Barriers and facilitators to the conduct of critical care research in low and lower-middle income countries: A scoping review

Abstract

Background Improvements in health-related outcomes for critically ill adults in low and lower-middle income countries need systematic investments in research capacity and infrastructure. High-quality research has been shown to strengthen health systems; yet, research contributions from these regions remain negligible or absent. We undertook a scoping review to describe barriers and facilitators for the conduct of critical care research. Methods We searched MEDLINE and EMBASE up to December 2021 using a strategy that combined keyword and controlled vocabulary terms. We included original studies that reported on barriers or facilitators to the conduct of critical care research in these settings. Two reviewers independently reviewed titles and abstracts, and where necessary, the full-text to select eligible studies. For each study, reviewers independently extracted data using a standardized data extraction form. Barriers and facilitators were classified along the lines of a previous review and based on additional themes that emerged. Study quality was assessed using appropriate tools. Results We identified 2693 citations, evaluated 49 studies and identified 6 for inclusion. Of the included studies, four were qualitative, one was a cross-sectional survey and one was reported as an ‘analysis’. The total number of participants ranged from 20–100 and included physicians, nurses, allied healthcare workers and researchers. Barriers identified included limited funding, poor institutional & national investment, inadequate access to mentors, absence of training in research methods, limited research support staff, and absence of statistical support. Our review identified potential solutions such as developing a mentorship network, streamlining of regulatory processes, implementing a centralized institutional research agenda, developing a core-outcome dataset and enhancing access to low-cost technology. Conclusion Our scoping review highlights important barriers to the conduct of critical care research in low and lower-middle income countries, identifies potential solutions, and informs researchers, policymakers and governments on the steps necessary for strengthening research systems.

The research environment of critical care in three Asian countries: A cross-sectional questionnaire survey

“…Our results were consistent with previous studies evaluating challenges for critical care research. A scoping review in lower-middle income settings identified limited funding/investment, inadequate access to mentors/training, and limited research/statistical support staff as barriers in critical care research in lower-middle income countries ( 14 ). An international survey on barriers and facilitators of conducting randomized controlled trials in pediatric critical care reported that lack of funding was the major barrier and that protected time for research, a stable recruit system, collaboration with a research network, government funding, and academic department support were the facilitators ( 18 ).…”

“…Trial groups such as the Canadian Critical Care Trials Group (CCCTG), for example, have established their research supporting environments such as meetings, ethics committee, a mentoring system, funding system, and research coordinators, which enabled them to conduct numerous high-quality clinical trials ( 13 ). In contrast, financial and personal support for research activities are major barriers for critical care research in lower-middle income countries ( 14 ). In addition, a survey targeting Japanese and Korean physicians identified a lack of personnel support and time for research as the main hindrance to conducting clinical trials ( 15 ).…”

Model for enhancing the research conducted by the university medical staff: Participatory action research

“…Previous studies reported several barriers to initiating healthcare research in developing countries [ [29] , [30] , [31] , [32] , [33] , [34] , [35] ]. These include work, overloads, limited funding, inadequate human and financial capacity, poor research knowledge, absence of a research culture, lack of time and motivation, inadequate supportive systems, and poorly defined research policies [ [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] ]. In comparison, the barriers to conducting research in developed countries were inaccessibility to research supervisors or mentors, a lack of biostatistical support, insufficient time, inadequate research experience, and a lack of supportive enthusiasm from colleagues [ 32 , 35 ].…”

Are open access article processing charges affordable for otolaryngologists in low-income and middle-income countries?

“…In addition to barriers already faced by LMIC researchers such as limited funding, inadequate institutional and national investment in research [16,17 ▪ ], they are significantly affected by APCs. Although their HIC counterparts often benefit from institutional funding or research grants that cover APCs, this survey shows that LMIC otolaryngology researchers are often left to pay for APCs using their personal funds.…”