Exploring the Research Interest, Capacity and Culture of NHS Staff in South-East Scotland following the SARS-CoV-2 Pandemic: a Qualitative Study

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The UK Government has published its strategy to increase research within the National Health Service (NHS) and to implement lessons learned from the SARS-CoV-2 pandemic. We have investigated the current research interest, culture, and capacity amongst staff in one small, non-teaching regional Health Board in Scotland to determine how research activity may be increased and how attitudes to research may have changed following the recent pandemic. Methods Semi-structured interviews ( n = 28) were conducted with staff of all grades exploring the research culture at an organisational, team and individual level. Topics included perceived barriers and facilitators for engaging in research activities and the impact of the SARS-CoV-2 pandemic on changes in attitude to research within the NHS. Interviews were audio recorded, transcribed verbatim, and analysed using thematic analysis. Results Respondents comprised 7 nurses/midwives, 6 doctors/dentists, 3 allied health professionals, 3 other therapeutic and 9 admin/support staff. Some staff had research written into their job descriptions. All respondents identified similar facilitators and barriers to undertaking research, irrespective of their role or experience with research. Four key themes affecting research capacity and capability were time, resources, culture, and communication. Responses varied between staff grades where those who had research embedded as part of their training and professional role expressed more accepting views to undertaking research. Issues identified were the provision of protected time, skills training, practical support from research facilitators, active encouragement by managers of all grades, improved communication, the development of ‘champions’ working in clinical teams and the adoption of a research strategy at Board level. The pandemic had a negative impact on research activity but many respondents expressed an increased awareness of the importance of research as a priority in improving health outcomes during the pandemic. Conclusions The research interest and culture in our Health Board can be improved by addressing the four broad themes identified, thereby increasing research capacity in line with Government aspirations. The findings may have relevance for other small health providers that intend to respond to the call to increase their research profile. Research Capacity Health Research Research Capacity Building Innovation Research Activity Barriers Motivators Pandemic BACKGROUND It is well recognised that patients experience better outcomes in healthcare settings that are more research-active [1–4]. Clinical research activity is therefore a key driver to improve the quality of patient care. The UK Government has recently published its ‘Vision for Research’ and ‘Implementation Plan’ that seeks to develop a research culture and increase research activity within the National Health Service (NHS) [5,6]. The Scottish Government is a key partner in implementing this UK-wide strategy that also seeks to build on the lessons from the SARS-CoV-2 pandemic [7]. Previous studies investigating attitudes of clinical staff to research have noted differences between medical, nursing and Allied Health Professionals (AHPs) in their research skill levels and confidence in undertaking research [8,9]. Approaches to increasing research activity in health care settings have identified, for example, the need for training [10], funding [11,12], protected time [8,13], the use of research facilitators [14–17] and links with academia [18,19]. The health service in Scotland comprises 14 Health Boards, of varying size and engagement in research. NHS Fife is one of the smaller, non-teaching Boards serving a population of 370,000 with a workforce of 8,500. The NHS Fife Research, Innovation and Knowledge department (formerly Research and Development, R&D) supports a small group of research active staff through a range of services including the provision of clinical research nurses, librarians, research advisers and administrative staff. The recent initiative by the UK Government seeks to encourage clinical staff, of all grades, to see research as part of their role [6,7]. At present, little is known of the research culture and research interest amongst the general workforce in NHS Fife. We were particularly interested in assessing how staff perceptions of the role of, and importance of research in the NHS may have changed because of the SARS-CoV-2 pandemic. We undertook a mixed methods study of staff to investigate attitudes to research within the organisation. Information was collected using an online, validated questionnaire that enquired into aspects of research at the organisational, team and individual levels. Staff were also invited to take part in semi-structured interviews to obtain more in-depth information relating to attitudes, barriers, and motivators to research. The results from the quantitative aspects of the study have been published [20]. This paper presents the results from the qualitative interviews where the aim was to explore in more depth the attitudes of staff, both active and non-active in research, and record their suggestions on improving the research culture and increasing research activity within our health board. METHODS The aim of this qualitative part of our mixed-methods study was to explore staff attitudes on the research culture and capacity within NHS Fife using semi-structured interviews. Key objectives were to: (1) describe the current perceptions of the research interest, capacity, and culture, (2) investigate barriers and motivators for research activity and (3) assess any change in staff attitudes to research following the SARS-CoV-2 pandemic. NHS Fife and Health and Social Care Partnership staff were recruited via the online survey [20]. The survey was advertised via the NHS Fife Communication Department’s weekly updates which were sent to all staff with an NHS Fife email address. Managers were also asked to encourage their staff to participate and promote the study within team meetings. A further advertisement appeared on staff computer desktop screens. Staff who wanted to engage with the study completed the online questionnaire. After completing it, respondents were invited to provide their NHS Fife email address if they were interested in taking part in the additional interview arm of the study. These participants were then contacted by an author (MP) to arrange a date and time for the interview. An additional snowball sampling method was utilised by contacting current research active and non-active staff and asking them to contact others who may be interested in participating in the interview. All interviews took place between December 2021 and February 2022 by MP, a clinical psychologist assistant trained in qualitative methods. One interview was conducted by FQ, a Professor of Health Care Research (PhD) experienced in qualitative methods. Interviews were conducted online using a video call via Microsoft™ Teams software. The duration of each interview was approximately 30 minutes. Interviews were recorded using a digital recorder, the Microsoft™ Teams transcription service and then further transcribed verbatim to increase validity and reliability. Field notes were not taken. No respondents were re-interviewed and no transcripts were returned to the interviewees for addition or correction. Each respondent received a £20 gift voucher. The semi-structured interviews utilised a topic and question guide to focus discussion (Additional File 1). The guide was constructed using the same principal domains as the online questionnaire [20], the research culture and capacity on an individual, team and organisational level. The guide was piloted on three independent healthcare professionals and revised according to feedback. Interviews were transcribed verbatim by a professional transcribing service, Dictate2Us . All transcripts were anonymised. Data analysis followed Braun and Clarke’s 6-step guide to thematic analysis [21]: familiarising oneself with data, generation of initial codes, searching for themes, reviewing themes, defining, and naming themes, reporting on themes. Interview transcripts were coded by MP manually using Microsoft™ Word processor. Saturation was reached by the 21st interview. An additional two qualitative researchers (FQ and FD) analysed a subset of 12 out of the 28 interview transcripts and generated themes in parallel, using the 6-step guide to thematic analysis. The 12 transcripts were chosen at random and the additional reviewers were blinded as to the respondent’s staff grade. The three researchers (MP, FQ and FD) then compared findings and reached a consensus on final themes. The research project had NHS Fife Management approval. Approval from an NHS Ethics committee was not required under guidance from the Health Research Authority as respondents were NHS staff ( www.hra-decisiontools.org.uk ). However, the study was conducted in accordance with the principles written into the Declaration of Helsinki (June 1964). Informed consent was obtained using an information sheet (Additional File 2) and consent script (Additional File 3). Verbal consent was audio recorded at the beginning of each semi-structured interview and evidenced within the interview transcripts. Respondents were informed that they were free to withdraw at any time, for any reason and any published quotations would be anonymised. The study is reported following the Consolidated Criteria for Reporting Qualitative Research (COREQ) [22] (Additional File 4). RESULTS Respondents Fifty-seven individuals expressed an interest in taking part in the semi-structured interviews. Twenty-eight individuals were interviewed (18 female, 10 male) and the remainder either did not respond to the researcher’s request to set up a date ( n = 25) or were too busy to participate ( n = 4). Respondents included a mix of staff: 7 nursing/midwifery, 6 medical/dental, 3 allied health professionals, 3 other therapeutic and 9 admin/support staff. Some staff had research written into their job descriptions whilst others did not. Some staff who claimed not to undertake research did take on activities that were associated with research. This non-recognition of what research entails was more noticeable in professions that traditionally see themselves as ‘patient-focussed’ only and non-researchers. Research Findings All the respondents identified similar facilitators and barriers to undertaking research activity within the organisation, irrespective of their role or experience with research. The degree that these factors affected the individual respondent varied according to their circumstances, but to a lesser or greater degree all respondents identified: Time, Resources, Culture, and Communication, as themes that influenced research activity. We also asked respondents about their thoughts on how the SARS-CoV-2 pandemic had affected their perception of research. Within these broad themes, there were intrinsic as well as extrinsic factors that were found to be indicators of research facilitators and barriers amongst NHS staff (Table 1). Individuals who had research as part of their professional role (primarily medical staff and psychologists) had more accepting views to undertaking research than those job roles which have not traditionally been involved in the research process (all other respondents). Insert table 1 here….. Although we identified 4 themes affecting research capacity and capability during this study, many of the themes did not have distinct boundaries and points raised by respondents were often relevant to more than a single theme. Identified Themes: Time: The impact of time on research capacity was a re-occurring theme which had an important bearing on an individual’s consideration in undertaking research. This was often the first aspect mentioned when discussing barriers to engaging in research and, clearly, was a prominent consideration by the respondents. Those individuals who had protected time to do research valued this, enabling the individual to fit research activity into their work schedule. R20 “in order to do anything productive from a research point of view, you’ve got to get something like the NES [NHS Education for Scotland] fellowship ...and then you do get some ring-fenced time” When asked what could be done to facilitate the organisation’s research activity, individuals cited ring-fenced time as a key consideration. R6 “So giving people funded time to do research is important” R10 “I think the way of making a session where you could do a research session, that would be fantastic” Protected time for research was not available to many staff and this made the thought of research daunting: R28 “in clinical work that you’re employed to do isn’t research, you are employed to see people on a one-to-one basis and to fulfil that role, that clinical role” R18 “It [research] is not something I’ve looked into seriously, and I think the - the reason for that is time” Additionally, it was considered that research would require staff working in their own time and that was not possible or desirable for some respondents. R25 “People obviously live busy lives, they may not have—not have time to undertake research and all that” R1 “… and then previously we had an employee who was doing some research initiated by himself and he was trying to do that within the lab time, and he did it on his own time, so it was less than perfect and less than ideal” It was noticeable that staff in professions traditionally associated with undertaking research activity, such as medical and psychology, were less likely to cite access to research time as a barrier when compared to other professions such as nurses who, traditionally, have not had research integrated into their role. This may be because some professions have the concept of research time built into their professional role whilst others do not. R15 “I think it’s easier probably for medical staff to take part in research possibly because they’ve got protected study time, et cetera. I think it’s a lot harder for nursing staff to be involved” Resources: Resources to enable research was mentioned as either a facilitator (access to) or barrier (absence of) when undertaking research. Research-active respondents were more aware of and more likely to have accessed available resources through the R&D office than those who were not research-active. Although staff motivation to undertake research does require external resources to foster it, motivation itself is a resource that can be utilised by an individual and therefore should be encouraged by the organisation. Personal motivation was the main driver for people to undertake research, often driven by improving patient or staff care, professional development, or job/team satisfaction. R6 “ I'm interested in research 'cause I think it helps you drive better care for your patients” Additional educational resources were cited as a prerequisite to become research active. R15 “I think there’s need to be upskilling of us to be able to be involved in research” Respondents who identified the need for resources and recognised that support departments were available within NHS Fife were positive about their value. R6 “I have found the R&D department to be really helpful and they've been very supportive to our aspirations to try and expand the research portfolio” R2 “ I think my experience of the Research Department is that it is very accessible and approachable” R28 “There’s help available, librarians available as well to help with things like your systematic review even as a trainee is just so, so helpful” Not everyone in the organisation was aware of the presence of these departments, or found them accessible. R6 “One of the problems potentially is linking people who have an aspiration to do research when they start” R18 “ I wonder whether some kind of information regarding how to do an effective [literature] search. Perhaps that might be helpful if people want to engage in it that way” Research active individuals were generally aware of the support within NHS Fife, whereas those who were not active in research were not. Respondents were keen to have a research facilitator/mentor to help them with studies. There is a research advisor within the R&D department though this study suggests that it is not widely known throughout the organisation. Additionally, some individuals mentioned that having staff within their area who were dedicated to research would be a valued resource. R15 “Whether there’s some way in each area you can have somebody who doesn’t necessarily carry out research but it could be that linked person with the research and development, so if anything came up, they could be the person to disseminate, you know, for dementia champions and all these things, and it might be you that you want to have somebody who’s a research and quality improvement or something sort of champion in each area, and then they could be that link” One individual identified that without the support of others they would feel isolated undertaking research themselves, further illustrating the value of resources and a supportive environment around research building. R2 “Definitely interested and liked to know more but a bit concerned about being isolated the first time that you do your own research” Culture: In addition to awareness of, and availability of resources to facilitate research, the use of these resources also needs to be acceptable to the potential researcher within the culture of the organisation and their team. The culture, or perception of the culture, of an organisation, can act as a support or a barrier to research activity. To understand this impact on NHS Fife employees we asked respondents about the impact of the culture on an individual, team, and organisational level. A positive culture of the department towards research was seen to be beneficial. R15 “ I think you have to have a manager, your direct manager has to be supportive and encouraging and make that part of their ethos whether it would be ward or team-based” But a perceived obstructive, counter-culture of the organisation was seen as a barrier. R11 “The thing that I think is most difficult is trying to get somewhere like the, well, the MDT [Multi-disciplinary Team] on board. It can be quite difficult to even just get small changes and patient care made so in terms of like new evidence for things” Medical staff spoke about an established research culture and how to grow it in the future. We're pivoting what we do to suit the current environment but still grow our research interest in, you know. It’s about bringing resource involvement, experience and work Clinical psychologists also had a positive attitude to research in the organisation. (In referring to medical staff and psychologists we have excluded the respondent number as it would have identified their profession) I think it is…it [research] is fundamental just in the way we think and the way we operate Furthermore, research is integral to some trainee posts and this normalises the activity in those groups. R10 “ I think trainees are more encouraged to think about research” However, when those healthcare staff outside of medicine, dentistry, and psychology (Nurses, Midwives, Allied Health Professions, Healthcare Scientists, and Pharmacy staff, NMAHPs) discussed the acceptability of research in their culture they appeared less supported. An advanced nurse practitioner who acknowledged that “one of the pillars of practise is research and education” appeared less comfortable in the supportive culture for them to undertake research generally. Furthermore, staff who worked in non-patient facing support departments were likely to use research to inform practice, but did not consider their role would be to undertake the research themselves. R12 “But generally, it [research] is not something I think that nurses do” R15 “ And a lot of our doctors are very involved in research but as a [profession deleted], I found it extremely hard” Unsurprisingly, a supportive manager was seen to make research more acceptable to NMAHPs. R15 “I think you have to have a manager, your direct manager has to be supportive and encouraging and make that part of their ethos whether it would be ward or team-based” R20 “It [research] is still highly valuable and seen as an integral part, particularly from your high ups than a leadership team” In addition to the culture of the individual within their workplace, the organisational pressure and culture within NHS Fife was seen to have a strong impact on research activity. Some of the respondents who were research active within their role considered that the organisation could do more to build research into the staff role. R20 “ So, yes, it [research] is valued but the infrastructure, the kind of framework for being able to do it is not there” R6 “I think there's a will to do research, but I'm just not totally convinced that they [the organisation] have an overarching strategy and a way promoting it effectively” Many of the respondents reported a lack of visibility of ongoing research projects and activity, or research resources (including the R&D department) within the organisation. If staff were more aware of research within the organisation that visibility would also embed it into the culture of the workplace as it would seem a standard part of the organisation’s ethos. Defining what is, and is not research activity is subjective and may be reflective of the culture of the individual involved. Staff who are familiar with being researchers were happy to define themselves as such, but nurses and others where research is not seen as part of their role appeared more reluctant to put themselves into that category, even if, as in some cases, they had done postgraduate degrees or had engaged in research being run in the organisation. Communication: A common criticism raised by respondents concerned communication within the organisation about research activities, opportunities, and the dissemination of findings. Although it was difficult to measure the level of awareness of research activity within the organisation, comments made by many respondents suggested that research visibility was low amongst individuals who were not themselves research active. R2 “I'm not aware that I would know very much about what research is actually going on in the hospital or across NHS Fife” R6 “What we don't do very well is signpost who is research active” R12 “I know obviously we’ve got a research department, I’m not aware of what they do, what research they kind of generate, how that has then impacted on practise” Comments gave the impression that you needed to be actively doing research to be aware that it existed. This then became a barrier to other people in accepting that research activity was possible within the organisation. Some respondents were aware of the publicity about research distributed via the NHS Fife staff communication tool (‘Blink’) and in regular newsletters from the R&D department. But these were seen as passive, impersonal methods of communication that did not inspire staff to seek more information about ongoing research projects, or in opportunities to engage in research in the organisation. R12 “Usually there’s a sort of blurb connected on Blink for you to read it but it’s not connections as such, it’s just basically informing you of what separate teams are doing” R10 “ I get the bulletin [from R&D] and I usually have a flick through it, just to see what’s going on but I’m not really aware of anything specific was happening” A more proactive approach to communication, with personal interaction was suggested to increase communication between researchers, research departments and other staff. R1 “ It [communication] could definitely improve, for example and maybe it's what I need to do. Maybe I need to call up R&D say ‘come and have, you know, come and look round come and chat to us’. ‘Come and tell us what you do’ or coming up a TEAMs meeting or something, but I don't feel it should be my job to do that” R15 “It might be good if it [research] was part of some sort of mandatory induction or something like that, that it was a bit more visible” Furthermore, targeting the communication in a way that made the research more relevant to staff was seen as beneficial, especially when examples of how, or why research was undertaken. R12 “It’s making the research team more visible about these are all the research projects that we’ve done, this is what we found, this is why your job is easier, this is why… this is the benefit for you, for all these projects. So once people see tangible benefits, I think they’re more likely to buy into the research in the first place” It was suggested that a ‘champion’ could also act as a visible way of communicating ongoing research to others in the organisation. R15 “I was talking about having almost a link. If you got some people, whether it’d be a consultant or nurse, an OT [Occupational Therapist] or somebody in each team who can be that link, then they can bring these ideas to the home and encourage” Some staff described supporting research activity for others but not getting any feedback about the final conclusions. This lack of communication did not make the individuals feel valued or involved. R1 “ But then don't know what happens after that, you know? And we don't know if there's anything published and we don't know if anybody was acknowledged. Or so it is very much the Mushroom Syndrome” Communication about all forms of research is vital for making it part of the accepted culture of the organisation, and a positive endeavour for individuals. The respondents’ comments suggested that the organisation was not very active in communicating research activity in a way that engaged the staff working within it. Although there were some processes to publicise research activity, these were not very engaging to staff who felt a more personal approach was likely to be more successful. SARS-CoV-2 Pandemic: A specific enquiry was made into perceptions of the impact of the SARS-CoV-2 pandemic on research interest and activity. During this period most respondents had become more aware of the value of research to improving healthcare to tackle the pandemic. R15 “that when you see it [research] actually in action, it does make a more of a priority” R15 “I think maybe it’s been more apparent to people, the evidence, you know, of what research means” R18 “the engagement with research has been quite high or with, because, because things are changing all the time. So, we’re needing to keep up with it so we know what to tell people and we know what to look for….. I think there’s certainly this slight shift in wanting to engage with research and recognising the importance of it.” Some respondents spoke about how they would take research forward from the lessons learnt from the pandemic, including new areas to study. R25 “ can adapt to the situation, learn lessons, and before it, planning, future planning for any similar events. I think, yeah, I think it’s vital to research, it’s vital going forward” R10 “we’ve been moved to consulting in a completely different way, which we’ve never researched before” This shows that putting clinical research in context (in this case, relating to an emerging health issue) made it more relevant and accessible to staff, and more valued as a priority in the organisation. R15 “I definitely think it [research] should be a lot higher up than it is. I think COVID has shown that, you know” Although there were many examples of a positive impact of SARS-CoV-2 on the research landscape, for a small number of respondents, the pandemic negatively impacted on the ability to engage with research. An increased workload during the SARS-CoV-2 pandemic made participation in research unfeasible. R1 “ it [COVID] is just the straw that broke the camel’s back. Our ability to support research is severely hampered by our staffing, uh status, and the requirements being placed on us” Additionally, the constantly evolving information that came out from the research into treating SARS-CoV-2 also felt overwhelming to the staff working during this time. R18 “But I think the - the myriad of it has just made people a little bit tired perhaps, unfortunately” DISCUSSION The principal study aim was to explore staff views about engaging in and supporting research in the health board, and to elicit suggestions as to how research activity could be enhanced. We also sought views on how the SARS-CoV-2 pandemic may have affected attitudes to research in the NHS. We sought to gain an insight into the attitude of all staff grades and professions, so we did not limit our sample to only certain professions, or to only research-active, or research-inactive personnel. Consequently, we obtained views from different staff roles, responsibilities, and research experience within the organisation to obtain a varied and comprehensive response base for analysis. Four overarching themes emerged from our analyses, namely, Time, Resources, Culture and Communication, with additional factors including intrinsic and extrinsic aspects (Table 1). In addition, the impact of the SARS-CoV-2 pandemic on research activity and on attitudes to research were explored. Time as a theme We asked the respondents to consider the research culture and capacity in NHS Fife on an individual, team, and organisational level. The responses reflected those seen in previous studies in healthcare organisations. The lack of time being an almost universally mentioned barrier to investigator-initiated research activity, and protected research time facilitating activity is a theme echoed by other studies assessing research capability and capacity building [8, 13]. Ring fenced research time provides one important resource to plan and undertake research, but it also provides a ‘legitimacy’ to the researcher to undertake the work. Medical staff and psychologists working in professions traditionally associated with research activity were less likely to cite access to research time as a barrier when compared to other professions such as nurses who have, traditionally, not had research as part of their role. Initiatives to provide protected time within a clinical role have included funded fellowships, though these tend to be biassed towards medical applicants. Competition is intense and the success rate of applications from NMAHPs is poor [5, 26]. Resources as a theme Alongside providing time to do or support research there also needs to be other resources such as training, specialist advice and practical support, particularly with the associated bureaucracy. Some respondents acknowledged the help they had received through the R&D department whilst others were aware of its existence but were unaware of the services offered. One resource to increase research activity widely mentioned by respondents, irrespective of their role within the organisation, was the availability of a research mentor, facilitator, or link person (different terms were used, but, essentially, respondents were referring to an individual whose role was to guide staff through the research process). Some felt this individual should be embedded within their department or team, others felt they should sit within their profession i.e. an AHP specific research facilitator. Research facilitators / mentors can have a positive effect on building capacity [14, 16, 17]. A qualitative study evaluating the provision of research training noted that trainees developed transferable skills including the ability to act as facilitators to other research interested staff in the organisation [23]. Research facilitators may be considered a resource in terms of ‘time’ by sharing some research tasks with the active researcher. The skills needed to be an effective research facilitator include experience in research design, project management, data analysis (quantitative and qualitative), report writing (grants, ethics), communication, the intricacies of clinical research and a recognition of their own limitations [17]. In addition to having a research skill set, effective facilitators need to be enthusiastic, approachable, and encouraging when engaging with staff. Culture as a theme Organisational culture in healthcare can be defined as ‘the shared ways of thinking, feeling, and behaving in healthcare organisations’ [24]. This culture has been described as existing in three layers: (1) Visible aspects, including structural features (infrastructure, estate) and established and accepted ways of working, (2) Shared ways of thinking, namely the values and beliefs that justify actions, and (3) Shared assumptions, the unspoken, unconscious expectations of staff within their professions. Additionally, due to the complexity of healthcare delivery, aspects of workplace culture may vary across the organisation, specific to individual professions or specialities, resulting in various subcultures that will have a different perspective on the research environment and the question of ‘culture.’ Staff in a profession that traditionally engaged with research were comfortable with either undertaking research themselves, or encouraging colleagues to do it. They saw the value in research, had accessed resources and accepted research as the way for healthcare to develop. Research had a legitimacy in their role along with the more ‘traditional’ clinical work. Some of these staff still had problems getting the time or other resources (capacity), but were receptive to the culture of research in developing knowledge. In comparison, those NMAHP professions where research was not part of their remit or remuneration had less research activity and lacked confidence to be research active, or felt it was only for higher banded staff. Often staff mentioned that they reviewed the literature adopting evidence-based practice to inform their clinical work, but did not develop this activity further. With workforce restructuring and extra responsibilities being placed on more senior staff, this may change the expectation of individuals and their subcultures to acknowledge their ‘legitimacy’ to undertake research. An important aspect in developing a research culture is the support and active encouragement given by senior and middle managers, reflecting the adoption of a research strategy at Board level. This aspect has been commented on by others [25, 26] and considered a critically important component. However, NHS Fife is not a designated teaching/university board within the Scottish system. The Board receives a performance and activity-based allocation from the Scottish Government to fund the R&D department in covering the unmet costs of supporting commercial, non-commercial, and investigator-initiated research; it does not attract more substantial funding that the larger, teaching Boards receive. This may result in research and innovation being less of a priority for a non-teaching Health Board, such as NHS Fife. Communication as a theme Gaps in communication within the organisation were highlighted by some respondents despite the efforts made in disseminating regular newsletters by the R&D department, and monthly notices of papers published by NHS Fife staff by the library service. Some respondents were aware of these circulars but considered they were impersonal and not apparently relevant to their own clinical area. Other respondents were unaware of these circulars, raising the need to increase their visibility and penetration within the service. The importance of good communication as a component of an organisation’s research culture has been emphasised by others [13, 27]. If staff are to be encouraged to become research active, the resources available and the impact of research on the individual, healthcare and the organisation should be visible to all who work within it. If this visibility is limited through inadequate communication there is a danger that research activity will mainly be restricted to people driven to do it by factors external to the organisation, such as professional requirements or prior experience gained in other organisations. Recognition of research activity Some respondents were undertaking research but did not recognise it as such. Others considered they were undertaking research activities when searching the literature for evidence to inform changes in clinical practice. Additionally, clinical effectiveness activities were seen as ‘research’ rather than service improvement. It is difficult to objectively define ‘research activity.’ Branbenburg, 2024, did a scoping review of the literature to understand research engagement in medicine [28] concluding that ‘outcome measures were highly heterogenous, suggesting there is no agreed outcome measure for “research engagement”’. Friessen, 2017, also felt that healthcare organisations should provide education about what constitutes ‘research’ so that staff can recognise when they are doing it [29]. Being aware of what research is being undertaken in the organisation, how staff can support it, and what resources are available to start it, raises the profile of research within the context of the organisation and staff groups. Influence of the SARS-Cov-2 pandemic on staff attitudes to research This study was conducted between December 2021 and February 2022. The SARS-CoV-2 virus started circulating in the UK early 2020, and the country entered a national lockdown in March 2020. Most restrictions were lifted mid-2021 with the final ones being removed by March 2022. Consequently, the study was undertaken within a timescale that the respondents would likely have recent memories of a time working in healthcare before, during and after the peak of the pandemic. The pandemic affected all aspects of healthcare delivery and clinical research at the time. Within NHS Fife recruitment to the majority of clinical trials was suspended, and the research teams opened urgent public health studies addressing the emerging pandemic. Research staff engaged with clinical teams in previously low research areas, promoting the value of clinical research to otherwise research naïve staff. Other staff volunteered as participants in a national study being hosted in NHS Fife, again promoting the value of research to previously research naïve staff. Clinical staff had questions about the best way to manage the pandemic, were presented with ever changing information about treating patients, and ultimately had to adapt to new ways of working, leading to many questioning previously held assumptions about healthcare practices. Furthermore, patients were more questioning of staff about their own healthcare, seeking answers and reassurance during this uncertain period. This upheaval and search for answers put research in the forefront of the response to the pandemic. For most of the respondents the pandemic had increased their interest in research, either seeing the value of it in the organisation, or by giving them personal motivation to study an issue of importance. This illustrates that putting clinical research in context, in this case, relating to an emerging health issue, made it more relevant to staff. Furthermore, the resources and support offered by the NHS Fife R&D office to those wanting to engage in research were similar before and after the pandemic, so any changes in research culture after the pandemic were possibly due to intrinsic factors within individuals rather than a shift in the framework around research. However, there was little evidence from the respondents that the organisational culture had shifted towards research because of the pandemic, but the visibility of research had. It is important that staff feel able to engage with research activities by supporting it, contributing to it, and initiating it themselves, depending on their personal motivation and abilities. Whatever their level on interest, staff need resources and a supportive organisational culture to take this forward. It is also important that this new awareness and enthusiasm for research across all groups of staff is nurtured within the organisation before it fades and staff become disillusioned, possibly reinforcing any previous negative attitudes that research is not something they can, or should engage with. Strengths and weaknesses We sought to obtain views across all staff groups and did not confine our sample to only those professions that traditionally engage in research. Many studies have looked at research culture in particular professional groups, but this study recruited across professional groups within the same organisation to enable us to make comparisons in attitudes of sub-groups. However, the respondents were self-selected which has the potential to skew the results to reflect the views of those who had an interest in research and were motivated to take part in the questionnaire survey, and interviews. We are aware that staff members who were not interested in research, or who had had previous negative experiences were less likely to take the time to participate in the study and provide information about their perspective of the culture of research within NHS Fife, and the impact of the SARS-CoV-2 pandemic. All but one of the interviews were conducted by one trained researcher though multiple, experienced researchers analysed the transcripts to increase the reliability of the identified themes and subthemes. Furthermore, we are confident that saturation was achieved. During our analysis we did not classify respondents as research active/inactive because this was difficult to objectively classify from the transcripts. Additionally, some respondents did not recognise they were undertaking research activities in their roles, whilst others confused literature searching, to inform ongoing practice, as a research activity. Summary of the findings and recommendations. It was clear from the responses that different cohorts of respondents had patterns of self-reflection based on assumptions, possibly due to expectations of their clinical role and the degree of which research featured in their initial training. Medical staff and psychologists felt more comfortable and receptive to research, whereas the NMAHPs often suggested that research was not part of their initial training, their role, and culture; they needed more ‘permission’ from their peers or managers to engage in research. This personal perception reinforced the cohort stereotypes and requires a cultural shift in the organisation/professions to elicit a positive change. Additionally, there is a need to define ‘research’ and educate staff in awareness of the spectrum of research activity to enable them to classify their activities. This is of particular importance for those staff that have research written into their job description. Staff may then be considered ‘research active’ as distinct from being ‘research aware.’ The findings from our interviews broadly concur with those from the questionnaire arm of the study [20], though additional aspects emerged from our in-depth investigation, including the apparent confusion amongst some of the respondents as to what activities constitutes ‘research’, and the need for improved communication. Overall, our findings suggest that to increase research activity in our Health Board we should focus on the following: (1) provide protected time and backfill for staff wishing to engage in research, (2) increase resources to support research-active staff, to include training, admin support to tackle the associated bureaucracy (ethics, protocol writing, applications for research fellowships), advice on study design, data analysis, and help in securing grant funding, particularly for pilot studies, (3) expand the culture by adopting policies at Board level to promote research as a priority, recognising that different strategies will be needed covering different types of research (commercial, non-commercial, investigator-initiated, opportunities to benefit from intellectual property). Associated activities should look to increase links with academia and other potential external partners, to encourage managers of all grades to promote research as part of everyday practice and to include research activity as part of the career pathway, particularly for those staff that have research included in their job description, (4) improve communication throughout the organisation by increasing penetration of the various newsletters and alerts currently circulated to provide details to staff of services available to help them engage in research, of current, newly established and completed research projects underway in the organisation, of opportunities to become more involved in projects, and of current publications by NHS Fife staff. Improvements in communication should also feature alerts to patients of ongoing projects and any opportunities to volunteer for a study. Some NHS Fife staff undertake post-graduate courses some of which will involve completing a research study. It is particularly important to encourage them at an early stage to consult the R&D department and library to establish what resources are available to assist them in their project, including writing up their dissertation and any papers arising from their work. Staff that are successful in passing their course may consider becoming a ‘Research Champion, Mentor or Facilitator’ to work within their professional group or team to provide guidance to others in developing their own research career, and to promoting evidence-based practice by reviewing the medical literature. It is anticipated that the results of this study will be used to assist in setting strategy, planning local initiatives, and assessing change in research capacity and culture indicators over time. The findings may have relevance for other non-teaching Health Boards in Scotland, and for other health providers that intend to respond to the call to increase their research profile. Abbreviations AHP: Allied Health Professionals COREQ: Consolidated Criteria for Reporting Qualitative Research COVID: with reference to the SARS-CoV-2 virus HEI: Higher Education Institute NHS: National Health Service NMAHP: Nurses, midwives, allied health professionals R&D: Research and Development UK: United Kingdom Declarations Ethics approval and consent to participate As the study participants were NHS staff a formal review by an NHS ethics committee was not required following advice obtained using the Health Research Authority decision tools (www.hra-decisiontools.org.uk) and directly from the East of Scotland Research Ethics Service (NHS Tayside). Informed consent was obtained from all subjects who volunteered to take part in the qualitative interview arm of the study. All study methods were carried out in accordance with the principles written into the Declaration of Helsinki (June 1964). Management approval Management approval was obtained from NHS Fife. The study protocol was reviewed and approved by internal staff in NHS Fife and by one external reviewer from NHS Forth Valley. Consent for publication All respondents gave verbal consent allowing publication of their comments as anonymised quotations. Availability of data and materials All data generated or analysed during this study are included in this published article and supplementary information files. Competing interests The authors declare that they have no competing interests. Funding NHS Fife, Research, Innovation and Knowledge Department sponsored and funded the project. References Ozdemir BA, Karthikesalingam A, Sinha S, Poloniecki JD, Hinchliffe RJ, Thompson MM, Gower JD, Boaz A, Holt PJ. Research Activity and the Association with Mortality. PLoS One. 2015;10:e0118253. doi: 10.1371/journal.pone.0118253 Boaz A, Hanney S, Jones T, Soper B. Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review. BMJ Open 2015;5: e009415. doi:10.1136/ bmjopen-2015-009415 Jonker L, Fisher SJ. The correlation between National Health Service Trusts’ clinical trial activity and both mortality rates and Care Quality Commission ratings: a retrospective cross-sectional study. J Public Health. 2018;157:1–6. doi: 10.1016/j.puhe. 2017.12.022 Jonker L, Fisher SJ, Dagnan D. Patients admitted to more research-active hospitals have more confidence in staff and are better informed about their condition and medication: Results from a retrospective cross-sectional study. J Eval Clin Pract. 2020;26:203–8. doi: 10.1111/jep.13118 Saving and Improving Lives: The Future of UK Clinical Research Delivery. Published 23 March 2021. The Future of UK Clinical Research Delivery – GOV.UK (www.gov.uk), accessed 24 th May 2023. The Future of UK Clinical Research Delivery: 2022 to 2025 Implementation Plan. Published 30 June 2022 https://www.gov.uk/government/publications/the-future-of-uk-clinical-research-delivery-2022-to-2025-implementation-plan, accessed 24 th May 2023. Chief Scientist Office, Edinburgh. Three Year Plan for Implementing the Vision for the Future of UK Clinical Research Delivery. https://www.cso.scot.nhs.uk/three-year-plan-for-implementing-the-vision-for-the-future-of-uk-clinical-research-delivery-published/ accessed 17 th January 2024. Gill SD, Gwini SM, Otmar R, Lane SE, Quirk F, Fuscaldo G. Assessing research capacity in Victoria’s south-west health service providers. Aust J Rural Health 2019; 27: 505-513. https//doi.org/10.1111/ajr.12558 Lee SA, Byth K, Gifford JA, Balasubramanian M, Fozzard CA, Skapetis T, Flood VM. Assessment of Health Research Capacity in Western Sydney Local Health District (WSLHD): A Study on Medical, Nursing and Allied Health Professionals. J Multidisciplinary Healthcare 2020; 13: 153–163. Slade SC, Philip K, Morris ME. Frameworks for embedding a research culture in allied health practice: a rapid review. Health Research Policy and Systems. 2018; 16: 29. https://doi.org/10.1186/s12961-018-0304-2 Wenke R, Weir KA, Noble C, Mahoney J, Mickan S. Not enough time for research? Use of supported funding to promote allied health research activity. J Multidisciplinary Healthcare. 2018; 11: 269–277. Ried K, Farmer EA, Weston KM. Bursaries, writing grants and fellowships: a strategy to develop research capacity in primary health care. BMC Family Practice 2007; 8:19 https://doi:10.1186/1471-2296-8-19 Gee M, Cooke J. How do NHS organisations plan research capacity development? Strategies, strengths and opportunities for improvement. BMC Health Services Research 2018; 18: 198. https://doi.org/10.1186/s12913-018-2992-2 Grange A, Herne S, Casey A, Wordsworth L. Building research capacity. Nursing Management. 2005; 12: 32-37. Pain T, Petersen M, Fernando M. Building Allied Health Research Capacity at a Regional Australian Hospital: A Follow-up Study. Internet Journal of Allied Health Sciences and Practice. 2018;16(4) ISSN 1540-1580X (Article 8). Whitworth A, Haining S, Stringer H. Enhancing research capacity across healthcare and higher education sectors: development and evaluation of an integrated model. BMC Health Services Research 2012; 12: 287. http://www.biomedcentral.com/1472-6963/12/287 Flenady T, Dwyer T, Kahl J, Sobolewska A, Reid-Searl K, Signal T. Research-capacity building for clinicians: understanding how the research facilitator role fosters clinician’s engagement in the research process. Health Research Policy and Systems 2022; 20: 45. https://doi.org/10.1186/s12961-022-00849-8 Back-Pettersson S, Jensen KP, Kylen S, Sernert N, Hermansson E. Nurses’ experiences of participation in a research and development programme. J Clin Nursing. 2012; 22: 1103–1111. https//doi.org/10.1111/j.1365-2702.2012.04297.x Babl FE, Dalziel SR, Borland ML. Establishing a research network. J Paed Child Health. 2020; 56: 857–863. https//doi.org/10.1111/jpc.14896 Chinn DJ, Pribanova M, Quirk F. The research interest, capacity and culture of NHS staff in South East Scotland and changes in attitude to research following the pandemic: a cross-sectional survey. BMC Health Services Research, 2023: doi:10.1186/s12913-023-09196-y Braun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology. 2006; 3(2): 77-101. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 2007; 19 (6): 349–357 Schmidt D, Duncanson K, Webster E, Saurman E, Lyle D. Critical realistic exploration of long-term outcomes, impacts and skill development from an Australian Rural Research Capacity Building Programme: a qualitative study. BMJ Open 2022; 12: e065972 doi:10.1136/bmjopn-2022-065972. Mannion R, Davies H. Understanding organisational culture for healthcare quality improvement. BMJ Open 2018; 363:k4907 doi:10.1136/bmj.k4907. Moore J, Crozier K, Kite K. An action research approach for developing research and innovation in nursing and midwifery practice: Building research capacity in one NHS foundation trust. Nurse Education Today 2012; 32: 39-45. Trusson D, Rowley E, Bramley L. A mixed-methods study of challenges and benefits of clinical academic careers for nurses, midwives and allied health professionals. BMJ Open 2019; 9: e030595. doi:10.1136/ bmjopen-2019-030595. Luckson M, Duncan F, Rajai A, Haigh C. Exploring the research culture of nurses and allied health professionals (AHPs) in a research-focused and a non-research-focused healthcare organization in the UK. J Clin Nurs 2018; 27: e1462-e1476. https//doi.org/10.1111/jocn.14264 Brandenburg C, Stehlik P, Noble, C, Wenks R, Jones K, Hattingh L et al. How can healthcare organisations increase doctors’ research engagement? A scoping review. Journal of Health Organisation and Management. In the press. DOI: 10.21203/rs.3.rs-3130367/v1 Friesen EL, Comino EJ. Research culture and capacity in community health services: results of a structured survey of staff. Australian Journal of Primary Health 2017; 23: 123-131. Table 1 Table 1. Principal themes and sub-themes (intrinsic and extrinsic factors) to increase research activity Theme Intrinsic factor Extrinsic factor Time Provide protected time Availability of NHS Education for Scotland fellowships, particularly for NMAHPs Include research in job descriptions and job plans Resources R&D department support & advice Library External grants Internal training courses External training courses Local sources of funding Access to HEIs Research mentorship within clinical teams Personal motivation Culture Research as a strategic priority for the organisation Professional training and culture Management support at Team and Organisation levels Research as a component of trainee development Develop ‘research champions’ throughout the organisation Career development Communication Increase visibility of research activities Professional development requirements Increase feedback to staff on research findings and impact on practice R&D newsletters to be targeted to individual teams. ‘Research champions’ embedded in clinical teams to circulate research news at team meetings NMAHPs: Nurses, midwives, allied health professionals, HEIs: Higher Educational Institutes, R&D: Research and Development Additional Declarations No competing interests reported. Supplementary Files AdditionalFile1InterviewGuide.docx AdditionalFile2PIS.docx AdditionalFile3Consentscript.docx AdditionalFile4COREQchecklist.docx Cite Share Download PDF Status: Published Journal Publication published 18 Aug, 2025 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 14 Nov, 2024 Reviews received at journal 05 Sep, 2024 Reviewers agreed at journal 26 Aug, 2024 Reviews received at journal 23 Aug, 2024 Reviews received at journal 21 Aug, 2024 Reviewers agreed at journal 19 Aug, 2024 Reviewers agreed at journal 14 Aug, 2024 Reviewers invited by journal 13 Aug, 2024 Editor invited by journal 02 Feb, 2024 Submission checks completed at journal 31 Jan, 2024 Editor assigned by journal 31 Jan, 2024 First submitted to journal 29 Jan, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eIt is well recognised that patients experience better outcomes in healthcare settings that are more research-active [1\u0026ndash;4]. Clinical research activity is therefore a key driver to improve the quality of patient care. The UK Government has recently published its \u0026lsquo;Vision for Research\u0026rsquo; and \u0026lsquo;Implementation Plan\u0026rsquo; that seeks to develop a research culture and increase research activity within the National Health Service (NHS) [5,6]. The Scottish Government is a key partner in implementing this UK-wide strategy that also seeks to build on the lessons from the SARS-CoV-2 pandemic [7]. Previous studies investigating attitudes of clinical staff to research have noted differences between medical, nursing and Allied Health Professionals (AHPs) in their research skill levels and confidence in undertaking research [8,9]. Approaches to increasing research activity in health care settings have identified, for example, the need for training [10], funding [11,12], protected time [8,13], the use of research facilitators [14\u0026ndash;17] and links with academia [18,19].\u003c/p\u003e \u003cp\u003eThe health service in Scotland comprises 14 Health Boards, of varying size and engagement in research. NHS Fife is one of the smaller, non-teaching Boards serving a population of 370,000 with a workforce of 8,500. The NHS Fife Research, Innovation and Knowledge department (formerly Research and Development, R\u0026amp;D) supports a small group of research active staff through a range of services including the provision of clinical research nurses, librarians, research advisers and administrative staff. The recent initiative by the UK Government seeks to encourage clinical staff, of all grades, to see research as part of their role [6,7]. At present, little is known of the research culture and research interest amongst the general workforce in NHS Fife. We were particularly interested in assessing how staff perceptions of the role of, and importance of research in the NHS may have changed because of the SARS-CoV-2 pandemic.\u003c/p\u003e \u003cp\u003eWe undertook a mixed methods study of staff to investigate attitudes to research within the organisation. Information was collected using an online, validated questionnaire that enquired into aspects of research at the organisational, team and individual levels. Staff were also invited to take part in semi-structured interviews to obtain more in-depth information relating to attitudes, barriers, and motivators to research. The results from the quantitative aspects of the study have been published [20]. This paper presents the results from the qualitative interviews where the aim was to explore in more depth the attitudes of staff, both active and non-active in research, and record their suggestions on improving the research culture and increasing research activity within our health board.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThe aim of this qualitative part of our mixed-methods study was to explore staff attitudes on the research culture and capacity within NHS Fife using semi-structured interviews. Key objectives were to: (1) describe the current perceptions of the research interest, capacity, and culture, (2) investigate barriers and motivators for research activity and (3) assess any change in staff attitudes to research following the SARS-CoV-2 pandemic.\u003c/p\u003e\n\u003cp\u003eNHS Fife and Health and Social Care Partnership staff were recruited via the online survey [20]. The survey was advertised via the NHS Fife Communication Department\u0026rsquo;s weekly updates which were sent to all staff with an NHS Fife email address. Managers were also asked to encourage their staff to participate and promote the study within team meetings. A further advertisement appeared on staff computer desktop screens. Staff who wanted to engage with the study completed the online questionnaire. After completing it, respondents were invited to provide their NHS Fife email address if they were interested in taking part in the additional interview arm of the study. These participants were then contacted by an author (MP) to arrange a date and time for the interview. An additional snowball sampling method was utilised by contacting current research active and non-active staff and asking them to contact others who may be interested in participating in the interview.\u003c/p\u003e\n\u003cp\u003eAll interviews took place between December 2021 and February 2022 by MP, a clinical psychologist assistant trained in qualitative methods. One interview was conducted by FQ, a Professor of Health Care Research (PhD) experienced in qualitative methods. Interviews were conducted online using a video call via \u003cem\u003eMicrosoft\u0026trade; Teams\u003c/em\u003e software. The duration of each interview was approximately 30 minutes. Interviews were recorded using a digital recorder, the \u003cem\u003eMicrosoft\u0026trade; Teams\u003c/em\u003e transcription service and then further transcribed verbatim to increase validity and reliability. Field notes were not taken. No respondents were re-interviewed and no transcripts were returned to the interviewees for addition or correction. Each respondent received a \u0026pound;20 gift voucher.\u003c/p\u003e\n\u003cp\u003eThe semi-structured interviews utilised a topic and question guide to focus discussion (Additional File 1). The guide was constructed using the same principal domains as the online questionnaire [20], the research culture and capacity on an individual, team and organisational level. The guide was piloted on three independent healthcare professionals and revised according to feedback.\u003c/p\u003e\n\u003cp\u003eInterviews were transcribed verbatim by a professional transcribing service, \u003cem\u003eDictate2Us\u003c/em\u003e. All transcripts were anonymised. Data analysis followed Braun and Clarke\u0026rsquo;s 6-step guide to thematic analysis [21]: familiarising oneself with data, generation of initial codes, searching for themes, reviewing themes, defining, and naming themes, reporting on themes.\u003c/p\u003e\n\u003cp\u003eInterview transcripts were coded by MP manually using \u003cem\u003eMicrosoft\u0026trade; Word\u003c/em\u003e processor. Saturation was reached by the 21st interview. An additional two qualitative researchers (FQ and FD) analysed a subset of 12 out of the 28 interview transcripts and generated themes in parallel, using the 6-step guide to thematic analysis. The 12 transcripts were chosen at random and the additional reviewers were blinded as to the respondent\u0026rsquo;s staff grade. The three researchers (MP, FQ and FD) then compared findings and reached a consensus on final themes.\u003c/p\u003e\n\u003cp\u003eThe research project had NHS Fife Management approval. Approval from an NHS Ethics committee was not required under guidance from the Health Research Authority as respondents were NHS staff (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.hra-decisiontools.org.uk\u003c/span\u003e\u003c/span\u003e). However, the study was conducted in accordance with the principles written into the Declaration of Helsinki (June 1964). Informed consent was obtained using an information sheet (Additional File 2) and consent script (Additional File 3). Verbal consent was audio recorded at the beginning of each semi-structured interview and evidenced within the interview transcripts. Respondents were informed that they were free to withdraw at any time, for any reason and any published quotations would be anonymised.\u003c/p\u003e\n\u003cp\u003eThe study is reported following the Consolidated Criteria for Reporting Qualitative Research (COREQ) [22] (Additional File 4).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eRespondents\u003c/h2\u003e \u003cp\u003eFifty-seven individuals expressed an interest in taking part in the semi-structured interviews. Twenty-eight individuals were interviewed (18 female, 10 male) and the remainder either did not respond to the researcher\u0026rsquo;s request to set up a date (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;25) or were too busy to participate (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4). Respondents included a mix of staff: 7 nursing/midwifery, 6 medical/dental, 3 allied health professionals, 3 other therapeutic and 9 admin/support staff. Some staff had research written into their job descriptions whilst others did not. Some staff who claimed not to undertake research did take on activities that were associated with research. This non-recognition of what research entails was more noticeable in professions that traditionally see themselves as \u0026lsquo;patient-focussed\u0026rsquo; only and non-researchers.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eResearch Findings\u003c/h3\u003e\n\u003cp\u003eAll the respondents identified similar facilitators and barriers to undertaking research activity within the organisation, irrespective of their role or experience with research. The degree that these factors affected the individual respondent varied according to their circumstances, but to a lesser or greater degree all respondents identified: Time, Resources, Culture, and Communication, as themes that influenced research activity. We also asked respondents about their thoughts on how the SARS-CoV-2 pandemic had affected their perception of research. Within these broad themes, there were intrinsic as well as extrinsic factors that were found to be indicators of research facilitators and barriers amongst NHS staff (Table\u0026nbsp;1). Individuals who had research as part of their professional role (primarily medical staff and psychologists) had more accepting views to undertaking research than those job roles which have not traditionally been involved in the research process (all other respondents).\u003c/p\u003e \u003cp\u003e \u003cem\u003eInsert table 1 here\u0026hellip;..\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAlthough we identified 4 themes affecting research capacity and capability during this study, many of the themes did not have distinct boundaries and points raised by respondents were often relevant to more than a single theme.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eIdentified Themes:\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eTime:\u003c/h2\u003e \u003cp\u003eThe impact of time on research capacity was a re-occurring theme which had an important bearing on an individual\u0026rsquo;s consideration in undertaking research. This was often the first aspect mentioned when discussing barriers to engaging in research and, clearly, was a prominent consideration by the respondents. Those individuals who had protected time to do research valued this, enabling the individual to fit research activity into their work schedule.\u003c/p\u003e \u003cp\u003eR20 \u003cem\u003e\u0026ldquo;in order to do anything productive from a research point of view, you\u0026rsquo;ve got to get something like the NES [NHS Education for Scotland] fellowship ...and then you do get some ring-fenced time\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eWhen asked what could be done to facilitate the organisation\u0026rsquo;s research activity, individuals cited ring-fenced time as a key consideration.\u003c/p\u003e \u003cp\u003eR6 \u003cem\u003e\u0026ldquo;So giving people funded time to do research is important\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR10 \u003cem\u003e\u0026ldquo;I think the way of making a session where you could do a research session, that would be fantastic\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eProtected time for research was not available to many staff and this made the thought of research daunting:\u003c/p\u003e \u003cp\u003eR28 \u003cem\u003e\u0026ldquo;in clinical work that you\u0026rsquo;re employed to do isn\u0026rsquo;t research, you are employed to see people on a one-to-one basis and to fulfil that role, that clinical role\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR18 \u003cem\u003e\u0026ldquo;It [research] is not something I\u0026rsquo;ve looked into seriously, and I think the - the reason for that is time\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAdditionally, it was considered that research would require staff working in their own time and that was not possible or desirable for some respondents.\u003c/p\u003e \u003cp\u003eR25 \u003cem\u003e\u0026ldquo;People obviously live busy lives, they may not have\u0026mdash;not have time to undertake research and all that\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR1 \u0026ldquo;\u0026hellip;\u003cem\u003eand then previously we had an employee who was doing some research initiated by himself and he was trying to do that within the lab time, and he did it on his own time, so it was less than perfect and less than ideal\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eIt was noticeable that staff in professions traditionally associated with undertaking research activity, such as medical and psychology, were less likely to cite access to research time as a barrier when compared to other professions such as nurses who, traditionally, have not had research integrated into their role. This may be because some professions have the concept of research time built into their professional role whilst others do not.\u003c/p\u003e \u003cp\u003eR15 \u003cem\u003e\u0026ldquo;I think it\u0026rsquo;s easier probably for medical staff to take part in research possibly because they\u0026rsquo;ve got protected study time, et cetera. I think it\u0026rsquo;s a lot harder for nursing staff to be involved\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eResources:\u003c/h2\u003e \u003cp\u003eResources to enable research was mentioned as either a facilitator (access to) or barrier (absence of) when undertaking research. Research-active respondents were more aware of and more likely to have accessed available resources through the R\u0026amp;D office than those who were not research-active.\u003c/p\u003e \u003cp\u003eAlthough staff motivation to undertake research does require external resources to foster it, motivation itself is a resource that can be utilised by an individual and therefore should be encouraged by the organisation. Personal motivation was the main driver for people to undertake research, often driven by improving patient or staff care, professional development, or job/team satisfaction.\u003c/p\u003e \u003cp\u003eR6 \u0026ldquo;\u003cem\u003eI'm interested in research 'cause I think it helps you drive better care for your patients\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAdditional educational resources were cited as a prerequisite to become research active.\u003c/p\u003e \u003cp\u003eR15 \u003cem\u003e\u0026ldquo;I think there\u0026rsquo;s need to be upskilling of us to be able to be involved in research\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eRespondents who identified the need for resources and recognised that support departments were available within NHS Fife were positive about their value.\u003c/p\u003e \u003cp\u003eR6 \u003cem\u003e\u0026ldquo;I have found the R\u0026amp;D department to be really helpful and they've been very supportive to our aspirations to try and expand the research portfolio\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR2 \u0026ldquo;\u003cem\u003eI think my experience of the Research Department is that it is very accessible and approachable\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR28 \u003cem\u003e\u0026ldquo;There\u0026rsquo;s help available, librarians available as well to help with things like your systematic review even as a trainee is just so, so helpful\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eNot everyone in the organisation was aware of the presence of these departments, or found them accessible.\u003c/p\u003e \u003cp\u003eR6 \u003cem\u003e\u0026ldquo;One of the problems potentially is linking people who have an aspiration to do research when they start\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR18 \u0026ldquo;\u003cem\u003eI wonder whether some kind of information regarding how to do an effective [literature] search. Perhaps that might be helpful if people want to engage in it that way\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eResearch active individuals were generally aware of the support within NHS Fife, whereas those who were not active in research were not.\u003c/p\u003e \u003cp\u003eRespondents were keen to have a research facilitator/mentor to help them with studies. There is a research advisor within the R\u0026amp;D department though this study suggests that it is not widely known throughout the organisation. Additionally, some individuals mentioned that having staff within their area who were dedicated to research would be a valued resource.\u003c/p\u003e \u003cp\u003eR15 \u003cem\u003e\u0026ldquo;Whether there\u0026rsquo;s some way in each area you can have somebody who doesn\u0026rsquo;t necessarily carry out research but it could be that linked person with the research and development, so if anything came up, they could be the person to disseminate, you know, for dementia champions and all these things, and it might be you that you want to have somebody who\u0026rsquo;s a research and quality improvement or something sort of champion in each area, and then they could be that link\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eOne individual identified that without the support of others they would feel isolated undertaking research themselves, further illustrating the value of resources and a supportive environment around research building.\u003c/p\u003e \u003cp\u003eR2 \u003cem\u003e\u0026ldquo;Definitely interested and liked to know more but a bit concerned about being isolated the first time that you do your own research\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eCulture:\u003c/h2\u003e \u003cp\u003eIn addition to awareness of, and availability of resources to facilitate research, the use of these resources also needs to be acceptable to the potential researcher within the culture of the organisation and their team. The culture, or perception of the culture, of an organisation, can act as a support or a barrier to research activity. To understand this impact on NHS Fife employees we asked respondents about the impact of the culture on an individual, team, and organisational level. A positive culture of the department towards research was seen to be beneficial.\u003c/p\u003e \u003cp\u003eR15 \u0026ldquo;\u003cem\u003eI think you have to have a manager, your direct manager has to be supportive and encouraging and make that part of their ethos whether it would be ward or team-based\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eBut a perceived obstructive, counter-culture of the organisation was seen as a barrier.\u003c/p\u003e \u003cp\u003eR11 \u003cem\u003e\u0026ldquo;The thing that I think is most difficult is trying to get somewhere like the, well, the MDT [Multi-disciplinary Team] on board. It can be quite difficult to even just get small changes and patient care made so in terms of like new evidence for things\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eMedical staff spoke about an established research culture and how to grow it in the future.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWe're pivoting what we do to suit the current environment but still grow our research interest in, you know. It\u0026rsquo;s about bringing resource involvement, experience and work\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eClinical psychologists also had a positive attitude to research in the organisation.\u003c/p\u003e \u003cp\u003e \u003cem\u003e(In referring to medical staff and psychologists we have excluded the respondent number as it would have identified their profession)\u003c/em\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003eI think it is\u0026hellip;it [research] is fundamental just in the way we think and the way we operate\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eFurthermore, research is integral to some trainee posts and this normalises the activity in those groups.\u003c/p\u003e \u003cp\u003eR10 \u0026ldquo;\u003cem\u003eI think trainees are more encouraged to think about research\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eHowever, when those healthcare staff outside of medicine, dentistry, and psychology (Nurses, Midwives, Allied Health Professions, Healthcare Scientists, and Pharmacy staff, NMAHPs) discussed the acceptability of research in their culture they appeared less supported. An advanced nurse practitioner who acknowledged that \u003cem\u003e\u0026ldquo;one of the pillars of practise is research and education\u0026rdquo;\u003c/em\u003e appeared less comfortable in the supportive culture for them to undertake research generally. Furthermore, staff who worked in non-patient facing support departments were likely to use research to inform practice, but did not consider their role would be to undertake the research themselves.\u003c/p\u003e \u003cp\u003eR12 \u003cem\u003e\u0026ldquo;But generally, it [research] is not something I think that nurses do\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR15 \u0026ldquo;\u003cem\u003eAnd a lot of our doctors are very involved in research but as a [profession deleted], I found it extremely hard\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eUnsurprisingly, a supportive manager was seen to make research more acceptable to NMAHPs.\u003c/p\u003e \u003cp\u003eR15 \u003cem\u003e\u0026ldquo;I think you have to have a manager, your direct manager has to be supportive and encouraging and make that part of their ethos whether it would be ward or team-based\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR20 \u003cem\u003e\u0026ldquo;It [research] is still highly valuable and seen as an integral part, particularly from your high ups than a leadership team\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eIn addition to the culture of the individual within their workplace, the organisational pressure and culture within NHS Fife was seen to have a strong impact on research activity. Some of the respondents who were research active within their role considered that the organisation could do more to build research into the staff role.\u003c/p\u003e \u003cp\u003eR20 \u0026ldquo;\u003cem\u003eSo, yes, it [research] is valued but the infrastructure, the kind of framework for being able to do it is not there\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR6 \u003cem\u003e\u0026ldquo;I think there's a will to do research, but I'm just not totally convinced that they [the organisation] have an overarching strategy and a way promoting it effectively\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eMany of the respondents reported a lack of visibility of ongoing research projects and activity, or research resources (including the R\u0026amp;D department) within the organisation. If staff were more aware of research within the organisation that visibility would also embed it into the culture of the workplace as it would seem a standard part of the organisation\u0026rsquo;s ethos.\u003c/p\u003e \u003cp\u003eDefining what is, and is not research activity is subjective and may be reflective of the culture of the individual involved. Staff who are familiar with being researchers were happy to define themselves as such, but nurses and others where research is not seen as part of their role appeared more reluctant to put themselves into that category, even if, as in some cases, they had done postgraduate degrees or had engaged in research being run in the organisation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eCommunication:\u003c/h2\u003e \u003cp\u003eA common criticism raised by respondents concerned communication within the organisation about research activities, opportunities, and the dissemination of findings. Although it was difficult to measure the level of awareness of research activity within the organisation, comments made by many respondents suggested that research visibility was low amongst individuals who were not themselves research active.\u003c/p\u003e \u003cp\u003eR2 \u003cem\u003e\u0026ldquo;I'm not aware that I would know very much about what research is actually going on in the hospital or across NHS Fife\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR6 \u003cem\u003e\u0026ldquo;What we don't do very well is signpost who is research active\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR12 \u003cem\u003e\u0026ldquo;I know obviously we\u0026rsquo;ve got a research department, I\u0026rsquo;m not aware of what they do, what research they kind of generate, how that has then impacted on practise\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eComments gave the impression that you needed to be actively doing research to be aware that it existed. This then became a barrier to other people in accepting that research activity was possible within the organisation. Some respondents were aware of the publicity about research distributed via the NHS Fife staff communication tool (\u0026lsquo;Blink\u0026rsquo;) and in regular newsletters from the R\u0026amp;D department. But these were seen as passive, impersonal methods of communication that did not inspire staff to seek more information about ongoing research projects, or in opportunities to engage in research in the organisation.\u003c/p\u003e \u003cp\u003eR12 \u003cem\u003e\u0026ldquo;Usually there\u0026rsquo;s a sort of blurb connected on Blink for you to read it but it\u0026rsquo;s not connections as such, it\u0026rsquo;s just basically informing you of what separate teams are doing\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR10 \u0026ldquo;\u003cem\u003eI get the bulletin [from R\u0026amp;D] and I usually have a flick through it, just to see what\u0026rsquo;s going on but I\u0026rsquo;m not really aware of anything specific was happening\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eA more proactive approach to communication, with personal interaction was suggested to increase communication between researchers, research departments and other staff.\u003c/p\u003e \u003cp\u003eR1 \u0026ldquo;\u003cem\u003eIt [communication] could definitely improve, for example and maybe it's what I need to do. Maybe I need to call up R\u0026amp;D say \u0026lsquo;come and have, you know, come and look round come and chat to us\u0026rsquo;. \u0026lsquo;Come and tell us what you do\u0026rsquo; or coming up a TEAMs meeting or something, but I don't feel it should be my job to do that\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR15 \u003cem\u003e\u0026ldquo;It might be good if it [research] was part of some sort of mandatory induction or something like that, that it was a bit more visible\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eFurthermore, targeting the communication in a way that made the research more relevant to staff was seen as beneficial, especially when examples of how, or why research was undertaken.\u003c/p\u003e \u003cp\u003eR12 \u003cem\u003e\u0026ldquo;It\u0026rsquo;s making the research team more visible about these are all the research projects that we\u0026rsquo;ve done, this is what we found, this is why your job is easier, this is why\u0026hellip; this is the benefit for you, for all these projects. So once people see tangible benefits, I think they\u0026rsquo;re more likely to buy into the research in the first place\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eIt was suggested that a \u0026lsquo;champion\u0026rsquo; could also act as a visible way of communicating ongoing research to others in the organisation.\u003c/p\u003e \u003cp\u003eR15 \u003cem\u003e\u0026ldquo;I was talking about having almost a link. If you got some people, whether it\u0026rsquo;d be a consultant or nurse, an OT [Occupational Therapist] or somebody in each team who can be that link, then they can bring these ideas to the home and encourage\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eSome staff described supporting research activity for others but not getting any feedback about the final conclusions. This lack of communication did not make the individuals feel valued or involved.\u003c/p\u003e \u003cp\u003eR1 \u0026ldquo;\u003cem\u003eBut then don't know what happens after that, you know? And we don't know if there's anything published and we don't know if anybody was acknowledged. Or so it is very much the Mushroom Syndrome\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eCommunication about all forms of research is vital for making it part of the accepted culture of the organisation, and a positive endeavour for individuals. The respondents\u0026rsquo; comments suggested that the organisation was not very active in communicating research activity in a way that engaged the staff working within it. Although there were some processes to publicise research activity, these were not very engaging to staff who felt a more personal approach was likely to be more successful.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSARS-CoV-2 Pandemic:\u003c/h2\u003e \u003cp\u003eA specific enquiry was made into perceptions of the impact of the SARS-CoV-2 pandemic on research interest and activity. During this period most respondents had become more aware of the value of research to improving healthcare to tackle the pandemic.\u003c/p\u003e \u003cp\u003eR15 \u003cem\u003e\u0026ldquo;that when you see it [research] actually in action, it does make a more of a priority\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR15 \u003cem\u003e\u0026ldquo;I think maybe it\u0026rsquo;s been more apparent to people, the evidence, you know, of what research means\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR18 \u003cem\u003e\u0026ldquo;the engagement with research has been quite high or with, because, because things are changing all the time. So, we\u0026rsquo;re needing to keep up with it so we know what to tell people and we know what to look for\u0026hellip;.. I think there\u0026rsquo;s certainly this slight shift in wanting to engage with research and recognising the importance of it.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eSome respondents spoke about how they would take research forward from the lessons learnt from the pandemic, including new areas to study.\u003c/p\u003e \u003cp\u003eR25 \u0026ldquo;\u003cem\u003ecan adapt to the situation, learn lessons, and before it, planning, future planning for any similar events. I think, yeah, I think it\u0026rsquo;s vital to research, it\u0026rsquo;s vital going forward\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eR10 \u003cem\u003e\u0026ldquo;we\u0026rsquo;ve been moved to consulting in a completely different way, which we\u0026rsquo;ve never researched before\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThis shows that putting clinical research in context (in this case, relating to an emerging health issue) made it more relevant and accessible to staff, and more valued as a priority in the organisation.\u003c/p\u003e \u003cp\u003eR15 \u003cem\u003e\u0026ldquo;I definitely think it [research] should be a lot higher up than it is. I think COVID has shown that, you know\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAlthough there were many examples of a positive impact of SARS-CoV-2 on the research landscape, for a small number of respondents, the pandemic negatively impacted on the ability to engage with research. An increased workload during the SARS-CoV-2 pandemic made participation in research unfeasible.\u003c/p\u003e \u003cp\u003eR1 \u0026ldquo;\u003cem\u003eit [COVID] is just the straw that broke the camel\u0026rsquo;s back. Our ability to support research is severely hampered by our staffing, uh status, and the requirements being placed on us\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAdditionally, the constantly evolving information that came out from the research into treating SARS-CoV-2 also felt overwhelming to the staff working during this time.\u003c/p\u003e \u003cp\u003e \u003cem\u003eR18 \u0026ldquo;But I think the - the myriad of it has just made people a little bit tired perhaps, unfortunately\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe principal study aim was to explore staff views about engaging in and supporting research in the health board, and to elicit suggestions as to how research activity could be enhanced. We also sought views on how the SARS-CoV-2 pandemic may have affected attitudes to research in the NHS. We sought to gain an insight into the attitude of all staff grades and professions, so we did not limit our sample to only certain professions, or to only research-active, or research-inactive personnel. Consequently, we obtained views from different staff roles, responsibilities, and research experience within the organisation to obtain a varied and comprehensive response base for analysis. Four overarching themes emerged from our analyses, namely, Time, Resources, Culture and Communication, with additional factors including intrinsic and extrinsic aspects (Table\u0026nbsp;1). In addition, the impact of the SARS-CoV-2 pandemic on research activity and on attitudes to research were explored.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTime as a theme\u003c/h2\u003e \u003cp\u003eWe asked the respondents to consider the research culture and capacity in NHS Fife on an individual, team, and organisational level. The responses reflected those seen in previous studies in healthcare organisations. The lack of time being an almost universally mentioned barrier to investigator-initiated research activity, and protected research time facilitating activity is a theme echoed by other studies assessing research capability and capacity building [8, 13]. Ring fenced research time provides one important resource to plan and undertake research, but it also provides a \u0026lsquo;legitimacy\u0026rsquo; to the researcher to undertake the work. Medical staff and psychologists working in professions traditionally associated with research activity were less likely to cite access to research time as a barrier when compared to other professions such as nurses who have, traditionally, not had research as part of their role. Initiatives to provide protected time within a clinical role have included funded fellowships, though these tend to be biassed towards medical applicants. Competition is intense and the success rate of applications from NMAHPs is poor [5, 26].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eResources as a theme\u003c/h2\u003e \u003cp\u003eAlongside providing time to do or support research there also needs to be other resources such as training, specialist advice and practical support, particularly with the associated bureaucracy. Some respondents acknowledged the help they had received through the R\u0026amp;D department whilst others were aware of its existence but were unaware of the services offered.\u003c/p\u003e \u003cp\u003eOne resource to increase research activity widely mentioned by respondents, irrespective of their role within the organisation, was the availability of a research mentor, facilitator, or link person (different terms were used, but, essentially, respondents were referring to an individual whose role was to guide staff through the research process). Some felt this individual should be embedded within their department or team, others felt they should sit within their profession i.e. an AHP specific research facilitator. Research facilitators / mentors can have a positive effect on building capacity [14, 16, 17]. A qualitative study evaluating the provision of research training noted that trainees developed transferable skills including the ability to act as facilitators to other research interested staff in the organisation [23]. Research facilitators may be considered a resource in terms of \u0026lsquo;time\u0026rsquo; by sharing some research tasks with the active researcher. The skills needed to be an effective research facilitator include experience in research design, project management, data analysis (quantitative and qualitative), report writing (grants, ethics), communication, the intricacies of clinical research and a recognition of their own limitations [17]. In addition to having a research skill set, effective facilitators need to be enthusiastic, approachable, and encouraging when engaging with staff.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eCulture as a theme\u003c/h2\u003e \u003cp\u003eOrganisational culture in healthcare can be defined as \u0026lsquo;the shared ways of thinking, feeling, and behaving in healthcare organisations\u0026rsquo; [24]. This culture has been described as existing in three layers: (1) Visible aspects, including structural features (infrastructure, estate) and established and accepted ways of working, (2) Shared ways of thinking, namely the values and beliefs that justify actions, and (3) Shared assumptions, the unspoken, unconscious expectations of staff within their professions. Additionally, due to the complexity of healthcare delivery, aspects of workplace culture may vary across the organisation, specific to individual professions or specialities, resulting in various subcultures that will have a different perspective on the research environment and the question of \u0026lsquo;culture.\u0026rsquo; Staff in a profession that traditionally engaged with research were comfortable with either undertaking research themselves, or encouraging colleagues to do it. They saw the value in research, had accessed resources and accepted research as the way for healthcare to develop. Research had a legitimacy in their role along with the more \u0026lsquo;traditional\u0026rsquo; clinical work. Some of these staff still had problems getting the time or other resources (capacity), but were receptive to the culture of research in developing knowledge. In comparison, those NMAHP professions where research was not part of their remit or remuneration had less research activity and lacked confidence to be research active, or felt it was only for higher banded staff. Often staff mentioned that they reviewed the literature adopting evidence-based practice to inform their clinical work, but did not develop this activity further. With workforce restructuring and extra responsibilities being placed on more senior staff, this may change the expectation of individuals and their subcultures to acknowledge their \u0026lsquo;legitimacy\u0026rsquo; to undertake research.\u003c/p\u003e \u003cp\u003eAn important aspect in developing a research culture is the support and active encouragement given by senior and middle managers, reflecting the adoption of a research strategy at Board level. This aspect has been commented on by others [25, 26] and considered a critically important component. However, NHS Fife is not a designated teaching/university board within the Scottish system. The Board receives a performance and activity-based allocation from the Scottish Government to fund the R\u0026amp;D department in covering the unmet costs of supporting commercial, non-commercial, and investigator-initiated research; it does not attract more substantial funding that the larger, teaching Boards receive. This may result in research and innovation being less of a priority for a non-teaching Health Board, such as NHS Fife.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eCommunication as a theme\u003c/h2\u003e \u003cp\u003eGaps in communication within the organisation were highlighted by some respondents despite the efforts made in disseminating regular newsletters by the R\u0026amp;D department, and monthly notices of papers published by NHS Fife staff by the library service. Some respondents were aware of these circulars but considered they were impersonal and not apparently relevant to their own clinical area. Other respondents were unaware of these circulars, raising the need to increase their visibility and penetration within the service. The importance of good communication as a component of an organisation\u0026rsquo;s research culture has been emphasised by others [13, 27]. If staff are to be encouraged to become research active, the resources available and the impact of research on the individual, healthcare and the organisation should be visible to all who work within it. If this visibility is limited through inadequate communication there is a danger that research activity will mainly be restricted to people driven to do it by factors external to the organisation, such as professional requirements or prior experience gained in other organisations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eRecognition of research activity\u003c/h2\u003e \u003cp\u003eSome respondents were undertaking research but did not recognise it as such. Others considered they were undertaking research activities when searching the literature for evidence to inform changes in clinical practice. Additionally, clinical effectiveness activities were seen as \u0026lsquo;research\u0026rsquo; rather than service improvement. It is difficult to objectively define \u0026lsquo;research activity.\u0026rsquo; Branbenburg, 2024, did a scoping review of the literature to understand research engagement in medicine [28] concluding that \u0026lsquo;outcome measures were highly heterogenous, suggesting there is no agreed outcome measure for \u0026ldquo;research engagement\u0026rdquo;\u0026rsquo;. Friessen, 2017, also felt that healthcare organisations should provide education about what constitutes \u0026lsquo;research\u0026rsquo; so that staff can recognise when they are doing it [29]. Being aware of what research is being undertaken in the organisation, how staff can support it, and what resources are available to start it, raises the profile of research within the context of the organisation and staff groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eInfluence of the SARS-Cov-2 pandemic on staff attitudes to research\u003c/h2\u003e \u003cp\u003eThis study was conducted between December 2021 and February 2022. The SARS-CoV-2 virus started circulating in the UK early 2020, and the country entered a national lockdown in March 2020. Most restrictions were lifted mid-2021 with the final ones being removed by March 2022. Consequently, the study was undertaken within a timescale that the respondents would likely have recent memories of a time working in healthcare before, during and after the peak of the pandemic.\u003c/p\u003e \u003cp\u003eThe pandemic affected all aspects of healthcare delivery and clinical research at the time. Within NHS Fife recruitment to the majority of clinical trials was suspended, and the research teams opened urgent public health studies addressing the emerging pandemic. Research staff engaged with clinical teams in previously low research areas, promoting the value of clinical research to otherwise research na\u0026iuml;ve staff. Other staff volunteered as participants in a national study being hosted in NHS Fife, again promoting the value of research to previously research na\u0026iuml;ve staff. Clinical staff had questions about the best way to manage the pandemic, were presented with ever changing information about treating patients, and ultimately had to adapt to new ways of working, leading to many questioning previously held assumptions about healthcare practices. Furthermore, patients were more questioning of staff about their own healthcare, seeking answers and reassurance during this uncertain period. This upheaval and search for answers put research in the forefront of the response to the pandemic.\u003c/p\u003e \u003cp\u003eFor most of the respondents the pandemic had increased their interest in research, either seeing the value of it in the organisation, or by giving them personal motivation to study an issue of importance. This illustrates that putting clinical research in context, in this case, relating to an emerging health issue, made it more relevant to staff. Furthermore, the resources and support offered by the NHS Fife R\u0026amp;D office to those wanting to engage in research were similar before and after the pandemic, so any changes in research culture after the pandemic were possibly due to intrinsic factors within individuals rather than a shift in the framework around research. However, there was little evidence from the respondents that the organisational culture had shifted towards research because of the pandemic, but the visibility of research had. It is important that staff feel able to engage with research activities by supporting it, contributing to it, and initiating it themselves, depending on their personal motivation and abilities. Whatever their level on interest, staff need resources and a supportive organisational culture to take this forward. It is also important that this new awareness and enthusiasm for research across all groups of staff is nurtured within the organisation before it fades and staff become disillusioned, possibly reinforcing any previous negative attitudes that research is not something they can, or should engage with.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and weaknesses\u003c/h2\u003e \u003cp\u003eWe sought to obtain views across all staff groups and did not confine our sample to only those professions that traditionally engage in research. Many studies have looked at research culture in particular professional groups, but this study recruited across professional groups within the same organisation to enable us to make comparisons in attitudes of sub-groups. However, the respondents were self-selected which has the potential to skew the results to reflect the views of those who had an interest in research and were motivated to take part in the questionnaire survey, and interviews. We are aware that staff members who were not interested in research, or who had had previous negative experiences were less likely to take the time to participate in the study and provide information about their perspective of the culture of research within NHS Fife, and the impact of the SARS-CoV-2 pandemic.\u003c/p\u003e \u003cp\u003eAll but one of the interviews were conducted by one trained researcher though multiple, experienced researchers analysed the transcripts to increase the reliability of the identified themes and subthemes. Furthermore, we are confident that saturation was achieved. During our analysis we did not classify respondents as research active/inactive because this was difficult to objectively classify from the transcripts. Additionally, some respondents did not recognise they were undertaking research activities in their roles, whilst others confused literature searching, to inform ongoing practice, as a research activity.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSummary of the findings and recommendations.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIt was clear from the responses that different cohorts of respondents had patterns of self-reflection based on assumptions, possibly due to expectations of their clinical role and the degree of which research featured in their initial training. Medical staff and psychologists felt more comfortable and receptive to research, whereas the NMAHPs often suggested that research was not part of their initial training, their role, and culture; they needed more \u0026lsquo;permission\u0026rsquo; from their peers or managers to engage in research. This personal perception reinforced the cohort stereotypes and requires a cultural shift in the organisation/professions to elicit a positive change. Additionally, there is a need to define \u0026lsquo;research\u0026rsquo; and educate staff in awareness of the spectrum of research activity to enable them to classify their activities. This is of particular importance for those staff that have research written into their job description. Staff may then be considered \u0026lsquo;research active\u0026rsquo; as distinct from being \u0026lsquo;research aware.\u0026rsquo;\u003c/p\u003e \u003cp\u003eThe findings from our interviews broadly concur with those from the questionnaire arm of the study [20], though additional aspects emerged from our in-depth investigation, including the apparent confusion amongst some of the respondents as to what activities constitutes \u0026lsquo;research\u0026rsquo;, and the need for improved communication. Overall, our findings suggest that to increase research activity in our Health Board we should focus on the following: (1) \u003cb\u003eprovide protected time\u003c/b\u003e and backfill for staff wishing to engage in research, (2) \u003cb\u003eincrease resources\u003c/b\u003e to support research-active staff, to include training, admin support to tackle the associated bureaucracy (ethics, protocol writing, applications for research fellowships), advice on study design, data analysis, and help in securing grant funding, particularly for pilot studies, (3) \u003cb\u003eexpand the culture\u003c/b\u003e by adopting policies at Board level to promote research as a priority, recognising that different strategies will be needed covering different types of research (commercial, non-commercial, investigator-initiated, opportunities to benefit from intellectual property). Associated activities should look to increase links with academia and other potential external partners, to encourage managers of all grades to promote research as part of everyday practice and to include research activity as part of the career pathway, particularly for those staff that have research included in their job description, (4) \u003cb\u003eimprove communication\u003c/b\u003e throughout the organisation by increasing penetration of the various newsletters and alerts currently circulated to provide details to staff of services available to help them engage in research, of current, newly established and completed research projects underway in the organisation, of opportunities to become more involved in projects, and of current publications by NHS Fife staff. Improvements in communication should also feature alerts to patients of ongoing projects and any opportunities to volunteer for a study.\u003c/p\u003e \u003cp\u003eSome NHS Fife staff undertake post-graduate courses some of which will involve completing a research study. It is particularly important to encourage them at an early stage to consult the R\u0026amp;D department and library to establish what resources are available to assist them in their project, including writing up their dissertation and any papers arising from their work. Staff that are successful in passing their course may consider becoming a \u0026lsquo;Research Champion, Mentor or Facilitator\u0026rsquo; to work within their professional group or team to provide guidance to others in developing their own research career, and to promoting evidence-based practice by reviewing the medical literature.\u003c/p\u003e \u003cp\u003eIt is anticipated that the results of this study will be used to assist in setting strategy, planning local initiatives, and assessing change in research capacity and culture indicators over time. The findings may have relevance for other non-teaching Health Boards in Scotland, and for other health providers that intend to respond to the call to increase their research profile.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAHP: Allied Health Professionals\u003c/p\u003e\n\u003cp\u003eCOREQ: Consolidated Criteria for Reporting Qualitative Research\u003c/p\u003e\n\u003cp\u003eCOVID: with reference to the SARS-CoV-2 virus\u003c/p\u003e\n\u003cp\u003eHEI: Higher Education Institute\u003c/p\u003e\n\u003cp\u003eNHS: National Health Service\u003c/p\u003e\n\u003cp\u003eNMAHP: Nurses, midwives, allied health professionals\u003c/p\u003e\n\u003cp\u003eR\u0026amp;D: Research and Development\u003c/p\u003e\n\u003cp\u003eUK: United Kingdom\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs the study participants were NHS staff a formal review by an NHS ethics committee was not required following advice obtained using the Health Research Authority decision tools (www.hra-decisiontools.org.uk) and directly from the East of Scotland Research Ethics Service (NHS Tayside). \u0026nbsp;Informed consent was obtained from all subjects who volunteered to take part in the qualitative interview arm of the study. All study methods were carried out in accordance with the principles written into the Declaration of Helsinki (June 1964).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eManagement approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eManagement approval was obtained from NHS Fife. The study protocol was reviewed and approved by internal staff in NHS Fife and by one external reviewer from NHS Forth Valley.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll respondents gave verbal consent allowing publication of their comments as anonymised quotations.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article and supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNHS Fife, Research, Innovation and Knowledge Department sponsored and funded the project.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOzdemir BA, Karthikesalingam A, Sinha S, Poloniecki JD, Hinchliffe RJ, Thompson MM, Gower JD, Boaz A, Holt PJ. Research Activity and the Association with Mortality. PLoS One. 2015;10:e0118253. doi: 10.1371/journal.pone.0118253\u003c/li\u003e\n\u003cli\u003eBoaz A, Hanney S, Jones T, Soper B. Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review. BMJ Open 2015;5: e009415. doi:10.1136/ bmjopen-2015-009415\u003c/li\u003e\n\u003cli\u003eJonker L, Fisher SJ. The correlation between National Health Service Trusts\u0026rsquo; clinical trial activity and both mortality rates and Care Quality Commission ratings: a retrospective cross-sectional study. J Public Health. 2018;157:1\u0026ndash;6. doi: 10.1016/j.puhe. 2017.12.022\u003c/li\u003e\n\u003cli\u003eJonker L, Fisher SJ, Dagnan D. Patients admitted to more research-active hospitals have more confidence in staff and are better informed about their condition and medication: Results from a retrospective cross-sectional study. J Eval Clin Pract. 2020;26:203\u0026ndash;8. doi: 10.1111/jep.13118\u003c/li\u003e\n\u003cli\u003eSaving and Improving Lives: The Future of UK Clinical Research Delivery. Published 23 March 2021. The Future of UK Clinical Research Delivery \u0026ndash; GOV.UK (www.gov.uk), accessed 24\u003csup\u003eth\u003c/sup\u003e May 2023.\u003c/li\u003e\n\u003cli\u003eThe Future of UK Clinical Research Delivery: 2022 to 2025 Implementation Plan. Published 30 June 2022 https://www.gov.uk/government/publications/the-future-of-uk-clinical-research-delivery-2022-to-2025-implementation-plan, accessed 24\u003csup\u003eth\u003c/sup\u003e May 2023.\u003c/li\u003e\n\u003cli\u003eChief Scientist Office, Edinburgh. Three Year Plan for Implementing the Vision for the Future of UK Clinical Research Delivery. https://www.cso.scot.nhs.uk/three-year-plan-for-implementing-the-vision-for-the-future-of-uk-clinical-research-delivery-published/ accessed 17\u003csup\u003eth\u003c/sup\u003e January 2024.\u003c/li\u003e\n\u003cli\u003eGill SD, Gwini SM, Otmar R, Lane SE, Quirk F, Fuscaldo G. Assessing research capacity in Victoria\u0026rsquo;s south-west health service providers. Aust J Rural Health 2019; 27: 505-513. https//doi.org/10.1111/ajr.12558 \u003c/li\u003e\n\u003cli\u003eLee SA, Byth K, Gifford JA, Balasubramanian M, Fozzard CA, Skapetis T, Flood VM. Assessment of Health Research Capacity in Western Sydney Local Health District (WSLHD): A Study on Medical, Nursing and Allied Health Professionals. J Multidisciplinary Healthcare 2020; 13: 153\u0026ndash;163.\u003c/li\u003e\n\u003cli\u003eSlade SC, Philip K, Morris ME. 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Building research capacity. Nursing Management. 2005; 12: 32-37.\u003c/li\u003e\n\u003cli\u003ePain T, Petersen M, Fernando M. Building Allied Health Research Capacity at a Regional Australian Hospital: A Follow-up Study. Internet Journal of Allied Health Sciences and Practice. 2018;16(4) ISSN 1540-1580X (Article 8).\u003c/li\u003e\n\u003cli\u003eWhitworth A, Haining S, Stringer H. Enhancing research capacity across healthcare and higher education sectors: development and evaluation of an integrated model. BMC Health Services Research 2012; 12: 287. http://www.biomedcentral.com/1472-6963/12/287\u003c/li\u003e\n\u003cli\u003eFlenady T, Dwyer T, Kahl J, Sobolewska A, Reid-Searl K, Signal T. Research-capacity building for clinicians: understanding how the research facilitator role fosters clinician\u0026rsquo;s engagement in the research process. Health Research Policy and Systems 2022; 20: 45. https://doi.org/10.1186/s12961-022-00849-8 \u003c/li\u003e\n\u003cli\u003eBack-Pettersson S, Jensen KP, Kylen S, Sernert N, Hermansson E. Nurses\u0026rsquo; experiences of participation in a research and development programme. J Clin Nursing. 2012; 22: 1103\u0026ndash;1111. https//doi.org/10.1111/j.1365-2702.2012.04297.x \u003c/li\u003e\n\u003cli\u003eBabl FE, Dalziel SR, Borland ML. Establishing a research network. J Paed Child Health. 2020; 56: 857\u0026ndash;863. https//doi.org/10.1111/jpc.14896 \u003c/li\u003e\n\u003cli\u003eChinn DJ, Pribanova M, Quirk F. The research interest, capacity and culture of NHS staff in South East Scotland and changes in attitude to research following the pandemic: a cross-sectional survey. BMC Health Services Research, 2023: doi:10.1186/s12913-023-09196-y\u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology. 2006; 3(2): 77-101.\u003c/li\u003e\n\u003cli\u003eTong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 2007; 19 (6): 349\u0026ndash;357\u003c/li\u003e\n\u003cli\u003eSchmidt D, Duncanson K, Webster E, Saurman E, Lyle D. Critical realistic exploration of long-term outcomes, impacts and skill development from an Australian Rural Research Capacity Building Programme: a qualitative study. BMJ Open 2022; 12: e065972 doi:10.1136/bmjopn-2022-065972. \u003c/li\u003e\n\u003cli\u003eMannion R, Davies H. Understanding organisational culture for healthcare quality improvement. BMJ Open 2018; 363:k4907 doi:10.1136/bmj.k4907.\u003c/li\u003e\n\u003cli\u003eMoore J, Crozier K, Kite K. An action research approach for developing research and innovation in nursing and midwifery practice: Building research capacity in one NHS foundation trust. Nurse Education Today 2012; 32: 39-45.\u003c/li\u003e\n\u003cli\u003eTrusson D, Rowley E, Bramley L. A mixed-methods study of challenges and benefits of clinical academic careers for nurses, midwives and allied health professionals. BMJ Open 2019; 9: e030595. doi:10.1136/ bmjopen-2019-030595.\u003c/li\u003e\n\u003cli\u003eLuckson M, Duncan F, Rajai A, Haigh C. Exploring the research culture of nurses and allied health professionals (AHPs) in a research-focused and a non-research-focused healthcare organization in the UK. J Clin Nurs 2018; 27: e1462-e1476. https//doi.org/10.1111/jocn.14264\u003c/li\u003e\n\u003cli\u003eBrandenburg C, Stehlik P, Noble, C, Wenks R, Jones K, Hattingh L et al. How can healthcare organisations increase doctors\u0026rsquo; research engagement? A scoping review. Journal of Health Organisation and Management. \u003cem\u003eIn the press. \u003c/em\u003eDOI: 10.21203/rs.3.rs-3130367/v1\u003c/li\u003e\n\u003cli\u003eFriesen EL, Comino EJ. Research culture and capacity in community health services: results of a structured survey of staff. Australian Journal of Primary Health 2017; 23: 123-131.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Principal themes and sub-themes (intrinsic and extrinsic factors) to increase research activity\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntrinsic factor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExtrinsic factor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eProvide protected time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eAvailability of NHS Education for Scotland fellowships, particularly for NMAHPs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eInclude research in job descriptions and job plans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResources\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eR\u0026amp;D department support \u0026amp; advice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eLibrary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eExternal grants\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eInternal training courses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eExternal training courses\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eLocal sources of funding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eAccess to HEIs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eResearch mentorship within clinical teams\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003ePersonal motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCulture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eResearch as a strategic priority for the organisation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eProfessional training and culture\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eManagement support at Team and Organisation levels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eResearch as a component of trainee development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eDevelop \u0026lsquo;research champions\u0026rsquo; throughout the organisation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eCareer development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eIncrease visibility of research activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eProfessional development requirements\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eIncrease feedback to staff on research findings and impact on practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003eR\u0026amp;D newsletters to be targeted to individual teams.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.201228878648234%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lsquo;Research champions\u0026rsquo; embedded in clinical teams to circulate research news at team meetings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.39938556067588%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNMAHPs: Nurses, midwives, allied health professionals, HEIs: Higher Educational Institutes,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eR\u0026amp;D: Research and Development\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Research Capacity, Health Research, Research Capacity Building, Innovation, Research Activity, Barriers, Motivators, Pandemic","lastPublishedDoi":"10.21203/rs.3.rs-3909362/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3909362/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eResearch is a key driver in improving the quality of care in health settings. The UK Government has published its strategy to increase research within the National Health Service (NHS) and to implement lessons learned from the SARS-CoV-2 pandemic. We have investigated the current research interest, culture, and capacity amongst staff in one small, non-teaching regional Health Board in Scotland to determine how research activity may be increased and how attitudes to research may have changed following the recent pandemic.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eSemi-structured interviews (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;28) were conducted with staff of all grades exploring the research culture at an organisational, team and individual level. Topics included perceived barriers and facilitators for engaging in research activities and the impact of the SARS-CoV-2 pandemic on changes in attitude to research within the NHS. Interviews were audio recorded, transcribed verbatim, and analysed using thematic analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eRespondents comprised 7 nurses/midwives, 6 doctors/dentists, 3 allied health professionals, 3 other therapeutic and 9 admin/support staff. Some staff had research written into their job descriptions. All respondents identified similar facilitators and barriers to undertaking research, irrespective of their role or experience with research. Four key themes affecting research capacity and capability were time, resources, culture, and communication. Responses varied between staff grades where those who had research embedded as part of their training and professional role expressed more accepting views to undertaking research. Issues identified were the provision of protected time, skills training, practical support from research facilitators, active encouragement by managers of all grades, improved communication, the development of \u0026lsquo;champions\u0026rsquo; working in clinical teams and the adoption of a research strategy at Board level. The pandemic had a negative impact on research activity but many respondents expressed an increased awareness of the importance of research as a priority in improving health outcomes during the pandemic.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe research interest and culture in our Health Board can be improved by addressing the four broad themes identified, thereby increasing research capacity in line with Government aspirations. The findings may have relevance for other small health providers that intend to respond to the call to increase their research profile.\u003c/p\u003e","manuscriptTitle":"Exploring the Research Interest, Capacity and Culture of NHS Staff in South-East Scotland following the SARS-CoV-2 Pandemic: a Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-02 16:15:14","doi":"10.21203/rs.3.rs-3909362/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-14T15:41:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-05T04:30:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220794041451637945558243956568725124437","date":"2024-08-26T21:14:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-24T03:11:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-22T00:54:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"315863507428177433429239200087290570883","date":"2024-08-19T07:51:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207722898457005517537554586817761420679","date":"2024-08-14T05:22:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-13T09:17:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-02-02T07:59:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-02-01T02:34:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-02-01T02:34:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-01-29T18:49:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b2ab7ac-f5bb-4082-8727-b34dae6110dc","owner":[],"postedDate":"February 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-25T16:38:14+00:00","versionOfRecord":{"articleIdentity":"rs-3909362","link":"https://doi.org/10.1186/s12913-025-13074-0","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2025-08-18 16:29:45","publishedOnDateReadable":"August 18th, 2025"},"versionCreatedAt":"2024-02-02 16:15:14","video":"","vorDoi":"10.1186/s12913-025-13074-0","vorDoiUrl":"https://doi.org/10.1186/s12913-025-13074-0","workflowStages":[]},"version":"v1","identity":"rs-3909362","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3909362","identity":"rs-3909362","version":["v1"]},"buildId":"ApUGefWb6u5IBVtyqm6d5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}