An emerging TIMER-2C framework for addressing barriers to research culture and productivity among local healthcare providers in the Middle East and sub-Saharan Africa: a qualitative study and modified Delphi approach
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Background
Contributions from healthcare professionals in the Middle East and North Africa (MENA) and sub-Saharan Africa (SSA) to research globally, are minimal when compared to other regions. We sought to identify barriers and facilitators of research productivity by local healthcare professionals from MENA and SSA.
Methods
We conducted qualitative interviews with a modified Delphi approach comprising two rounds of interviewing to: 1) identify barriers and facilitators, and 2) establish consensus on the most prominent factors. We purposively sampled 16 established and early career health researchers from Jordan, Qatar, Egypt, Lebanon, North Sudan, South Sudan, Nigeria, Ghana, Kenya, Uganda, Ethiopia, and South Africa. Interview guides were grounded in the “Capacity Strengthening of Health Research in Conflict” and the “Health Equity Implementation” frameworks. We explored barriers, facilitators, and recommendations for increasing research output. Transcripts were managed in ATLAS.ti and analyzed deductively and inductively to identify emerging themes.
Results
The most prominent barriers and facilitators are multilevel at individual, institutional, national, and global levels. At the individual level, researchers faced expertise and mentorship gaps, and time and funding constraints. Passion for research, protected time, and training facilitated research productivity. Institutional barriers included a greater emphasis on clinical service and teaching, limited research opportunities, and insufficient supportive policies to foster a research culture. Nationally, poor communication of research findings and a poor public image of research limited national investment in research and many countries need strategies to promote research and introduce national research funding mechanisms. Global barriers include inequitable funding and collaborations, bias from publishers, epistemic injustice, and parachute science. Addressing funding disparities, establishing fair collaborations, and giving greater recognition to local health researchers were key facilitators of research output. We identified six interlinked core themes and one overarching theme from which we coined the TIMER-2C conceptual framework to represent: 1) T ime, 2) I nstability, Interest & Infrastructure, 3) M oney & Resources, 4) E xpertise & Experience, 5) R ecognition, and 6) constructive C ollaboration, elements to generate a positive research C ulture. Building a research culture involves establishing circles of support and building research capacity to create sustainable pipelines of researchers.
Conclusion
We identified the presence or lack of a research culture as an overarching factor for driving or impeding research contributions from MENA and SSA. We unveil an emerging conceptual framework, the TIMER-2C framework , that depicts and explains the relationship between factors associated with research productivity. This framework with its seven constructs can be a useful tool for evaluating local and global strategies to increase research output. We recommend further use of this framework to guide the design, implementation and evaluation of multi-pronged strategies to enhance research contributions from healthcare professionals in MENA, SSA, and other similar contexts.
