Qualitative Research in an International Research Program: Maintaining Momentum while Building Capacity in Nurses

Abstract

Nurses are knowledgeable about issues that affect quality and equity of care and are well qualified to inform policy, yet their expertise is seldom acknowledged and their input infrequently invited. In 2007, a large multidisciplinary team of researchers and decisionmakers from Canada and five low-and middle-income countries (Barbados, Jamaica, Uganda, Kenya, and South Africa) received funding to implement a participatory action research (PAR) program entitled "Strengthening Nurses' Capacity for HIV Policy Development in sub-Saharan Africa and the Caribbean." The goal of the research program was to explore and promote nurses' involvement in HIV policy development and to improve nursing practice in countries with a high HIV disease burden. A core element of the PAR program was the enhancement of the research capacity, and particularly qualitative capacity, of nurses through the use of mentorship, role-modeling, and the enhancement of institutional support. In this article we: (a) describe the PAR program and research team; (b) situate the research program by discussing attitudes to qualitative research in the study countries; (c) highlight the incremental formal and informal qualitative research capacity building initiatives undertaken as part of this PAR program; (d) describe the approaches used to maintain rigor while implementing a complex research program; and (e) identify strategies to ensure that capacity building was locally-owned. We conclude with a discussion of challenges and opportunities and provide an informal analysis of the research capacity that was developed within our international team using a PAR approach.

Taking account of context in population health intervention research: guidance for producers, users and funders of research

“…[132][133][134] Nurses tend to be excluded from traditional hierarchies of power and influence within the health professions in LMICs and so are rarely involved in developing clinical guidelines and workplace policies designed to reduce risk. 133,135 A mixed-methods programme of research was undertaken between 2008 and 2012 57,58 to examine the impact of district leadership hubs established by the research team in four countries (Kenya, Uganda, South Africa and Jamaica). The hubs engaged nurses and other members of the district teams in a participatory action research approach that aimed to improve clinical practices and workplace policies related to the care of people with HIV-infected and their families.…”

The impact of leadership hubs on the uptake of evidence-informed nursing practices and workplace policies for HIV care: a quasi-experimental study in Jamaica, Kenya, Uganda and South Africa

“…This mixed composition was intended to extend the vertical networks (across system layers) of the nurses who joined the hubs and to activate district-level change by stimulating horizontal collaboration among hub members. Leadership hubs were designed to act as the lever for change, or enabling mechanism, that would transform enhanced capacity into action leading to policy and practice change [ 72 , 75 , 77 ]. This hub intervention targeted improvements in policies and patient care within health care institutions as orchestrated through a district-level change process.…”

“…A common slate of training workshops (seven) was delivered to hubs over 3 years to build skills in using research evidence to identify gaps in clinical practice and workplace policies for their districts, using evidence generated by the research programme. The training approach was consistent with PAR processes [ 79 ] and designed to improve hubs’ abilities to identify, question and take action on setting-specific health system issues, thereby empowering members as change agents [ 76 , 77 ]. Through the workshops, we addressed four aspects of capacity: ability (knowledge and skills); resources (financial, material, logistics); authority (control, voice, participation); and responsibility (accountability, monitoring).…”

“…Country RAs were trained by the principal investigators (NE, DK, EK) and project manager (SR) through a 1-week intensive session. Research staff were introduced to the protocol and to PAR, taught how to conduct field sampling and assess eligibility of health care institutions and participants, instructed on how to obtain consent and trained to use all data collection measures [ 77 ]. Prior to follow-up data collection, an updated field guide was developed and refresher training held.…”

“…The main quantitative study findings are described in this paper. Qualitative results are published elsewhere [ 9 , 56 , 75 – 77 ]. This study was carried out with support from the Global Health Research Initiative (GHRI), a collaborative research funding partnership of the Canadian Institutes of Health Research, the Canadian International Development Agency, Health Canada, the International Development Research Centre and the Public Health Agency of Canada.…”