An Interactive Global Health Study Builder Tool to Empower Frontline Healthcare Workers in Research Leadership

An Interactive Global Health Study Builder Tool to Empower Frontline Healthcare Workers in Research Leadership | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article An Interactive Global Health Study Builder Tool to Empower Frontline Healthcare Workers in Research Leadership Paul Tunde Kingpriest, Samuel Driver, Aashna Uppal, Hams Bashir, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7903851/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Frontline healthcare workers, particularly in low- and middle-income countries (LMICs), are often best positioned to identify and address context-specific health challenges through research. However, many lack access to user-friendly tools and support systems that facilitate research initiation and implementation. This paper describes the development, pilot testing, and early outcomes of an interactive online global health study builder tool to support frontline healthcare workers with little or no formal research training in leading pragmatic studies. Methods A multidisciplinary team comprising researchers, nurses, midwives, community health workers, software developers, and communication experts co-designed the tool through an iterative process of consultations and baselining meetings. This tool walks users through six key stages of research: formulating a research question, designing the study, engaging communities, obtaining permissions, managing data, and disseminating results, while providing multilingual, contextually relevant resources. A pilot version of the tool was launched and feedback guided refinement. Results The feedback from 44 pilot users highlighted the tool’s practicality, multilingual accessibility, and intuitive design. Participants reported increased confidence in conducting research and valued the collaborative features. Suggestions led to key improvements, including guide videos, simplified navigation, enhanced visuals, and added guidance tools, strengthening its usability and relevance across LMIC contexts. Conclusion The study builder tool demonstrates the feasibility and value of digital tools in enabling frontline healthcare workers to build sustainable research experience. This open-access solution represents a scalable model for empowering local research leadership and influencing practice and policy in LMIC contexts. Clinical trial number: not applicable Research capacity digital tools global health LMICs study builder implementation research Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background Research leadership among frontline healthcare workers is an essential yet underdeveloped component of health systems strengthening in low- and middle-income countries (LMICs). Nurses, midwives, community health workers and other allied healthcare workers are often closest to the realities of health service delivery and thus best placed to identify priority problems, generate locally relevant evidence, and implement context-appropriate solutions [1]. However, despite their critical position, these crucial elements of the healthcare workforce face persistent structural and institutional barriers to engaging in research, including limited training opportunities, lack of mentorship, insufficient access to research tools and resources, and minimal institutional support [2,3]. Over the past 15 years, The Global Health Network (TGHN), a World Health Organization Collaborating Centre for Research Capacity Strengthening, has worked to address these barriers by developing and disseminating open-access digital resources that enable healthcare workers to undertake and lead high quality health research. With a global membership exceeding one million, TGHN has built a wide array of initiatives to support research readiness in LMICs. These include online training courses, research resource hubs, needs assessments, and structured evaluation frameworks, as well as communities of practice that foster peer support and cross-country learning [4,5]. In furtherance of its mission to democratise research and promote equity in knowledge generation and sharing, TGHN developed an interactive study builder tool designed specifically for healthcare workers with limited or no prior research experience (https://globalhealthstudybuilder.org/). The tool aims to guide users through the essential steps of designing and conducting a simple yet pragmatic health study. This toolkit is evidence-led, with the steps informed from the WHO Tropical Training in Tropical Disease Research core competencies for health researchers, and subsequent studies that support that competences can be grouped into these steps [6,7]. Mapping the competencies to these steps is also validated by analysing use of other tools across TGHN, such as the health research cycle, the process map and the research ecosystem across TGHN all support these same groupings and so we use these consistently in the development of new tools [8]. Therefore, we know that the steps in the study builder tool logically break down and tackle the barriers that we know researcher face in the process of planning and running a study. This paper describes the design and development process of the study builder tool, the pilot testing carried out with frontline users, and the improvements made based on these researchers’ feedback. It also reflects on the significance of participatory approach and the implications of such tools for advancing locally led research and influencing practice and policy in LMIC settings. Methods Tool Design and Development Process The study builder tool was conceptualised and developed through a collaborative and iterative design process based on the core steps determined through evidence and over a decade of providing a wide range of tools and training resources to research teams. The goal was to bring these together in a logical and accessible sequence that would guide researchers through the process of running a study, and at every step make the information and tools they would need available at that specific point. A multidisciplinary working group was established, comprising researchers, software developers, digital content specialists, communications experts, project managers, and, critically, frontline healthcare workers including nurses, midwives, and community health workers from LMICs to refine and curate these resources into the study builder tool. This composition ensured the relevance, usability, and contextual appropriateness of the tool. The development process began with a series of baselining and development meetings to agree on the scope, structure, and functionality of the tool. These meetings focused on mapping the researchers experience on using the tool, defining the knowledge offered at each step, and identifying digital formats most suitable for varied contexts. The tool was structured into six stages of research practice: Setting the Research Question; Designing the Study; Community Engagement; Obtaining Permissions and Ethical Approval; Data Management; and Dissemination and Implementation (Fig. 1 ) This six-stage approach is strongly evidence based, as described earlier and aligned with other resources and training offered by TGHN (Uppal et al., 2025 ). Each stage includes explanatory texts, practical examples, and curated resources drawn from TGHN’s existing resource gateway ( https://hub.tghn.org/resources-gateway ). Researchers are presented with reflective questions at the end of each stage to guide application of learning to their own study ideas. Examples include: “What problem or gap have you identified in your environment?” and “Using the PICO/PECO framework, what is your research question?” (Fig. 2 ). Healthcare workers with experience conducting research in LMICs developed most of the guidance materials provided to support each step. Their contributions include written texts and video recordings, which shared personal experiences, strategies for overcoming barriers, and context-specific guidance. These were made accessible in four languages (English, French, Spanish, and Portuguese). All videos included transcripts to ensure inclusivity across literacy levels and linguistic backgrounds. Digital Development and Interface Design Following the development process, a prototype was developed by TGHN’s software development team. Continuous feedback loops between the project team and researcher members allowed for real-time refinements. Once the prototype’s functionality was finalised, it was handed over to the user interface (UI) and user experience (UX) teams to improve design aesthetics, navigation, and accessibility. A comprehensive guide, frequently asked question (FAQ) section, and introductory resources (text and video) were integrated to support first-time researchers (Fig. 3 ). To foster collaboration and knowledge sharing, the tool allows researchers to set up individual profiles, invite collaborators to join study teams, and leave comments at each research stage (Fig. 4 ). All ongoing and completed studies are visible within the platform to encourage transparency and knowledge exchange, while safeguarding user-generated content through backend moderation by the TGHN digital team (Fig. 5 ). Pilot Testing through the 1,000 Challenge After an initiative in-house pretesting, the pilot phase of the tool was launched as part of the 1,000 Challenge in partnership with the Nursing Now Challenge (De et al., 2023 ; NDM News, 2023 ). Dissemination was primarily carried out through TGHN’s Global Research Nurses network and Nursing Now’s communications channels (The Burdett Trust, 2023 ). Participants were invited to engage with the tool. Feedback was captured through online survey provided at the completion of the study and through direct consultations with those with completed studies. Feedback was collected on usability, clarity of content, relevance of resources, perceived utility, and suggestions for improvement. Iterative Refinement User feedback guided a series of modifications including the introduction of short videos for each research stage to enhance comprehension, streamlining of the user workflow to reduce unnecessary navigation steps, improving the design elements to enhance visual appeal and user engagement and expansion of the community features, including options for group chats and further requests for support. All changes were tested internally before the final version of the tool was launched. Data oversight mechanisms were established to ensure that posted studies adhered to ethical standards. A disclaimer and terms of use were built into the registration process, and TGHN retains the right to remove content that violates community or ethical standards. Ethics All participants involved in the assessment of the develop of this resource provided informed consent prior to their participation. In addition, those who contributed to the development of media resources signed a written media consent form, in line with the University of Oxford policy. Institutional ethical approval was granted by the Oxford Tropical Research Ethics Committee (OxTREC) for mixed-method impact research, under reference number 541 − 18. Results Tool Features and Functionalities The global health study builder tool now incorporates a range of features designed to support novice researchers through a structured yet flexible study development, guiding and support process. The six-stage framework provides scaffolded guidance, each with a combination of: bespoke introduction texts and videos explaining each research step; reflective prompts to encourage application of learning; curated access to relevant tools and resources through TGHN’s resource gateway; a multilingual interface (English, French, Spanish, Portuguese); integrated collaboration functions allowing users to invite co-researchers, comment on work-in-progress, and build joint study portfolios; visibility of all ongoing and completed studies on the platform to foster transparency and peer learning; a volunteer community for user support and moderation The tool also included a clear user guide, an FAQ section, and further support channels and signposting to ensure ease of navigation and fast access to the missing knowledge or tools they are experiencing at each specific step. Language inclusivity was prioritised with multilingual transcripts and native-language content contributors. This resource is free and open access, ensuring full and equitable accessibility. Pilot Engagement and User Feedback A total of 44 users from 16 LMICs completed a study and provided feedback in the pilot phase of the study builder use. Of these, 36 were female and 8 were male. By professional background, 23 participants identified as nurses, 8 as midwives, 6 as community health workers, 2 as laboratory staff, and 5 as pharmacists (Fig. 6 ; Appendix 1). These users were invited to use the platform over a defined testing period and provide structured feedback. User feedback offered rich insights into the tool’s functionality, accessibility, and relevance. Most participants praised the focus on pragmatic, context-sensitive research and noted the tool’s alignment with real-world health system priorities in their respective settings. The multilingual interface and intuitive layout were widely appreciated, with users highlighting the straightforward language and easy navigation as major enablers. Participants reported an increase in their confidence to independently design a research study. For some, the tool helped to demystify research by breaking it into manageable, well-explained components. The collaborative features were also highly valued. Users noted that the ability to invite colleagues, leave comments, and jointly develop studies encouraged interprofessional teamwork and knowledge sharing. Moreover, the shared development of content, particularly the personal experiences shared by healthcare workers from LMICs, was described as authentic, practical, and relatable. Feedback gathered during the pilot phase directly informed several key improvements to the tool. Notably, short explainer videos were introduced at each stage to cater to different learning styles. Navigation was also simplified to reduce cognitive load and address login difficulties. Also, in response to aesthetic concerns raised by users, the user interface was enhanced to improve visual appeal and user engagement. Additional guidance tools, including downloadable templates, checklists, and annotated examples, were also integrated to support structured learning. Illustrative quotes from pilot participants are summarised in Table 1 , capturing common themes and specific suggestions that informed subsequent platform refinements. Table 1 Selected User Feedback from the Study Builder Tool Pilot Theme User Quote User Details Commendation “I love how the examples are based in real world. Not just theory. It is practical, not like what we learn in school” KU, Midwife, Nigeria Language Accessibility “This is a good tool that will help lots (of) nurses. The resources need to be made available in Latin American languages and maybe a short video explaining the process could help nurses understand the process better.” DM, Midwife, Argentina Navigation and Login “I struggled to log in and set up the password, there are too many steps. Otherwise, I like the tool and I think it will help many young nurses to do research. I didn’t have this kind of privilege as a young nurse; I had to learn by myself.” MB, Nurse, Kenya Registration Process “I struggled to follow the process explained in the email until someone helped me. Can you put a video to explain the registration process?” LN, Midwife, Malawi Visual Design “The resources in it are quite useful but the thing itself doesn’t look attractive.” HB, Pharmacist, Sudan To ensure responsible use, an ethical oversight mechanism was added, including content moderation, the ability to report inappropriate content, and clear terms of use. These safeguards were embedded within the registration process to ensure adherence to community and ethical standards. Overall, users expressed strong enthusiasm for the tool’s future applications, noting its potential utility within institutional research capacity-building initiatives across LMICs. Discussion Here we report development, piloting, and refinement of an interactive study builder tool designed to empower frontline healthcare workers in LMICs to lead their own locally relevant health research. The tool represents a novel response to long-standing challenges in research capacity strengthening, particularly the lack of practical, accessible, and context-appropriate platforms tailored to the realities of health professionals at all levels. Our tool shares conceptual features with existing digital solutions such as OpenEpi, a free web-based suite of epidemiological and statistical tools used globally by public health practitioners, including in LMICs. OpenEpi emphasises accessibility, multi-language support, and user friendliness, enabling users without advanced training to perform statistical analyses confidently (Kevin Sullivan et al., 2014 ). However, unlike OpenEpi, which focuses on post-data-collection analysis, our study builder guides the user through the entire research journey, from question formulation through dissemination, offering a more comprehensive end-to-end design and implementation scaffold. Another relevant comparison is with digital qualitative data analysis platforms such as Quirkos, which, with its intuitive interface and live collaboration features, supports non-academic users in thematic analysis. While Quirkos serves primarily analytical needs, our study builder tool integrates the full research lifecycle and includes interactive support mechanisms, such as reflective prompts and peer commenting (Ting et al., 2024 ). Having a range of researchers who work in low-resource setting directly designing this solution was central to the success of the project. By involving healthcare workers with lived experience of delivering care and navigating research challenges in LMICs, the content and functionality of the tool were rooted in practical realities. This participatory development process ensured the tool was not only technically sound but also culturally and professionally relevant. It also fostered a sense of ownership and trust among the target user base, which is critical for long-term uptake (Langley et al., 2018 ). This approach aligns with phenomenological and participatory methods used in the development of eHealth tools, such as in COPD support platforms co-created with patients, where iterative cycles of interview, prototyping, and user validation shaped tool design (Lundell et al., 2022 ). As highlighted in reviews of co-design and co-creation in LMIC health services research, such methods build trust, incorporate diverse voices, and improve contextual fit, though they may face practical challenges including time, resourcing, and power dynamics (Agnello et al., 2024 ; Singh et al., 2023 ). The six-stage structure of the tool reflects internationally recognised research processes while remaining flexible to accommodate users with varying levels of experience. The reflective questions and curated learning resources offered a blend of education and application that allowed users to progress from idea generation to implementation with minimal external supervision. Moreover, the inclusion of multilingual options and real-world examples increased accessibility and usability across a broad range of settings. This approach differs from tools like OpenEpi or Quirkos, which, while accessible, are narrowly focused on analysis or qualitative work (Kevin Sullivan et al., 2014 ; Ting et al., 2024 ). The TGHN study builder represents a more holistic model, integrating guidance, collaboration, and resource linkage across research stages. Findings from the pilot demonstrated strong user engagement, perceived usefulness, and demand for such a resource. Participants highlighted the value of the tool for professional growth and evidence-informed practice. This aligns with previous calls for inclusive and practical digital innovations to close the persistent gap in research participation among frontline workers (Goodyear-Smith et al., 2019 ). The tool’s open-access and collaborative design also has important implications for fostering community-based learning and practice-based research networks. By enabling users to connect with peers, share study designs, and comment on each other’s work, the platform supports a learning health system model. This form of decentralised and democratised research infrastructure is particularly relevant in LMICs, where formal mentorship and institutional support structures may be limited (Lescano et al., 2018 ). While the majority of the pilot users were drawn from nursing and midwifery networks, the tool has been intentionally designed for use in pragmatic health research studies by all levels of the healthcare workforce and across sectors. Health workers in low-resource settings report lack structured mentorship and institutional support for research and therefore stand to benefit most from a tool that is accessible, practical, and adaptable to their realities (Walker et al., 2025 ). This should enable broad applicability, as this is designed to work for any form of health research. Study, in any disease and in any setting. This tool addresses a critical gap by empowering frontline health workers who are frequently excluded from conventional research training opportunities. Future evaluations should explore uptake and impact across a wider range of healthcare professionals, geographies, and languages. Additional features such as offline access, mobile optimisation, and integration with existing institutional research workflows may also enhance future versions. Finally, while content moderation provides a safeguard for ethical compliance, promoting a culture of ethical research practice among users remains essential. Ongoing education and institutional engagement will be needed to reinforce responsible conduct. Conclusion This paper has described the development, and pilot testing of an interactive study builder tool designed to support frontline healthcare workers in LMICs to lead pragmatic and locally relevant research. Informed by the lived realities of nurses, midwives, and community health workers, and guided by global standards for ethical and practical research, the tool provides an accessible and structured pathway from problem identification to dissemination. The pilot demonstrated the tool’s potential to increase research confidence, foster collaboration, and empower users to contribute to evidence generation and practice improvement within their local health systems. By combining technical design with participatory co-development, and by integrating language accessibility and peer support, this initiative contributes meaningfully to the broader goal of equitable research capacity strengthening. As global health moves towards more inclusive and decentralised models of evidence production, tools such as this study builder offer a scalable, low-barrier entry point for frontline professionals to engage in research leadership. Further dissemination, contextual adaptations, and formal evaluation will be critical to sustaining impact and ensuring that locally led research continues to shape policy and practice in LMIC contexts. Abbreviations FAQ Frequently Asked Questions LMICs Low–and Middle–Income Countries OxTREC Oxford Tropical Research Ethics Committee TGHN The Global Health Network UI User Interface UX User Experience Declarations Ethics approval and consent to participate: All participants involved in the co-creation exercise provided informed consent prior to their participation. In addition, those who contributed to the development of media resources signed a written media consent form, in line with the University of Oxford policy. Institutional ethical approval was granted by the Oxford Tropical Research Ethics Committee (OxTREC) for mixed-method impact research, under reference number 541-18. Consent for publication : All participants involved in the co-creation process provided informed consent. Those who contributed to the development of media resources additionally signed a media release form, in accordance with University of Oxford regulations. Availability of data : All data relating to the participants feedback is available in the attached appendix 1. The study builder tool is an open access tool available at https://globalhealthstudybuilder.org/. Competing Interests : The authors declare no competing interests. Funding: Development of the global health study builder tool was supported by a grant from The Burdett Trust for Nursing . Author Contributions: PTK: conceptualisation, methodology, formal analysis, investigation, resources, data curation, visualisation, software, validation, writing – original draft, review and editing, project administration. SD, AU, HB, CK, AS, MB, ASO, ASR: conceptualisation, methodology, resources, writing – review and editing. SD, AS: software, validation. KW: methodology, writing – review and editing. TL: conceptualisation, methodology, resources, supervision, writing – review and editing. All authors read and approved the final manuscript. Acknowledgements: The authors would like to express their sincere gratitude to all members of The Global Health Network’s digital and communications team, as well as the frontline healthcare workers across participating countries who contributed to the design, development, and piloting of the study builder tool. We particularly acknowledge the invaluable contributions of Shan Gray, Arancha de la Horra, Zainab Al-Rawni and Daniella Morelli for their roles in supporting content development and dissemination. Special appreciation is extended to the Nursing Now Challenge team for their collaboration and support in implementing and disseminating the 1,000 Challenge initiative. We would like to specifically recognise Aisha Holloway and Hannah Finch for their contributions to this partnership. We are grateful to our volunteer community moderators and content contributors whose efforts helped shape the learning resources and provided critical guidance to users during the pilot phase. Finally, we thank Gavin Chait and Leo Boante for leading the software development of the study builder platform. References WHO. State of the world’s nursing 2020: investing in education, jobs and leadership [Internet]. 2020 [cited 2025 Aug 28]. p. 116. https://www.who.int/publications/i/item/9789240003279. Accessed 28 Aug 2025 Scala E, Price C, Day J. An Integrative Review of Engaging Clinical Nurses in Nursing Research. Journal of Nursing Scholarship [Internet]. John Wiley & Sons, Ltd; 2016 [cited 2025 Aug 28];48:423–30. https://doi.org/10.1111/JNU.12223 Norman MK, Bridges MW, Hofmann R. The Four Paradoxes That Stop Practitioners from Using Research to Change Professional Practice and How to Overcome Them. Education Sciences 2024, Vol 14, Page 996 [Internet]. 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BioMed Central Ltd; 2023 [cited 2025 Aug 26];8:1–8. https://doi.org/10.1186/S41256-023-00290-6/FIGURES/1 Goodyear-Smith F, Bazemore A, Coffman M, Fortier RDW, Howe A, Kidd M, et al. Research gaps in the organisation of primary healthcare in low-income and middle-income countries and ways to address them: a mixed-methods approach. BMJ Glob Health [Internet]. BMJ Publishing Group Ltd; 2019 [cited 2025 Aug 28];4:1482. https://doi.org/10.1136/BMJGH-2019-001482 Lescano AG, Cohen CR, Raj T, Rispel L, Garcia PJ, Zunt JR, et al. Strengthening Mentoring in Low- and Middle-Income Countries to Advance Global Health Research: An Overview. Am J Trop Med Hyg [Internet]. The American Society of Tropical Medicine and Hygiene; 2018 [cited 2025 Aug 26];100:3–8. https://doi.org/10.4269/AJTMH.18-0556 Additional Declarations No competing interests reported. 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Programme","correspondingAuthor":false,"prefix":"","firstName":"Mwanamvua","middleName":"","lastName":"Boga","suffix":""},{"id":535184877,"identity":"ac7f0d8d-7563-4645-bda2-6b888951ca56","order_by":8,"name":"Aromoke Sanjo-Odutayo","email":"","orcid":"","institution":"Babcock University","correspondingAuthor":false,"prefix":"","firstName":"Aromoke","middleName":"","lastName":"Sanjo-Odutayo","suffix":""},{"id":535184878,"identity":"96ab57ac-6f31-4e05-9d4d-f8b6425318de","order_by":9,"name":"Amina Suleiman Rajah","email":"","orcid":"","institution":"Bayero University","correspondingAuthor":false,"prefix":"","firstName":"Amina","middleName":"Suleiman","lastName":"Rajah","suffix":""},{"id":535184879,"identity":"12544156-2d21-4807-97cb-7c46c861cb53","order_by":10,"name":"Trudie Lang","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Trudie","middleName":"","lastName":"Lang","suffix":""}],"badges":[],"createdAt":"2025-10-20 08:53:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7903851/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7903851/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":97988998,"identity":"0f5dea1e-2714-4847-b5c8-bcec560afa2d","added_by":"auto","created_at":"2025-12-11 14:21:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33530,"visible":true,"origin":"","legend":"\u003cp\u003eStages of the research cycle in the study builder\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7903851/v1/be354573726acaa35fe6edb7.png"},{"id":98424589,"identity":"d8c667f3-cc05-4afa-b4df-355b7f2bb525","added_by":"auto","created_at":"2025-12-17 16:33:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":126806,"visible":true,"origin":"","legend":"\u003cp\u003eStage 1 of the study process showing link to resources, community and reflective questions.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7903851/v1/dc18e13636c9528b2157f290.png"},{"id":97989004,"identity":"8410566b-9fad-4d21-a33f-e0ed6aaf6cc8","added_by":"auto","created_at":"2025-12-11 14:21:24","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":74726,"visible":true,"origin":"","legend":"\u003cp\u003eUser Guide Page\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7903851/v1/60d321bbc22e5cf0242fff9f.png"},{"id":97989001,"identity":"eb6db6d9-d695-4c36-b7a2-0b62381f9afc","added_by":"auto","created_at":"2025-12-11 14:21:24","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":18485,"visible":true,"origin":"","legend":"\u003cp\u003eExample researcher profile page\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7903851/v1/53be00cf1e7238410fde8780.png"},{"id":98424321,"identity":"b2537712-6dc4-4bb8-a9d9-643348adce9f","added_by":"auto","created_at":"2025-12-17 16:33:11","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":78928,"visible":true,"origin":"","legend":"\u003cp\u003eUser interface showing the side tabs including the “View all Studies” tab\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-7903851/v1/c276a7513e970b86208c3074.png"},{"id":97988999,"identity":"f5cce411-2a9e-47ae-9dca-d7f7f35b0fa2","added_by":"auto","created_at":"2025-12-11 14:21:24","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":52848,"visible":true,"origin":"","legend":"\u003cp\u003eShowing the geographic distribution of pilot users.\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-7903851/v1/356a9a04551238cc3f05c088.png"},{"id":99796022,"identity":"9a94443e-72dc-455e-922d-66737bf1fc2a","added_by":"auto","created_at":"2026-01-08 13:40:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":971210,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7903851/v1/88780989-d26f-4679-8424-5b4e88a7cf91.pdf"},{"id":98423551,"identity":"6a48ab15-3047-43f0-932d-ae25a4b1478a","added_by":"auto","created_at":"2025-12-17 16:32:21","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":14270,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7903851/v1/2c821146049d33b5a62599e4.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"An Interactive Global Health Study Builder Tool to Empower Frontline Healthcare Workers in Research Leadership","fulltext":[{"header":"Background","content":"\u003cp\u003eResearch leadership among frontline healthcare workers is an essential yet underdeveloped component of health systems strengthening in low- and middle-income countries (LMICs). Nurses, midwives, community health workers and other allied healthcare workers are often closest to the realities of health service delivery and thus best placed to identify priority problems, generate locally relevant evidence, and implement context-appropriate solutions [1]. However, despite their critical position, these crucial elements of the healthcare workforce face persistent structural and institutional barriers to engaging in research, including limited training opportunities, lack of mentorship, insufficient access to research tools and resources, and minimal institutional support [2,3].\u003c/p\u003e\n\u003cp\u003eOver the past 15 years, The Global Health Network (TGHN), a World Health Organization Collaborating Centre for Research Capacity Strengthening, has worked to address these barriers by developing and disseminating open-access digital resources that enable healthcare workers to undertake and lead high quality health research. With a global membership exceeding one million, TGHN has built a wide array of initiatives to support research readiness in LMICs. These include online training courses, research resource hubs, needs assessments, and structured evaluation frameworks, as well as communities of practice that foster peer support and cross-country learning [4,5].\u003c/p\u003e\n\u003cp\u003eIn furtherance of its mission to democratise research and promote equity in knowledge generation and sharing, TGHN developed an interactive study builder tool designed specifically for healthcare workers with limited or no prior research experience (https://globalhealthstudybuilder.org/). The tool aims to guide users through the essential steps of designing and conducting a simple yet pragmatic health study. This toolkit is evidence-led, with the steps informed from the WHO Tropical Training in Tropical Disease Research core competencies for health researchers, and subsequent studies that support that competences can be grouped into these steps [6,7]. Mapping the competencies to these steps is also validated by analysing use of other tools across TGHN, such as the health research cycle, the process map and the research ecosystem across TGHN all support these same groupings and so we use these consistently in the development of new tools [8]. Therefore, we know that the steps in the study builder tool logically break down and tackle the barriers that we know researcher face in the process of planning and running a study.\u003c/p\u003e\n\u003cp\u003eThis paper describes the design and development process of the study builder tool, the pilot testing carried out with frontline users, and the improvements made based on these researchers\u0026rsquo; feedback. It also reflects on the significance of participatory approach and the implications of such tools for advancing locally led research and influencing practice and policy in LMIC settings.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eTool Design and Development Process\u003c/h2\u003e\u003cp\u003eThe study builder tool was conceptualised and developed through a collaborative and iterative design process based on the core steps determined through evidence and over a decade of providing a wide range of tools and training resources to research teams. The goal was to bring these together in a logical and accessible sequence that would guide researchers through the process of running a study, and at every step make the information and tools they would need available at that specific point. A multidisciplinary working group was established, comprising researchers, software developers, digital content specialists, communications experts, project managers, and, critically, frontline healthcare workers including nurses, midwives, and community health workers from LMICs to refine and curate these resources into the study builder tool. This composition ensured the relevance, usability, and contextual appropriateness of the tool.\u003c/p\u003e\u003cp\u003eThe development process began with a series of baselining and development meetings to agree on the scope, structure, and functionality of the tool. These meetings focused on mapping the researchers experience on using the tool, defining the knowledge offered at each step, and identifying digital formats most suitable for varied contexts. The tool was structured into six stages of research practice: Setting the Research Question; Designing the Study; Community Engagement; Obtaining Permissions and Ethical Approval; Data Management; and Dissemination and Implementation (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) This six-stage approach is strongly evidence based, as described earlier and aligned with other resources and training offered by TGHN (Uppal et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eEach stage includes explanatory texts, practical examples, and curated resources drawn from TGHN\u0026rsquo;s existing resource gateway (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://hub.tghn.org/resources-gateway\u003c/span\u003e\u003cspan address=\"https://hub.tghn.org/resources-gateway\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Researchers are presented with reflective questions at the end of each stage to guide application of learning to their own study ideas. Examples include: \u0026ldquo;What problem or gap have you identified in your environment?\u0026rdquo; and \u0026ldquo;Using the PICO/PECO framework, what is your research question?\u0026rdquo; (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eHealthcare workers with experience conducting research in LMICs developed most of the guidance materials provided to support each step. Their contributions include written texts and video recordings, which shared personal experiences, strategies for overcoming barriers, and context-specific guidance. These were made accessible in four languages (English, French, Spanish, and Portuguese). All videos included transcripts to ensure inclusivity across literacy levels and linguistic backgrounds.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDigital Development and Interface Design\u003c/h3\u003e\n\u003cp\u003eFollowing the development process, a prototype was developed by TGHN\u0026rsquo;s software development team. Continuous feedback loops between the project team and researcher members allowed for real-time refinements. Once the prototype\u0026rsquo;s functionality was finalised, it was handed over to the user interface (UI) and user experience (UX) teams to improve design aesthetics, navigation, and accessibility. A comprehensive guide, frequently asked question (FAQ) section, and introductory resources (text and video) were integrated to support first-time researchers (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTo foster collaboration and knowledge sharing, the tool allows researchers to set up individual profiles, invite collaborators to join study teams, and leave comments at each research stage (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAll ongoing and completed studies are visible within the platform to encourage transparency and knowledge exchange, while safeguarding user-generated content through backend moderation by the TGHN digital team (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003ePilot Testing through the 1,000 Challenge\u003c/h3\u003e\n\u003cp\u003eAfter an initiative in-house pretesting, the pilot phase of the tool was launched as part of the 1,000 Challenge in partnership with the Nursing Now Challenge (De et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; NDM News, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Dissemination was primarily carried out through TGHN\u0026rsquo;s Global Research Nurses network and Nursing Now\u0026rsquo;s communications channels (The Burdett Trust, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eParticipants were invited to engage with the tool. Feedback was captured through online survey provided at the completion of the study and through direct consultations with those with completed studies. Feedback was collected on usability, clarity of content, relevance of resources, perceived utility, and suggestions for improvement.\u003c/p\u003e\n\u003ch3\u003eIterative Refinement\u003c/h3\u003e\n\u003cp\u003eUser feedback guided a series of modifications including the introduction of short videos for each research stage to enhance comprehension, streamlining of the user workflow to reduce unnecessary navigation steps, improving the design elements to enhance visual appeal and user engagement and expansion of the community features, including options for group chats and further requests for support.\u003c/p\u003e\u003cp\u003eAll changes were tested internally before the final version of the tool was launched. Data oversight mechanisms were established to ensure that posted studies adhered to ethical standards. A disclaimer and terms of use were built into the registration process, and TGHN retains the right to remove content that violates community or ethical standards.\u003c/p\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003e All participants involved in the assessment of the develop of this resource provided informed consent prior to their participation. In addition, those who contributed to the development of media resources signed a written media consent form, in line with the University of Oxford policy. Institutional ethical approval was granted by the Oxford Tropical Research Ethics Committee (OxTREC) for mixed-method impact research, under reference number 541\u0026thinsp;\u0026minus;\u0026thinsp;18.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eTool Features and Functionalities\u003c/h2\u003e\u003cp\u003eThe global health study builder tool now incorporates a range of features designed to support novice researchers through a structured yet flexible study development, guiding and support process. The six-stage framework provides scaffolded guidance, each with a combination of: bespoke introduction texts and videos explaining each research step; reflective prompts to encourage application of learning; curated access to relevant tools and resources through TGHN\u0026rsquo;s resource gateway; a multilingual interface (English, French, Spanish, Portuguese); integrated collaboration functions allowing users to invite co-researchers, comment on work-in-progress, and build joint study portfolios; visibility of all ongoing and completed studies on the platform to foster transparency and peer learning; a volunteer community for user support and moderation\u003c/p\u003e\u003cp\u003eThe tool also included a clear user guide, an FAQ section, and further support channels and signposting to ensure ease of navigation and fast access to the missing knowledge or tools they are experiencing at each specific step. Language inclusivity was prioritised with multilingual transcripts and native-language content contributors. This resource is free and open access, ensuring full and equitable accessibility.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePilot Engagement and User Feedback\u003c/h3\u003e\n\u003cp\u003eA total of 44 users from 16 LMICs completed a study and provided feedback in the pilot phase of the study builder use. Of these, 36 were female and 8 were male. By professional background, 23 participants identified as nurses, 8 as midwives, 6 as community health workers, 2 as laboratory staff, and 5 as pharmacists (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e; Appendix 1). These users were invited to use the platform over a defined testing period and provide structured feedback.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eUser feedback offered rich insights into the tool\u0026rsquo;s functionality, accessibility, and relevance. Most participants praised the focus on pragmatic, context-sensitive research and noted the tool\u0026rsquo;s alignment with real-world health system priorities in their respective settings. The multilingual interface and intuitive layout were widely appreciated, with users highlighting the straightforward language and easy navigation as major enablers. Participants reported an increase in their confidence to independently design a research study. For some, the tool helped to demystify research by breaking it into manageable, well-explained components.\u003c/p\u003e\u003cp\u003eThe collaborative features were also highly valued. Users noted that the ability to invite colleagues, leave comments, and jointly develop studies encouraged interprofessional teamwork and knowledge sharing. Moreover, the shared development of content, particularly the personal experiences shared by healthcare workers from LMICs, was described as authentic, practical, and relatable.\u003c/p\u003e\u003cp\u003eFeedback gathered during the pilot phase directly informed several key improvements to the tool. Notably, short explainer videos were introduced at each stage to cater to different learning styles. Navigation was also simplified to reduce cognitive load and address login difficulties. Also, in response to aesthetic concerns raised by users, the user interface was enhanced to improve visual appeal and user engagement. Additional guidance tools, including downloadable templates, checklists, and annotated examples, were also integrated to support structured learning. Illustrative quotes from pilot participants are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, capturing common themes and specific suggestions that informed subsequent platform refinements.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eSelected User Feedback from the Study Builder Tool Pilot\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUser Quote\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUser Details\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommendation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;I love how the examples are based in real world. Not just theory. It is practical, not like what we learn in school\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKU, Midwife, Nigeria\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLanguage Accessibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;This is a good tool that will help lots (of) nurses. The resources need to be made available in Latin American languages and maybe a short video explaining the process could help nurses understand the process better.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDM, Midwife, Argentina\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNavigation and Login\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;I struggled to log in and set up the password, there are too many steps. Otherwise, I like the tool and I think it will help many young nurses to do research. I didn\u0026rsquo;t have this kind of privilege as a young nurse; I had to learn by myself.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMB, Nurse, Kenya\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegistration Process\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;I struggled to follow the process explained in the email until someone helped me. Can you put a video to explain the registration process?\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLN, Midwife, Malawi\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisual Design\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ldquo;The resources in it are quite useful but the thing itself doesn\u0026rsquo;t look attractive.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHB, Pharmacist, Sudan\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTo ensure responsible use, an ethical oversight mechanism was added, including content moderation, the ability to report inappropriate content, and clear terms of use. These safeguards were embedded within the registration process to ensure adherence to community and ethical standards.\u003c/p\u003e\u003cp\u003eOverall, users expressed strong enthusiasm for the tool\u0026rsquo;s future applications, noting its potential utility within institutional research capacity-building initiatives across LMICs.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHere we report development, piloting, and refinement of an interactive study builder tool designed to empower frontline healthcare workers in LMICs to lead their own locally relevant health research. The tool represents a novel response to long-standing challenges in research capacity strengthening, particularly the lack of practical, accessible, and context-appropriate platforms tailored to the realities of health professionals at all levels.\u003c/p\u003e\u003cp\u003eOur tool shares conceptual features with existing digital solutions such as OpenEpi, a free web-based suite of epidemiological and statistical tools used globally by public health practitioners, including in LMICs. OpenEpi emphasises accessibility, multi-language support, and user friendliness, enabling users without advanced training to perform statistical analyses confidently (Kevin Sullivan et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). However, unlike OpenEpi, which focuses on post-data-collection analysis, our study builder guides the user through the entire research journey, from question formulation through dissemination, offering a more comprehensive end-to-end design and implementation scaffold. Another relevant comparison is with digital qualitative data analysis platforms such as Quirkos, which, with its intuitive interface and live collaboration features, supports non-academic users in thematic analysis. While Quirkos serves primarily analytical needs, our study builder tool integrates the full research lifecycle and includes interactive support mechanisms, such as reflective prompts and peer commenting (Ting et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHaving a range of researchers who work in low-resource setting directly designing this solution was central to the success of the project. By involving healthcare workers with lived experience of delivering care and navigating research challenges in LMICs, the content and functionality of the tool were rooted in practical realities. This participatory development process ensured the tool was not only technically sound but also culturally and professionally relevant. It also fostered a sense of ownership and trust among the target user base, which is critical for long-term uptake (Langley et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis approach aligns with phenomenological and participatory methods used in the development of eHealth tools, such as in COPD support platforms co-created with patients, where iterative cycles of interview, prototyping, and user validation shaped tool design (Lundell et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). As highlighted in reviews of co-design and co-creation in LMIC health services research, such methods build trust, incorporate diverse voices, and improve contextual fit, though they may face practical challenges including time, resourcing, and power dynamics (Agnello et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Singh et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe six-stage structure of the tool reflects internationally recognised research processes while remaining flexible to accommodate users with varying levels of experience. The reflective questions and curated learning resources offered a blend of education and application that allowed users to progress from idea generation to implementation with minimal external supervision. Moreover, the inclusion of multilingual options and real-world examples increased accessibility and usability across a broad range of settings. This approach differs from tools like OpenEpi or Quirkos, which, while accessible, are narrowly focused on analysis or qualitative work (Kevin Sullivan et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Ting et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The TGHN study builder represents a more holistic model, integrating guidance, collaboration, and resource linkage across research stages.\u003c/p\u003e\u003cp\u003eFindings from the pilot demonstrated strong user engagement, perceived usefulness, and demand for such a resource. Participants highlighted the value of the tool for professional growth and evidence-informed practice. This aligns with previous calls for inclusive and practical digital innovations to close the persistent gap in research participation among frontline workers (Goodyear-Smith et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe tool\u0026rsquo;s open-access and collaborative design also has important implications for fostering community-based learning and practice-based research networks. By enabling users to connect with peers, share study designs, and comment on each other\u0026rsquo;s work, the platform supports a learning health system model. This form of decentralised and democratised research infrastructure is particularly relevant in LMICs, where formal mentorship and institutional support structures may be limited (Lescano et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile the majority of the pilot users were drawn from nursing and midwifery networks, the tool has been intentionally designed for use in pragmatic health research studies by all levels of the healthcare workforce and across sectors. Health workers in low-resource settings report lack structured mentorship and institutional support for research and therefore stand to benefit most from a tool that is accessible, practical, and adaptable to their realities (Walker et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). This should enable broad applicability, as this is designed to work for any form of health research. Study, in any disease and in any setting. This tool addresses a critical gap by empowering frontline health workers who are frequently excluded from conventional research training opportunities. Future evaluations should explore uptake and impact across a wider range of healthcare professionals, geographies, and languages. Additional features such as offline access, mobile optimisation, and integration with existing institutional research workflows may also enhance future versions. Finally, while content moderation provides a safeguard for ethical compliance, promoting a culture of ethical research practice among users remains essential. Ongoing education and institutional engagement will be needed to reinforce responsible conduct.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e This paper has described the development, and pilot testing of an interactive study builder tool designed to support frontline healthcare workers in LMICs to lead pragmatic and locally relevant research. Informed by the lived realities of nurses, midwives, and community health workers, and guided by global standards for ethical and practical research, the tool provides an accessible and structured pathway from problem identification to dissemination.\u003c/p\u003e\u003cp\u003eThe pilot demonstrated the tool\u0026rsquo;s potential to increase research confidence, foster collaboration, and empower users to contribute to evidence generation and practice improvement within their local health systems. By combining technical design with participatory co-development, and by integrating language accessibility and peer support, this initiative contributes meaningfully to the broader goal of equitable research capacity strengthening.\u003c/p\u003e\u003cp\u003eAs global health moves towards more inclusive and decentralised models of evidence production, tools such as this study builder offer a scalable, low-barrier entry point for frontline professionals to engage in research leadership. Further dissemination, contextual adaptations, and formal evaluation will be critical to sustaining impact and ensuring that locally led research continues to shape policy and practice in LMIC contexts.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFAQ\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFrequently Asked Questions\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLow\u0026ndash;and Middle\u0026ndash;Income Countries\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOxTREC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOxford Tropical Research Ethics Committee\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTGHN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eThe Global Health Network\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUser Interface\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUX\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUser Experience\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants involved in the co-creation exercise provided informed consent prior to their participation. In addition, those who contributed to the development of media resources signed a written media consent form, in line with the University of Oxford policy. Institutional ethical approval was granted by the Oxford Tropical Research Ethics Committee (OxTREC) for mixed-method impact research, under reference number 541-18.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eAll participants involved in the co-creation process provided informed consent. Those who contributed to the development of media resources additionally signed a media release form, in accordance with University of Oxford regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data\u003c/strong\u003e: All data relating to the participants feedback is available in the attached appendix 1. The study builder tool is an open access tool available at https://globalhealthstudybuilder.org/.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e: The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003cbr\u003eDevelopment of the global health study builder tool was supported by a grant from \u003cstrong\u003eThe Burdett Trust for Nursing\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePTK: conceptualisation, methodology, formal analysis, investigation, resources, data curation, visualisation, software, validation, writing \u0026ndash; original draft, review and editing, project administration.\u003c/p\u003e\n\u003cp\u003eSD, AU, HB, CK, AS, MB, ASO, ASR: conceptualisation, methodology, resources, writing \u0026ndash; review and editing.\u003c/p\u003e\n\u003cp\u003eSD, AS: software, validation.\u003c/p\u003e\n\u003cp\u003eKW: methodology, writing \u0026ndash; review and editing.\u003c/p\u003e\n\u003cp\u003eTL: conceptualisation, methodology, resources, supervision, writing \u0026ndash; review and editing.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors would like to express their sincere gratitude to all members of The Global Health Network\u0026rsquo;s digital and communications team, as well as the frontline healthcare workers across participating countries who contributed to the design, development, and piloting of the study builder tool.\u003c/p\u003e\n\u003cp\u003eWe particularly acknowledge the invaluable contributions of Shan Gray, Arancha de la Horra, Zainab Al-Rawni and Daniella Morelli for their roles in supporting content development and dissemination.\u003c/p\u003e\n\u003cp\u003eSpecial appreciation is extended to the Nursing Now Challenge team for their collaboration and support in implementing and disseminating the 1,000 Challenge initiative. We would like to specifically recognise Aisha Holloway and Hannah Finch for their contributions to this partnership.\u003c/p\u003e\n\u003cp\u003eWe are grateful to our volunteer community moderators and content contributors whose efforts helped shape the learning resources and provided critical guidance to users during the pilot phase.\u003c/p\u003e\n\u003cp\u003eFinally, we thank Gavin Chait and Leo Boante for leading the software development of the study builder platform.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. State of the world\u0026rsquo;s nursing 2020: investing in education, jobs and leadership [Internet]. 2020 [cited 2025 Aug 28]. p. 116. https://www.who.int/publications/i/item/9789240003279. Accessed 28 Aug 2025\u003c/li\u003e\n\u003cli\u003eScala E, Price C, Day J. An Integrative Review of Engaging Clinical Nurses in Nursing Research. Journal of Nursing Scholarship [Internet]. John Wiley \u0026amp; Sons, Ltd; 2016 [cited 2025 Aug 28];48:423\u0026ndash;30. https://doi.org/10.1111/JNU.12223\u003c/li\u003e\n\u003cli\u003eNorman MK, Bridges MW, Hofmann R. The Four Paradoxes That Stop Practitioners from Using Research to Change Professional Practice and How to Overcome Them. Education Sciences 2024, Vol 14, Page 996 [Internet]. Multidisciplinary Digital Publishing Institute; 2024 [cited 2025 Aug 28];14:996. https://doi.org/10.3390/EDUCSCI14090996\u003c/li\u003e\n\u003cli\u003eTGHN. WHO Collaborating Centre \u0026bull; The Global Health Network [Internet]. 2025 [cited 2025 Aug 28]. https://hub.tghn.org/about/who-collaborating-centre/. Accessed 28 Aug 2025\u003c/li\u003e\n\u003cli\u003eTGHN. Global Activities \u0026bull; The Global Health Network [Internet]. 2025 [cited 2025 Aug 28]. https://hub.tghn.org/global-activities/. Accessed 28 Aug 2025\u003c/li\u003e\n\u003cli\u003eJul\u0026eacute; A, Furtado T, Boggs L, Van Loggerenberg F, Ewing V, Vahedi M, et al. Developing a globally applicable evidence-informed competency framework to support capacity strengthening in clinical research. BMJ Glob Health [Internet]. BMJ Publishing Group Ltd; 2017 [cited 2025 Oct 8];2. https://doi.org/10.1136/BMJGH-2016-000229\u003c/li\u003e\n\u003cli\u003eWalker RJ, Kingpriest PT, Gong J, Naisanga M, Ashraf MN, Roberti J, et al. Global perspectives on infectious diseases at risk of escalation and their drivers. Nature Scientific Reports. 2025; https://doi.org/https://doi.org/10.1038/s41598-025-22573-3\u003c/li\u003e\n\u003cli\u003eTGHN. Home \u0026bull; Process Map [Internet]. 2023 [cited 2025 Oct 8]. https://processmap.tghn.org/. Accessed 8 Oct 2025\u003c/li\u003e\n\u003cli\u003eUppal A, Kagoro F, Monteiro-Krebs L, Bueno FTC, Marques LP, Tessema SK, et al. Pathfinder studies: a novel tool for process mapping data-driven health research to build global research capacity. BMC Med Res Methodol [Internet]. BioMed Central Ltd; 2025 [cited 2025 Sep 23];25:1\u0026ndash;8. https://doi.org/10.1186/S12874-025-02638-7/FIGURES/5\u003c/li\u003e\n\u003cli\u003eNDM News. The Global Health Network launch The 1000 Challenge \u0026mdash; Nuffield Department of Medicine [Internet]. 2023 [cited 2025 Aug 28]. https://www.ndm.ox.ac.uk/news/the-global-health-network-launch-the-1000-challenge. Accessed 28 Aug 2025\u003c/li\u003e\n\u003cli\u003eDe A, Horra L, Lang T, Holloway A. OA-345 The 1,000 global research studies challenge: developing nursing, midwifery and community health workers\u0026rsquo; research leaders to transform global healthcare. BMJ Glob Health [Internet]. BMJ Publishing Group Ltd; 2023 [cited 2025 Aug 29];8:A13.1-A13. https://doi.org/10.1136/BMJGH-2023-EDC.29\u003c/li\u003e\n\u003cli\u003eThe Burdett Trust. Nursing Now Challenge and The Global Health Network announce co-launch of groundbreaking global work: The 1,000 Challenge \u0026ndash; The Burdett Trust for Nursing [Internet]. 2023 [cited 2025 Aug 28]. https://www.btfn.org.uk/nursing-now-challenge-and-the-global-health-network-announce-co-launch-of-groundbreaking-global-work-the-1000-challenge/. Accessed 28 Aug 2025\u003c/li\u003e\n\u003cli\u003eKevin Sullivan by M, Andrew Dean MG, Minn Minn Soe M. An Introduction to OpenEpi Version 3.0.1. 2014; \u003c/li\u003e\n\u003cli\u003eTing H, Turner D, Memon A, Gong J. Qualitative data analysis software: Reflecting on 10 years of Quirkos. Asian Journal of Business Research. 2024;14. https://doi.org/10.14707/ajbr.240177\u003c/li\u003e\n\u003cli\u003eLangley J, Wolstenholme D, Cooke J. \u0026ldquo;Collective making\u0026rdquo; as knowledge mobilisation: The contribution of participatory design in the co-creation of knowledge in healthcare. BMC Health Serv Res [Internet]. BioMed Central Ltd.; 2018 [cited 2025 Aug 28];18:1\u0026ndash;10. https://doi.org/10.1186/S12913-018-3397-Y/FIGURES/2\u003c/li\u003e\n\u003cli\u003eLundell S, Toots A, S\u0026ouml;nnerfors P, Halvarsson A, Wadell K. Participatory methods in a digital setting: experiences from the co-creation of an eHealth tool for people with chronic obstructive pulmonary disease. BMC Med Inform Decis Mak [Internet]. BioMed Central Ltd; 2022 [cited 2025 Aug 26];22:1\u0026ndash;14. https://doi.org/10.1186/S12911-022-01806-9/FIGURES/3\u003c/li\u003e\n\u003cli\u003eAgnello DM, Balaskas G, Steiner A, Chastin S. Methods Used in Co-Creation Within the Health CASCADE Co-Creation Database and Gray Literature: Systematic Methods Overview. Interact J Med Res [Internet]. Interactive Journal of Medical Research; 2024 [cited 2025 Aug 26];13:e59772. https://doi.org/10.2196/59772\u003c/li\u003e\n\u003cli\u003eSingh DR, Sah RK, Simkhada B, Darwin Z. Potentials and challenges of using co-design in health services research in low- and middle-income countries. Glob Health Res Policy [Internet]. BioMed Central Ltd; 2023 [cited 2025 Aug 26];8:1\u0026ndash;8. https://doi.org/10.1186/S41256-023-00290-6/FIGURES/1\u003c/li\u003e\n\u003cli\u003eGoodyear-Smith F, Bazemore A, Coffman M, Fortier RDW, Howe A, Kidd M, et al. Research gaps in the organisation of primary healthcare in low-income and middle-income countries and ways to address them: a mixed-methods approach. BMJ Glob Health [Internet]. BMJ Publishing Group Ltd; 2019 [cited 2025 Aug 28];4:1482. https://doi.org/10.1136/BMJGH-2019-001482\u003c/li\u003e\n\u003cli\u003eLescano AG, Cohen CR, Raj T, Rispel L, Garcia PJ, Zunt JR, et al. Strengthening Mentoring in Low- and Middle-Income Countries to Advance Global Health Research: An Overview. Am J Trop Med Hyg [Internet]. The American Society of Tropical Medicine and Hygiene; 2018 [cited 2025 Aug 26];100:3\u0026ndash;8. https://doi.org/10.4269/AJTMH.18-0556 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Research capacity, digital tools, global health, LMICs, study builder, implementation research","lastPublishedDoi":"10.21203/rs.3.rs-7903851/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7903851/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrontline healthcare workers, particularly in low- and middle-income countries (LMICs), are often best positioned to identify and address context-specific health challenges through research. However, many lack access to user-friendly tools and support systems that facilitate research initiation and implementation. This paper describes the development, pilot testing, and early outcomes of an interactive online global health study builder tool to support frontline healthcare workers with little or no formal research training in leading pragmatic studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA multidisciplinary team comprising researchers, nurses, midwives, community health workers, software developers, and communication experts co-designed the tool through an iterative process of consultations and baselining meetings. This tool walks users through six key stages of research: formulating a research question, designing the study, engaging communities, obtaining permissions, managing data, and disseminating results, while providing multilingual, contextually relevant resources. A pilot version of the tool was launched and feedback guided refinement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe feedback from 44 pilot users highlighted the tool’s practicality, multilingual accessibility, and intuitive design. Participants reported increased confidence in conducting research and valued the collaborative features. Suggestions led to key improvements, including guide videos, simplified navigation, enhanced visuals, and added guidance tools, strengthening its usability and relevance across LMIC contexts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study builder tool demonstrates the feasibility and value of digital tools in enabling frontline healthcare workers to build sustainable research experience. This open-access solution represents a scalable model for empowering local research leadership and influencing practice and policy in LMIC contexts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number: \u003c/strong\u003enot applicable\u003c/p\u003e","manuscriptTitle":"An Interactive Global Health Study Builder Tool to Empower Frontline Healthcare Workers in Research Leadership","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-11 14:21:13","doi":"10.21203/rs.3.rs-7903851/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6785c842-d4f0-4115-9f53-d921cccefccd","owner":[],"postedDate":"December 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-07T14:10:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-11 14:21:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7903851","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7903851","identity":"rs-7903851","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}