Educational and Wider Interventions that Increase Research Activity and Capacity of Clinicians in Low to Middle Income Countries: A Systematic Review and Narrative Synthesis

摘要

Research capacity building of clinicians in low to middle income countries may be the most powerful intervention to strengthen health systems, improve clinical standards and address inequities in healthcare. Research training in the form of workshops, postgraduate courses and collaborations are interventions that have been used to increase research activity and capacity. The aim of this literature review is to identify educational and other interventions that worked for clinicians, their characteristics and how they may have worked.Methods: Systematic search of electronic databases was performed for relevant articles from January 2000 to October 2013. Due to the small number of papers, the complex interventions and diverse methods used, a narrative synthesis along themes was used to distil the evidence. The data was collated, reviewed and themed to form four middle-level theories. A theory-driven search of the literature was then performed to identify articles to test the theories. A theoretical framework was then developed to conceptualise how the theories relate in a research capacitybuilding programme.Results: Of 2833 identified articles, only 20 met the inclusion criteria. Most of the articles had multiple interventions, were descriptive accounts and were of variable quality. The interventions were complex and mostly poorly-described although they could be grouped into four broad classes in training workshops, postgraduate training, support and mentoring by collaboration and enhancements in the research environment. Postgraduate research training courses should be for clinicians who have funded and protected time away from clinical work. Clinical research teams can only thrive in a research-enhanced environment and supportive collaborations.Conclusion: Despite limited evidence from low to middle income countries, this review has identified that clinician-led research can be increased by focused development of a team of selected individuals and skills through postgraduate training, supported by collaborative networks and an enhanced research environment.