a significant difference between median

importance and performance was undertaking administrative activities (p= 0.15).

Using this approach, it is possible that a training need might be identified, that relates

to a task of moderate or little importance to participants. However, as we have noted,

all tasks received a median importance rating of 4 or above, with the exception of

designing research studies. Although a training need was identified for this task (p

<0.01), the median importance score was only 3.0 on the seven point scale.

Training needs were identified as those with a statistically significant difference

between importance and performance scores. Across the study population, the three

tasks with the largest training needs were managing multiple demands on time;

learning about new research developments; and assessing the relevance of research.

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Other research-related tasks with large training needs were applying research to

practice; securing time to undertake research; and accessing research literature.

Table 1 also compares the most significant training needs across the four largest

professional groups. Managing multiple demands on time represented a key gap, and

one of the most significant training needs, for all four groups. With regard to using

and conducting research, learning about new research developments was also a key

training need. In addition, AHPs particularly highlighted a need for training in

applying research in practice, whilst evaluation was a key gap for managers.

Research training priorities

In the second section of the survey, participants were invited to list up to three

research-related priority areas in which they would like to receive further training.

125/203 participants listed at least one priority. In total, we received 302 suggestions,

which fell in to eight categories (Figure 2).

Considering the study population as a whole, the largest number of suggestions (n=55

suggestions) related to training in research methods, including data analysis. Indeed

almost half of the priorities identified in this category (n=25) were for training in

conducting and interpreting statistical analyses. Other participants sought training in

techniques such as systematic reviewing or questionnaire development, whilst some

also wanted to learn how to choose the most appropriate research design or method

for a given project.

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The practicalities of conducting research represented another training priority for

participants (n=39 suggestions). Suggestions in this category included how to identify

research topics and develop proposals, as well as guidance in aspects of the research

process such as securing research ethics permissions. A further 32 comments related

specifically to training in how to obtain funding to undertake research. Priorities here

included how to identify and apply for appropriate sources of funding.

Another area of priority was finding and using research evidence in practice. 32 of the

302 suggestions related to training in how to develop better online search strategies to

identify relevant research quickly and effectively. We also received a further 26

suggestions about training in critical appraisal of research, whilst another 37 related to

the process of applying research findings to practice. Priorities in this latter category

included how to assess the relevance of research to a specific patient population or

organisation, and how to use evidence in developing both business cases and clinical

guidelines.

Figure 2 shows how the balance of priority areas differed between the four largest

professional groups. Amongst doctors, the largest number of training suggestions

related to research methods, including carrying out statistical analysis. This was also

important to AHPs, along with training in the practicalities of conducting research.

Nurses and managers also prioritised training in research methods, but the largest

number of suggestions from both these groups related to training in how to apply

research findings to change practice.

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Barriers to being involved in research

We did not directly ask participants about barriers that may impede them from using

research or becoming involved in it. However, when asked to identify their priorities

for training, a number of participants instead described challenges they face in this

area. As we have already noted, our findings highlight that many participants are

faced with competing demands on their time, as well as dwindling resources. Some

participants wanted a protected time slot each week to work on audits and research, or

even research-related tasks, such as writing letters to journals. Most of these

suggestions were made by doctors: some had previously had time allocated to

undertake research, but found this later withdrawn because of a lack of funds.

A second key barrier was access to relevant equipment and resources. This

particularly related to online publications. Participants sought ‘open access to all

applicable research,’ ‘more access to online databases’ and ‘access to the university's

online library of journals.’ More fundamentally, others reported that they did not have

‘access to a computer in the library for research.’

DISCUSSION

In recent years there has been recognition that there needs to be a shift a marked shift

from a supply-driven culture of research production, towards a more demand-driven

approach, which seeks to foster a culture of partnership between academics and

decision-makers. [28,29] Within this, staff in health care and public health

organisations have a key role to play, [12] for example, within the NIHR CLAHRCs

in England. [13,15] Such collaboration should involve not only co-producing applied

health research, but also improving patient care and population health through the

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implementation of its findings. [2] In this paper, we have described the findings of an

exercise we conducted to inform our efforts to increase research use and participation

across a large research collaboration, and in doing so better link research and action.

[9] We sought the views of a wide range of health care and public health staff about

the training they need to conduct research and apply its findings in practice. Across

the study population, two of the three research-related tasks with the largest training

needs related to using research in practice: learning about new research developments

and assessing the relevance of research. Key research training needs identified were

similar across the four main professional groups. In contrast, however, in the free-text

section of the questionnaire, the training priorities that participants described related

not just to using research, but also to carrying it out. Priorities included training in

research methods, including data analysis; study design and data collection; and

applying research in practice. Accessing research evidence and applying for funding

were also important. The balance of suggestions was similar for doctors, AHPs, and

nurses. However, conducting empirical research was less of a priority for managers,

who focused more on the skills needed to use research findings. These results are

perhaps not surprising. As Walshe and Rundall note, many clinicians receive some

research-methods training as part of their professional development. In contrast,

managers often have no research training, and the the managerial culture is intensely

pragmatic, valuing the application of ideas in practice more than it does the search for

knowledge about those ideas. [30] It is, however, encouraging that managers in our

survey highlighted a need for training in using research to inform their practice. Again

compared with clinicians, personal experience and self-generated knowledge typically

play a much larger part in determining how managers approach their jobs, and there is

much less reliance on a shared body of formal knowledge in decision making. [30]

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Indeed, in the past it has been argued that much of the applied health research

evidence base lacks relevance to managers. [31]

Comparing the two exercises, accessing research and assessing its relevance emerge

as key areas of need, across the study population, including the four largest population

groups. The emphasis placed on conducting empirical research in the priority exercise

suggests that there may also be demand for training in this area, although there was

less emphasis on this in the importance/ performance exercise. As we have

highlighted, this also appears to be less relevant to managers, compared with doctors,

AHPs, and nurses. Participants across the study population also identified key gaps in

managing multiple demands on time and securing time to undertake research, and

highlighted a number of other challenges they face, including a lack of time for

research, and a lack of infrastructure, such as access to online publications. These also

need to be taken into account, as they may act as further barriers to research use and

participation, potentially reducing the impact of training. Nevertheless several

professional groups were underrepresented in our survey, and their perspectives

warrant further exploration, for example midwives and public health staff. In England,

it is particularly important that we understand how the latter group might best be

supported, following their transition from the NHS to local government.[33] We also

did not study primary care staff. Although participants represented a good spread of

organisations, our sample size was relatively small. However, the survey was

conducted in the first few months of our five year collaboration and it is encouraging

to see that there was clear interest in using and applying AHR, right across the

partnership. There are a number of limitations associated with using a convenience

sample, not least because the results are of unknown generalizability.[34] Staff who

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completed the survey are likely to be those who are most interested in the

topic.[20,22] It is perhaps therefore not a surprise that most thought research-related

tasks were important, especially given 51% of responses were received from staff

working in teaching or specialist hospitals. However, this sampling approach was

appropriate for our purposes as we sought to reach those most interested in research,

to prioritise our capability building efforts on this group in the first instance. We

received responses from 20 out of 35 CLAHRC partner health care or public health

organisations. Indeed, the interest and training needs identified in the survey were

consistent with our subsequent experience of running training events aimed at

building capacity for health care and public health staff to use research and work with

researchers. Demand has consistently exceeded supply and all events have been

oversubscribed.

There is a range of literature exploring current research use and participation in

specific groups, such as nurses[18] and allied health professionals. [19] Our study

goes beyond this to examine self-identified opportunities to improve research use, as

well as comparing across professional groups. Provider organisations have typically

been underrepresented in other surveys.[32] In contrast, we looked across a range of

different types of organisations, including providers of acute, mental health and

community care. Our study adds to a growing body of literature exploring research

training needs, and our findings align with what others have observed.[32] However,

this is the first such study to be conducted in England. We surveyed staff across a

large research partnership, and received responses from twenty separate organisations,

which ranged from large teaching hospitals, to small district general hospitals, as well

as public health organisations. Our findings may therefore be relevant to others who

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are looking to establish similar training programmes.

Although our quantitative approach enabled us to seek input from staff from a broad

range of organisations, it provided little opportunity for us to understand the

complexity of responses. For example, we are aware that a number of organisations

represented in the survey provide training and support for staff in finding and

appraising research, via their library services. However, this was identified as one of

the most significant training needs in both parts of this survey. It is not clear why

existing training provision is not meeting this need. There is also a need to further

explore the optimal ways to delivery training of this kind, perhaps using qualitative

methods, and how this might link in with the literature on barriers to research use.[6]

Finally, there is still only a limited literature on the long-term outcomes and

effectiveness of different training opportunities, including how research use might be

sustained in the longer term.[32]

The need to speed up the translation of research into practice is a priority for

researchers and funding bodies, alongside efforts to promote the co-production of

knowledge. In this study, we describe the areas where health care and public health

staff may benefit from further training in using and doing applied health research, to

better link research and action. [9] These include accessing research and assessing its

relevance, as well as the skills required to carry out empirical research, such as data

analysis. The priority study participants placed on all these topics, suggests that there

would be demand for training if it were provided. Learning opportunities addressing

these needs may help to improve the diffusion and adoption of research findings, and

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hence the quality of health care and public health services, for the benefit of patients

and populations.

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Acknowledgements

We thank all those who took the time to complete the survey, as well as interviewees

who contributed to the development of the survey; the pilot testers who advised on

how to refine it; and the individuals who distributed the weblink. We also thank Dr

Jessica Sheringham for feedback on an early draft and Dr Claire Nightingale for

statistical advice.

Competing interests

The authors declare they have no competing interests.

Funding statement

The research was funded by the National Institute for Health Research (NIHR)

Collaboration for Leadership in Applied Health Research and Care North Thames at

Barts Health NHS Trust. The views expressed are those of the authors and not

necessarily those of the NHS, the NIHR or the Department of Health.

Authors' contributions

Both authors designed the survey. HB conducted the analysis. HB wrote the paper.

NJF revised the paper for important intellectual content. Both authors read and

approved the final manuscript.

Data Sharing

All available study data are reported in the manuscript. No additional data are

available, to maintain participant confidentiality.

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Figure legends

Figure 1: Professional groups represented by respondents

Figure 2: Research training priorities by professional group

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Figure 1: Professional groups represented by respondents Figure 1

127x76mm (72 x 72 DPI)

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Figure 2: Research training priorities by professional group Figure 2

147x97mm (72 x 72 DPI)

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amongst staff

Journal: BMJ Open

Manuscript ID bmjopen-2016-012557.R1


Date Submitted by the Author: 11-Jul-2016







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Building capacity to use and undertake research in health organisations: survey of training needs and priorities amongst staff


1

1NIHR CLAHRC North Thames, Department of Applied Health Research, University


Corresponding author:

Dr Helen Barratt

NIHR CLAHRC North Thames, Department of Applied Health Research, University


[email protected]

020 7679 8285

Keywords:

Knowledge translation

Evidence use

Research participation

Training

Word count: 4652

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Abstract

Objectives: Efforts to improve health care and population health depend partly on the

ability of health organisations to use research knowledge and participate in its

production. We report the findings of a survey conducted to prioritise training needs

amongst health care and public health staff, in relation to the production and

implementation of research, across an applied health research collaboration.

Design: A questionnaire survey using a validated tool, the Hennessy-Hicks Training

Needs Assessment Questionnaire. Participants rated 25 tasks on a five-point scale

with regard to both their confidence in performing the task, and its importance to their

role.

Setting: A questionnaire weblink was distributed to a convenience sample of 35

health care and public health organisations in London and South East England, with a

request that they cascade the information to relevant staff

Participants: 203 individuals responded, from 20 health care and public health

organisations

Interventions: None

Outcome measures: Training needs were identified by comparing median

importance and performance scores for each task. Individuals were also invited to

describe up to three priority areas in which they require training.

Results: Across the study sample, evaluation; teaching; making do with limited

resources; coping with change and managing competing demands were identified as

key tasks. Assessing the relevance of research and learning about new developments

were the most relevant research-related tasks. Participants’ training priorities included

evaluation; finding, appraising and applying research evidence; and data analysis. Key

barriers to involvement included time and resources, as well as a lack of institutional

support for undertaking research.

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Conclusions: We identify areas in which health care and public health professionals

may benefit from support to facilitate their involvement in and use of applied health

research. We also describe barriers to participation and differing perceptions of

research between professional groups.

Strengths and limitations of this study:

• Our study is the first of its kind to be conducted in England and extends the

existing literature exploring research use and participation in specific groups

by examining self-identified opportunities to improve research use and

comparing across professional groups.

• The findings may relevant to others looking to establish research training

programmes, because we received responses from staff in twenty separate

organisations, including large teaching hospitals, small district general

hospitals, and public health organisations.

• Several professional groups were underrepresented in our survey, and their

perspectives warrant further exploration, for example midwives and public

health staff.

• Our sample size was relatively small, but the survey was conducted in the first

few months of our five year research collaboration and it is encouraging to see

that there was clear interest in using and applying research, right across the

partnership.

• Results from a convenience sample are of unknown generalizability and staff

who completed the survey are likely to be those who are most interested in the

topic, but this sampling approach was appropriate for our purposes as we

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sought to prioritise our capability building efforts and reach those most

interested in research.

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BACKGROUND

The provision of high-quality, affordable, health services is a growing challenge in

many developed countries. In England, for example, the NHS Five Year Forward

View set out the case for major system change and new ways of working. [1] Staff in

health care and public health organisations have a key role to play in improving

patient care and population health through the implementation and co-production of

applied health research (AHR). [2] Emerging evidence suggests there is an association

between the engagement of health care organisations in research and improvements in

their overall performance. [3] However, such organisations frequently fail to use

research evidence to inform practice. [4,5] Similar findings have been reported

globally, in both primary and secondary care. [6] In order to improve care, research

findings therefore need to be better integrated into practice and organisational

routines, alongside efforts to promote the co-production of knowledge and build

organisational absorptive capacity.[7]

Over the last 10 to 15 years, increasing attention has been paid to reducing the ‘know-

do’ gap. [8] Ellen et al set out a framework of possible organisational level activities

that might be undertaken to facilitate access, dissemination, exchange, and use of

evidence within health organisations. [9] The framework builds on earlier work by

Lavis et al which classified approaches to communicating research to end users as

push, pull or exchange efforts [10]. It acknowledges that the path from research

creation to utilisation may not be logical or linear, as well as the influence that context

may have on decision making. It includes four major domains of activity: 1)

establishing a climate for research use; 2) research production efforts; 3) activities

used to link research to action; and 4) evaluation. [9] The third domain, activities to

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link research to action, consists of three parts. The first includes ‘push’ efforts, such

as activities undertaken by researchers or intermediaries to disseminate research

evidence. Second, ‘facilitating pull’ efforts aim to provide ‘easy access’ to research

evidence, by ensuring that the appropriate infrastructure is in place to make the

process straightforward for knowledge users (e.g. IT systems, websites). Finally,

‘pull’ efforts seek to develop the personal capacity and capability of staff within

health organisations. This includes, for example, training that focuses, for example, on

the skills needed to find or appraise research evidence. Our specific focus in this paper

is on this final component: training as a means of increasing participation in and use

of AHR by health professionals.

The 2006 Cooksey Report highlighted the gap that exists in the UK between the

conduct of research and its implementation. [11] Subsequently, in 2007, the High

Level Group on Clinical Effectiveness, chaired by Sir John Tooke, called on the

health service to harness better the capacity of higher education to help address this

problem. It recommended the development of new ‘academic health centres’ to

encourage the conduct of relevant research and help embed a culture more receptive

to change in the NHS.[12,13] Collaborations for Leadership in Applied Health

Research and Care (CLAHRCs) were established in England [13] to facilitate the co-

production of research by staff in the health service and public health departments,

working together with academic researchers. [14,15] Funded by the National Institute

for Health Research (NIHR), the first round of five CLAHRCs was established in

2009. Evaluation demonstrated that the first wave had differing capabilities with

respect to reducing the ‘know-do’ gap, partly because of differing interpretations and

enactments of their mission. [16] However, success in this area will inevitably require

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a long-term, sustained focus on relationship building, resource allocation and, in some

cases, culture change. [17] The second wave of thirteen CLAHRCs has been in

operation across England since January 2014.

This article describes an exercise carried out to assess research training needs and

priorities amongst health care and public health staff across England’s largest

CLAHRC, NIHR CLAHRC North Thames. Alongside our programme of research,

we have established an Academy to build capacity and capability to co-produce

research and apply its outputs in practice (http://www.clahrc-

norththames.nihr.ac.uk/academy/). This exercise was conducted to inform the

Academy’s priorities and the development of a programme of activities, including

short courses. Drawing on the framework proposed by Ellen et al, the aim of these

activities is to increase participation in and use of applied health research by health

professionals, to better link research and action. [9] This is the first such study

conducted in the UK. Because of the size and breadth of our partnership, our findings

may be relevant to others seeking to establish similar programmes, addressing the

training needs of a range of professional groups. They also contribute to a growing

literature on research use, at a time when there is a need for evidence to support new

ways of working in many health care systems. [1] To date, much of this research has

taken place outside of the UK and it has typically studied the different behaviours of

specific health professions, such as nursing [18] and allied health professionals. [19]

This literature suggests that training needs and priorities may differ between groups,

but few previous studies have formally compared professions or examined self-

identified opportunities to improve research use or participation.

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METHODS

We used a self-administered online survey to explore research training needs across

NIHR CLAHRC North Thames in June 2014. This approach was chosen to elicit a

high volume of feedback in a short amount of time, from participants in

geographically separated areas. [20] The Hennessy-Hicks Training Needs Analysis

Questionnaire is a validated tool, which offers a means of evaluating training

requirements and prioritising education and development opportunities to meet local

needs. [21] It is tailored for use specifically with health teams and designed to be

adapted, without compromising its validity and reliability.

Study population

Launched in January 2014, and funded for five years, NIHR CLAHRC North Thames

involves 55 partner organisations across North Central and East London, as well as

parts of Bedfordshire, Essex and Hertfordshire. It covers a diverse population of over

6 million residents; 10% of the UK population. Partner organisations include higher

education institutions, health care and public health organisations, as well as third

sector organisations and industry partners. The intended audience for our programme

of short courses is staff working in our 35 partner health care and public health

organisations. These include 21 NHS provider organisations responsible for acute

hospital services, mental health or community care (known as NHS Trusts); 8

organisations responsible for purchasing or commissioning care on behalf of patients

in a designated geographical area (known as Clinical Commissioning Groups); and 8

local government departments, responsible for public health (known as Local

Authorities).

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Administration

We used the web-based tool, Opinio, to collect the survey data from a convenience

sample (available at https://www.ucl.ac.uk/isd/services/learning-teaching/elearning-

staff/core-tools/opinio). An email was sent to key CLAHRC contacts in partner

organisations, with a request that they disseminate the questionnaire weblink to staff

electronically. The email explained that the survey was to inform the design of

training opportunities for health care and public health staff, to increase their skills in

using research evidence. It stated that we were keen to receive responses from staff

with a range of backgrounds and experience, at all levels, from a range of groups

including but not limited to clinicians; nurses and midwives; allied health

professionals; managers and technical staff, such as laboratory workers. Reminder

emails were sent two weeks later and the survey was live for four weeks in total.

Questionnaire development

The survey questions were developed in line with guidance set out in the

questionnaire manual. [21] The basic questionnaire comprises a list of 30 tasks,

relating to a range of areas, including research, communication/ teamwork, clinical

tasks, administration, and management. Each item is rated along a 7-point scale with

respect to how important the task is to the respondent’s job (Rating A); and how well

the task is currently performed (Rating B). Comparing scores for self-assessed

importance/ performance provides an assessment of where the greatest training needs

lie. The greater the difference in scores, the greater the training need. The

questionnaire also facilitates comparison between the different tasks, such as research

and administration.

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The questionnaire is designed so that up to 25% of the original items (to a maximum

of 8) may be swapped for items of the researcher’s choice without compromising its

psychometric properties. Another 10 items may be added in.[21] The modification

process involved two stages. First, we identified possible additional tasks from the

literature on research use and participation by health care and public health staff, and

through one to one interviews with staff from a range of backgrounds (n=7). We did

this iteratively by sense checking new suggestions with subsequent interviewees.

Before releasing the survey, we pilot tested it with eight staff from a range of

professional backgrounds, drawn from across the CLAHRC. In the second stage of

the modification process, we presented the proposed changes to these individuals and

asked them to comment on whether the alternations appeared valid to them.

Throughout the modification process, we considered design factors such as the quality

of the questions, survey format and the way questions were presented.[22] Pilot

testers were provided with a copy of draft questionnaire. As well as asking them about

the proposed modifications to the list of tasks, we asked them whether the text of the

questionnaire was clear and how realistic it was in the context of their current role.

Overall, the tool was considered to be good, with clear instructions and of appropriate

length. Through this process we made minor modifications to the tool including:

adding in a definition of research; providing additional job categories in the section on

demographic data; and clarifying the instructions for the importance/ performance

rating exercise. Pilot testers considered the list of tasks to be clear and

comprehensible, acknowledging the challenges of compiling a list that would be of

broad relevance across a range of different types of health organisation. Two testers

suggested that we group together similar tasks. However, the questionnaire developers

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intended that the list should be organised randomly, so we opted to keep this approach

to maintain the integrity of the tool.

Section 1 of the final survey included a list of 25 tasks, 13 of which were directly

related to research. These are listed in Table 1. In line with guidance about the use of

the questionnaire, we retained 22/30 of the original survey items. In Section 2,

participants were invited to list up to three areas in which they felt they would benefit

from training to better equip them either to conduct research or apply its findings in

practice. We also collected basic demographic information, including professional

group, age and gender.

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(n = 39)

Doctors (n = 36)

Managers (n=22)

Nurses (n=27)

Importa

nce to

role

(median score)

Curre

nt

Perfo

rmance

(median score)

p value

Importa

nce to

role

(median score)

Curre

nt

Perfo

rmance

(median score)

p value

Importa

nce to

role

(median score)

Curre

nt

Perfo

rmance

(median score)

p value

Importa

nce to

role

(median score)

Curre

nt

Perfo

rmance

(median score)

p value

Importa

nce to

role

(median score)

Curre

nt

Perfo

rmance

(median score)

p value



5.00 4.00 <0.01 5.00 4.00 0.01 6.00 4.50 <0.01 4.00 4.00 0.87 6.00 4.00 <0.01


6.00 4.00 <0.01 6.00 4.00 <0.01 5.00 4.00 <0.01 7.00 5.00 <0.01 7.00 4.00 <0.01


5.00 5.00 <0.01 5.00 4.00 <0.01 6.00 5.00 <0.01 5.00 4.00 0.88 6.00 4.00 <0.01


6.00 4.00 <0.01 6.00 4.00 <0.01 6.00 5.00 <0.01 5.50 4.00 <0.01 6.00 4.00 <0.01

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4.00 3.00 <0.01 4.00 3.00 0.02 4.50 3.00 0.02 3.50 4.00 0.48 4.50 3.50 <0.01


6.00 5.00 <0.01 6.00 4.00 <0.01 6.00 4.50 <0.01 7.00 5.00 <0.01 7.00 5.00 <0.01


6.00 5.00 <0.01 6.00 4.00 <0.01 6.00 4.50 <0.01 6.00 4.50 <0.01 6.00 5.00 <0.01


5.00 4.00 <0.01 5.00 4.00 <0.01 5.00 4.50 0.01 4.50 4.00 0.07 5.50 4.00 0.08


4.00 3.00 <0.01 4.00 3.00 0.04 5.00 3.00 <0.01 4.00 3.00 0.02 5.00 2.50 <0.01


6.00 5.00 <0.01 7.00 5.00 <0.01 6.00 5.00 <0.01 6.50 5.00 <0.01 7.00 6.00 0.03


7.00 5.00 <0.01 7.00 5.00 <0.01 7.00 5.00 <0.01 7.00 5.00 <0.01 7.00 5.00 <0.01


5.00 4.00 <0.01 5.00 4.00 0.02 5.00 4.00 <0.01 3.00 4.00 0.64 5.50 4.00 <0.01

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5.00 4.00 <0.01 5.00 3.00 <0.01 5.00 3.00 <0.01 2.00 3.00 0.84 5.00 4.50 0.01


6.00 5.00 <0.01 6.00 5.00 0.04 5.00 4.00 <0.01 6.00 5.00 <0.01 6.00 5.00 0.28


5.00 4.00 <0.01 4.00 3.00 <0.01 5.00 3.00 <0.01 5.00 3.00 <0.01 5.00 4.00 0.01


5.00 4.00 <0.01 4.50 3.00 <0.01 5.00 3.00 <0.01 5.00 4.00 0.27 5.00 4.00 0.09


3.00 3.00 <0.01 3.00 3.00 0.01 4.50 2.50 <0.01 3.00 0.24 0.31 4.00 2.00 <0.01


4.00 4.00 0.03 4.00 3.00 0.14 5.00 4.00 0.35 3.00 3.00 0.34 6.00 5.00 0.06


4.00 2.00 <0.01 3.00 2.00 <0.01 5.00 2.00 <0.01 4.00 3.50 <0.01 4.50 3.50 <0.01


5.00 5.00 0.15 5.00 5.00 0.98 5.00 4.00 <0.01 6.00 5.50 0.54 5.00 5.00 0.83

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6.00 5.00 <0.01 6.00 5.00 <0.01 6.00 4.00 <0.01 6.00 5.00 0.02 6.00 4.00 <0.01


5.00 2.00 <0.01 4.00 2.00 <0.01 5.00 2.00 <0.01 4.00 3.00 0.04 5.00 2.00 <0.01


6.00 4.00 <0.01 6.00 4.00 <0.01 6.00 4.00 <0.01 6.00 4.00 <0.01 6.00 4.00 <0.01


5.00 4.00 <0.01 5.00 4.00 <0.01 5.00 4.00 <0.01 5.00 4.00 <0.01 5.00 4.00 <0.01


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Analysis


Section 1, comparing self-assessed importance and performance ratings for each task

to identify training needs. Given much of the existing literature focuses on individual













systematic method set out by Mayring and others.[26] Categories were derived

iteratively using Mayring’s step model of inductive category development. Within

this, the researcher (HB) reviewed all the free text data in light of the research

questions. Free text comments relating to similar topics (e.g. training in research

methods; using research in practice) were grouped together. From this, provisional

categories were deduced and revised, with constant reference to the data. The

reliaibility of the final categories was then checked by the research team, before

quantitative aspects of the analysis (e.g. frequency of the coded categories) were

conducted by HB. Priorities were first identified for the whole sample, and then

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compared using the same categories to examine potential differences between

professional groups.

Ethics approval





as vulnerable.

RESULTS





Demographics








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3 15


Total 20 203






In this section, we first describe participants’ self-assessment of the importance of the

25 tasks included in the questionnaire. We then compare this with the performance

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about the relative importance and performance of each task is provided in Table 1 and

data illustrating the distribution of responses is provided in Supplementary File 1.

Importance of tasks




















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Training needs

Comparing the median self-assessed importance and performance rating for each task

across the whole study population, we identified significant training needs for 24/25

tasks (p ≤0.05) (Table 1). The only task without a significant difference between

median importance and performance was undertaking administrative activities (p=

0.15). Using this approach, it is possible that a training need might be identified, that

relates to a task of moderate or little importance to participants. However, as we have

noted, all tasks received a median importance rating of 4 or above, with the exception

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of designing research studies. Although a training need was identified for this task (p





















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guidelines.




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research or becoming involved in it. However, there are a range of factors beyond

‘pull’ efforts such as training to develop the capacity and capability of staff within

health organisations.[9] When asked to identify their priorities for training, a number

of participants instead described challenges they face in using research or

participating in it. As we have already noted, our findings highlight that many

participants are faced with a lack of institutional support for them participating in

research, including competing demands on their time, as well as dwindling resources.

Some participants wanted a protected time slot each week to work on audits and

research, or even research-related tasks, such as writing letters to journals. Most of

these suggestions were made by doctors: some had previously had time allocated to







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DISCUSSION








implementation of its findings. [2] Training is one of a range of factors which may

help to facilitate access, dissemination, exchange, and use of evidence within health

organisations In this paper, we have described the findings of an exercise we

conducted to inform our efforts to increase research use and participation across a

large research collaboration through training, and in doing so better link research and

action. [9] We sought the views of a wide range of health care and public health staff

about the training they need to conduct research and apply its findings in practice. To

do this, we asked participants to self-assess the importance of tasks to their current

role, as well as their current performance in carrying them out. Training needs were

identified by comparing the mean of the two scores. Across the study population, two

of the three research-related tasks with the largest training needs related to using

research in practice: learning about new research developments and assessing the

relevance of research. Key research training needs identified were similar across the

four main professional groups. In contrast, however, in the free-text section of the

questionnaire, the training priorities that participants described related not just to

using research, but also to carrying it out. Priorities included training in research

methods, including data analysis; study design and data collection; and applying

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research in practice. Accessing research evidence and applying for funding were also

important. The balance of suggestions was similar for doctors, AHPs, and nurses.

However, conducting empirical research was less of a priority for managers, who

focused more on the skills needed to use research findings. These results are perhaps

not surprising. As Walshe and Rundall note, many clinicians receive some research-

methods training as part of their professional development. In contrast, managers

often have no research training, and the the managerial culture is intensely pragmatic,

valuing the application of ideas in practice more than it does the search for knowledge

about those ideas. [30] It is, however, encouraging that managers in our survey

highlighted a need for training in using research to inform their practice. Again












AHPs, and nurses. However, we did not collect detailed information on the seniority

or authority of respondents, partly to protect their anonymity. This may though impact

the ways in which participants respond. For example, those who consider service

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evaluation more important may be more senior. Participants across the study

population also identified key gaps in managing multiple demands on time and

securing time to undertake research, and highlighted a number of other challenges

they face, including a lack of time for research, and a lack of infrastructure, such as

access to online publications. These need to be taken into account, as they may act as

further barriers to research use and participation, potentially reducing the impact of

training. However, these findings are based on participants’ own self-assessment of

the importance of each task to their current role, rather than an objective assessment

of what is required of them, for example in a job description. Therefore, there may be

a discrepancy between what participants consider to be important, versus what their

employers require of them. Nevertheless several professional groups were

underrepresented in our survey, and their perspectives warrant further exploration, for

example midwives and public health staff. In England, it is particularly important that

we understand how the latter group might best be supported, following their transition

from the NHS to local government.[32] We also did not study primary care staff.

Although participants represented a good spread of organisations, our sample size was

relatively small. However, the survey was conducted in the first few months of our

five year collaboration and it is encouraging to see that there was clear interest in

using and applying AHR, right across the partnership. There are a number of

limitations associated with using a convenience sample, not least because the results

are of unknown generalizability.[33] Staff who completed the survey are likely to be

those who are most interested in the topic.[20,22] It is perhaps therefore not a surprise

that most thought research-related tasks were important, especially given 51% of

responses were received from staff working in teaching or specialist hospitals.

However, this sampling approach was appropriate for our purposes as we sought to

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reach those most interested in research, to prioritise our capability building efforts on

this group in the first instance. We received responses from 20 out of 35 CLAHRC

partner health care or public health organisations. Indeed, the interest and training

needs identified in the survey were consistent with our subsequent experience of

running training events aimed at building capacity for health care and public health

staff to use research and work with researchers. Demand has consistently exceeded

supply and all events have been oversubscribed.













are looking to establish similar training programmes. Nevertheless, training is only

one of a range of factors which may help to facilitate use of and participation in

research. A plethora of challenges and barriers can also be present at various levels

within a health system, including ensuring ‘buy-in’ from upper management and lack

of appropriate infrastructure. Due to the range of potential challenges, interventions

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should be considered within the context of wider systems issues.[8]












sustained in the longer term. [34]










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and populations.

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Acknowledgements





statistical advice.

Competing interests


Funding statement









Data sharing statement



References

1 NHS England. Five Year Forward View. London: : NHS England

https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf (accessed

26 Jan2016).

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sector: comparative qualitative study of the role of Collaborations for Leadership

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17 Rycroft-Malone J, Burton C, Wilkinson J, et al. Collective action for knowledge

mobilisation: a realist evaluation of the Collaborations for Leadership in Applied

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24 Hennessy D, Hicks C, Koesno H. The training and development needs of

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research.net/index.php/fqs/article/view/1089/2385 (accessed 5 Jun2015).

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critical review of health sector and generic management literature. Soc Sci Med

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29 Gibbons M, Limoges C, Nowotny H, et al. The New Production of Knowledge:

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health care. Milbank Q 2001;79:429–57, IV – V.

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health care managers: hospital CEO imperatives for improving quality and

lowering costs. Health Care Manage Rev 2007;32:150–9.

doi:10.1097/01.HMR.0000267792.09686.e3

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33 Anne Bowling. Research Methods in Health: Investigation Health and Health

Service. Third Edition. Maidenhead: : Open University Press 2009.

34 Holmes BJ, Schellenberg M, Schell K, et al. How funding agencies can support

research use in healthcare: an online province-wide survey to determine

knowledge translation training needs. Implement Sci 2014;9:71.

doi:10.1186/1748-5908-9-71

Figure legends



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102x60mm (600 x 600 DPI)

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102x61mm (600 x 600 DPI)

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Supplementary Information: Distribution of overall importance and performance scores for questionnaire tasks

Task Importance scores

Performance scores

Median

Interquartile range

Median

Interquartile range

1. Handling routine data 6 5-7 5 5-7

2. Critically evaluating published research 5 4-7 4 3-5

3. Evaluating your organisation’s performance 6 4-7 4 3-5

4. Interpreting research findings 5 4-7 5 4-5

5. Applying research results to your own practice 6 5-7 4 4-5

6. Identifying viable research topics 4 3-5.75 3 2-5

7. Introducing new ideas at work 6 5-7 5 4-5

8. Accessing relevant research literature to inform your work 6 5-7 5 3-6

9. Giving information about research to patients/the public 5 4-6 4 3-5

10. Statistically analysing your own research data 4 2-6 3 2-5

11. Teaching colleagues and/or students 6 5-7 5 5-6

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12. Managing multiple demands on your time 7 6-7 5 4-6

13. Writing up the findings of research studies or audits 5 3-7 4 3-5

14. Undertaking health promotion activities 5 3-6 4 2-5

15. Making do with limited resources 6 5-7 5 4-6

16. Assessing local health care needs 5 3-6 4 2-5

17. Collecting and collating relevant research 5 3-6 4 3-5

18. Designing research studies 3 2-6 3 2-4

19. Working as a member of a team doing research 4 2-6 4 3-5

20. Accessing resources to undertake research e.g. money, information, equipment 4 2-6 2 1-4

21. Undertaking administrative activities 5 4-6 5 4-6

22. Personally coping with change in the health service 6 5-7 5 4-5

23. Securing time to undertake research 5 2.5-7 2 1-4

24. Learning about new research developments in your field 6 5-7 4 3-5

25. Assessing the relevance of research to your organisation 5 4-7 4 3-5

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amongst staff

Journal: BMJ Open

Manuscript ID bmjopen-2016-012557.R2


Date Submitted by the Author: 28-Sep-2016







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Building capacity to use and undertake research in health 1

organisations: survey of training needs and priorities 2

amongst staff 3

4


1 5

1NIHR CLAHRC North Thames, Department of Applied Health Research, University 6

College London, 1-19 Torrington Place, London WC1E 6BT, UK 7

8

9

Corresponding author: 10

Dr Helen Barratt 11

NIHR CLAHRC North Thames, Department of Applied Health Research, University 12

College London, 1-19 Torrington Place, London WC1E 6BT, UK 13

[email protected] 14

020 7679 8285 15

16

17

Keywords: 18

Knowledge translation 19

Evidence use 20

Research participation 21

Training 22

23

Word count: 4652 24

25

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Abstract 1

Objectives: Efforts to improve health care and population health depend partly on the 2

ability of health organisations to use research knowledge and participate in its 3

production. We report the findings of a survey conducted to prioritise training needs 4

amongst health care and public health staff, in relation to the production and 5

implementation of research, across an applied health research collaboration. 6

Design: A questionnaire survey using a validated tool, the Hennessy-Hicks Training 7

Needs Assessment Questionnaire. Participants rated 25 tasks on a five-point scale 8

with regard to both their confidence in performing the task, and its importance to their 9

role. 10

Setting: A questionnaire weblink was distributed to a convenience sample of 35 11

health care and public health organisations in London and South East England, with a 12

request that they cascade the information to relevant staff 13

Participants: 203 individuals responded, from 20 health care and public health 14

organisations 15

Interventions: None 16

Outcome measures: Training needs were identified by comparing median 17

importance and performance scores for each task. Individuals were also invited to 18

describe up to three priority areas in which they require training. 19

Results: Across the study sample, evaluation; teaching; making do with limited 20

resources; coping with change and managing competing demands were identified as 21

key tasks. Assessing the relevance of research and learning about new developments 22

were the most relevant research-related tasks. Participants’ training priorities included 23

evaluation; finding, appraising and applying research evidence; and data analysis. Key 24

barriers to involvement included time and resources, as well as a lack of institutional 25

support for undertaking research. 26

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Conclusions: We identify areas in which health care and public health professionals 1

may benefit from support to facilitate their involvement in and use of applied health 2

research. We also describe barriers to participation and differing perceptions of 3

research between professional groups. 4

5

Strengths and limitations of this study: 6

• Our study is the first of its kind to be conducted in England and extends the 7

existing literature exploring research use and participation in specific groups 8

by examining self-identified opportunities to improve research use and 9

comparing across professional groups. 10

• The findings may relevant to others looking to establish research training 11

programmes, because we received responses from staff in twenty separate 12

organisations, including large teaching hospitals, small district general 13

hospitals, and public health organisations. 14

• Several professional groups were underrepresented in our survey, and their 15

perspectives warrant further exploration, for example midwives and public 16

health staff. 17

• Our sample size was relatively small, but the survey was conducted in the first 18

few months of our five year research collaboration and it is encouraging to see 19

that there was clear interest in using and applying research, right across the 20

partnership. 21

• Results from a convenience sample are of unknown generalizability and staff 22

who completed the survey are likely to be those who are most interested in the 23

topic, but this sampling approach was appropriate for our purposes as we 24

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sought to prioritise our capability building efforts and reach those most 1

interested in research. 2

3

4

5

6

7

8

9

10

11

12

13

14

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BACKGROUND 1

The provision of high-quality, affordable, health services is a growing challenge in 2

many developed countries. In England, for example, the NHS Five Year Forward 3

View set out the case for major system change and new ways of working. [1] Staff in 4

health care and public health organisations have a key role to play in improving 5

patient care and population health through the implementation and co-production of 6

applied health research (AHR). [2] Emerging evidence suggests there is an association 7

between the engagement of health care organisations in research and improvements in 8

their overall performance. [3] However, such organisations frequently fail to use 9

research evidence to inform practice. [4,5] Similar findings have been reported 10

globally, in both primary and secondary care. [6] In order to improve care, research 11

findings therefore need to be better integrated into practice and organisational 12

routines, alongside efforts to promote the co-production of knowledge and build 13

organisational absorptive capacity.[7] 14

15

Over the last 10 to 15 years, increasing attention has been paid to reducing the ‘know-16

do’ gap. [8] Ellen et al set out a framework of possible organisational level activities 17

that might be undertaken to facilitate access, dissemination, exchange, and use of 18

evidence within health organisations. [9] The framework builds on earlier work by 19

Lavis et al which classified approaches to communicating research to end users as 20

push, pull or exchange efforts [10]. It acknowledges that the path from research 21

creation to utilisation may not be logical or linear, as well as the influence that context 22

may have on decision making. It includes four major domains of activity: 1) 23

establishing a climate for research use; 2) research production efforts; 3) activities 24

used to link research to action; and 4) evaluation. [9] The third domain, activities to 25

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link research to action, consists of three parts. The first includes ‘push’ efforts, such 1

as activities undertaken by researchers or intermediaries to disseminate research 2

evidence. Second, ‘facilitating pull’ efforts aim to provide ‘easy access’ to research 3

evidence, by ensuring that the appropriate infrastructure is in place to make the 4

process straightforward for knowledge users (e.g. IT systems, websites). Finally, 5

‘pull’ efforts seek to develop the personal capacity and capability of staff within 6

health organisations. This includes, for example, training that focuses, for example, on 7

the skills needed to find or appraise research evidence. Our specific focus in this paper 8

is on this final component: training as a means of increasing participation in and use 9

of AHR by health professionals. 10

11

The 2006 Cooksey Report highlighted the gap that exists in the UK between the 12

conduct of research and its implementation. [11] Subsequently, in 2007, the High 13

Level Group on Clinical Effectiveness, chaired by Sir John Tooke, called on the 14

health service to harness better the capacity of higher education to help address this 15

problem. It recommended the development of new ‘academic health centres’ to 16

encourage the conduct of relevant research and help embed a culture more receptive 17

to change in the NHS.[12,13] Collaborations for Leadership in Applied Health 18

Research and Care (CLAHRCs) were established in England [13] to facilitate the co-19

production of research by staff in the health service and public health departments, 20

working together with academic researchers. [14,15] Funded by the National Institute 21

for Health Research (NIHR), the first round of five CLAHRCs was established in 22

2009. Evaluation demonstrated that the first wave had differing capabilities with 23

respect to reducing the ‘know-do’ gap, partly because of differing interpretations and 24

enactments of their mission. [16] However, success in this area will inevitably require 25

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a long-term, sustained focus on relationship building, resource allocation and, in some 1

cases, culture change. [17] The second wave of thirteen CLAHRCs has been in 2

operation across England since January 2014. 3

4

This article describes an exercise carried out to assess research training needs and 5

priorities amongst health care and public health staff across England’s largest 6

CLAHRC, NIHR CLAHRC North Thames. Alongside our programme of research, 7

we have established an Academy to build capacity and capability to co-produce 8

research and apply its outputs in practice (http://www.clahrc-9

norththames.nihr.ac.uk/academy/). This exercise was conducted to inform the 10

Academy’s priorities and the development of a programme of activities, including 11

short courses. Drawing on the framework proposed by Ellen et al, the aim of these 12

activities is to increase participation in and use of applied health research by health 13

professionals, to better link research and action. [9] This is the first such study 14

conducted in the UK. Because of the size and breadth of our partnership, our findings 15

may be relevant to others seeking to establish similar programmes, addressing the 16

training needs of a range of professional groups. They also contribute to a growing 17

literature on research use, at a time when there is a need for evidence to support new 18

ways of working in many health care systems. [1] To date, much of this research has 19

taken place outside of the UK and it has typically studied the different behaviours of 20

specific health professions, such as nursing [18] and allied health professionals. [19] 21

This literature suggests that training needs and priorities may differ between groups, 22

but few previous studies have formally compared professions or examined self-23

identified opportunities to improve research use or participation. 24

25

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METHODS 1

We used a self-administered online survey to explore research training needs across 2

NIHR CLAHRC North Thames in June 2014. This approach was chosen to elicit a 3

high volume of feedback in a short amount of time, from participants in 4

geographically separated areas. [20] The Hennessy-Hicks Training Needs Analysis 5

Questionnaire is a validated tool, which offers a means of evaluating training 6

requirements and prioritising education and development opportunities to meet local 7

needs. [21] It is tailored for use specifically with health teams and designed to be 8

adapted, without compromising its validity and reliability. 9

10

Study population 11

Launched in January 2014, and funded for five years, NIHR CLAHRC North Thames 12

involves 55 partner organisations across North Central and East London, as well as 13

parts of Bedfordshire, Essex and Hertfordshire. It covers a diverse population of over 14

6 million residents; 10% of the UK population. Partner organisations include higher 15

education institutions, health care and public health organisations, as well as third 16

sector organisations and industry partners. The intended audience for our programme 17

of short courses is staff working in our 35 partner health care and public health 18

organisations. These include 21 NHS provider organisations responsible for acute 19

hospital services, mental health or community care (known as NHS Trusts); 8 20

organisations responsible for purchasing or commissioning care on behalf of patients 21

in a designated geographical area (known as Clinical Commissioning Groups); and 8 22

local government departments, responsible for public health (known as Local 23

Authorities). 24

25

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Administration 1

We used the web-based tool, Opinio, to collect the survey data from a convenience 2

sample (available at https://www.ucl.ac.uk/isd/services/learning-teaching/elearning-3

staff/core-tools/opinio). An email was sent to key CLAHRC contacts in partner 4

organisations, with a request that they disseminate the questionnaire weblink to staff 5

electronically. The email explained that the survey was to inform the design of 6

training opportunities for health care and public health staff, to increase their skills in 7

using research evidence. It stated that we were keen to receive responses from staff 8

with a range of backgrounds and experience, at all levels, from a range of groups 9

including but not limited to clinicians; nurses and midwives; allied health 10

professionals; managers and technical staff, such as laboratory workers. Reminder 11

emails were sent two weeks later and the survey was live for four weeks in total. 12

13

Questionnaire development 14

The survey questions were developed in line with guidance set out in the 15

questionnaire manual. [21] The basic questionnaire comprises a list of 30 tasks, 16

relating to a range of areas, including research, communication/ teamwork, clinical 17

tasks, administration, and management. Each item is rated along a 7-point scale with 18

respect to how important the task is to the respondent’s job (Rating A); and how well 19

the task is currently performed (Rating B). Comparing scores for self-assessed 20

importance/ performance provides an assessment of where the greatest training needs 21

lie. The greater the difference in scores, the greater the training need. The 22

questionnaire also facilitates comparison between the different tasks, such as research 23

and administration. 24

25

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The questionnaire is designed so that up to 25% of the original items (to a maximum 1

of 8) may be swapped for items of the researcher’s choice without compromising its 2

psychometric properties. Another 10 items may be added in.[21] The modification 3

process involved two stages. First, we identified possible additional tasks from the 4

literature on research use and participation by health care and public health staff, and 5

through one to one interviews with staff from a range of backgrounds (n=7). We did 6

this iteratively by sense checking new suggestions with subsequent interviewees. 7

Before releasing the survey, we pilot tested it with eight staff from a range of 8

professional backgrounds, drawn from across the CLAHRC. In the second stage of 9

the modification process, we presented the proposed changes to these individuals and 10

asked them to comment on whether the alternations appeared valid to them. 11

Throughout the modification process, we considered design factors such as the quality 12

of the questions, survey format and the way questions were presented.[22] Pilot 13

testers were provided with a copy of draft questionnaire. As well as asking them about 14

the proposed modifications to the list of tasks, we asked them whether the text of the 15

questionnaire was clear and how realistic it was in the context of their current role. 16

Overall, the tool was considered to be good, with clear instructions and of appropriate 17

length. Through this process we made minor modifications to the tool including: 18

adding in a definition of research; providing additional job categories in the section on 19

demographic data; and clarifying the instructions for the importance/ performance 20

rating exercise. Pilot testers considered the list of tasks to be clear and 21

comprehensible, acknowledging the challenges of compiling a list that would be of 22

broad relevance across a range of different types of health organisation. Two testers 23

suggested that we group together similar tasks. However, the questionnaire developers 24

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intended that the list should be organised randomly, so we opted to keep this approach 1

to maintain the integrity of the tool. 2

3

Section 1 of the final survey included a list of 25 tasks, 13 of which were directly 4

related to research. These are listed in Table 1. In line with guidance about the use of 5

the questionnaire, we retained 22/30 of the original survey items. In Section 2, 6

participants were invited to list up to three areas in which they felt they would benefit 7

from training to better equip them either to conduct research or apply its findings in 8

practice. We also collected basic demographic information, including professional 9

group, age and gender. 10

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(n = 39)

Doctors (n = 36)

Managers (n=22)

Nurses (n=27)

Importa

nce to

role

(median score)

Curre

nt

Perfo

rmance

(median score)

p value

Importa

nce to

role

(median score)

Curre

nt

Perfo

rmance

(median score)

p value

Importa

nce to

role

(median score)

Curre

nt

Perfo

rmance

(median score)

p value

Importa

nce to

role

(median score)

Curre

nt

Perfo

rmance

(median score)

p value

Importa

nce to

role

(median score)

Curre

nt

Perfo

rmance

(median score)

p value



5.00 4.00 <0.01 5.00 4.00 0.01 6.00 4.50 <0.01 4.00 4.00 0.87 6.00 4.00 <0.01


6.00 4.00 <0.01 6.00 4.00 <0.01 5.00 4.00 <0.01 7.00 5.00 <0.01 7.00 4.00 <0.01


5.00 5.00 <0.01 5.00 4.00 <0.01 6.00 5.00 <0.01 5.00 4.00 0.88 6.00 4.00 <0.01


6.00 4.00 <0.01 6.00 4.00 <0.01 6.00 5.00 <0.01 5.50 4.00 <0.01 6.00 4.00 <0.01

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4.00 3.00 <0.01 4.00 3.00 0.02 4.50 3.00 0.02 3.50 4.00 0.48 4.50 3.50 <0.01


6.00 5.00 <0.01 6.00 4.00 <0.01 6.00 4.50 <0.01 7.00 5.00 <0.01 7.00 5.00 <0.01


6.00 5.00 <0.01 6.00 4.00 <0.01 6.00 4.50 <0.01 6.00 4.50 <0.01 6.00 5.00 <0.01


5.00 4.00 <0.01 5.00 4.00 <0.01 5.00 4.50 0.01 4.50 4.00 0.07 5.50 4.00 0.08


4.00 3.00 <0.01 4.00 3.00 0.04 5.00 3.00 <0.01 4.00 3.00 0.02 5.00 2.50 <0.01


6.00 5.00 <0.01 7.00 5.00 <0.01 6.00 5.00 <0.01 6.50 5.00 <0.01 7.00 6.00 0.03


7.00 5.00 <0.01 7.00 5.00 <0.01 7.00 5.00 <0.01 7.00 5.00 <0.01 7.00 5.00 <0.01


5.00 4.00 <0.01 5.00 4.00 0.02 5.00 4.00 <0.01 3.00 4.00 0.64 5.50 4.00 <0.01

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5.00 4.00 <0.01 5.00 3.00 <0.01 5.00 3.00 <0.01 2.00 3.00 0.84 5.00 4.50 0.01


6.00 5.00 <0.01 6.00 5.00 0.04 5.00 4.00 <0.01 6.00 5.00 <0.01 6.00 5.00 0.28


5.00 4.00 <0.01 4.00 3.00 <0.01 5.00 3.00 <0.01 5.00 3.00 <0.01 5.00 4.00 0.01


5.00 4.00 <0.01 4.50 3.00 <0.01 5.00 3.00 <0.01 5.00 4.00 0.27 5.00 4.00 0.09


3.00 3.00 <0.01 3.00 3.00 0.01 4.50 2.50 <0.01 3.00 0.24 0.31 4.00 2.00 <0.01


4.00 4.00 0.03 4.00 3.00 0.14 5.00 4.00 0.35 3.00 3.00 0.34 6.00 5.00 0.06


4.00 2.00 <0.01 3.00 2.00 <0.01 5.00 2.00 <0.01 4.00 3.50 <0.01 4.50 3.50 <0.01


5.00 5.00 0.15 5.00 5.00 0.98 5.00 4.00 <0.01 6.00 5.50 0.54 5.00 5.00 0.83

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6.00 5.00 <0.01 6.00 5.00 <0.01 6.00 4.00 <0.01 6.00 5.00 0.02 6.00 4.00 <0.01


5.00 2.00 <0.01 4.00 2.00 <0.01 5.00 2.00 <0.01 4.00 3.00 0.04 5.00 2.00 <0.01


6.00 4.00 <0.01 6.00 4.00 <0.01 6.00 4.00 <0.01 6.00 4.00 <0.01 6.00 4.00 <0.01


5.00 4.00 <0.01 5.00 4.00 <0.01 5.00 4.00 <0.01 5.00 4.00 <0.01 5.00 4.00 <0.01


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Analysis


Section 1, comparing self-assessed importance and performance ratings for each task

to identify training needs. Given much of the existing literature focuses on individual













systematic method set out by Mayring and others.[26] Categories were derived

iteratively using Mayring’s step model of inductive category development. Within

this, the researcher (HB) reviewed all the free text data in light of the research

questions. Free text comments relating to similar topics (e.g. training in research

methods; using research in practice) were grouped together. From this, provisional

categories were deduced and revised, with constant reference to the data. The

reliaibility of the final categories was then checked by the research team, before

quantitative aspects of the analysis (e.g. frequency of the coded categories) were

conducted by HB. Priorities were first identified for the whole sample, and then

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compared using the same categories to examine potential differences between

professional groups.

Ethics approval





as vulnerable.

RESULTS





Demographics








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3 15


Total 20 203






In this section, we first describe participants’ self-assessment of the importance of the

25 tasks included in the questionnaire. We then compare this with the performance

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about the relative importance and performance of each task is provided in Table 1 and

data illustrating the distribution of responses is provided in Supplementary File 1.

Importance of tasks




















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Training needs

Comparing the median self-assessed importance and performance rating for each task

across the whole study population, we identified significant training needs for 24/25

tasks (p ≤0.05) (Table 1). The only task without a significant difference between

median importance and performance was undertaking administrative activities (p=

0.15). Using this approach, it is possible that a training need might be identified, that

relates to a task of moderate or little importance to participants. However, as we have

noted, all tasks received a median importance rating of 4 or above, with the exception

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of designing research studies. Although a training need was identified for this task (p





















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guidelines.




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research or becoming involved in it. However, there are a range of factors beyond

‘pull’ efforts such as training to develop the capacity and capability of staff within

health organisations.[9] When asked to identify their priorities for training, a number

of participants instead described challenges they face in using research or

participating in it. As we have already noted, our findings highlight that many

participants are faced with a lack of institutional support for them participating in

research, including competing demands on their time, as well as dwindling resources.

Some participants wanted a protected time slot each week to work on audits and

research, or even research-related tasks, such as writing letters to journals. Most of

these suggestions were made by doctors: some had previously had time allocated to







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DISCUSSION








implementation of its findings. [2] Training is one of a range of factors which may

help to facilitate access, dissemination, exchange, and use of evidence within health

organisations In this paper, we have described the findings of an exercise we

conducted to inform our efforts to increase research use and participation across a

large research collaboration through training, and in doing so better link research and

action. [9] We sought the views of a wide range of health care and public health staff

about the training they need to conduct research and apply its findings in practice. To

do this, we asked participants to self-assess the importance of tasks to their current

role, as well as their current performance in carrying them out. Training needs were

identified by comparing the mean of the two scores. Across the study population, two

of the three research-related tasks with the largest training needs related to using

research in practice: learning about new research developments and assessing the

relevance of research. Key research training needs identified were similar across the

four main professional groups. In contrast, however, in the free-text section of the

questionnaire, the training priorities that participants described related not just to

using research, but also to carrying it out. Priorities included training in research

methods, including data analysis; study design and data collection; and applying

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research in practice. Accessing research evidence and applying for funding were also

important. The balance of suggestions was similar for doctors, AHPs, and nurses.

However, conducting empirical research was less of a priority for managers, who

focused more on the skills needed to use research findings. These results are perhaps

not surprising. As Walshe and Rundall note, many clinicians receive some research-

methods training as part of their professional development. In contrast, managers

often have no research training, and the the managerial culture is intensely pragmatic,

valuing the application of ideas in practice more than it does the search for knowledge

about those ideas. [30] It is, however, encouraging that managers in our survey

highlighted a need for training in using research to inform their practice. Again












AHPs, and nurses. However, we did not collect detailed information on the seniority

or authority of respondents, partly to protect their anonymity. This may though impact

the ways in which participants respond. For example, those who consider service

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evaluation more important may be more senior. Participants across the study

population also identified key gaps in managing multiple demands on time and

securing time to undertake research, and highlighted a number of other challenges

they face, including a lack of time for research, and a lack of infrastructure, such as

access to online publications. These need to be taken into account, as they may act as

further barriers to research use and participation, potentially reducing the impact of

training. However, these findings are based on participants’ own self-assessment of

the importance of each task to their current role, rather than an objective assessment

of what is required of them, for example in a job description. Therefore, there may be

a discrepancy between what participants consider to be important, versus what their

employers require of them. Nevertheless several professional groups were

underrepresented in our survey, and their perspectives warrant further exploration, for

example midwives and public health staff. In England, it is particularly important that

we understand how the latter group might best be supported, following their transition

from the NHS to local government.[32] We also did not study primary care staff.

Although participants represented a good spread of organisations, our sample size was

relatively small. However, the survey was conducted in the first few months of our

five year collaboration and it is encouraging to see that there was clear interest in

using and applying AHR, right across the partnership. There are a number of

limitations associated with using a convenience sample, not least because the results

are of unknown generalizability.[33] Staff who completed the survey are likely to be

those who are most interested in the topic.[20,22] It is perhaps therefore not a surprise

that most thought research-related tasks were important, especially given 51% of

responses were received from staff working in teaching or specialist hospitals.

However, this sampling approach was appropriate for our purposes as we sought to

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reach those most interested in research, to prioritise our capability building efforts on

this group in the first instance. We received responses from 20 out of 35 CLAHRC

partner health care or public health organisations. Indeed, the interest and training

needs identified in the survey were consistent with our subsequent experience of

running training events aimed at building capacity for health care and public health

staff to use research and work with researchers. Demand has consistently exceeded

supply and all events have been oversubscribed.













are looking to establish similar training programmes. Nevertheless, training is only

one of a range of factors which may help to facilitate use of and participation in

research. A plethora of challenges and barriers can also be present at various levels

within a health system, including ensuring ‘buy-in’ from upper management and lack

of appropriate infrastructure. Due to the range of potential challenges, interventions

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should be considered within the context of wider systems issues.[8]












sustained in the longer term. [34]










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and populations.

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Acknowledgements





statistical advice.

Competing interests


Funding statement









Data sharing statement



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Figure legends



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102x60mm (600 x 600 DPI)

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102x61mm (600 x 600 DPI)

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Supplementary Information: Distribution of overall importance and performance scores for questionnaire tasks

Task Importance scores

Performance scores

Median

Interquartile range

Median

Interquartile range

1. Handling routine data 6 5-7 5 5-7

2. Critically evaluating published research 5 4-7 4 3-5

3. Evaluating your organisation’s performance 6 4-7 4 3-5

4. Interpreting research findings 5 4-7 5 4-5

5. Applying research results to your own practice 6 5-7 4 4-5

6. Identifying viable research topics 4 3-5.75 3 2-5

7. Introducing new ideas at work 6 5-7 5 4-5

8. Accessing relevant research literature to inform your work 6 5-7 5 3-6

9. Giving information about research to patients/the public 5 4-6 4 3-5

10. Statistically analysing your own research data 4 2-6 3 2-5

11. Teaching colleagues and/or students 6 5-7 5 5-6

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12. Managing multiple demands on your time 7 6-7 5 4-6

13. Writing up the findings of research studies or audits 5 3-7 4 3-5

14. Undertaking health promotion activities 5 3-6 4 2-5

15. Making do with limited resources 6 5-7 5 4-6

16. Assessing local health care needs 5 3-6 4 2-5

17. Collecting and collating relevant research 5 3-6 4 3-5

18. Designing research studies 3 2-6 3 2-4

19. Working as a member of a team doing research 4 2-6 4 3-5

20. Accessing resources to undertake research e.g. money, information, equipment 4 2-6 2 1-4

21. Undertaking administrative activities 5 4-6 5 4-6

22. Personally coping with change in the health service 6 5-7 5 4-5

23. Securing time to undertake research 5 2.5-7 2 1-4

24. Learning about new research developments in your field 6 5-7 4 3-5

25. Assessing the relevance of research to your organisation 5 4-7 4 3-5

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