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Factors influencing community intensive care unit research participation: a qualitative descriptive study
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Purpose Community hospitals account for 90% of hospitals in Canada, but clinical research is mainly conducted in academic hospitals. Increasing community hospital research participation can improve generalizability of study results, while also accelerating study recruitment and increasing staff engagement. We aimed to identify and describe the factors that influence community intensive care unit (ICU) research participation and the development, implementation, and sustainability of a community ICU research program.MethodsWe conducted a qualitative descriptive study using semistructured interviews. Between April 2022 and May 2023, we interviewed a purposeful sample of individuals interested or involved in community hospital research in Canadian community ICUs. We analyzed qualitative data using both conventional content analysis and rapid qualitative analysis. Findings were deductively mapped out using the Ecological Model of Health Behavior. Quantitative survey data were analyzed using descriptive statistics.ResultsParticipants included 23 health care workers, ten research staff, and five hospital administrators (n = 38) from 20 community hospitals across six provinces in Canada. The main factors associated with community ICU research participation were 1) infrastructure, 2) personnel characteristics, 3) key relationships and connections, and 4) the COVID-19 pandemic.ConclusionIn this qualitative descriptive study, participants identified the physical resources, skills, and relationships required to start and sustain a clinical research program in a Canadian community ICU. Our findings suggest that all levels of the Canadian health care system need to invest in strengthening community hospital research capacity to increase research participation.
Objectif Les hoˆpitaux communautaires repre´sentent 90 % des hoˆpitaux au Canada, mais la recherche clinique est principalement mene´e dans les hoˆpitaux universitaires. L’augmentation de la participation a` la recherche dans les hoˆpitaux communautaires peut ame´liorer la ge´ne´ralisabilite´ des re´sultats des e´tudes, tout en acce´le´rant le recrutement et en mobilisant l’engagement du personnel. Notre objectif e´tait d’identifier et de de´crire les facteurs qui influencent la participation a` la recherche dans les unite´s de soins intensifs (USI) communautaires ainsi que l’e´laboration, la mise en œuvre et la durabilite´ d’un programme de recherche communautaire en USI. Me´thode Nous avons mene´ une e´tude descriptive qualitative a` l’aide d’entretiens semi-directifs. Entre avril 2022 et mai 2023, nous avons interroge´ un e´chantillon cible´ de personnes inte´resse´es ou implique´es dans la recherche en milieu hospitalier communautaire dans les unite´s de soins intensifs communautaires du Canada. Nous avons analyse´ les donne´es qualitatives en utilisant a` la fois l’analyse de contenu conventionnelle et l’analyse qualitative rapide. Les re´sultats ont e´te´cartographie´s de manie`re de´ductive a`l’aide du mode`le e´cologique de comportement en matie`re de sante´. Les donne´es quantitatives de l’enqueˆte ont e´te´ analyse´es a` l’aide de statistiques descriptives. Re´sultats Les participant es comprenaient 23 travailleurs et travailleuses de la sante´, dix membres du personnel de recherche et cinq membres de l’administration hospitalie`re (n = 38) provenant de 20 hoˆpitaux communautaires re´partis dans six provinces du Canada. Les principaux facteurs associe´s a` la participation a` la recherche en USI dans les collectivite´s e´taient 1) l’infrastructure, 2) les caracte´ristiques du personnel, 3) les relations et les liens cle´s, et 4) la pande´mie de COVID-19. Conclusion Dans cette e´tude descriptive qualitative, les participant es ont identifie´ les ressources physiques, les compe´tences et les relations ne´cessaires pour de´marrer et maintenir un programme de recherche clinique dans une unite´ de soins intensifs communautaire canadienne. Nos constatations sugge`rent que tous les niveaux du syste`me de soins de sante´ canadien doivent investir dans le renforcement de la capacite´ de recherche des hoˆpitaux communautaires afin d’accroıˆtre la participation a` la recherche. Keywords community hospital critical care research capacity research culture Community hospitals account for 544/602 (90%) hospitals in Canada.1 Nevertheless, most clinical research is conducted in academic hospitals,2–4 and few community hospitals have significant research engagement.5 Consequently, patients living near community hospitals have reduced access to health research and are less likely to be enrolled in clinical trials.6 This situation persisted during the COVID-19 pandemic despite international efforts to broadly recruit patients into large-scale clinical trials.3,5,7 This is problematic because of differences in sociodemographic and clinical characteristics between patients living near academic and community hospitals. Community hospitals are more likely to be located in suburban and rural communities,6,8 and to serve populations with higher proportions of recent immigrants,9 lower socioeconomic status,10 and reduced access to subspecialized care.11,12 In addition, patients in community hospitals tend to be older, with more comorbidities and a higher risk of in-hospital mortality.13 Therefore, increasing community hospital engagement in clinical research is necessary to ensure equitable patient access to research and to enhance the generalizability of research findings, study efficiency, and knowledge translation.3,13 Furthermore, clinical research participation improves quality of care, drives innovation, enhances clinical staff satisfaction and retention, and may improve patient outcomes.14–17 Despite these benefits, barriers to community hospital research participation include a lack of funding, protected time and experienced research staff, limited administrative support, and inadequate research infrastructure.18–20 Community hospitals also face unique contextual barriers that influence research program initiation, growth, and sustainability,21,22 including the lack of institutional commitment and mandates,2,5,7 and varying levels of university affiliation,23 resulting in a fragmented culture of research.7 In Canada, these challenges are compounded 12
Objectif Les hoˆpitaux communautaires repre´sentent 90 % des hoˆpitaux au Canada, mais la recherche clinique est principalement mene´e dans les hoˆpitaux universitaires. L’augmentation de la participation a` la recherche dans les hoˆpitaux communautaires peut ame´liorer la ge´ne´ralisabilite´ des re´sultats des e´tudes, tout en acce´le´rant le recrutement et en mobilisant l’engagement du personnel. Notre objectif e´tait d’identifier et de de´crire les facteurs qui influencent la participation a` la recherche dans les unite´s de soins intensifs (USI) communautaires ainsi que l’e´laboration, la mise en œuvre et la durabilite´ d’un programme de recherche communautaire en USI. Me´thode Nous avons mene´ une e´tude descriptive qualitative a` l’aide d’entretiens semi-directifs. Entre avril 2022 et mai 2023, nous avons interroge´ un e´chantillon cible´ de personnes inte´resse´es ou implique´es dans la recherche en milieu hospitalier communautaire dans les unite´s de soins intensifs communautaires du Canada. Nous avons analyse´ les donne´es qualitatives en utilisant a` la fois l’analyse de contenu conventionnelle et l’analyse qualitative rapide. Les re´sultats ont e´te´cartographie´s de manie`re de´ductive a`l’aide du mode`le e´cologique de comportement en matie`re de sante´. Les donne´es quantitatives de l’enqueˆte ont e´te´ analyse´es a` l’aide de statistiques descriptives. Re´sultats Les participant es comprenaient 23 travailleurs et travailleuses de la sante´, dix membres du personnel de recherche et cinq membres de l’administration hospitalie`re (n = 38) provenant de 20 hoˆpitaux communautaires re´partis dans six provinces du Canada. Les principaux facteurs associe´s a` la participation a` la recherche en USI dans les collectivite´s e´taient 1) l’infrastructure, 2) les caracte´ristiques du personnel, 3) les relations et les liens cle´s, et 4) la pande´mie de COVID-19. Conclusion Dans cette e´tude descriptive qualitative, les participant es ont identifie´ les ressources physiques, les compe´tences et les relations ne´cessaires pour de´marrer et maintenir un programme de recherche clinique dans une unite´ de soins intensifs communautaire canadienne. Nos constatations sugge`rent que tous les niveaux du syste`me de soins de sante´ canadien doivent investir dans le renforcement de la capacite´ de recherche des hoˆpitaux communautaires afin d’accroıˆtre la participation a` la recherche. Keywords community hospital critical care research capacity research culture Community hospitals account for 544/602 (90%) hospitals in Canada.1 Nevertheless, most clinical research is conducted in academic hospitals,2–4 and few community hospitals have significant research engagement.5 Consequently, patients living near community hospitals have reduced access to health research and are less likely to be enrolled in clinical trials.6 This situation persisted during the COVID-19 pandemic despite international efforts to broadly recruit patients into large-scale clinical trials.3,5,7 This is problematic because of differences in sociodemographic and clinical characteristics between patients living near academic and community hospitals. Community hospitals are more likely to be located in suburban and rural communities,6,8 and to serve populations with higher proportions of recent immigrants,9 lower socioeconomic status,10 and reduced access to subspecialized care.11,12 In addition, patients in community hospitals tend to be older, with more comorbidities and a higher risk of in-hospital mortality.13 Therefore, increasing community hospital engagement in clinical research is necessary to ensure equitable patient access to research and to enhance the generalizability of research findings, study efficiency, and knowledge translation.3,13 Furthermore, clinical research participation improves quality of care, drives innovation, enhances clinical staff satisfaction and retention, and may improve patient outcomes.14–17 Despite these benefits, barriers to community hospital research participation include a lack of funding, protected time and experienced research staff, limited administrative support, and inadequate research infrastructure.18–20 Community hospitals also face unique contextual barriers that influence research program initiation, growth, and sustainability,21,22 including the lack of institutional commitment and mandates,2,5,7 and varying levels of university affiliation,23 resulting in a fragmented culture of research.7 In Canada, these challenges are compounded 12
Description
Keywords
Community hospital Critical care Research capacity Research culture
Citation
Publisher
Springer