Int J Clin Pharm DOI 10.1007/s11096-015-0087-2

RESEARCH ARTICLE

Building hospital pharmacy practice research capacity in Qatar: a cross-sectional survey of hospital pharmacists Derek Stewart • Moza Al Hail • P. V. Abdul Rouf Wessam El Kassem • Lesley Diack • Binny Thomas • Ahmed Awaisu



Received: 5 September 2014 / Accepted: 18 February 2015  Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

P. V. Abdul Rouf  W. El Kassem  B. Thomas Women’s Hospital, Hamad Medical Corporation, Post Box 3050, Doha, Qatar

facilitators and barriers to participation in research. Results The response rate was 53.1 % (n = 213). High levels of interest were expressed for all aspects of research, with respondents less experienced and less confident. Summary scores for items of interest were significantly higher than experience and confidence (p \ 0.001). PCA identified four components: general attitudes towards research; confidence, motivation and resources; research culture; and support. While respondents were generally positive in response to all items, they were less sure of resources to conduct research, access to training and statistical support. They were also generally unsure of many aspects relating to research culture. Half (50.7 %, n = 108) had either never thought about being involved in research or taken no action. In multivariate binary logistic regression analysis, the significant factors were possessing postgraduate qualifications [odds ratio (OR) 3.48 (95 % CI 1.73–6.99), p \ 0.001] and having more positive general attitudes to research [OR 3.24 (95 % CI 1.62–4.67), p = 0.001]. Almost all (89.7 %, n = 172) expressed interest in being involved in research training. Conclusion HMC pharmacists expressed significantly higher levels of interest in research compared to experience and confidence. While general attitudes towards research were positive, there were some barriers relating to support (e.g. administration) and research culture. Positive attitudes towards research and possessing postgraduate qualifications were significant in relation to readiness to participate in research and research training. Findings are of key relevance when considering the aims of research capacity building of encouraging research, improving skills and identifying skills gaps.

A. Awaisu College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar

Keywords Hospital pharmacy  Qatar  Questionnaire  Research capacity

Abstract Background There is a need to systematically develop research capacity within pharmacy practice. Hamad Medical Corporation (HMC) is the principal nonprofit health care provider in Qatar. Traditionally, pharmacists in Qatar have limited training related to research and lack direct experience of research processes. Objectives To determine the interests, experience and confidence of hospital pharmacists employed by HMC, Qatar in relation to research, attitudes towards research, and facilitators and barriers. Setting Hospital pharmacy, Qatar. Method A cross-sectional survey of all pharmacists (n = 401). Responses were analysed using descriptive and inferential statistics, and principal component analysis (PCA). Main outcome measures Interests, experience and confidence in research; attitudes towards research; and

Electronic supplementary material The online version of this article (doi:10.1007/s11096-015-0087-2) contains supplementary material, which is available to authorized users. D. Stewart (&)  L. Diack School of Pharmacy and Life Sciences, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen AB10 1JG, UK e-mail: [email protected] M. Al Hail Hamad Medical Corporation, Post Box 3050, Doha, Qatar

123

Int J Clin Pharm

Impacts of findings on practice •







There is a need to formally assess the needs of pharmacists in relation to research training and determine associated facilitators and barriers to further pharmacy practice research. Self-reported pharmacists’ levels of interest in research may be much higher than levels of experience or confidence. Possessing a postgraduate qualification and a positive attitude towards research are key to identifying those pharmacists more likely to be research active. When stimulating pharmacists to take part in research, attention should be paid to issues including research training, support (e.g. administrative, IT) and organisational research culture.

Introduction The terms ‘evidence-based medicine’, ‘evidence based healthcare’ and ‘evidence based practice’ are integral to modern clinical practice. Sackett et al. [1] defined evidence based medicine as ‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients’. While these concepts are widely applied to therapeutic decision making, as judged by the plethora of clinical guidelines, there is less evidence to support processes of practice in healthcare. Such evidence is vital, especially as new roles, function and models of care are developed and implemented into standard practice. One barrier to deriving evidence is the lack of research capacity and specifically practitioners’ research awareness, understanding, skills and activities. Research capacity is defined as ‘enhancing the abilities of individuals, organisations and systems to undertake and disseminate high quality research effectively and efficiently’ [2]. The United Kingdom (UK) Department for International Development suggests that research capacity building aims to: support environments that encourage people to use research; improve researchers’ skills and access to research information and resources; and pay attention to skills gaps. The initial and key step in capacity building involves assessment of research training needs to determine the skills gap at individual and organisational levels. This is followed by developing strategies and plans, implementation at individual and organisational levels, monitoring and evaluation [2]. Cooke developed a framework to evaluate research capacity building in health care with four structural levels of the individual, team, organisation and supra-organisation [3]. Six principles encompass: developing appropriate skills and confidence through training and opportunities to apply skills; supporting research ‘close to practice’; need for

123

partnership and collaboration; appropriate dissemination to maximise impact; continuity and sustainability; and appropriate infrastructures. Many other similar frameworks have been published throughout the world [4]. There is a need to systematically develop research capacity within pharmacy practice. While Knapp et al. [5] reported a project growth in pharmacy education and research in faculties of pharmacy in the United States (US), few studies have reported the perspectives of practising pharmacists. Surveys of community pharmacists in the UK and pharmacists in Australia identified that respondents perceived practice research to be important and relevant but were less likely to participate themselves with confidence, lack of payment, time and opportunities cited as major barriers [6, 7]. Similar findings have been reported for other health professional groupings of social workers [8, 9], allied health professionals [10], speech-language pathology practitioners [11], physicians and nurses [12, 13]. Hamad Medical Corporation (HMC) is the principal non-profit health care provider in Qatar, with eight highly specialized hospitals accredited by Joint Commission International in the US [14]. While a wide range of pharmaceutical services are provided by approximately 700 pharmacists and pharmacy technicians, ward based clinical pharmacy services are a relatively recent development. There is a need to ensure sufficient research capacity to provide evidence of the benefits of clinical practice to patient care and the organisation, in line with the strategic focus of HMC on excellence in healthcare, education and research. Given differences in healthcare structures, processes and culture, findings of research evaluations of clinical pharmacy practice conducted elsewhere may not be generalisable to HMC. In 2001, the Academic Health System was launched, aiming to generate significant, positive impact on patient care through medical education and medical research. It is therefore essential that pharmacists and pharmacy practice research can contribute to the achievement of this aim. Traditionally, pharmacists in Qatar have very limited formal training related to research and lack direct experience and exposure to research processes. A 2 day workshop on basic research methods for around 40 HMC pharmacists was positively evaluated [15]. However, there remains a need to systematically assess the research training needs and identify individuals’ aspirations and skills gaps as a first step in building research capacity.

Aim of the study The aim of this research was to determine the interests, experience and confidence of HMC pharmacists in relation

Int J Clin Pharm

to research, their attitudes towards research, and any facilitators and barriers to research.

Ethical approval Approval to conduct the research was granted by HMC. The university ethics committee advised that there was no need for further ethical review.

senior practitioners, identified from professional networks in the UK and Qatar. Piloting was conducted in a random sample of 30 HMC pharmacists (response of 13/30) who were then excluded from the full study. Minor changes to questionnaire formatting were required to produce the final questionnaire. The final version of the questionnaire was developed in Snap 10 Professional (software for web and email questionnaire design, publication, data entry and analysis). Recruitment and questionnaire distribution

Methods This study was a cross-sectional survey of all pharmacists employed by HMC in Qatar (n = 401). Questionnaire development A draft questionnaire was developed, based on the following: • •



key published literature on research related interests, attitudes and skills of health professionals [6–13]. The Roberts’ Review, a United Kingdom review of the supply of people within science, technology and engineering, which defines competencies around different levels of research participation [16]. Theoretical frameworks i.

ii.

Diffusion of Innovations. Diffusion is a ‘process through which an innovation is communicated through certain channels over time among the members of social system’ [17, 18]. ‘Research’ was considered the innovation, with key elements of the adopter (pharmacist), communication channels, time, the social system (research culture), and members (the multidisciplinary team). Model of Behavior Change [19, 20]. Stages of change are described as ‘pre-contemplation’ (not ready), ‘contemplation’ (getting ready), ‘preparation’ (ready), ‘action’ and ‘maintenance’.

Questionnaire items were clustered in domains of: interests, experience and confidence in research (36 items); related knowledge, skills and attitudes; education and training (2 items); attitudinal items on research, and facilitators and barriers to participation in research (31 items); professional change and diffusion of innovations (3 items); and personal and practice demographics (5 items). Items were contextualised for the Qatari healthcare setting. Question types were a combination of closed, 5-point Likert scales and open to allow detailed comment. The questionnaire was pretested through face and content validity testing by an expert panel of seven academics and

All pharmacists were sent an email by the Executive Director of Pharmacy (Professor Moza Al Hail) that linked directly to study information and the questionnaire. Several evidence-based strategies were employed to maximise the response rate [21]: providing information which clearly stated the research aim, potential benefits, and assured anonymity; two email reminders at 2-weekly intervals; providing paper based and online response options; and entering respondents into a prize draw. Data were collected between October and December 2013. Analysis The survey instrument generated anonymised emails of online submissions to the e-technologist at Robert Gordon University. These were exported from Snap before direct import into SPSS (SPSS Inc., Cary, NC version 21.0). Data from the paper-based questionnaires were manually entered into SPSS, with a reliability check performed on a 10 % random sample. Descriptive analysis was undertaken for: respondent demographics (compared to the total pharmacist population using data held by HMC); interest, experience and confidence related to research; and readiness to participate in research and research training. Internal consistencies of the responses to items of interest, experience and confidence were tested using Cronbach’s alpha. Total scores for each scale were obtained by assigning values (1 = no, 2 = little, 3 = some, 4 = moderate, 5 = very moderate), with overall median and interquartile range (IQR) provided. Differences in these three scores were tested using Friedman’s two way analysis of variance by ranks. Correlation between overall scores of interest/experience, interest/confidence and experience/confidence were assessed using Spearman’s rho. The attitudinal items measured on 5-point Likert scales were subjected to principal components analysis (PCA)— a statistical technique used to reduce a large number of items or variables to a smaller, more manageable number of components [22]. Orthogonal (Varimax) rotation was performed initially to aid in the interpretation of the components, and the results were compared to oblique

123

Int J Clin Pharm

(Promax) rotation. Total scores were obtained by assigning scores of 1 (strongly agree) to 5 (strongly disagree) to each of the Likert statement responses. Internal consistencies of the resulting components were tested using Cronbach’s alpha. Alpha internal consistencies greater than 0.60 are regarded as desirable for psychometric scales [22]. Readiness in research and research training were both summarised into two categories: those not ready (I have never thought about being involved in research/I have thought about being involved in research but have taken no action, and I have never thought about research training/I have thought about research training but have taken no action) and the remainder, ready. Factors associated with readiness were identified using Chi square. Variables identified in univariate analysis with significance levels of p B 0.25 were further analysed in a multivariate binary logistic regression model. Content analysis was performed on the responses to the open questions [23].

Results The response rate was 53.1 % (n = 213). Just over half of the respondents (52.1 %, n = 111; population value 52.3 %) were male and aged less than 35 years of age (59.1 %, n = 126; population value 54.3 %). Almost two thirds (63.4 %, n = 135) had completed their pharmacy/ ‘entry to practice’ degree less than 10 years previously. The most common countries for completing undergraduate education were Egypt (40.4 %, n = 86; population value 38.6 %), Jordan (16.9 %, n = 36; population value 10.9 %) and Sudan (11.3 %, n = 24; population value 10.7 %). One third (32.9 %, n = 70) had completed a postgraduate course, most commonly ‘Clinical Pharmacy’ (n = 40) in the United Kingdom (n = 37). One third (30.0 %, n = 64) were currently studying for a postgraduate qualification. Almost all (97.7 %, n = 208) were working full time, largely in areas of drug supply (39.0 %, n = 83) and clinical practice (26.3 %, n = 56). In relation to statements around Diffusion of Innovation, 1.9 % (n = 4) resisted new ways of working, 4.2 % (n = 9) were cautious, tending to change once peers had, 31.0 % (n = 66) thought for some time before adopting new ways, 22.5 % (n = 48) served as a role model for others, and 38.5 % (n = 82) self-reported being innovative. Responses to items on interests, experience and confidence relating to different aspects of research are given in Table 1. High levels of interest were expressed for all items other than ‘writing a research proposal’ (47.9 %, n = 102 reporting some, little or no interest). More than half of the

123

respondents had little or no experience of: ‘research advances within my field and in related areas’ (54.0 %, n = 115); ‘systematically reviewing literature’ (50.2 %, n = 107); ‘writing a research proposal’ (56.3 %, n = 120); ‘using quantitative research methods’ (55.0 %, n = 117); ‘using qualitative research methods’ (57.8 %, n = 113); ‘analysing and interpreting results’ (55.8 %, n = 119); ‘giving an oral presentation (e.g. national or international conferences)’ (61.5 %, n = 131); and ‘writing and publishing research in academic journals’(69.4 %, n = 148). The alpha internal consistencies of the three scales of interest, experience and confidence were 0.96, 0.92 and 0.96 respectively. The median summary score for interest was 46 (IQR 35–55) (range possible 0–60), experience 30 (IQR 19–40) and confidence 32 (IQR 32–48). Scores for interest were significantly higher than experience and confidence (p \ 0.001). There were positive correlations between total scores for interest and experience, interest and confidence, and confidence and experience (p \ 0.001) with those more interested also more experienced and confident. When all attitudinal items were subjected to principal component analysis, the correlation matrix contained multiple coefficients above 0.3. The Kaiser–Meyer–Olkin measure of sampling adequacy (0.861) and Bartlett’s test of sphericity (significance \0.001) confirmed the factorability of the items. Four components had eigenvalues exceeding 1.0, for which Varimax rotation was used. The four-factor solution explained 56.5 % of the variance. The items in the four components pertained to: general attitudes towards aspects of research (alpha internal consistency 0.85); responses to items of confidence, motivation and resources (alpha internal consistency 0.91); responses to items relating to research culture (alpha internal consistency 0.79); and responses to items relating to support from others (alpha internal consistency 0.86). Responses to items relating to the four components are given in Table 2. Component 1: General attitudes towards aspects of research Respondents generally held positive attitudes, with a median overall score of 13 (IQR 8–18), range possible 8–40, with 8 representing best positive attitudinal score. Component 2: Confidence, motivation and resources While respondents were generally positive in response to all items, they were less sure of resources to conduct research, access to training courses and statistical support. The median overall score was 30 (IQR 24–35), range possible 11–55, with 11 representing best positive attitudinal score.

28.6 (61) 22.1 (47) 44.1 (94)

Giving an oral presentation (e.g. departmental)

Giving an oral presentation (e.g. national or international conference)

31.5 (67)

Using qualitative research methods (e.g. focus groups, interviews)

Analysing and interpreting results

30.0 (64)

Finding relevant literature Systematically reviewing literature 26.8 (57)

19.7 (42) 24.4 (52)

Developing research questions, aims, hypotheses and objectives

Using quantitative research methods (e.g. RCTs, cohort studies, surveys, questionnaires)

24.4 (52)

Generating research ideas

Writing a research proposal

26.8 (57) 22.5 (55)

Research advances within my field and

No experience = 1, % (n)

46 (IQR 35–55)

Item

Overall scale median (IQR)

14.6 (31)

5.2 (11)

Analysing and interpreting results

Writing and publishing research in academic journals

5.2 (11)

Using qualitative research methods (e.g. focus groups, interviews) 7.0 (15) 12.7 (27)

7.5 (16)

Using quantitative research methods (e.g. RCTs, cohort studies, surveys, questionnaires)

Giving an oral presentation (e.g. departmental) Giving an oral presentation (e.g. national or international conference)

3.8 (8) 9.4 (20)

Writing a research proposal

2.3 (5) 2.3 (5)

Developing research questions, aims, hypotheses and objectives Finding relevant literature

Systematically reviewing literature

2.3 (5) 2.3 (5)

Generating research ideas

No interest = 1, % (n)

Research advances within my field and

Item

Table 1 Responses to interest, experience and confidence in items (N = 213)

17.4 (37)

17.8 (38)

27.2 (58)

26.3 (56)

28.2 (60)

26.3 (56)

19.2 (41) 25.8 (55)

25.4 (54)

25.8 (48)

27.2 (58)

Little experience = 2, % (n)

15.0 (32)

16.4 (35) 18.3 (39)

18.8 (40)

16.9 (36)

14.6 (31)

8.5 (18)

12.2 (26)

10.3 (22) 9.9 (21)

9.4 (20)

3.3 (7)

Little interest = 2, % (n)

10.3 (22)

15.5 (33)

16.4 (35)

22.1 (47)

22.5 (48)

20.2 (43)

22.1 (47) 22.5 (48)

25.4 (54)

28.2 (60)

22.1 (47)

Some experience = 3, % (n)

15.5 (33)

13.1 (28) 11.3 (24)

20.7 (44)

21.6 (46)

17.4 (37)

30.0 (64)

17.8 (38)

21.1 (45) 20.2 (43)

20.7 (44)

22.5 (48)

Some interest = 3, % (n)

15.5 (33)

27.2 (58)

16.9 (36)

10.8 (23)

12.7 (27)

17.4 (37)

31.9 (68) 19.7 (42)

18.8 (40)

19.2 (41)

17.4 (37)

Moderate experience = 4, % (n)

21.1 (45)

29.6 (63) 31.5 (67)

28.2 (60)

31.9 (68)

27.2 (58)

21.6 (46)

35.7 (76)

30.0 (64) 33.3 (71)

26.3 (56)

25.8 (55)

Moderate interest = 4, % (n)

10.3 (22)

14.6 (31)

8.0 (17)

7.0 (15)

6.6 (14)

2.8 (6)

4.7 (10) 4.7 (10)

3.8 (8)

1.9 (4)

4.2 (9)

Very experienced = 5, % (n)

31.5 (67)

31.0 (66) 23.5 (50)

24.9 (53)

22.1 (47)

31.0 (66)

28.2 (60)

27.7 (59)

32.9 (70) 31.9 (68)

39.0 (83)

43.7 (93)

Very interested = 5, % (n)

2 (1–4)

3 (2–4)

2 (1–3)

2 (1–3)

2 (1–3)

2 (1–3)

3 (2–4) 2 (2–4)

3 (2–3)

3 (2–3)

2 (1–3)

Median (IQR)

4 (2–5)

4 (3–5) 4 (2–4)

4 (3–4)

4 (3–4)

4 (3–5)

3 (3–5)

4 (3–5)

4 (3–5) 4 (3–5)

4 (3–5)

4 (3–5)

Median (IQR)

Int J Clin Pharm

123

123

Percentages do not total 100 % due to missing data

32 (IQR 32–48)

11.7 (25)

Writing and publishing research in academic journals

Overall scale median (IQR)

13.1 (28)

7.0 (15)

Giving an oral presentation (e.g. departmental)

Giving an oral presentation (e.g. national or international conference)

7.0 (15)

Analysing and interpreting results

10.3 (22)

Using qualitative research methods (e.g. focus groups, interviews)

4.2 (9)

Systematically reviewing literature 8.9 (19) 10.3 (22)

Finding relevant literature

Writing a research proposal Using quantitative research methods (e.g. RCTs, cohort studies, surveys, questionnaires)

3.8 (8) 4.2 (9)

Developing research questions, aims, hypotheses and objectives

3.8 (8) 3.8 (8)

Generating research ideas

No confidence = 1, % (n)

Research advances within my field and

Item

Table 1 continued

30 (IQR 19–40)

46.9 (100)

Writing and publishing research in academic journals

Overall scale median (IQR)

No experience = 1, % (n)

Item

Table 1 continued

23.5 (50)

22.5 (48)

17.8 (38)

23.5 (50)

22.1 (47)

19.2 (41) 24.4 (52)

23.5 (50)

15.0 (32)

18.3 (39)

15.0 (32)

18.3 (39)

Little confidence = 2, % (n)

22.5 (48)

Little experience = 2, % (n)

26.3 (56)

20.7 (44)

19.2 (41)

26.3 (56)

28.2 (60)

30.5 (65) 26.3 (56)

25.8 (55)

24.9 (53)

32.4 (69)

31.5 (67)

26.8 (57)

Some confidence = 3, % (n)

10.8 (23)

Some experience = 3, % (n)

26.8 (57)

25.8 (55)

29.1 (62)

28.6 (61)

22.5 (48)

26.3 (56) 24.9 (53)

26.8 (57)

37.1 (79)

26.8 (57)

29.6 (63)

31.0 (66)

Moderate confidence = 4, % (n)

10.8 (23)

Moderate experience = 4, % (n)

8.5 (18)

14.6 (31)

23.5 (50)

11.3 (24)

13.1 (28)

11.3 (24) 10.8 (23)

16.4 (35)

15.0 (32)

15.5 (33)

16.9 (36)

16.9 (36)

Very confident = 5, % (n)

6.6 (14)

Very experienced = 5, % (n)

3 (2–4)

3 (2–4)

4 (3–4)

3 (2–4)

3 (2–4)

3 (2–4) 3 (2–4)

3 (2–4)

4 (3–4)

3 (3–4)

3 (3–4)

4 (3–4)

Median (IQR)

2 (1–3)

Median (IQR)

Int J Clin Pharm

Int J Clin Pharm Table 2 Component responses (N = 213) Statement

Strongly agree, 1 % (n)

Agree, 2 % (n)

Unsure, 3 % (n)

Disagree, 4 % (n)

Strongly disagree, 5 % (n)

Median (IQR)

Component 1—General attitudes towards aspects of research Being involved in research is important to my career Research is of little importance to me I feel that it is my professional duty to be involved in research

38.5 (82)

39.9 (85)

13.6 (29)

4.7 (10)

0.5 (1)

2 (1–3)

4.7 (10)

15.0 (32)

16.0 (34)

29.6 (63)

31.9 (68)

4 (3–5) 2 (1–3)

36.2 (77)

39.0 (83)

12.2 (26)

8.0 (17)

1.9 (4)

Research is of little relevance to practising pharmacists

5.6 (12)

11.7 (25)

23.9 (51)

23.0 (49)

31.9 (68)

4 (3–5)

Research is of little importance to my organisation

5.2 (11)

11.7 (25)

23.0 (49)

21.1 (45)

35.7 (76)

4 (3–5)

Research is more suited to academics rather than practising pharmacists Being involved in research is important to my career Research is of little importance to me

5.6 (12)

26.8 (57)

15.5 (33)

28.6 (61)

20.7 (44)

4 (2–4)

38.5 (82)

39.9 (85)

13.6 (29)

4.7 (10)

0.5 (1)

2 (1–3)

4.7 (10)

15.0 (32)

16.0 (34)

29.6 (63)

31.9 (68)

4 (3–5)

Median overall score of 13 (IQR 8–18), range possible 8–40, with 6 representing best positive attitudinal score Component 2—Confidence, motivation and resources I am motivated to be involved in research

31.9 (66)

39.9 (85)

16.9 (36)

7.0 (15)

2.3 (5)

2 (1–3)

I am entirely confident in my ability to be involved in research

31.0 (66)

41.8 (89)

21.6 (46)

2.8 (6)

0

2 (1–3)

I am entirely confident in my ability to assess my own research training needs

16.4 (35)

40.8 (87)

31.9 (68)

7.0 (15)

0.9 (2)

2 (1–3)

I am entirely confident in my ability to lead research teams

13.1 (28)

31.9 (68)

36.6 (78)

14.1 (30)

1.4 (3)

3 (2–3)

I already actively support others involved in research

23.0 (49)

40.8 (87)

22.5 (48)

10.3 (22)

0

2 (2–3)

I have sufficient information technology support to be involved in research

16.9 (36)

41.8 (89)

23.5 (50)

11.3 (24)

3.8 (8)

2 (2–3)

I have sufficient administrative support to be involved in research

20.7 (44)

36.2 (77)

31.0 (66)

6.1 (13)

3.3 (7)

2 (2–3)

I have sufficient opportunities to discuss my research ideas with others

15.0 (32)

30.5 (65)

32.4 (69)

16.9 (36)

2.3 (5)

3 (2–3) 3 (2–4)

I already have access to statistical support for research data analysis

8.9 (19)

23.0 (49)

37.1 (79)

25.4 (54)

2.8 (6)

I already have access to research training courses

10.3 (22)

36.6 (78)

21.6 (46)

22.5 (48)

6.1 (13)

3 (2–4)

I already have access to all of the resources I need to be involved in research

12.7 (27)

29.6 (63)

36.6 (78)

16.9 (36)

1.4 (3)

3 (2–3)

Median overall score of 30 (IQR 24–35), range possible 11–55, with 11 representing best positive attitudinal score. Component 3—Research culture I work within a research active pharmacy team

8.9 (19)

28.6 (61)

24.4 (52)

32.9 (70)

1.9 (4)

3 (2–4)

I work within a research active multidisciplinary team

10.3 (22)

24.4 (52)

27.7 (59)

34.3 (73)

0.5 (1)

3 (2–4)

I work within a research active work environment

13.6 (29)

29.6 (63)

26.8 (57)

24.9 (53)

1.9 (4)

3 (2–4)

I work within a supportive research environment

12.2 (26)

31.0 (66)

30.5 (65)

16.4 (35)

5.6 (12)

3 (2–3)

Being involved in research is already part of my practice

15.5 (33)

32.4 (69)

28.6 (61)

16.0 (34)

4.2 (9)

3 (2–3)

There are opportunities for me to attend research seminars and discussions

13.1 (28)

41.8 (89)

18.3 (39)

21.1 (45)

2.3 (5)

2 (2–3)

7.5 (16)

38.0 (81)

20.7 (44)

26.8 (57)

4.2 (9)

3 (2–4)

Others often discuss their research ideas with me

Median overall score of 20 (IQR 15–23), range possible 10–50, with 7 representing best positive attitudinal score Component 4—Support from others My fellow pharmacists are supportive of me being involved in research

21.1 (45)

37.6 (80)

26.8 (57)

10.3 (22)

1.4 (3)

2 (2–3)

My employing organisation is supportive of me being involved in research

26.3 (56)

42.7 (91)

15.5 (33)

10.3 (22)

1.9 (4)

2 (1–3)

My line manager (boss) is supportive of me being involved in research

25.8 (55)

43.2 (92)

16.4 (35)

8.4 (18)

3.3 (7)

2 (1–3)

Other healthcare professionals I work with are involved in research Other members of the wider healthcare team (non-pharmacists) are supportive of me being involved in research

8.5 (18) 15.5 (33)

36.2 (77) 32.4 (69)

35.7 (76) 29.1 (62)

14.1 (30) 14.6 (31)

2.8 (6) 4.7 (10)

3 (2–3) 3 (2–3)

Median overall score of 12 (IQR 9–15), range possible 5–25, with 5 representing best positive attitudinal score Percentages do not total 100 % due to missing data

123

Int J Clin Pharm Table 3 Binary logistic regression, readiness to be involved in research (N = 213) Variables Gender

Category

Odds ratio

Male

Reference

Female

1.64

Postgraduate qualification

No

Reference

Yes

3.48

Time since completed undergraduate degree

\5 years

Reference

C5 years

1.71

Component 1—General attitudes towards aspects of research [median score of 13

95 % CI

p value

0.86–3.11

0.133

1.73–6.99 \0.001 0.71–4.10

0.233

1.62–6.47

0.001

Reference

Bmedian score of 13

3.24

Component 2—Confidence, motivation and resources

[median score of 30

Reference

Bmedian score of 30

1.86

0.92–3.74

0.083

Component 3—Research culture

[median score of 20 Bmedian score of 20

Reference 1.79

0.90–3.54

0.095

Diffusion of innovations

Resistant/cautious/change once peers change

Reference

Role model/innovative

1.61

0.80–3.25

0.182

For components, the lower the score represents more positive responses

Component 3: Research culture Apart from the opportunities to attend research seminars and discussions, respondents were generally unsure of many aspects of research culture. The median overall score was 20 (IQR 15–23), range possible 10–50, with 10 representing best positive attitudinal score. Component 4: Support from others Respondents agreed that their fellow pharmacists, employing organisation and line managers were supportive of their involvement in research. The median overall score was 12 (IQR 9–15), range possible 5–25, with 5 representing best positive attitudinal score. Readiness to be involved in research In response to questions on involvement in research, 16.9 % (n = 36) had never thought about being involved in research, 33.7 % (n = 72) had thought about being involved but had taken no action, 17.4 % (n = 37) had thought about being involved and discussed with others, 5.2 % (n = 11) had been involved in research in the past but had no plans to be involved in the future, 9.9 % (n = 21) had been involved in research in the past and had plans to be involved in the future, and 14.6 % (n = 31) were currently involved in research. In univariate analysis, those more ready had been qualified longer as pharmacists (p = 0.007), had a postgraduate qualification (p \ 0.001), had a more positive general attitude to research (p \ 0.001), were more positive in terms of confidence,

123

motivation and resources (p = 0.002), and responded more positively in terms of research culture (p = 0.001). Binary logistic regression data are given in Table 3. The significant factors were possessing a postgraduate qualification [odds ratio (OR) 3.48 (95 % CI 1.73–6.99), p \ 0.001] and having a more positive general attitude to research [OR 3.24 (95 % CI 1.62–4.67), p = 0.001]. In terms of research training, 14.6 % (n = 31) had never thought about research training, 30.5 % (n = 65) had thought about research training but had taken no action, 20.7 % (n = 44) had thought about research training and discussed with others, 16.4 % (n = 35) had a plan for my research training, 6.6 % (n = 35) had enrolled for research training and 8.5 % (n = 18) had undertaken research training. In univariate analysis, those more ready had a postgraduate qualification (p \ 0.001), had a more positive general attitude to research (p \ 0.001), were more positive in terms of confidence, motivation and resources (p = 0.008), and responded more positively in terms of research culture (p \ 0.001). Binary logistic regression data are given in Table 4. The only significant factors were possessing a postgraduate qualification [OR 2.76 (95 % CI 1.40–5.43), p = 0.003] and having a more positive general attitude to research [OR 3.50 (95 % CI 1.82–6.75), p \ 0.001]. Almost all (89.7 %, n = 172) expressed interest in being involved in some form of research training; 26.8 % (n = 57) opted for training but not leading to a formal qualification, 21.6 % (n = 46) for university training at postgraduate certificate or diploma levels, 24.9 % (n = 53) for university training at masters level, and 16.4 % (n = 35) for university training at doctorate level. Key

Int J Clin Pharm Table 4 Binary logistic regression, readiness undertake research training (N = 213) Variables Postgraduate qualification Time since completed undergraduate degree

Category

Odds ratio

No

Reference

Yes

2.76

\5 years

Reference

C5 years

1.46

Component 1—General attitudes towards aspects of research [median score of 13

p value

1.40–5.43

0.003

0.65–3.30

0.357

Reference

Bmedian score of 13

3.50

Component 2—Confidence, motivation and resources

[median score of 30

Reference

Bmedian score of 30

1.32

Component 3—Research culture

[median score of 20

Reference

Bmedian score of 20 Resistant/cautious/change once peers change Role model/innovative

Diffusion of innovations

95 % CI

1.82–6.75 \0.001 0.67–2.61

0.421

1.90

0.98–1.86

0.056

Reference 1.02

0.65–1.96

0.942

For components, the lower the score represents more positive responses

areas of research identified were: specific patient groups (e.g. geriatrics, renal, pregnancy); therapeutic areas (e.g. diabetes mellitus, cardiovascular, pain); and pharmacy related processes (e.g. medication errors, clinical pharmacy, management and quality issues).

Discussion Key findings of this study are that respondents expressed high levels of interest in almost all aspects of research but were generally less confident and experienced. Principal component analysis of attitudinal items identified four components: general attitudes towards aspects of research; confidence, motivation and access; research culture; and support from others. Half of respondents had either never thought about being involved in research or had taken no action, with the significant independent factors being possessing a postgraduate qualification and more positive general attitudes towards research. Similarly, just under half had never thought about research training or had taken no action, with postgraduate qualifications and more positive general attitudes again being significant. The majority of respondents expressed interest in being involved in some form of research training. There are several limitations to the study and hence the results should be interpreted with caution. Despite the strategies employed to maximise participation, responses were received from just over half the study population which may have introduced and response bias. The reasons for non-participation are unknown and may have been due to the length of the questionnaire and/or difficulties in understanding research terms such as ‘cohort study’. Nonrespondents may have had no or little apparent interest in research or research training. While respondent

demographics were similar to the population, findings may not be generalizable within HMC or further afield. Findings are based on self reports with the potential for social desirability bias. Furthermore, there may have been an element of acquiescence bias surrounding the use of standard, fixed option responses for each item. Saris et al. [24] recommend adopting item specific scales to avoid respondents selecting the same ‘agree’ or ‘disagree’ response for each item. One strength of this research compared to other research in the field [6–13] is the comprehensive data collection of research interests, confidence, experience, attitudes and aspirations, together with identification of attitudinal components, and significant independent factors impacting research readiness and research training readiness highlighted via the regression analysis. The positive responses in relation to the need for, and relevance of, practice research have been demonstrated in other professional groupings [6–13], some of which have also reported higher levels of interest compared to confidence and experience [9, 11]. The internal reliability values for the item scales of interest, experience and confidence were high and there were positive correlations between interest and experience, interest and confidence, and confidence and experience. These data provide evidence of the robustness of the survey tool. The high summary scores for interest are notable and could themselves act as facilitators in progressing the pharmacy practice research agenda. The lower scores for experience and confidence are similarly important in developing researcher training and support programmes, and have been identified in other professions [11]. Respondents in this study were interested in all aspects of research, ranging from awareness of and systematically reviewing the research literature to generating research ideas, data collection and analysis, and dissemination. While these findings are similar to those of the Australian speech-language pathology

123

Int J Clin Pharm

workforce [11], respondents in our study had very little experience in the dissemination of research findings. Dissemination is essential to ensure that research has the widest possible impact in terms of practitioners, teams, organisations and most importantly patient care, while also being necessary for accumulating evidence of practice. Analysis of the responses to the attitudinal items identified four key components, each of which is relevant in terms of facilitating research training and research participation and also identifying and resolving barriers. The scores for component 1, general attitudes, were general favourable and higher than those of component 2, confidence, motivation and resources. Responses to the items relating to confidence were in accord with those of the confidence scale and are important in developing confident and competent research active pharmacists. Of note, there was less agreement for statements on items of support in areas of administration, IT, statistics and training indicating that these issues around structures and processes may be barriers to practice research. In terms of component 3, research culture, there was less agreement around issues such as working within research active pharmacy teams, multidisciplinary teams and environments. However, there were higher levels of agreement for component 4, support from fellow pharmacists, line managers and the organisation. While this support is encouraging, it may be undermined by a perceived negative research culture. These findings are of key relevance when considering the aims of research capacity building of encouraging research, improving researchers’ skills and identifying skills gaps [2]. As described by Cooke, there is a need to reflect on capacity building at the four structural levels of HMC, namely the individual pharmacists, the team (which could be the pharmacy team or the multidisciplinary team), the organisation, and supra-organisation [3]. Just over half of the respondents were not entirely confident in their abilities to identify their own training needs and hence a research driven needs assessment tool, such as the questionnaire used in this study, could be applied throughout organisations. Additionally, teams and organisations themselves also need to reflect on their strategic aims and plans around research and importantly ensure a positive research culture and that practitioners are supported by appropriate access to structures and processes such as statistical and administrative advice and services. This approach is in line with the steps of capacity building recommended by the UK Department for International Development: assessing training needs; strategic development and planning; implementing; and monitoring and evaluating [2]. Positive attitudes towards research and possessing a postgraduate qualification were significant in relation to readiness to participate in research and research training. While it may not be practicable to determine pharmacists’ attitudes, it is straightforward to identify those

123

with postgraduate education and training and there may be merit in prioritising and encouraging these individuals to be more research active. Indeed, it is unrealistic to expect that all pharmacists will be research active; all need to be research aware and supporting research, with less directly involved and leading research. The aspirations of the individual must be taken into consideration as part of any needs assessment. As discussed earlier, research findings will be used as part of research capacity development in HMC. There is a need to systematically evaluate the impact of strategic developments on research activity and outputs, using both qualitative and quantitative methodologies. Qualitative approaches could also provide further depth and explanation around identified facilitators and barriers. This study has aided in identifying gaps in pharmacists’ skills and organisational issues, and also allowed targeting of individuals for further training. The approach could be adopted universally by different professional groupings across the world and indeed there is much merit in undertaking a multiprofessional approach to research capacity building which would reflect interprofessional working and patient care.

Conclusion HMC pharmacists expressed significantly higher levels of interest in research compared to their experience and confidence. While general attitudes towards research were positive, there were some barriers relating to support (e.g. administration, IT) and research culture. Possessing a postgraduate qualification and a positive attitude towards were significant in relation to readiness to participate in research and research training. Findings are of key relevance when considering the aims of research capacity building of encouraging research, improving researchers’ skills and identifying skills gaps. Acknowledgments The authors would like to acknowledge the following for their contribution and support provided throughout this research: Dr. L. McHattie (research design); Dr. M. Bashir, Dr. S. Lutfi, Dr. N. Kheir, Dr. R. Singh, Dr. Wilby, Dr. K. MacLure, Dr. H. Vosper (questionnaire review); E. Watson (E-technology support); all study respondents. Funding

Funding was provided by Hamad Medical Corporation.

Conflicts of interest The authors have no conflicts of interest to declare.

References 1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. Br Med J. 1996;7023:712.

Int J Clin Pharm 2. Department for International Development. Capacity building in research. Available from https://www.gov.uk/government/ uploads/system/uploads/attachment_data/file/187568/HTN_Capa city_Building_Final_21_06_10.pdf. Accessed 15 July 2014. 3. Cooke J. A framework to evaluate research capacity building in health care. BMC Fam Pract. 2005;6(1):44. 4. Boyd A, Cole DC, Cho DB, Aslanyan G, Bates I. Frameworks for evaluating health research capacity strengthening: a qualitative study. Health Res Policy Syst. 2013;11:46. 5. Knapp KK, Manolakis M, Webster AA, Olsen KM. Projected growth in pharmacy education and research, 2010 to 2015. Am J Pharm Educ. 2011;75(6):108. 6. Rosenbloom K, Taylor K, Harding G. Community pharmacists’ attitudes towards research. Int J Pharm Pract. 2000;8(2):103–10. 7. Peterson G, Jackson SL, Fitzmaurice KD, Gee PR. Attitudes of Australian pharmacists towards practice based research. J Clin Pharm Ther. 2009;34:397–405. 8. Berger R. EBP: practitioners in search of evidence. J Soc Work. 2010;10:175. 9. Harvey D, Plummer D, Pighills A, Pain T. Practitioner research capacity: a survey of social workers in Northern Queensland. Aust Soc Work. 2013;66(4):540–54. 10. Pager S, Holden L, Golenko X. Motivators, enablers, and barriers to building allied health research capacity. J Multidiscip Health. 2012;5:53–9. 11. Finch E, Cornwell P, Ward EC, McPhail SM. Factors influencing research engagement: research interest, confidence and experience in an Australian speech-language pathology workforce. BMC Health Serv Res. 2013;13(1):144. 12. Salmon P, Peters S, Rogers A, Gask L, Clifford R, Iredale W, Morriss R. Peering through the barriers in GPs’ explanations for declining to participate in research: the role of professional autonomy and the economy of time. Fam Pract. 2007;24:269. 13. McMaster R, Jammali-Blasi A, Andersson-Noorgard K, Cooper K, McInnes E. Research involvement, support needs, and factors

14. 15.

16.

17. 18.

19. 20.

21.

22. 23. 24.

affecting research participation: a survey of Mental Health Consultation Liaison Nurses. Int J Ment Health Nurs. 2013;22(2):154–61. Hamad Medical Corporation. Available at http://www.hmc.org. qa/. Accessed 15 July 2014. Elkassem W, Pallivalapila A, McHattie L, Al Hail M, Diack L, Stewart D. Advancing the pharmacy practice research agenda: views and experiences of pharmacists in Qatar. Int J Clin Pharm. 2013;35:692–6. Roberts G. SET for Success: ‘the Report of Sir Gareth Roberts’ Review’, 2002. Available at http://www.rcuk.ac.uk/RCUK-prod/ assets/documents/skills/IndependentReviewHodge.pdf. Accessed 15 July 2014. Rogers EM. Diffusion of innovations. New York: Free Press; 2003. ISBN 9780743222099. Greenhalgh T, Robert G, MacFarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82:581–629. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;2(1):38. Prochaska JM, Prochaska JO, Levesque DA. A transtheoretical approach to changing organizations. Adm Policy Ment Health. 2001;28(4):247. Nakash RA, Hutton JL, Stein J, Gates S, Lamb SE. Maximising response to questionnaires—a systematic review of randomised trials in health research. BMC Med Res Methodol. 2006;6:5. DeVellis RF. Scale development: theory and applications. California: Sage Publications; 1991. ISBN 9781412980449. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88. Saris WE, Revilla M, Krosnick JA, Shae EM. Comparing questions with agree/disagree response options to questions with itemspecific response options. Surv Res Methods. 2010;4(1):61–79.

123

Building hospital pharmacy practice research capacity in Qatar: a cross-sectional survey of hospital pharmacists.

There is a need to systematically develop research capacity within pharmacy practice. Hamad Medical Corporation (HMC) is the principal non-profit heal...
219KB Sizes 0 Downloads 9 Views