This was the first national survey of AHP’s to explore perceptions of research in NHS health and social care settings. The study fulfilled the aim of generating a UK-wide picture of the perceived research capacity and culture across AHP professions.
Key findings indicated adequate levels of research success at individual-level and organisation-level, but less than adequate research success at team-level, based on previously defined categories for RCC tool responses [29]. Participants felt that at individual level they were successful at finding and critically appraising research literature, but not so successful/confident with other research skills. Whilst participants were typically motivated to engage in research to develop skills and increase job satisfaction, prioritisation of other work roles and lack of time were seen as key barriers. Participants rated their healthcare organisations most successful at promoting evidence-based clinical practice and encouraging research activity relevant to practice, and least successful at ensuring career pathways in research were available, and providing access to research software. Furthermore, whilst organisations were perceived to be good at providing library access and sharing information about research activity within the organisation, they were rated poorly for providing administrative support for research, and for establishing joint clinical/academic contracts. At team level, almost all categories of research activity and support were rated as less than adequate, with availability of software and applying for external research funding being rated as least successful.
Previous studies using the RCC tool have universally reported higher success ratings at organisation-level than at individual- or team-level. In other UK-based studies with AHP participants or with a mix of AHP and nursing participants, team-level ratings at aggregate level were also reported as high as, or higher than, individual-level ratings [24, 25]. This contrasts with the results from our survey. The less than adequate team-level scores of research capacity in our results echo anecdotal evidence that blockages to AHP research engagement and activity are particularly evident at middle-management level in organisations [24]. This is potentially due to low levels of research confidence among healthcare clinical team managers, combined with a common perception of conflicting push-pull demands on time and resources between patient care and research. Authors who found a similar disparity between team level success and success at individual and organisation level in an Australian study [31] concluded that research support at team level does not offer the connection needed between the organisation and the individual. Unfortunately, whilst individual AHPs may feel they have adequate research capability, and whilst research strategies might be produced and endorsed at board level, it falls to middle management to implement such strategies in daily practice and to support research-active individuals within their clinical teams. Team-level ‘middle’ managers therefore have a vital role in implementing evidence-based practice [32] and supporting their clinical teams in performing research activities’ [33]. However, only if they are equipped with the appropriate knowledge and skills, resources and authority, and support from senior management senior management [34] can middle managers be the key to facilitating AHP research engagement [35]. Of note, a recent Australian study surveying multiple healthcare disciplines suggests that inadequate research skill/ support at team-level may be a problem specific to allied health research [36]. National research support organisations may therefore need to target resources and efforts specifically towards supporting AHP team managers, ensuring they have access to relevant training, mentorship and support.
Key research motivators and barriers at an individual level identified by AHPs in our study reflected those in almost all previous studies for AHPs and other healthcare professionals in and beyond the UK. These suggest that whilst prioritisation of other job roles and lack of time present common barriers, research is almost universally seen as a positive way for clinical staff to develop skills and derive satisfaction from their jobs. Encouraging research development is likely to bring longer term workforce benefits, including more motivated and knowledgeable clinical teams [7, 37]. Moreover, investing in staff development is perhaps more important than ever in the post-Covid healthcare system, where health services are stretched like never before [38]. This is an important consideration for strategic workforce planning, where reversing the trend of NHS staff leaving service is now viewed as a crucial workstream. In turn, this may counter the unhelpful perception of research as an additional luxury and a distraction from the ‘real’ clinical work.
Of further interest is our important finding that research is rarely discussed as a routine part of personal development appraisals among participants in our survey; content analysis from free text responses similarly reflected participants’ perceptions of the low priority given to research activity, the lack of research career pathways, and limited or unclear opportunities for research engagement. The recently published SCORR tool has been developed specifically for clinicians as a tool to aid self-appraisal of research engagement levels. It can be used at appraisals to inform development needs, and may provide a helpful tool to initiate and support research discussions. Participants in our survey reported a surprising range of research engagement levels using this tool; the majority rated themselves at level 2 or 3 on the scale, indicating engagement as ‘consumers’ of research evidence to improve clinical care or for service development, which would be the lowest expected levels for healthcare professionals in clinical practice. Only 21% rated themselves at higher levels of 4 or 5 on the scale, indicating actively delivering or leading research to generate new research evidence. Furthermore, most respondents had not engaged in any research-related activity over the previous 12 months. The adequate levels of research skill or confidence reported in general by participants, does not, therefore seem to translate into higher levels of research engagement. This may indicate a gap in understanding of the research skills needed to drive the generation of new research knowledge, or may simply reflect a lack of aspiration or opportunity.
Mirroring findings from a recent unpublished survey led by CAHPR [39], participants in our survey reported low levels of awareness of research support infrastructures, including CAHPR and NIHR training schemes for AHPs. Whilst declaring clear intentions to support and increase AHP clinical research, these organisations could potentially play a stronger role in promoting and embedding a research culture in healthcare. In particular, there seems to be a need for them to focus attention on support for AHP clinical team managers. This might include ensuring healthcare managers have access to mentorship and support networks as well as information and resources, in addition to providing support for individual AHP researchers. Closer links with NHS England/NHS Improvement might help to ensure these organisations are visible, relevant and accessible to those working in crucial roles in NHS health and social care to facilitate research engagement.
Study limitations
The results of this survey should be viewed in the context of several study limitations. Firstly, although the number of participants was significantly greater than any previous studies evaluating research capacity, this still represents only a small proportion of AHPs working in NHS health and social care across the UK. The survey length and ongoing Covid pandemic at the time the survey was distributed were potential deterrents for busy clinicians to participate. Despite this, all four UK nations and all 14 AHP professions across a range of healthcare originations were represented in the survey responses.
Secondly, with all surveys there is inevitably a risk of self-selection bias towards participants with an interest (and therefore potentially greater engagement) in research, and the proportion of respondents with Masters and PhD level qualifications (49%) and research in their job roles (34%) likely reflects this. It is unclear whether the lower numbers of participants from outside England and from certain professions was due to lack of engagement in research, or due to other factors such as challenges with the distribution and promotion of the survey.
Thirdly, whilst the RCC tool probably represents the best tool currently available for assessing research capacity and capability, it may not be sensitive enough to evaluate all aspects and levels of research capacity. Research capacity frameworks identify factors which might be better evaluated using methods other than self-report questionnaire, such as research partnerships, publications, investment in infrastructure, and planning for sustainability and continuity [20]. Furthermore, a cross-sectional survey provides a snapshot of perceptions at a single time-point and is not able to identify trends over time. The tool does, however, provide a clear insight into current perceptions among AHPs of the research capacity and culture in the NHS at organization-, team- and individual-level.
Finally, in this manuscript, we have only presented topline results from our initial analysis of the data generated in this study. Whilst this provides invaluable information that will inform implementation of national research capacity strategies for AHPs, further in-depth analysis will provide an understanding of differences in research capacity and culture between different regions, professions and healthcare organisations that will be of interest to a variety of stakeholders.
Despite these limitations, this first ever national survey provides an important evaluation of the individual challenges, motivators, and confidence levels in research among AHPs. It highlights where organisation-level research support is sufficient and where it could be improved, and has exposed the team-level inadequacies that need addressing in order to unblock future AHP research potential.