Barriers and Enablers of Research Participation Among Undergraduate Health Students in Sub- Saharan Africa: A Systematic Review

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However, in Sub-Saharan Africa (SSA), the participation of undergraduate health students in research remains limited. This review aims to systematically explore the barriers and enablers to research participation among UHS in SSA. Methods A systematic search was conducted across MEDLINE, Embase, Scopus, CINAHL, and Web of Science databases for studies published in English from 2000 to 2024. Studies were screened and assessed for quality using the Mixed Methods Appraisal Tool. Data were synthesized through narrative synthesis. Results Ten studies from Uganda, South Africa, Namibia, Rwanda, Sudan, and Nigeria were included, with quality ratings from moderate (60%) to very high (100%). Reported research activities covered early (conceptualisation, ethics approval), middle (data collection, analysis), and late (dissemination, publication) phases. Barriers were clustered into: (1) resource constraints; (2) time and curriculum pressures; (3) inadequate mentorship; (4) knowledge and skills gaps; (5) administrative and ethical hurdles; (6) perceptions, attitudes to research and (7) Gender, Language and Cultural barriers. Enablers included: (1) early research exposure; (2) strong mentorship; (3) access to funding/resources; (4) research skills training; (5) individual motivation; and (6) institutional/peer support. Some factors such as supervision and resources were reported as both barriers and enablers. Conclusion UHS in SSA face intertwined structural, institutional, and personal challenges to research participation. Strengthening mentorship, integrating research early into curricula, improving access to resources, and providing skills training may enhance engagement and build sustainable research capacity in the region. Trial registration This review was prospectively registered on PROSPERO database (PROSPERO 2024 CRD42024581644). Undergraduate health students research participation barriers enablers Sub-Saharan Africa research capacity building. Figures Figure 1 1. INTRODUCTION Research has been a veritable tool to increasing the understanding of diseases, disease mechanisms and offering evidence-based strategies to protect public health [ 1 ]. With the presence of epidemics and pandemics in recent years, such as HIV, COVID-19 and M-pox [ 2 , 3 ], there is an increased need for research to bridge knowledge gap and provide appropriate tools to tackle these rising public health challenges [ 4 ]. Sub-Saharan Africa (SSA), with a population of approximately 1.26 billion, carries a disproportionately high share of the global disease and mortality burden, accounting for 25% of the world’s total [ 5 ]. This situation is largely driven by limitations in the quality of healthcare services across the region, further compounded by a critical shortage of locally generated research evidence to inform effective healthcare interventions and policies [ 6 ]. Africa has just 198 researchers per million people, compared to over 4,000 per million in countries like the United Kingdom and the United States [ 7 , 8 ]. Moreover, no African nation has met the African Union’s target of allocating 1% of its gross domestic product to research and development [ 7 ]. This gap has led many African nations to rely heavily on findings from high-income countries, whose disease profiles and levels of medical advancement differ significantly from those in SSA [ 6 ]. Such reliance can lead to poor health outcomes, as seen during the Ebola outbreak in West Africa, where a lack of skilled local clinical researchers contributed to increased disease transmission and mortality rather than effective containment [ 6 , 9 ]. Consequently, there is a growing emphasis across SSA on strengthening undergraduate engagement in research activities [ 5 ]. Undergraduate Health Students (UHS) are widely regarded as the main pipeline of future healthcare professionals, including clinicians and health research scientists [ 6 ]. The undergraduate period presents a strategic window for developing research competencies, fostering scientific curiosity, and nurturing positive attitudes and behaviours. These can promote sustained involvement in research throughout their careers [ 10 ]. There are several examples of students who were engaged in research as undergraduates, who have gone on to make great achievements [ 10 ]. Although several African countries have implemented measures such as integrating research methodology early into academic curricula to strengthen research capacity [ 6 ], for most undergraduate health related programs, students often only get to experience research as components of the traditional final/penultimate year thesis [ 9 ]. UHS research participation can go beyond this norm and can be integrated across the curriculum as early as their first year [ 11 , 12 ]. Earlier and diverse exposure to research can result in the development of cognitive skills including critical thinking and reasoning, which has been linked to higher self-efficacy, and better outcomes for patients and health system [ 10 ]. It can also foster increased competencies in academic writing, scientific communication, data collection and analysis, which can increase their likelihood of pursuing research careers, contributing to publications, and implementing evidence-based practices in clinical (and a variety of) settings [ 6 , 9 ]. Furthermore, in the context of Sub-Saharan Africa, where strengthening indigenous research capacity represents a strategic imperative for addressing regional health challenges, nurturing research engagement at the undergraduate level establishes essential foundations for sustainable research ecosystems [ 13 , 14 ]. As highlighted, the benefits of research participation are vast, and in other climes, involving undergraduate students in research has been viewed as a high impact practice [ 15 , 16 ]. However, the current understanding of the barriers and enablers of research participation among undergraduate health students in SSA remains fragmented, with studies typically focusing on specific health disciplines, single institutions or particular countries within the vast and diverse SSA region [ 17 ]. For instance, Awofeso et al. [ 18 ] conducted a similar study but focused only on medical students at the College of Medicine, University of Lagos. In contrast, another study [ 6 ] focused on 12 universities within Uganda offering health professional courses. To our knowledge, there has been no comprehensive synthesis of evidence as regards undergraduate health student's perspectives on research participation in SSA. This knowledge gap may limit the development of evidence-based strategies to build research capacity, starting at the undergraduate level. 1.1. Aim/Objectives To address this evidence gap, our systematic review aims to synthesize evidence on the barriers and enablers to research participation among undergraduate health students across SSA. In doing this, we will also explore the various forms and/or types of research activities undertaken by undergraduate health students in Sub-Saharan Africa. The findings will help to provide recommendations for enhance undergraduate health students’ participation in research and strengthen research capacity building at the undergraduate stages in health professions education in SSA. 2. METHODS We conducted this review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [ 19 ]. This review protocol was registered on PROSPERO (ID: CRD42024581644) on 23rd August 2024. 2.1. Eligibility Criteria Inclusion Criteria: Studies were included if they involved undergraduate students enrolled in health-related programs (medicine, nursing, pharmacy, public health, and allied health professions) in Sub-Saharan African countries and collected primary data using qualitative, quantitative, or mixed-methods approaches to explore barriers and enablers affecting research participation among this population. Exclusion Criteria: Studies were excluded if they featured only in-service health professionals, postgraduate students or undergraduate students not enrolled in a health-related discipline. We also excluded studies not conducted in Sub Saharan Africa, and other studies such as reviews, opinion pieces, commentaries, editorials, and books. 2.2. Search strategy A systematic search was conducted across five databases, MEDLINE, Embase, Scopus, CINAHL, and Web of Science databases for studies published in English from 2000 to 2024. We chose to limit the start of the search from 2000 onwards as this year marked key transformative commitments in education- the World Education Forum held in Dakar, Senegal in April 2020 [ 20 ]. This forum attended by world leaders led to the birth of the Dakar Framework for Action, aimed at driving the achievement of education for all, particularly in Sub Saharan Africa and other contexts. In the framework, priority areas of focus mapped out for sub-Saharan Africa include: improving quality and access, improving the quality and relevance of education, institutional and professional capacity building and improving partnership. These areas demonstrate relevance to the aim of this systematic review. The search included 3 main construct blocks using the PCC framework combined with Boolean operators: (1) Population terms capturing undergraduate students in health-related disciplines, (2) Concept terms addressing both barriers and enablers to participation in research, and (3) Context terms capturing Sub-Saharan Africa and all individual country names within the region. See example of a search string below. Table 1 Search string carried out on SCOPUS database S/N Search Terms 1 TITLE-ABS-KEY (undergraduate* OR "medical student*" OR "nursing student*" OR "health science* student*" OR "healthcare student*" OR "health profession* student*" OR "public health student*" OR "pharmacy student*" OR "allied health* student*" OR "university student*" ) 2 TITLE-ABS-KEY ( ( barrier* OR obstacle* OR challeng* OR imped* OR hinder* ) OR ( enabl* OR foster* OR facilitat* OR motivat* OR promot* ) ) 3 TITLE-ABS-KEY ( research ) 4 TITLE-ABS-KEY ( participat* OR involv* OR engag* OR le?d* OR partner* or collaborat* ) 5 TITLE-ABS-KEY ( "Sub-Saharan Africa" OR "Sub Saharan Africa" OR SSA OR Angola OR Benin OR botswana OR "Burkina Faso" OR burundi OR cameroon OR "Cape Verde" OR "Central African Republic" OR chad OR comoros OR "Congo" OR "Democratic Republic of Congo" OR drc OR "Republic of Congo" OR "Cote d'Ivoire" OR "Ivory Coast" OR djibouti OR "Equatorial Guinea" OR eritrea OR ethiopia OR gabon OR gambia OR ghana OR guinea OR "Guinea-Bissau" OR kenya OR lesotho OR liberia OR madagascar OR malawi OR mali OR mauritania OR mauritius OR mozambique OR namibia OR niger OR nigeria OR rwanda OR "Sao Tome and Principe" OR senegal OR seychelles OR "Sierra Leone" OR somalia OR "South Africa" OR "South Sudan" OR sudan OR swaziland OR eswatini OR tanzania OR togo OR uganda OR zambia OR zimbabwe ) 6 #1 AND #2 AND #3 AND #4 AND #5 AND PUBYEAR > 2000 AND PUBYEAR < 2025 AND ( LIMIT-TO ( LANGUAGE, "English" ) ) 2.3. Study screening and selection All identified records were collated and imported into Covidence systematic review software, where duplicate records were identified and removed. Following that, three reviewers (AEB, UUA and CDN) independently screened the titles and abstracts of the deduplicated records against the eligibility criteria. Afterwards, the full texts of studies deemed potentially eligible during the initial screening were retrieved and independently assessed by the same three reviewers. At each stage, any discrepancies between reviewers were resolved through discussion and consensus, with a fourth reviewer (AYA) serving as an umpire when necessary. Through this process, we documented the number of studies excluded at each stage in a PRISMA flow diagram. 2.4. Data extraction After finalizing the list of included studies, we utilized a data extraction form we developed to systematically collect information from each study. Data extracted included study characteristics (authors, publication year, country, study design, sample size), participant demographics (age range, gender distribution, academic year, health discipline), and specific details about research activities, barriers, and enablers to research participation among undergraduate health students in Sub-Saharan Africa. 2.5. Quality appraisal Studies were appraised for quality using the Mixed Methods Appraisal Tool (MMAT) Version 2018 [ 21 ]. The MMAT was selected for its versatility in evaluating various study designs including qualitative, quantitative and mixed methods. We meticulously assessed each study against key methodological criteria specific to its design type as outlined in the MMAT framework. Each criterion was scored using a three-point scale (‘yes’, ‘no’, or ‘cannot tell’), with individual study quality scores calculated as the percentage of criteria receiving a "yes" response. We subsequently categorized the overall quality of studies using a six-tier classification system: 0% (no quality), 20% (very low quality), 40% (poor quality), 60% (moderate quality), 80% (good quality), and 100% (very high quality). Any discrepancies or disagreements in quality assessments were resolved through reviewer discussions. The results were comprehensively documented in a tabular format, providing transparent evaluation of the methodological rigor underpinning our synthesis. While we described the quality appraisal scores of included studies, we did not exclude any study based on the scores. This was to make sure that we collected data from all studies related to the research question. 2.6. Data Synthesis We employed a narrative synthesis approach, guided by the framework proposed by [ 22 ], adapted specifically for our review objectives. This approach to synthesis will focus on integrating findings from the various study designs to provide a comprehensive understanding of the research topic. This began with a preliminary synthesis, where AEB, PAK, and UFI independently created textual descriptions of the included studies, and developed tables to comprehensively summarize study characteristics, participant demographics and key research findings. These reviewers then used systematic vote counting to identify frequently reported barriers and enablers to research participation across the studies. This preliminary stage also allowed us to extract data relevant to our other objectives, particularly the various ways UHS participate in research, and the types of research activities they engage in. The research activities were grouped into phases following our adaptation of the Whittemore and Melkus’s [ 23 ] framework on the research process. The same three reviewers then explored relationships in the data through collaborative thematic analysis. Here we grouped similar barriers and enablers firstly into clusters or analytical themes. Afterwards, we iteratively developed summary themes by comparing findings across different study designs, contexts, and student populations, with any disagreements resolved through discussion and consultation with another reviewer (CDN) when necessary. This process enabled us to organize our findings for a more comprehensive understanding. The narrative synthesis approach was particularly suited to our diverse set of qualitative, quantitative, and mixed-methods studies, allowing us to integrate findings that would not have been suitable for meta-analysis due to methodological and contextual heterogeneity across the Sub-Saharan African region. 3. RESULTS 3.1. Study selection Of 2411 studies identified from across the 5 databases, only 10 studies met the eligibility criteria. This study selection process is shown in Fig. 1 . 3.2. Study characteristics The review included 10 studies across various Sub-Saharan African countries. Single site studies were conducted in Namibia (n = 1) [ 24 ], Uganda (n = 3) [ 6 , 25 , 26 ], South Africa(n = 2) [ 9 , 27 ], Rwanda (n = 1) [ 28 ], Sudan (n = 1) [ 29 ], and Nigeria (n = 1) [ 18 ]. Additionally, one multi-site study conducted across three universities in Uganda, South Africa, Sudan [ 17 ]. The studies consisted of various study designs, including 3 qualitative [ 24 , 26 , 27 ], 5 quantitative [ 6 , 9 , 18 , 28 , 29 ], and 2 mixed-methods studies [ 17 , 25 ]. Sample sizes varied considerably, ranging from 20 [ 24 ] to 1,815 participants [ 17 ]. Across all included studies, study participants represented various health professions located in different colleges, schools and departments across various universities. These included medicine, nursing/midwifery, pharmacy, dentistry, physiotherapy, occupational therapy, speech-language and hearing therapy, human nutrition, biomedical sciences, medical radiography, public health, and allied health professions (where unspecified in some cases). These characteristics reflected the heterogeneous nature of research contexts and objectives across the studies. Thus, we did not conduct a meta-analysis. 3.3. Quality Assessment The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) version 2018. Scores ranged from 60% (moderate quality) to 100% (very high quality) across the included studies. Of the 10 studies, five studies were rated as very high quality (100%) [ 9 , 24 , 27 , 28 , 29 ], three as high quality (80%) [ 6 , 17 , 26 ], and two as moderate quality (60%) [ 18 , 25 ]. Notably, no studies were rated as low quality. This indicates a strong methodological quality of the included studies. Table 2 shows a description of the characteristics of included studies and quality appraisal scores. Table 2 Characteristics of the included studies and Quality appraisal scores S/N AUTHOR, YEAR OF PUBLICATION COUNTRY STUDY AIM STUDY DESIGN, SAMPLE SIZE AGE RANGE, GENDER DISTRIBUTION ACADEMIC YEAR, HEALTH DISCIPLINE QUALITY 1. Ashipala and Livingi 2021 [ 24 ] Namibia To explore and describe undergraduate nursing students' challenges when writing research proposals at the University of Namibia (UNAM) Qualitative, explorative, descriptive and contextual design. (semi-structured interviews) N = 20 18–30 years: 16 participants 31–40 years: 3 participants 41–50 years: 1 participant. 11 Males and 9 Female Nursing 3rd year ***** 2. Delport et al. 2023 [ 17 ] South Africa, Sudan, Uganda. To explore and compare the inclusion and impact of research training in undergraduate medical curricula across three African institutions; University of Pretoria, (South Africa); Al Neelain University (Sudan); Busitema University (Uganda). South Africa: Cross-sectional study using mixed methods (focus group discussions, key informant interviews, and survey analysis). Sudan: Cross-sectional study using mixed methods (research project evaluations, faculty questionnaires, and curriculum document analysis). Uganda: Interventional study using quantitative methods (pre- and post-test questionnaires) Total: 41 faculty members and 554 students across all three studies. South Africa: 7 students in each FGD group, 3 KIIs, 275 (2015), 292 (2016), and 287 (2017) students in the survey. Sudan: 19 student research projects evaluated, 38 faculty members surveyed, and 167 students participated in module evaluations. Uganda: 72 students participated in the study. Uganda: Mean age was 24 years, with a median age of 23 years and an interquartile range of 21–28 years. Nearly equal representation of male (50.4%) and female (49.6%) students. Other countries did not specify age ranges or specify gender distribution. South Africa: Second to final year medical students. Sudan: Third to fourth year medical students. Uganda: Second-year medical and nursing students. Medical students across all three institutions; additionally, nursing students in Uganda. Qualitative component: **** Quantitative Component: *** Mixed Methods Component: **** Final score = *** 3. Kiyimba et al. 2022 [ 6 ] Uganda To assess research involvement of undergraduate students exploring awareness, barriers and motivators in all the 12 undergraduate HPS’ schools in Uganda. Makerere University (MAK), Mbarara University of Science and Technology (MUST), Busitema University (BU), Kabale University (KU), Gulu University (GU), Kampala International University (KIU), King Caesar University (KCU), Uganda Christian University (UCU), Muni University, Soroti University, Lira University, and Islamic University in Uganda (IUIU) Cross-sectional Quantitative study(survey) n = 398 Mean age 23.9 ± 3.7 years 267 (67.1%) male, 131 (32.9%) female Academic year: Year 1: 43 (10.8%) Year 2: 111 (27.9%) Year 3: 97 (24.4%) Year 4: 119 (29.9%) Year 5: 28 (7%) Health disciplines: MBChB: 220 (55.3%) BDS: 10 (2.5%) BNUR: 52 (13.1%) BPHARM: 44 (11.1%) Others: 72 (18.1%). Participants were from various health-related programs including Bachelor of Medicine and Surgery (MBChB), Bachelor of Biomedical Sciences (BSB), Bachelor of Nursing/Midwifery (BSN/MW), Bachelor of Pharmacy (BPHARM), Bachelor of Dental Surgery (BDS), Bachelor of Medical Radiography (BMR), and Bachelor of Science in Anesthesia (BSA). **** 4. Awofeso et al. 2020 [ 18 ] Nigeria To examine the perceptions, attitudes, and the perceived barriers faced by medical students in Nigeria toward research at the College of Medicine, University of Lagos, Nigeria Cross-sectional quantitative study n = 221 medical students (out of 835 distributed questionnaires, 26.5% response rate) Age range = 17–34 years (mean 21.1 ± 2.8 years) Male: 128 (57.9%) Female: 93 (42.1%) Preclinical (200–300 levels): 98 (44.4%) Clinical (400–600 levels): 123 (55.7%) Medicine (medical students) *** 5. Marais et al. 2019 [ 27 ] South Africa To document the enablers and constraints of undergraduate research at Stellenbosch University Faculty of Medicine and Health Sciences (FMHS) and to explore how the presence or absence of choice influenced students' engagement with research in this context. Exploratory descriptive qualitative study using semi-structured interviews n = 21 participants total (10 students, 11 staff members) All allied health student participants were female. MB,ChB staff participants were male; 1 of the four MB,ChB student participants was male. Human Nutrition, Occupational Therapy, Physiotherapy, Speech-Language and Hearing Therapy, and Medicine (MB,ChB) Females: 6 allied health students + 3 MB,ChB students = 9 females Males: 1 MB,ChB student + 8 MB,ChB staff members = 9 males So, the gender distribution among the 21 participants is 9 females and 12 males. Students were primarily in their 4th year for allied health programs, while MB,ChB students typically conducted research in their 6th year. ***** 6. Munabi et al. 2006 [ 25 ] Uganda To document the status of research among graduate and undergraduate students before the change to the new problem-based curriculum at Makerere University Faculty of Medicine. Cross-sectional Quantitative Study (survey) n = 424 students (372 undergraduates, 52 postgraduates) 40% (169/424) female, 60% (258/424) male, 1% (7/424) did not indicate their sex Medicine ***** 7. Mugabo et al. 2021 [ 28 ] Rwanda To describe the level of research involvement amongst undergraduate students at the College of Medicine and Health Sciences (CMHS) at University of Rwanda (UR) and to assess factors associated with research involvement. Cross-sectional Quantitative Study (survey) n = 324 Age range: Mean age 23.3 years (standard deviation 2.27) Gender distribution: Males: 65.1% (n = 211) Females: 33.3% (n = 108). Preferred not to disclose: 1.5% (n = 5) Academic year: Second year: 18.2% (n = 59) Third year: 47.2% (n = 153) Fourth year: 18.2% (n = 59) Fifth year: 6.2% (n = 20) Health disciplines: School of Medicine and Pharmacy: 46.6% (n = 151) School of Nursing and Midwifery: 28.1% (n = 91) School of Health Sciences: 10.2% (n = 33) School of Public Health: 9.6% (n = 31) School of Dentistry: 5.6% (n = 18) ***** 8. Osman 2016 [ 29 ] Sudan To explore students' perceptions, attitudes, motives and barriers toward research, and their perceptions on the quality of research supervision at University of Medical Sciences and Technology Cross-sectional Quantitative Study (survey) n = 104 Age range: Mean age 22 ± 1.4 years Gender distribution: 45 (43.3%) males, 59 (56.7%) females Final (5th) year medical students Medicine ***** 9. Bovijn et al. 2017 [ 9 ] South Africa To quantify voluntary research involvement among medical and allied health professions (AHP) students at the Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa, and to explore factors associated with such involvement. It also sought to determine if voluntary research involvement and/or other demographic factors are associated with self-perceived research competence and attitude toward future research participation. Cross-sectional Quantitative Study (survey) n = 1815 (80.2% response rate) Age Range: The median age for the whole group was 21 years, with a range of 17 to 37 years. Gender Distribution: Male: 463 (25.6%) Female: 1339 (73.8%) Not specified: 13 (0.6%) undergraduate programme in Medicine and Surgery (MB,ChB – a 6 year programme); as well as four undergraduate AHP programmes: Bachelor of Science (BSc) in Dietetics (DT), Bachelor of Occupational therapy (OT), BSc in Physiotherapy (PT), and Bachelor of Speech, language and hearing therapy (SLHT), all 4 year programmes. ***** 10. Wakida et al. 2022 [ 26 ] Uganda To evaluate the perceptions of undergraduates and mentors on the appropriateness, acceptability, and feasibility of the HEPI-TUITAH Micro-Research Approach to HIV Training in Uganda: Mbarara University of Science and Technology (MUST), Bishop Stuart University (BSU), and Lira University (LU). Cross-sectional descriptive qualitative study n = 24 undergraduate health students and 13 mentors in 5 focus group discussions (5–8 participants per group) Not specified Not specified ***** 5***** or 100% quality criteria met 4 **** or 80% quality criteria met 3 *** or 60% quality criteria met 2 ** or 40% quality criteria met 1 * or 20% quality criteria met 3.4. Research Activities To systematically categorize the diverse research activities identified across the included studies, we adapted an already established research process framework [ 23 ]. This adaptation involved consolidating their original phases into three distinct phases to better reflect the undergraduate research experience: Early Phase: Encompasses the original conceptual, design, and planning phases, focusing on foundational research preparation, proposal development, grant writing and obtaining ethical approval. Middle Phase: Combines the empirical and analytical phases, covering active data collection, analysis and management activities Late Phase: Corresponds to the dissemination phase, involving scholarly communication and knowledge translation activities including writing of manuscripts, publication of peer-reviewed articles, writing abstracts and presenting at conferences. This classification facilitates a comprehensive understanding of how undergraduate health students engage in research activities. See Table 3 below. Table 3 Research activities undertaken by UHS in SSA Phases of research Research activities mentioned No of studies References Early Phase Research proposal writing 6 [ 6 , 17 , 24 , 26 , 28 , 29 ] Study design and protocol development 5 [ 17 , 27 , 28 , 29 , 26 ] Literature review 4 [ 17 , 24 , 27 , 26 ] Grant writing 2 [ 26 , 28 ] Ethics approval 5 [ 24 , 27 , 28 , 29 , 26 ] Middle Phase Data Collection 5 [ 6 , 17 , 25 , 26 , 28 ] Data Analysis and Management 5 [ 9 , 17 , 26 , 28 ] Later Phase Manuscript Writing 5 [ 6 , 27 , 28 , 29 , 26 ] Publication of peer-reviewed articles 7 [ 6 , 9 , 17 , 18 , 27 , 28 , 29 , 26 ] Writing abstracts and presenting at conferences 5 [ 6 , 9 , 18 , 28 , 29 , 26 ] 3.4.1. Other Research activities The studies also document the various roles that UHS play in participating in research activities. Four studies document research assistant roles as a common entry point to research [ 6 , 9 , 25 , 28 ]. In one study, the findings report that 61% of UHS who participated in that study had served as research assistant at one point in their research journey. Other roles include First author positions in a published paper [ 6 , 26 , 28 ], Co-authors [ 6 , 25 , 28 , 29 ] and as Principal investigators [ 6 , 25 ]. Interestingly, UHS were also involved in curricular research and voluntary research depending on the contexts. In the multisite study by Delport et al [ 17 ], findings reveal different approaches to curricular research integration in three contexts, South Africa, Sudan, and Uganda, revealing different approaches to research integration. In Uganda, UHS were involved in a one-week research methods training module, followed by an application of research skills in a community setting hereafter. In contrast, UHS in South Africa participated in research modules during their second year, which entailed literature reviews, protocol development, and research report writing. While in Sudan, students in the third year participated in research methodology courses followed by individual research projects in the fourth year. On the other hand, in a Nigerian study, about 52.9% of participants reported participating in a voluntary research project [ 18 ]. This finding suggest that research participation could extend the traditional “mandatory research projects” style offered in institutions. 3.5. Barriers To Research Participation The barriers to research participation among UHS was grouped into 7 themes: Resource Constraints; Time and Curriculum pressures; Knowledge and skills gap; Administrative, Ethical and Operational Hurdles; Mentorship and Supervision Challenges, Perceptions and Attitudes to Research; Gender, Language and Cultural barriers. 3.5.1. Resource Constraints Across the included studies, financial challenges were identified as the most common barrier reported by Undergraduate health students in six studies [ 6 , 9 , 24 , 27 , 28 , 29 ]. Beyond financial limitations, UHS also reported inadequate infrastructure including limited library resources and the lack of well-equipped laboratory [ 24 ] and computer facilities [ 18 , 29 ]. In another study, students reported a poor awareness of available research resources [ 27 ]. 3.5.2. Time And Curriculum Pressures Time related constraints constituted the second most prominent barrier theme. Seven studies reported difficulty in balancing personal life, academic work, and research, coupled with insufficient time allocation for research [ 6 , 17 , 18 , 24 , 25 , 27 , 29 ]. The demanding nature of curriculum for health professions education was another common barrier, coupled with an overwhelming workload [ 18 , 24 , 26 , 27 , 29 ]. With these constraints, UHS were not likely to have time for research. 3.5.3. Mentorship and Supervision Challenges Supervision and mentorship doubled as pronounced barriers. In 6 studies, UHS expressed a lack of professional supervisors and proper mentorship/guidance needed to support their research process [ 6 , 9 , 18 , 25 , 28 , 29 ]. In some studies, UHS described experiences of poor communication with research supervisors [ 17 , 24 , 26 ], and in others, they felt the supervisors were not fully committed and unwilling to supervise [ 17 , 29 ]. In the backdrop of such challenges, supportive specialized staff such as biostatisticians, bioethicists and editors were lacking [ 29 ]. 3.5.4. Knowledge and skills gap In this theme, UHS reported a reported lack of knowledge about the research process [ 24 , 28 , 29 ], in three studies. In addition, two studies identified an inadequate research and biostatistics curriculum [ 18 , 29 ]. On the skills gap, UHS in some studies reported an absence of structured content on research [ 27 ], a lack of mandatory courses on research methodology [ 6 ], lack of statistical support [ 9 ], and poor research skills [ 17 ], as key barriers. 3.5.5. Administrative, Ethical and Operational Hurdles Even upon receiving the skills they needed for research, UHS also faced another hurdle: difficulty gaining administrative and ethical approval for their research. Students faced lengthy approval processes and burdensome requirements [ 9 , 24 , 27 , 29 ]. Likewise, they reported the research activities as not being well organized [ 17 ]. Asides these challenges, UHS reported some operational challenges that may exist outside of their control. In one study, COVID-19 pandemic restrictions deterred research participation among UHS [ 26 ]. Other times, UHS faced difficulties in selection of research topics, patient follow-up, and availability of sample/study subjects [ 17 , 24 , 29 ]. Other barriers identified include the lack of collaborations and recognition of research efforts [ 6 , 18 , 25 ]. 3.5.6. Perceptions and Attitudes to Research UHS had varying perceptions and attitudes towards research, that constituted this barrier theme. In three studies, students described research as complex, difficult and stressful [ 6 , 17 , 18 ]. In some studies, participants reported a lack of interest and motivation for research [ 6 , 18 , 29 ]. In one study, research anxiety and fear of conducting independent research was reported as barriers to research participation [ 17 ]. Another concerning finding was that students felt unqualified to do research [ 28 ]. 3.5.7. Gender, Language and Cultural Barriers The most pronounced finding within this theme relates to significant gender disparities that exist in research participation. Considering one of the included studies with the largest sample size (n = 1,815), they found that male students were significantly more likely to be involved in voluntary research compared to female students, with an odds ratio of 1.99 (95% CI: 1.48–2.67; p < 0.001) [ 9 ]. This finding was corroborated by Mugabo et al. [ 28 ], who reported that more male students (52.6%) had participated in research projects compared to female students (43.5%, p = 0.023). However, in the study by Bovijn et al. [ 9 ], they found that female students reported lower self-perceived research competence and demonstrated reduced interest in future research participation when compared to their male counterparts. Language and cultural barriers emerged as significant challenges that may affect research participation barriers within research teams [ 9 , 25 , 26 ]. Specifically, Wakida et al. [ 26 ] identified communication challenges due to language barriers within research teams as a key impediment to effective collaboration and research participation. 3.6. Enablers/Facilitators of Research Participation We found various enablers or facilitators of research participation among UHS in SSA reported in the included studies. These were grouped into 6 themes; Early Exposure to research and Integration in curriculum; Quality mentorship and supervision; Access to Funding and Resources; Research skill development; Individual Motivation and Professional Identity; and Support from groups and institutions. 3.6.1. Early Exposure to Research and Integration in Curriculum This was cited as the most common facilitator theme across the included studies. Six studies cited the inclusion of research in the early years of undergraduate study as prominent facilitators of research participation among UHS [ 6 , 17 , 18 , 24 , 27 , 29 ]. The value of structured curriculum approaches was emphasized by findings supporting structured time allocation for research [ 25 , 27 ], mandatory research components [ 29 ], and problem-based learning curricula [ 18 ]. Likewise, completion of curricular research projects and hands-on research experience were also identified as enabling factors [ 25 , 26 ]. Additionally, participants who had previous research experience were likely to participate in future research projects [ 9 , 18 , 25 ]. 3.6.2. Quality Mentorship and Supervision Within this theme, UHS emphasized the importance of a role model/mentor to provide guidance [ 6 , 17 , 25 , 26 , 28 ]. Nevertheless, two studies [ 6 , 24 ] highlighted that proper guidance extended to support with topic selection, manuscript writing, and publication processes, with faculty mentoring students as well [ 28 ]. Similarly in five studies, UHS highlighted the need for supportive supervisors [ 6 , 24 , 27 , 28 , 29 ]. In a particular study, the aspects of quality supervision were emphasized, as supportive supervisors possessing knowledge, experience, and research skills to assist in research facilitated the engagement of UHS in research [ 29 ]. 3.6.3. Access to Funding and Resources While resource and funding constraints acted as barriers, studies reported that access to adequate funding and resources was also an important facilitator. Enablers reported here included a call for funding for research projects [ 6 , 25 , 26 , 28 ]. Improved internet access and data availability [ 24 , 25 ], as well as the provision of library resources [ 25 ] were also recognized as enabling factors. 3.6.4. Research Skills Development Three studies emphasized the value of research methodology training, including short courses on research methodology, data analysis, proposal development, and manuscript writing [ 6 , 17 , 26 ]. Similarly, library information literacy [ 24 ], practical application of research during community placements [ 17 ], hands-on training [ 26 ], and pre-dissemination training [ 26 ] were seen as crucial facilitators. 3.6.5. Individual Motivation and Professional Identity This theme encompasses both the internal psychological drivers and professional aspirations that motivate UHS to engage in research. Recognition and rewards emerged as powerful motivators that validate UHS’s research efforts and provide tangible benefits for participation. Acknowledgement of research achievements was reported as an enabler by two studies [ 6 , 27 ], and monetary rewards was identified by another study [ 6 ]. However, benefits exceed monetary benefits and could include opportunities to attend or present at a conference [ 26 , 28 ], as well as publication opportunities [ 26 ]. Participants' perceptions of benefits of research participation could serve as their motivation. In two studies, students perceived that research experience may increase their acceptance into residency programs [ 6 , 29 ]. In other studies, participants perceived research as important and relevant to personal development, clinical work and careers [ 6 , 25 , 26 , 29 ]. Additionally, the positive attitudes towards research and willingness to learn were identified as a fundamental motivator to research participation [ 18 ]. These findings may suggest that students with positive research attitudes and perceptions approach research challenges with resilience and view difficulties as learning opportunities rather than insurmountable barriers. 3.6.6. Support from groups and institutions. As reported by Wakida et al. [ 26 ], the interprofessional education approach (the approach of bringing together students from different health disciplines) was seen as valuable for peer mentorship, teamwork, and academic collaboration. Other studies reported collaboration with other researchers [ 6 ], involvement in ongoing research projects [ 28 ], working in groups [ 27 ], and peer collaboration [ 28 ] as enablers to research participation. These findings suggest that research participation could be enhanced when students perceive it as a collaborative rather than isolated activity. Maintaining a suitable institutional research environment was identified as essential to supporting research participation and growth [ 6 , 27 , 28 ]. In essence, these could include the establishment of undergraduate research support centers [ 28 ] and facilitating the complex hurdle of ethics and institutional permissions processes [ 27 ]. With the creation of such support centres and streamlining ethical approval processes, UHS can face lesser barriers to participating in research activities. Interestingly, some factors were reported as both barriers and enablers depending on the context. 4. DISCUSSION Our systematic review synthesized evidence on the barriers and enablers to research participation among undergraduate health students in SSA. We found that UHS face significant barriers to research participation, primarily due to resource constraints. These findings align with those of Pallamparthy and Basavareddy [ 30 ], and Alsaleem et al. [ 31 ] which identified inadequate funding, insufficient research facilities, and limited access to medical journals and relevant databases as barriers to student research engagement in India and Saudi Arabia respectively. UHS reported difficulty balancing academic responsibilities, personal life, and research activities due to limited time allocation for scholarly work and the intensive and demanding nature of their curriculum. As a result, UHS were less likely to engage in or complete research projects. These findings align with similar research published in 2020 and 2024, which highlighted that medical students often struggle to conduct research while managing the rigours of their medical training, leading to reduced participation and completion rates [ 32 , 33 ]. However, findings from a study conducted by Pallamparthy and Basavareddy [ 30 ] among medical students in India revealed 56% of respondents believed that engaging in research was not a waste of time and did not interfere with their academic studies. Supervision and mentorship also emerged as significant barriers as UHS frequently reported the absence of qualified supervisors and inadequate mentorship essential for navigating the research process. In some studies reviewed, UHS described instances of poor communication with their supervisors, while others expressed frustration over a perceived lack of commitment and willingness to provide meaningful guidance. These findings are consistent with the works of El Achi et al. [ 34 ]; Kiyimba et al. [ 6 ], who identified limited access to mentorship, guidance and collaborative opportunities as major perceived barriers to student involvement in research. Another prominent barrier identified was the reported lack of knowledge about the research process and gaps in research skills, with students citing the absence of structured content on research, and limited access to statistical support. These findings are consistent with those of Ferdoush et al. [ 32 ], who reported that in Bangladesh, limited proficiency in statistical analysis and insufficient training in research methodology significantly hindered undergraduate research participation. Despite acquiring the necessary research skills, UHS encountered significant challenges in executing their research projects. One prominent hurdle was the difficulty in obtaining administrative and ethical approvals, which were often characterised by prolonged processing times, burdensome procedures and requirements. This corroborated with Ashour and Hatamleh [ 35 ] who identified difficulties obtaining ethical or institutional approval as a significant barrier to research engagement, among medical students. Furthermore, in three included studies, students described research as complex, challenging, and mentally taxing, also reporting a general lack of interest and motivation to engage in research activities. One study specifically highlighted research-related anxiety and fear of undertaking independent research as significant obstacles to participation. Additionally, a recurring concern was that many students felt inadequately prepared or unqualified to conduct research. In contrast to these negative perceptions, El Achi et al. [ 34 ] reported predominantly positive attitudes among students, with high mean scores for research perception (4.35 ± 0.57) and attitude (3.58 ± 0.48). Their study also found a strong willingness among students to engage in research. Similarly, findings Soe et al. [ 36 ] reflected generally favourable attitudes toward scientific research, further challenging the notion of widespread disinterest. Another key finding was the marked gender disparity in research participation. Several included studies observed that male students were significantly more likely to engage in voluntary research activities compared to their female peers. In addition to gender-based differences, language and cultural barriers were identified as significant impediments to effective research participation. Communication challenges within research teams, particularly those stemming from language differences, were reported to hinder collaboration and limit opportunities for meaningful engagement in research activities. However, contrasting evidence exists. A study by Noorelahi et al. [ 37 ] conducted in Saudi Arabia found a statistically significant gender difference in favour of female medical students, with 79% reporting previous involvement in medical research surpassing the participation rate of their male counterparts. This divergence suggests that gender disparities in research engagement may be context-specific, influenced by sociocultural, institutional, and educational factors. On facilitators of research participation, we found early integration of research into undergraduate curricula as a key enabler for research engagement among UHS. Likewise prior research experience was associated with a greater likelihood of future participation. Similarly, findings from Idrus et al. [ 38 ] revealed that most respondents supported the inclusion of undergraduate research in the dentistry programme curriculum as a key enabler to their involvement in research. Findings from our review also revealed that UHS students consistently emphasised the vital role of having a mentor or role model to provide structured and sustained guidance throughout the research process. Students repeatedly highlighted the value of supportive supervision, particularly when supervisors demonstrated not only encouragement but also strong research expertise, experience, and academic competence. Notably, the study by Alsalim et al. [ 39 ] affirmed the transformative impact of such mentorship on undergraduate research experiences. With this guidance, Students reported increased confidence and a strengthened belief in their ability to undertake and contribute meaningfully to research tasks. While resource and funding constraints were identified as significant barriers, several studies also highlighted the availability of adequate funding and resources as key facilitators of research engagement. Additional facilitating factors within this theme included improved internet connectivity, enhanced data accessibility, and the provision of adequate library and learning resources. These findings align with those of Shafiei and Soltaninejad [ 40 ], who reported that the availability of appropriate research tools and software not only supported effective research conduct but also served as a strong motivator for both students and faculty members to participate in research activities and pursue deeper academic inquiry. Our review identified three studies that highlighted the importance of research methodology training as a key facilitator of student engagement and competence in research. These included short courses in research methodology, data analysis, proposal development, and manuscript writing. In addition, the provision of library information literacy, opportunities for the practical application of research during community placements, hands-on workshops, and pre-dissemination training were also recognised as essential components in strengthening research capacity. These findings align with the study by Mahomed et al. [ 41 ], which reported that many students found research training activities enjoyable and beneficial, significantly enhancing their understanding of the research process. The theme on 'individual motivation and professional identity' captures the internal psychological drivers and evolving professional aspirations that motivate UHS to engage in research. Recognition and rewards consistently emerged as influential motivators, offering both validation and tangible benefits that encourage research participation. Here, intrinsic interest in research and a positive attitude toward scholarly inquiry were identified as foundational motivators. Students who approached research with enthusiasm and curiosity demonstrated greater resilience in the face of challenges, often viewing obstacles as opportunities for learning and growth rather than deterrents. This mindset not only fosters persistence but also reflects a deeper alignment between individual motivation and professional identity. Supporting this, Alhabib et al. [ 42 ] identified admission into residency programmes, genuine interest in research, and financial incentives as key drivers of undergraduate research participation. Similarly, Saboor et al. [ 43 ] found that intrinsic interest was the most significant personal motivator among medical students. Support from groups and a conducive institutional research environment is crucial for fostering active participation and the growth of research capacity, particularly among UHS. Key strategies include the establishment of undergraduate research support centres and the simplification of processes related to ethical approvals and institutional permissions. These measures can significantly reduce administrative barriers and enhance students' ability to participate in meaningful research activities. Evidence from a study Hasan et al. [ 44 ] in Bangladesh further underscores the importance of institutional support, highlighting that encouragement from faculty members was a significant motivator for undergraduate research involvement. In this review, we grouped participation in research activities according to phases. In the early phase, research design and proposal writing emerged as one of the most reported activities among students, often serving as the initial gateway into the research process. Similarly, Burgoyne et al. [ 45 ] highlighted that a notable proportion of students had participated in study design and sampling activities that are critical for building foundational research skills such as formulating research questions, selecting appropriate methodologies, and understanding sampling techniques. In addition, several students were reported to have engaged in grant writing efforts as a means of securing resources or funding for their research. This aligns with the findings of Hasan et al. [ 44 ], who noted that medical students Bangladesh increasingly participate in research projects beyond their formal academic requirements. In the middle phase, as reported in various included studies, obtaining ethical clearance was prioritised as an essential step before data collection commenced, reflecting standard research practice and adherence to ethical guidelines. Following this, data collection, data analysis and data management activities were reported to occur concurrently or subsequently. These stages played a pivotal role in helping students develop analytical skills, data literacy, and an understanding of data protection and confidentiality principles. This process not only ensured compliance but also reinforced the importance of protecting participants' rights and maintaining research accountability among UHS. In the late phase, the reviewed studies highlight a range of research dissemination activities undertaken by UHS students following the completion of data collection and analysis. A notable emphasis was placed on manuscript writing, reported across five studies, underscoring the role of academic and scientific writing in developing students’ critical thinking and communication skills. Additionally, students were reported to participate in abstract writing and conference presentations. These activities contributed significantly to the development of students’ research communication and oral presentation skills. Public presentation of research fosters confidence and the ability to articulate scientific ideas clearly to varied audiences (both essential attributes for emerging professionals). Bovijn et al. [ 9 ] further support this trend, noting that while a smaller proportion of students presented at conferences (6.7%) or published in journals (1.2%), these outputs were typically voluntary and often occurred outside the core curriculum. This suggests that while formal structures for dissemination may be limited, motivated students seek additional opportunities to share their work. Strengths and Limitations The inclusion of studies from multiple countries and health disciplines offers a rich and well-structured view of undergraduate research activities. This review is grounded in strong methodological principles, following PRISMA 2020 guidelines, PROSPERO registration, comprehensive database searches, and systematic quality appraisal using the Mixed Methods Appraisal Tool enhances transparency, reproducibility, and credibility. By providing insights from structural, institutional, personal, and cultural perspectives, this review offers practical, context-sensitive recommendations that speak directly to the realities of undergraduate research in Sub-Saharan Africa. However, the uneven geographical coverage limits the generalisability of the findings to the entire SSA region, and restricting the search to English-language publications may have introduced language bias by excluding potentially relevant studies in French, Portuguese, or other local languages. The heterogeneity in study designs, participant populations, and contexts necessitated a narrative rather than quantitative synthesis, the former of which is more susceptible to interpretive bias. The exclusion of grey literature and reliance solely on peer-reviewed sources may have also overlooked important but unpublished perspectives, particularly from low-resource settings. In addition, many of the included studies relied on self-reported data, which are inherently vulnerable to recall and social desirability biases. Finally, the temporal scope (2000–2024) may have excluded older but still relevant evidence from countries with long-established traditions in undergraduate research. 5. CONCLUSION This systematic review highlights the complex interplay of barriers and enablers influencing research participation among UHS in Sub-Saharan Africa. While constraints such as limited funding, inadequate mentorship, insufficient research skills, curriculum overload, and bureaucratic challenges hinder participation, several facilitators such as early curriculum integration, quality supervision, access to research training, collaboration opportunities, and institutional support emerge as critical enablers. Notably, some factors like mentorship and resource availability function as either barriers or enablers depending on the context, underscoring the need for tailored interventions. To strengthen undergraduate research engagement in SSA, we recommend embedding research early in curricula, enhancing mentorship structures, improving access to resources and funding, simplifying ethics and administrative processes, fostering interdisciplinary collaborations, offering targeted research training, and addressing gender and cultural disparities. These efforts are essential to building sustainable research capacity and developing a future health workforce equipped to respond to local and global health challenges. Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Competing interests The authors declare no competing interests. Funding None Author Contribution Conceptualization: AEB, AYA, CDN; Methodology: AEB, AYA, CDN; Protocol development and registration: AEB, CDN, UUA, AYA; Database searches: AEB; Study screening and selection: AEB, UUA, CDN, AYA; Data extraction: AEB, UUA, CDN; Quality appraisal: AEB, UUA, CDN; Data synthesis and thematic analysis: AEB, CDN, PAK, UFI; Arbitration and conflict resolution: AYA, UFI; Writing—original draft: AEB, PAK, UFI; Writing—review and editing: AYA, UUA, CDN; Project administration and Supervision: AEB. All authors read and approved the final manuscript. Acknowledgement We appreciate all the authors of included studies. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7527269","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":512534606,"identity":"18b6b384-7043-4d5c-9b7b-c9acc617673a","order_by":0,"name":"Archibong Edem Bassey","email":"data:image/png;base64,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","orcid":"","institution":"University of Warwick","correspondingAuthor":true,"prefix":"","firstName":"Archibong","middleName":"Edem","lastName":"Bassey","suffix":""},{"id":512534607,"identity":"45c456da-75a5-422c-bec1-be9a6a282367","order_by":1,"name":"Prosper Ayenmo Kanu","email":"","orcid":"","institution":"University of Calabar","correspondingAuthor":false,"prefix":"","firstName":"Prosper","middleName":"Ayenmo","lastName":"Kanu","suffix":""},{"id":512534608,"identity":"6e5a4a91-3a73-4a73-8e92-b9cd3b3aeb04","order_by":2,"name":"Uchenna Frank Imo","email":"","orcid":"","institution":"University of Calabar","correspondingAuthor":false,"prefix":"","firstName":"Uchenna","middleName":"Frank","lastName":"Imo","suffix":""},{"id":512534609,"identity":"a0872194-6659-4c50-9ab8-9d81a3996620","order_by":3,"name":"Usoro Udousoro Akpan","email":"","orcid":"","institution":"University of Warwick","correspondingAuthor":false,"prefix":"","firstName":"Usoro","middleName":"Udousoro","lastName":"Akpan","suffix":""},{"id":512534610,"identity":"1f5b4d0c-6372-47b0-8c4b-1132483afdf9","order_by":4,"name":"Yusuff Adebayo Adebisi","email":"","orcid":"","institution":"University of Glasgow","correspondingAuthor":false,"prefix":"","firstName":"Yusuff","middleName":"Adebayo","lastName":"Adebisi","suffix":""},{"id":512534611,"identity":"31a01fa3-7e29-4188-81ce-c5f34ea857c5","order_by":5,"name":"Chinaza Duke Nwosu","email":"","orcid":"","institution":"Coventry University","correspondingAuthor":false,"prefix":"","firstName":"Chinaza","middleName":"Duke","lastName":"Nwosu","suffix":""}],"badges":[],"createdAt":"2025-09-03 13:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7527269/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7527269/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-026-08681-2","type":"published","date":"2026-02-17T15:56:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":91417670,"identity":"f0bf53d1-55f6-46ea-9ba4-69e9b1e9ed38","added_by":"auto","created_at":"2025-09-16 09:39:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40409,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy selection using the PRISMA flow diagram\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7527269/v1/4e38f962edd6de418894d82e.png"},{"id":103251030,"identity":"d52004fe-8c9f-48c1-87ce-5231a7eac316","added_by":"auto","created_at":"2026-02-23 16:01:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1462438,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7527269/v1/9cbe1488-572f-4ddc-95fc-b0781a38f3e6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Barriers and Enablers of Research Participation Among Undergraduate Health Students in Sub- Saharan Africa: A Systematic Review","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eResearch has been a veritable tool to increasing the understanding of diseases, disease mechanisms and offering evidence-based strategies to protect public health [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. With the presence of epidemics and pandemics in recent years, such as HIV, COVID-19 and M-pox [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], there is an increased need for research to bridge knowledge gap and provide appropriate tools to tackle these rising public health challenges [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Sub-Saharan Africa (SSA), with a population of approximately 1.26\u0026nbsp;billion, carries a disproportionately high share of the global disease and mortality burden, accounting for 25% of the world\u0026rsquo;s total [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This situation is largely driven by limitations in the quality of healthcare services across the region, further compounded by a critical shortage of locally generated research evidence to inform effective healthcare interventions and policies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Africa has just 198 researchers per million people, compared to over 4,000 per million in countries like the United Kingdom and the United States [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Moreover, no African nation has met the African Union\u0026rsquo;s target of allocating 1% of its gross domestic product to research and development [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This gap has led many African nations to rely heavily on findings from high-income countries, whose disease profiles and levels of medical advancement differ significantly from those in SSA [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Such reliance can lead to poor health outcomes, as seen during the Ebola outbreak in West Africa, where a lack of skilled local clinical researchers contributed to increased disease transmission and mortality rather than effective containment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eConsequently, there is a growing emphasis across SSA on strengthening undergraduate engagement in research activities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Undergraduate Health Students (UHS) are widely regarded as the main pipeline of future healthcare professionals, including clinicians and health research scientists [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The undergraduate period presents a strategic window for developing research competencies, fostering scientific curiosity, and nurturing positive attitudes and behaviours. These can promote sustained involvement in research throughout their careers [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. There are several examples of students who were engaged in research as undergraduates, who have gone on to make great achievements [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough several African countries have implemented measures such as integrating research methodology early into academic curricula to strengthen research capacity [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], for most undergraduate health related programs, students often only get to experience research as components of the traditional final/penultimate year thesis [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. UHS research participation can go beyond this norm and can be integrated across the curriculum as early as their first year [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Earlier and diverse exposure to research can result in the development of cognitive skills including critical thinking and reasoning, which has been linked to higher self-efficacy, and better outcomes for patients and health system [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. It can also foster increased competencies in academic writing, scientific communication, data collection and analysis, which can increase their likelihood of pursuing research careers, contributing to publications, and implementing evidence-based practices in clinical (and a variety of) settings [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Furthermore, in the context of Sub-Saharan Africa, where strengthening indigenous research capacity represents a strategic imperative for addressing regional health challenges, nurturing research engagement at the undergraduate level establishes essential foundations for sustainable research ecosystems [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAs highlighted, the benefits of research participation are vast, and in other climes, involving undergraduate students in research has been viewed as a high impact practice [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, the current understanding of the barriers and enablers of research participation among undergraduate health students in SSA remains fragmented, with studies typically focusing on specific health disciplines, single institutions or particular countries within the vast and diverse SSA region [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. For instance, Awofeso et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] conducted a similar study but focused only on medical students at the College of Medicine, University of Lagos. In contrast, another study [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] focused on 12 universities within Uganda offering health professional courses. To our knowledge, there has been no comprehensive synthesis of evidence as regards undergraduate health student's perspectives on research participation in SSA. This knowledge gap may limit the development of evidence-based strategies to build research capacity, starting at the undergraduate level.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003e1.1. Aim/Objectives\u003c/h2\u003e\u003cp\u003eTo address this evidence gap, our systematic review aims to synthesize evidence on the barriers and enablers to research participation among undergraduate health students across SSA. In doing this, we will also explore the various forms and/or types of research activities undertaken by undergraduate health students in Sub-Saharan Africa.\u003c/p\u003e\u003cp\u003eThe findings will help to provide recommendations for enhance undergraduate health students\u0026rsquo; participation in research and strengthen research capacity building at the undergraduate stages in health professions education in SSA.\u003c/p\u003e\u003c/div\u003e"},{"header":"2. METHODS","content":"\u003cp\u003eWe conducted this review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This review protocol was registered on PROSPERO (ID: CRD42024581644) on 23rd August 2024.\u003c/p\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Eligibility Criteria\u003c/h2\u003e\u003cp\u003eInclusion Criteria: Studies were included if they involved undergraduate students enrolled in health-related programs (medicine, nursing, pharmacy, public health, and allied health professions) in Sub-Saharan African countries and collected primary data using qualitative, quantitative, or mixed-methods approaches to explore barriers and enablers affecting research participation among this population.\u003c/p\u003e\u003cp\u003eExclusion Criteria: Studies were excluded if they featured only in-service health professionals, postgraduate students or undergraduate students not enrolled in a health-related discipline. We also excluded studies not conducted in Sub Saharan Africa, and other studies such as reviews, opinion pieces, commentaries, editorials, and books.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Search strategy\u003c/h2\u003e\u003cp\u003eA systematic search was conducted across five databases, MEDLINE, Embase, Scopus, CINAHL, and Web of Science databases for studies published in English from 2000 to 2024. We chose to limit the start of the search from 2000 onwards as this year marked key transformative commitments in education- the World Education Forum held in Dakar, Senegal in April 2020 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This forum attended by world leaders led to the birth of the Dakar Framework for Action, aimed at driving the achievement of education for all, particularly in Sub Saharan Africa and other contexts. In the framework, priority areas of focus mapped out for sub-Saharan Africa include: improving quality and access, improving the quality and relevance of education, institutional and professional capacity building and improving partnership. These areas demonstrate relevance to the aim of this systematic review.\u003c/p\u003e\u003cp\u003eThe search included 3 main construct blocks using the PCC framework combined with Boolean operators: (1) \u003cb\u003ePopulation\u003c/b\u003e terms capturing undergraduate students in health-related disciplines, (2) \u003cb\u003eConcept\u003c/b\u003e terms addressing both barriers and enablers to participation in research, and (3) \u003cb\u003eContext\u003c/b\u003e terms capturing Sub-Saharan Africa and all individual country names within the region. See example of a search string below.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSearch string carried out on SCOPUS database\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eS/N\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSearch Terms\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTITLE-ABS-KEY (undergraduate* OR \"medical student*\" OR \"nursing student*\" OR \"health science* student*\" OR \"healthcare student*\" OR \"health profession* student*\" OR \"public health student*\" OR \"pharmacy student*\" OR \"allied health* student*\" OR \"university student*\" )\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTITLE-ABS-KEY ( ( barrier* OR obstacle* OR challeng* OR imped* OR hinder* ) OR ( enabl* OR foster* OR facilitat* OR motivat* OR promot* ) )\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTITLE-ABS-KEY ( research )\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTITLE-ABS-KEY ( participat* OR involv* OR engag* OR le?d* OR partner* or collaborat* )\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTITLE-ABS-KEY ( \"Sub-Saharan Africa\" OR \"Sub Saharan Africa\" OR SSA OR Angola OR Benin OR botswana OR \"Burkina Faso\" OR burundi OR cameroon OR \"Cape Verde\" OR \"Central African Republic\" OR chad OR comoros OR \"Congo\" OR \"Democratic Republic of Congo\" OR drc OR \"Republic of Congo\" OR \"Cote d\u0026amp;apos;Ivoire\" OR \"Ivory Coast\" OR djibouti OR \"Equatorial Guinea\" OR eritrea OR ethiopia OR gabon OR gambia OR ghana OR guinea OR \"Guinea-Bissau\" OR kenya OR lesotho OR liberia OR madagascar OR malawi OR mali OR mauritania OR mauritius OR mozambique OR namibia OR niger OR nigeria OR rwanda OR \"Sao Tome and Principe\" OR senegal OR seychelles OR \"Sierra Leone\" OR somalia OR \"South Africa\" OR \"South Sudan\" OR sudan OR swaziland OR eswatini OR tanzania OR togo OR uganda OR zambia OR zimbabwe )\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e#1 AND #2 AND #3 AND #4 AND #5 AND PUBYEAR\u0026thinsp;\u0026gt;\u0026thinsp;2000 AND PUBYEAR\u0026thinsp;\u0026lt;\u0026thinsp;2025 AND ( LIMIT-TO ( LANGUAGE, \"English\" ) )\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Study screening and selection\u003c/h2\u003e\u003cp\u003eAll identified records were collated and imported into Covidence systematic review software, where duplicate records were identified and removed. Following that, three reviewers (AEB, UUA and CDN) independently screened the titles and abstracts of the deduplicated records against the eligibility criteria. Afterwards, the full texts of studies deemed potentially eligible during the initial screening were retrieved and independently assessed by the same three reviewers. At each stage, any discrepancies between reviewers were resolved through discussion and consensus, with a fourth reviewer (AYA) serving as an umpire when necessary. Through this process, we documented the number of studies excluded at each stage in a PRISMA flow diagram.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Data extraction\u003c/h2\u003e\u003cp\u003eAfter finalizing the list of included studies, we utilized a data extraction form we developed to systematically collect information from each study. Data extracted included study characteristics (authors, publication year, country, study design, sample size), participant demographics (age range, gender distribution, academic year, health discipline), and specific details about research activities, barriers, and enablers to research participation among undergraduate health students in Sub-Saharan Africa.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.5. Quality appraisal\u003c/h2\u003e\u003cp\u003eStudies were appraised for quality using the Mixed Methods Appraisal Tool (MMAT) Version 2018 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The MMAT was selected for its versatility in evaluating various study designs including qualitative, quantitative and mixed methods.\u003c/p\u003e\u003cp\u003eWe meticulously assessed each study against key methodological criteria specific to its design type as outlined in the MMAT framework. Each criterion was scored using a three-point scale (\u0026lsquo;yes\u0026rsquo;, \u0026lsquo;no\u0026rsquo;, or \u0026lsquo;cannot tell\u0026rsquo;), with individual study quality scores calculated as the percentage of criteria receiving a \"yes\" response. We subsequently categorized the overall quality of studies using a six-tier classification system: 0% (no quality), 20% (very low quality), 40% (poor quality), 60% (moderate quality), 80% (good quality), and 100% (very high quality). Any discrepancies or disagreements in quality assessments were resolved through reviewer discussions. The results were comprehensively documented in a tabular format, providing transparent evaluation of the methodological rigor underpinning our synthesis. While we described the quality appraisal scores of included studies, we did not exclude any study based on the scores. This was to make sure that we collected data from all studies related to the research question.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.6. Data Synthesis\u003c/h2\u003e\u003cp\u003eWe employed a narrative synthesis approach, guided by the framework proposed by [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], adapted specifically for our review objectives. This approach to synthesis will focus on integrating findings from the various study designs to provide a comprehensive understanding of the research topic.\u003c/p\u003e\u003cp\u003eThis began with a preliminary synthesis, where AEB, PAK, and UFI independently created textual descriptions of the included studies, and developed tables to comprehensively summarize study characteristics, participant demographics and key research findings. These reviewers then used systematic vote counting to identify frequently reported barriers and enablers to research participation across the studies. This preliminary stage also allowed us to extract data relevant to our other objectives, particularly the various ways UHS participate in research, and the types of research activities they engage in. The research activities were grouped into phases following our adaptation of the Whittemore and Melkus\u0026rsquo;s [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] framework on the research process.\u003c/p\u003e\u003cp\u003eThe same three reviewers then explored relationships in the data through collaborative thematic analysis. Here we grouped similar barriers and enablers firstly into clusters or analytical themes. Afterwards, we iteratively developed summary themes by comparing findings across different study designs, contexts, and student populations, with any disagreements resolved through discussion and consultation with another reviewer (CDN) when necessary. This process enabled us to organize our findings for a more comprehensive understanding.\u003c/p\u003e\u003cp\u003eThe narrative synthesis approach was particularly suited to our diverse set of qualitative, quantitative, and mixed-methods studies, allowing us to integrate findings that would not have been suitable for meta-analysis due to methodological and contextual heterogeneity across the Sub-Saharan African region.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Study selection\u003c/h2\u003e\u003cp\u003eOf 2411 studies identified from across the 5 databases, only 10 studies met the eligibility criteria. This study selection process is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Study characteristics\u003c/h2\u003e\u003cp\u003eThe review included 10 studies across various Sub-Saharan African countries. Single site studies were conducted in Namibia (n\u0026thinsp;=\u0026thinsp;1) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], Uganda (n\u0026thinsp;=\u0026thinsp;3) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], South Africa(n\u0026thinsp;=\u0026thinsp;2) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], Rwanda (n\u0026thinsp;=\u0026thinsp;1) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], Sudan (n\u0026thinsp;=\u0026thinsp;1) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], and Nigeria (n\u0026thinsp;=\u0026thinsp;1) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Additionally, one multi-site study conducted across three universities in Uganda, South Africa, Sudan [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe studies consisted of various study designs, including 3 qualitative [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], 5 quantitative [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], and 2 mixed-methods studies [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Sample sizes varied considerably, ranging from 20 [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] to 1,815 participants [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Across all included studies, study participants represented various health professions located in different colleges, schools and departments across various universities. These included medicine, nursing/midwifery, pharmacy, dentistry, physiotherapy, occupational therapy, speech-language and hearing therapy, human nutrition, biomedical sciences, medical radiography, public health, and allied health professions (where unspecified in some cases).\u003c/p\u003e\u003cp\u003eThese characteristics reflected the heterogeneous nature of research contexts and objectives across the studies. Thus, we did not conduct a meta-analysis.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Quality Assessment\u003c/h2\u003e\u003cp\u003eThe quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) version 2018. Scores ranged from 60% (moderate quality) to 100% (very high quality) across the included studies. Of the 10 studies, five studies were rated as very high quality (100%) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], three as high quality (80%) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and two as moderate quality (60%) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Notably, no studies were rated as low quality. This indicates a strong methodological quality of the included studies.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows a description of the characteristics of included studies and quality appraisal scores.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of the included studies and Quality appraisal scores\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eS/N\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAUTHOR, YEAR OF PUBLICATION\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCOUNTRY\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSTUDY AIM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSTUDY DESIGN, SAMPLE SIZE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAGE RANGE, GENDER DISTRIBUTION\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eACADEMIC YEAR, HEALTH DISCIPLINE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eQUALITY\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAshipala and Livingi 2021 [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNamibia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo explore and describe undergraduate nursing students' challenges when writing research proposals at the University of Namibia (UNAM)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eQualitative, explorative, descriptive and contextual design. (semi-structured interviews)\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18\u0026ndash;30 years: 16 participants\u003c/p\u003e\u003cp\u003e31\u0026ndash;40 years: 3 participants\u003c/p\u003e\u003cp\u003e41\u0026ndash;50 years: 1 participant.\u003c/p\u003e\u003cp\u003e11 Males and 9 Female\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNursing \u003c/p\u003e\u003cp\u003e3rd year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e*****\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDelport et al. 2023 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSouth Africa, Sudan, Uganda.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo explore and compare the inclusion and impact of research training in undergraduate medical curricula across three African institutions; University of Pretoria, (South Africa); Al Neelain University (Sudan); Busitema University (Uganda).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSouth Africa: Cross-sectional study using mixed methods (focus group discussions, key informant interviews, and survey analysis).\u003c/p\u003e\u003cp\u003eSudan: Cross-sectional study using mixed methods (research project evaluations, faculty questionnaires, and curriculum document analysis).\u003c/p\u003e\u003cp\u003eUganda: Interventional study using quantitative methods (pre- and post-test questionnaires)\u003c/p\u003e\u003cp\u003eTotal: 41 faculty members and 554 students across all three studies.\u003c/p\u003e\u003cp\u003eSouth Africa: 7 students in each FGD group, 3 KIIs, 275 (2015), 292 (2016), and 287 (2017) students in the survey.\u003c/p\u003e\u003cp\u003eSudan: 19 student research projects evaluated, 38 faculty members surveyed, and 167 students participated in module evaluations.\u003c/p\u003e\u003cp\u003eUganda: 72 students participated in the study.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUganda: Mean age was 24 years, with a median age of 23 years and an interquartile range of 21\u0026ndash;28 years. Nearly equal representation of male (50.4%) and female (49.6%) students.\u003c/p\u003e\u003cp\u003eOther countries did not specify age ranges or specify gender distribution.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSouth Africa: Second to final year medical students.\u003c/p\u003e\u003cp\u003eSudan: Third to fourth year medical students.\u003c/p\u003e\u003cp\u003eUganda: Second-year medical and nursing students.\u003c/p\u003e\u003cp\u003eMedical students across all three institutions; additionally, nursing students in Uganda.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eQualitative component:\u003c/p\u003e\u003cp\u003e****\u003c/p\u003e\u003cp\u003eQuantitative Component:\u003c/p\u003e\u003cp\u003e***\u003c/p\u003e\u003cp\u003eMixed Methods Component:\u003c/p\u003e\u003cp\u003e****\u003c/p\u003e\u003cp\u003eFinal score = ***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKiyimba et al. 2022 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUganda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo assess research involvement of undergraduate students exploring awareness, barriers and motivators in all the 12 undergraduate HPS\u0026rsquo; schools in Uganda.\u003c/p\u003e\u003cp\u003eMakerere University (MAK), Mbarara University of Science and Technology (MUST), Busitema University (BU), Kabale University (KU), Gulu University (GU), Kampala International University (KIU), King Caesar University (KCU), Uganda Christian University (UCU), Muni University, Soroti University, Lira University, and Islamic University in Uganda (IUIU)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCross-sectional Quantitative study(survey)\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;398\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean age 23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7 years\u003c/p\u003e\u003cp\u003e267 (67.1%) male, 131 (32.9%) female\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAcademic year:\u003c/p\u003e\u003cp\u003eYear 1: 43 (10.8%)\u003c/p\u003e\u003cp\u003eYear 2: 111 (27.9%)\u003c/p\u003e\u003cp\u003eYear 3: 97 (24.4%)\u003c/p\u003e\u003cp\u003eYear 4: 119 (29.9%)\u003c/p\u003e\u003cp\u003eYear 5: 28 (7%)\u003c/p\u003e\u003cp\u003eHealth disciplines:\u003c/p\u003e\u003cp\u003eMBChB: 220 (55.3%)\u003c/p\u003e\u003cp\u003eBDS: 10 (2.5%)\u003c/p\u003e\u003cp\u003eBNUR: 52 (13.1%)\u003c/p\u003e\u003cp\u003eBPHARM: 44 (11.1%)\u003c/p\u003e\u003cp\u003eOthers: 72 (18.1%).\u003c/p\u003e\u003cp\u003eParticipants were from various health-related programs including Bachelor of Medicine and Surgery (MBChB), Bachelor of Biomedical Sciences (BSB), Bachelor of Nursing/Midwifery (BSN/MW), Bachelor of Pharmacy (BPHARM), Bachelor of Dental Surgery (BDS), Bachelor of Medical Radiography (BMR), and Bachelor of Science in Anesthesia (BSA).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e****\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAwofeso et al. 2020 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNigeria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo examine the perceptions, attitudes, and the perceived barriers faced by medical students in Nigeria toward research at the College of Medicine, University of Lagos, Nigeria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCross-sectional quantitative study\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;221 medical students (out of 835 distributed questionnaires, 26.5% response rate)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAge range\u0026thinsp;=\u0026thinsp;17\u0026ndash;34 years (mean 21.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8 years)\u003c/p\u003e\u003cp\u003eMale: 128 (57.9%)\u003c/p\u003e\u003cp\u003eFemale: 93 (42.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePreclinical (200\u0026ndash;300 levels): 98 (44.4%)\u003c/p\u003e\u003cp\u003eClinical (400\u0026ndash;600 levels): 123 (55.7%)\u003c/p\u003e\u003cp\u003eMedicine (medical students)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarais et al. 2019 [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSouth Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo document the enablers and constraints of undergraduate research at Stellenbosch University Faculty of Medicine and Health Sciences (FMHS) and to explore how the presence or absence of choice influenced students' engagement with research in this context. \u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eExploratory descriptive qualitative study using semi-structured interviews\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;21 participants total (10 students, 11 staff members)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAll allied health student participants were female. MB,ChB staff participants were male; 1 of the four MB,ChB student participants was male.\u003c/p\u003e\u003cp\u003eHuman Nutrition, Occupational Therapy, Physiotherapy, Speech-Language and Hearing Therapy, and Medicine (MB,ChB)\u003c/p\u003e\u003cp\u003eFemales: 6 allied health students\u0026thinsp;+\u0026thinsp;3 MB,ChB students\u0026thinsp;=\u0026thinsp;9 females\u003c/p\u003e\u003cp\u003eMales: 1 MB,ChB student\u0026thinsp;+\u0026thinsp;8 MB,ChB staff members\u0026thinsp;=\u0026thinsp;9 males\u003c/p\u003e\u003cp\u003eSo, the gender distribution among the 21 participants is 9 females and 12 males.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eStudents were primarily in their 4th year for allied health programs, while MB,ChB students typically conducted research in their 6th year.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e*****\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMunabi et al. 2006 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUganda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo document the status of research among graduate and undergraduate students before the change to the new problem-based curriculum at Makerere University Faculty of Medicine.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCross-sectional Quantitative Study (survey)\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;424 students (372 undergraduates, 52 postgraduates)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e40% (169/424) female, 60% (258/424) male, 1% (7/424) did not indicate their sex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMedicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e*****\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMugabo et al. 2021 [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRwanda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo describe the level of research involvement amongst undergraduate students at the College of Medicine and Health Sciences (CMHS) at University of Rwanda (UR) and to assess factors associated with research involvement.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCross-sectional Quantitative Study (survey)\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;324\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAge range: Mean age 23.3 years (standard deviation 2.27)\u003c/p\u003e\u003cp\u003eGender distribution:\u003c/p\u003e\u003cp\u003eMales: 65.1% (n\u0026thinsp;=\u0026thinsp;211)\u003c/p\u003e\u003cp\u003eFemales: 33.3% (n\u0026thinsp;=\u0026thinsp;108).\u003c/p\u003e\u003cp\u003ePreferred not to disclose: 1.5% (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAcademic year:\u003c/p\u003e\u003cp\u003eSecond year: 18.2% (n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003cp\u003eThird year: 47.2% (n\u0026thinsp;=\u0026thinsp;153)\u003c/p\u003e\u003cp\u003eFourth year: 18.2% (n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003cp\u003eFifth year: 6.2% (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\u003cp\u003eHealth disciplines:\u003c/p\u003e\u003cp\u003eSchool of Medicine and Pharmacy: 46.6% (n\u0026thinsp;=\u0026thinsp;151)\u003c/p\u003e\u003cp\u003eSchool of Nursing and Midwifery: 28.1% (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e\u003cp\u003eSchool of Health Sciences: 10.2% (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e\u003cp\u003eSchool of Public Health: 9.6% (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e\u003cp\u003eSchool of Dentistry: 5.6% (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e*****\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOsman 2016 [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSudan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo explore students' perceptions, attitudes, motives and barriers toward research, and their perceptions on the quality of research supervision at University of Medical Sciences and Technology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCross-sectional Quantitative Study (survey)\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAge range: Mean age 22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 years\u003c/p\u003e\u003cp\u003eGender distribution: 45 (43.3%) males, 59 (56.7%) females\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFinal (5th) year medical students\u003c/p\u003e\u003cp\u003eMedicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e*****\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBovijn et al. 2017 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSouth Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo quantify voluntary research involvement among medical and allied health professions (AHP) students at the Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa, and to explore factors associated with such involvement. It also sought to determine if voluntary research involvement and/or other demographic factors are associated with self-perceived research competence and attitude toward future research participation.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCross-sectional Quantitative Study (survey)\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;1815 (80.2% response rate)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAge Range:\u003c/p\u003e\u003cp\u003eThe median age for the whole group was 21 years, with a range of 17 to 37 years.\u003c/p\u003e\u003cp\u003eGender Distribution:\u003c/p\u003e\u003cp\u003eMale: 463 (25.6%)\u003c/p\u003e\u003cp\u003eFemale: 1339 (73.8%)\u003c/p\u003e\u003cp\u003eNot specified: 13 (0.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eundergraduate programme in Medicine and Surgery (MB,ChB\u003c/p\u003e\u003cp\u003e\u0026ndash; a 6 year programme); as well as four undergraduate\u003c/p\u003e\u003cp\u003eAHP programmes: Bachelor of Science (BSc) in Dietetics\u003c/p\u003e\u003cp\u003e(DT), Bachelor of Occupational therapy (OT), BSc in\u003c/p\u003e\u003cp\u003ePhysiotherapy (PT), and Bachelor of Speech, language\u003c/p\u003e\u003cp\u003eand hearing therapy (SLHT), all 4 year programmes.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e*****\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWakida et al. 2022 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUganda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo evaluate the perceptions of undergraduates and mentors on the appropriateness, acceptability, and feasibility of the HEPI-TUITAH Micro-Research Approach to HIV Training in Uganda: Mbarara University of Science and Technology (MUST), Bishop Stuart University (BSU), and Lira University (LU).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCross-sectional descriptive qualitative study \u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;24 undergraduate health students and 13 mentors\u003c/p\u003e\u003cp\u003ein 5 focus group discussions (5\u0026ndash;8 participants per group)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNot specified\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNot specified\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e*****\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e5***** or 100% quality criteria met\u003c/p\u003e\u003cp\u003e4 **** or 80% quality criteria met\u003c/p\u003e\u003cp\u003e3 *** or 60% quality criteria met\u003c/p\u003e\u003cp\u003e2 ** or 40% quality criteria met\u003c/p\u003e\u003cp\u003e1 * or 20% quality criteria met\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.4. Research Activities\u003c/h2\u003e\u003cp\u003eTo systematically categorize the diverse research activities identified across the included studies, we adapted an already established research process framework [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This adaptation involved consolidating their original phases into three distinct phases to better reflect the undergraduate research experience:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eEarly Phase: Encompasses the original conceptual, design, and planning phases, focusing on foundational research preparation, proposal development, grant writing and obtaining ethical approval.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMiddle Phase: Combines the empirical and analytical phases, covering active data collection, analysis and management activities\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eLate Phase: Corresponds to the dissemination phase, involving scholarly communication and knowledge translation activities including writing of manuscripts, publication of peer-reviewed articles, writing abstracts and presenting at conferences.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThis classification facilitates a comprehensive understanding of how undergraduate health students engage in research activities. See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e below.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResearch activities undertaken by UHS in SSA\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhases of research\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearch activities mentioned\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo of studies\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReferences\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEarly Phase\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearch proposal writing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudy design and protocol development\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLiterature review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrant writing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEthics approval\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMiddle Phase\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eData Collection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eData Analysis and Management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLater Phase\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eManuscript Writing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublication of peer-reviewed articles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWriting abstracts and presenting at conferences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e3.4.1. Other Research activities\u003c/h2\u003e\u003cp\u003eThe studies also document the various roles that UHS play in participating in research activities. Four studies document research assistant roles as a common entry point to research [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In one study, the findings report that 61% of UHS who participated in that study had served as research assistant at one point in their research journey. Other roles include First author positions in a published paper [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], Co-authors [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and as Principal investigators [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eInterestingly, UHS were also involved in curricular research and voluntary research depending on the contexts. In the multisite study by Delport et al [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], findings reveal different approaches to curricular research integration in three contexts, South Africa, Sudan, and Uganda, revealing different approaches to research integration. In Uganda, UHS were involved in a one-week research methods training module, followed by an application of research skills in a community setting hereafter. In contrast, UHS in South Africa participated in research modules during their second year, which entailed literature reviews, protocol development, and research report writing. While in Sudan, students in the third year participated in research methodology courses followed by individual research projects in the fourth year. On the other hand, in a Nigerian study, about 52.9% of participants reported participating in a voluntary research project [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This finding suggest that research participation could extend the traditional \u0026ldquo;mandatory research projects\u0026rdquo; style offered in institutions.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.5. Barriers To Research Participation\u003c/h2\u003e\u003cp\u003eThe barriers to research participation among UHS was grouped into 7 themes: Resource Constraints; Time and Curriculum pressures; Knowledge and skills gap; Administrative, Ethical and Operational Hurdles; Mentorship and Supervision Challenges, Perceptions and Attitudes to Research; Gender, Language and Cultural barriers.\u003c/p\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003e3.5.1. Resource Constraints\u003c/h2\u003e\u003cp\u003eAcross the included studies, financial challenges were identified as the most common barrier reported by Undergraduate health students in six studies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Beyond financial limitations, UHS also reported inadequate infrastructure including limited library resources and the lack of well-equipped laboratory [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and computer facilities [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In another study, students reported a poor awareness of available research resources [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003e3.5.2. Time And Curriculum Pressures\u003c/h2\u003e\u003cp\u003eTime related constraints constituted the second most prominent barrier theme. Seven studies reported difficulty in balancing personal life, academic work, and research, coupled with insufficient time allocation for research [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The demanding nature of curriculum for health professions education was another common barrier, coupled with an overwhelming workload [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. With these constraints, UHS were not likely to have time for research.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003e3.5.3. Mentorship and Supervision Challenges\u003c/h2\u003e\u003cp\u003eSupervision and mentorship doubled as pronounced barriers. In 6 studies, UHS expressed a lack of professional supervisors and proper mentorship/guidance needed to support their research process [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In some studies, UHS described experiences of poor communication with research supervisors [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and in others, they felt the supervisors were not fully committed and unwilling to supervise [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In the backdrop of such challenges, supportive specialized staff such as biostatisticians, bioethicists and editors were lacking [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\u003ch2\u003e3.5.4. Knowledge and skills gap\u003c/h2\u003e\u003cp\u003eIn this theme, UHS reported a reported lack of knowledge about the research process [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], in three studies. In addition, two studies identified an inadequate research and biostatistics curriculum [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. On the skills gap, UHS in some studies reported an absence of structured content on research [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], a lack of mandatory courses on research methodology [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], lack of statistical support [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and poor research skills [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], as key barriers.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section3\"\u003e\u003ch2\u003e3.5.5. Administrative, Ethical and Operational Hurdles\u003c/h2\u003e\u003cp\u003eEven upon receiving the skills they needed for research, UHS also faced another hurdle: difficulty gaining administrative and ethical approval for their research. Students faced lengthy approval processes and burdensome requirements [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Likewise, they reported the research activities as not being well organized [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Asides these challenges, UHS reported some operational challenges that may exist outside of their control. In one study, COVID-19 pandemic restrictions deterred research participation among UHS [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Other times, UHS faced difficulties in selection of research topics, patient follow-up, and availability of sample/study subjects [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Other barriers identified include the lack of collaborations and recognition of research efforts [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\u003ch2\u003e3.5.6. Perceptions and Attitudes to Research\u003c/h2\u003e\u003cp\u003eUHS had varying perceptions and attitudes towards research, that constituted this barrier theme. In three studies, students described research as complex, difficult and stressful [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In some studies, participants reported a lack of interest and motivation for research [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In one study, research anxiety and fear of conducting independent research was reported as barriers to research participation [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Another concerning finding was that students felt unqualified to do research [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003e3.5.7. Gender, Language and Cultural Barriers\u003c/h2\u003e\u003cp\u003eThe most pronounced finding within this theme relates to significant gender disparities that exist in research participation. Considering one of the included studies with the largest sample size (n\u0026thinsp;=\u0026thinsp;1,815), they found that male students were significantly more likely to be involved in voluntary research compared to female students, with an odds ratio of 1.99 (95% CI: 1.48\u0026ndash;2.67; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This finding was corroborated by Mugabo et al. [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], who reported that more male students (52.6%) had participated in research projects compared to female students (43.5%, p\u0026thinsp;=\u0026thinsp;0.023). However, in the study by Bovijn et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], they found that female students reported lower self-perceived research competence and demonstrated reduced interest in future research participation when compared to their male counterparts. Language and cultural barriers emerged as significant challenges that may affect research participation barriers within research teams [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Specifically, Wakida et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] identified communication challenges due to language barriers within research teams as a key impediment to effective collaboration and research participation.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003e3.6. Enablers/Facilitators of Research Participation\u003c/h2\u003e\u003cp\u003eWe found various enablers or facilitators of research participation among UHS in SSA reported in the included studies. These were grouped into 6 themes; Early Exposure to research and Integration in curriculum; Quality mentorship and supervision; Access to Funding and Resources; Research skill development; Individual Motivation and Professional Identity; and Support from groups and institutions.\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003e3.6.1. Early Exposure to Research and Integration in Curriculum\u003c/h2\u003e\u003cp\u003eThis was cited as the most common facilitator theme across the included studies. Six studies cited the inclusion of research in the early years of undergraduate study as prominent facilitators of research participation among UHS [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe value of structured curriculum approaches was emphasized by findings supporting structured time allocation for research [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], mandatory research components [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], and problem-based learning curricula [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Likewise, completion of curricular research projects and hands-on research experience were also identified as enabling factors [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Additionally, participants who had previous research experience were likely to participate in future research projects [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003e3.6.2. Quality Mentorship and Supervision\u003c/h2\u003e\u003cp\u003eWithin this theme, UHS emphasized the importance of a role model/mentor to provide guidance [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Nevertheless, two studies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] highlighted that proper guidance extended to support with topic selection, manuscript writing, and publication processes, with faculty mentoring students as well [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSimilarly in five studies, UHS highlighted the need for supportive supervisors [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In a particular study, the aspects of quality supervision were emphasized, as supportive supervisors possessing knowledge, experience, and research skills to assist in research facilitated the engagement of UHS in research [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003e3.6.3. Access to Funding and Resources\u003c/h2\u003e\u003cp\u003eWhile resource and funding constraints acted as barriers, studies reported that access to adequate funding and resources was also an important facilitator. Enablers reported here included a call for funding for research projects [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Improved internet access and data availability [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], as well as the provision of library resources [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] were also recognized as enabling factors.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section3\"\u003e\u003ch2\u003e3.6.4. Research Skills Development\u003c/h2\u003e\u003cp\u003eThree studies emphasized the value of research methodology training, including short courses on research methodology, data analysis, proposal development, and manuscript writing [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Similarly, library information literacy [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], practical application of research during community placements [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], hands-on training [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and pre-dissemination training [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] were seen as crucial facilitators.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section3\"\u003e\u003ch2\u003e3.6.5. Individual Motivation and Professional Identity\u003c/h2\u003e\u003cp\u003eThis theme encompasses both the internal psychological drivers and professional aspirations that motivate UHS to engage in research.\u003c/p\u003e\u003cp\u003eRecognition and rewards emerged as powerful motivators that validate UHS\u0026rsquo;s research efforts and provide tangible benefits for participation. Acknowledgement of research achievements was reported as an enabler by two studies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], and monetary rewards was identified by another study [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, benefits exceed monetary benefits and could include opportunities to attend or present at a conference [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], as well as publication opportunities [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eParticipants' perceptions of benefits of research participation could serve as their motivation. In two studies, students perceived that research experience may increase their acceptance into residency programs [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In other studies, participants perceived research as important and relevant to personal development, clinical work and careers [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Additionally, the positive attitudes towards research and willingness to learn were identified as a fundamental motivator to research participation [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. These findings may suggest that students with positive research attitudes and perceptions approach research challenges with resilience and view difficulties as learning opportunities rather than insurmountable barriers.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec30\" class=\"Section3\"\u003e\u003ch2\u003e3.6.6. Support from groups and institutions.\u003c/h2\u003e\u003cp\u003eAs reported by Wakida et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], the interprofessional education approach (the approach of bringing together students from different health disciplines) was seen as valuable for peer mentorship, teamwork, and academic collaboration. Other studies reported collaboration with other researchers [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], involvement in ongoing research projects [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], working in groups [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], and peer collaboration [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] as enablers to research participation. These findings suggest that research participation could be enhanced when students perceive it as a collaborative rather than isolated activity.\u003c/p\u003e\u003cp\u003eMaintaining a suitable institutional research environment was identified as essential to supporting research participation and growth [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In essence, these could include the establishment of undergraduate research support centers [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and facilitating the complex hurdle of ethics and institutional permissions processes [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. With the creation of such support centres and streamlining ethical approval processes, UHS can face lesser barriers to participating in research activities.\u003c/p\u003e\u003cp\u003eInterestingly, some factors were reported as both barriers and enablers depending on the context.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eOur systematic review synthesized evidence on the barriers and enablers to research participation among undergraduate health students in SSA.\u003c/p\u003e\u003cp\u003eWe found that UHS face significant barriers to research participation, primarily due to resource constraints. These findings align with those of Pallamparthy and Basavareddy [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and Alsaleem et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] which identified inadequate funding, insufficient research facilities, and limited access to medical journals and relevant databases as barriers to student research engagement in India and Saudi Arabia respectively. UHS reported difficulty balancing academic responsibilities, personal life, and research activities due to limited time allocation for scholarly work and the intensive and demanding nature of their curriculum. As a result, UHS were less likely to engage in or complete research projects. These findings align with similar research published in 2020 and 2024, which highlighted that medical students often struggle to conduct research while managing the rigours of their medical training, leading to reduced participation and completion rates [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, findings from a study conducted by Pallamparthy and Basavareddy [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] among medical students in India revealed 56% of respondents believed that engaging in research was not a waste of time and did not interfere with their academic studies. Supervision and mentorship also emerged as significant barriers as UHS frequently reported the absence of qualified supervisors and inadequate mentorship essential for navigating the research process. In some studies reviewed, UHS described instances of poor communication with their supervisors, while others expressed frustration over a perceived lack of commitment and willingness to provide meaningful guidance. These findings are consistent with the works of El Achi et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]; Kiyimba et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], who identified limited access to mentorship, guidance and collaborative opportunities as major perceived barriers to student involvement in research. Another prominent barrier identified was the reported lack of knowledge about the research process and gaps in research skills, with students citing the absence of structured content on research, and limited access to statistical support. These findings are consistent with those of Ferdoush et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], who reported that in Bangladesh, limited proficiency in statistical analysis and insufficient training in research methodology significantly hindered undergraduate research participation. Despite acquiring the necessary research skills, UHS encountered significant challenges in executing their research projects. One prominent hurdle was the difficulty in obtaining administrative and ethical approvals, which were often characterised by prolonged processing times, burdensome procedures and requirements. This corroborated with Ashour and Hatamleh [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] who identified difficulties obtaining ethical or institutional approval as a significant barrier to research engagement, among medical students. Furthermore, in three included studies, students described research as complex, challenging, and mentally taxing, also reporting a general lack of interest and motivation to engage in research activities. One study specifically highlighted research-related anxiety and fear of undertaking independent research as significant obstacles to participation. Additionally, a recurring concern was that many students felt inadequately prepared or unqualified to conduct research. In contrast to these negative perceptions, El Achi et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] reported predominantly positive attitudes among students, with high mean scores for research perception (4.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57) and attitude (3.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48). Their study also found a strong willingness among students to engage in research. Similarly, findings Soe et al. [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] reflected generally favourable attitudes toward scientific research, further challenging the notion of widespread disinterest. Another key finding was the marked gender disparity in research participation. Several included studies observed that male students were significantly more likely to engage in voluntary research activities compared to their female peers. In addition to gender-based differences, language and cultural barriers were identified as significant impediments to effective research participation. Communication challenges within research teams, particularly those stemming from language differences, were reported to hinder collaboration and limit opportunities for meaningful engagement in research activities. However, contrasting evidence exists. A study by Noorelahi et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] conducted in Saudi Arabia found a statistically significant gender difference in favour of female medical students, with 79% reporting previous involvement in medical research surpassing the participation rate of their male counterparts. This divergence suggests that gender disparities in research engagement may be context-specific, influenced by sociocultural, institutional, and educational factors.\u003c/p\u003e\u003cp\u003eOn facilitators of research participation, we found early integration of research into undergraduate curricula as a key enabler for research engagement among UHS. Likewise prior research experience was associated with a greater likelihood of future participation. Similarly, findings from Idrus et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] revealed that most respondents supported the inclusion of undergraduate research in the dentistry programme curriculum as a key enabler to their involvement in research. Findings from our review also revealed that UHS students consistently emphasised the vital role of having a mentor or role model to provide structured and sustained guidance throughout the research process. Students repeatedly highlighted the value of supportive supervision, particularly when supervisors demonstrated not only encouragement but also strong research expertise, experience, and academic competence. Notably, the study by Alsalim et al. [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] affirmed the transformative impact of such mentorship on undergraduate research experiences. With this guidance, Students reported increased confidence and a strengthened belief in their ability to undertake and contribute meaningfully to research tasks. While resource and funding constraints were identified as significant barriers, several studies also highlighted the availability of adequate funding and resources as key facilitators of research engagement. Additional facilitating factors within this theme included improved internet connectivity, enhanced data accessibility, and the provision of adequate library and learning resources. These findings align with those of Shafiei and Soltaninejad [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], who reported that the availability of appropriate research tools and software not only supported effective research conduct but also served as a strong motivator for both students and faculty members to participate in research activities and pursue deeper academic inquiry. Our review identified three studies that highlighted the importance of research methodology training as a key facilitator of student engagement and competence in research. These included short courses in research methodology, data analysis, proposal development, and manuscript writing. In addition, the provision of library information literacy, opportunities for the practical application of research during community placements, hands-on workshops, and pre-dissemination training were also recognised as essential components in strengthening research capacity. These findings align with the study by Mahomed et al. [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], which reported that many students found research training activities enjoyable and beneficial, significantly enhancing their understanding of the research process. The theme on 'individual motivation and professional identity' captures the internal psychological drivers and evolving professional aspirations that motivate UHS to engage in research. Recognition and rewards consistently emerged as influential motivators, offering both validation and tangible benefits that encourage research participation. Here, intrinsic interest in research and a positive attitude toward scholarly inquiry were identified as foundational motivators. Students who approached research with enthusiasm and curiosity demonstrated greater resilience in the face of challenges, often viewing obstacles as opportunities for learning and growth rather than deterrents. This mindset not only fosters persistence but also reflects a deeper alignment between individual motivation and professional identity. Supporting this, Alhabib et al. [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] identified admission into residency programmes, genuine interest in research, and financial incentives as key drivers of undergraduate research participation. Similarly, Saboor et al. [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] found that intrinsic interest was the most significant personal motivator among medical students. Support from groups and a conducive institutional research environment is crucial for fostering active participation and the growth of research capacity, particularly among UHS. Key strategies include the establishment of undergraduate research support centres and the simplification of processes related to ethical approvals and institutional permissions. These measures can significantly reduce administrative barriers and enhance students' ability to participate in meaningful research activities. Evidence from a study Hasan et al. [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] in Bangladesh further underscores the importance of institutional support, highlighting that encouragement from faculty members was a significant motivator for undergraduate research involvement.\u003c/p\u003e\u003cp\u003eIn this review, we grouped participation in research activities according to phases. In the early phase, research design and proposal writing emerged as one of the most reported activities among students, often serving as the initial gateway into the research process. Similarly, Burgoyne et al. [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] highlighted that a notable proportion of students had participated in study design and sampling activities that are critical for building foundational research skills such as formulating research questions, selecting appropriate methodologies, and understanding sampling techniques. In addition, several students were reported to have engaged in grant writing efforts as a means of securing resources or funding for their research. This aligns with the findings of Hasan et al. [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], who noted that medical students Bangladesh increasingly participate in research projects beyond their formal academic requirements.\u003c/p\u003e\u003cp\u003eIn the middle phase, as reported in various included studies, obtaining ethical clearance was prioritised as an essential step before data collection commenced, reflecting standard research practice and adherence to ethical guidelines. Following this, data collection, data analysis and data management activities were reported to occur concurrently or subsequently. These stages played a pivotal role in helping students develop analytical skills, data literacy, and an understanding of data protection and confidentiality principles. This process not only ensured compliance but also reinforced the importance of protecting participants' rights and maintaining research accountability among UHS.\u003c/p\u003e\u003cp\u003eIn the late phase, the reviewed studies highlight a range of research dissemination activities undertaken by UHS students following the completion of data collection and analysis. A notable emphasis was placed on manuscript writing, reported across five studies, underscoring the role of academic and scientific writing in developing students\u0026rsquo; critical thinking and communication skills. Additionally, students were reported to participate in abstract writing and conference presentations. These activities contributed significantly to the development of students\u0026rsquo; research communication and oral presentation skills. Public presentation of research fosters confidence and the ability to articulate scientific ideas clearly to varied audiences (both essential attributes for emerging professionals). Bovijn et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] further support this trend, noting that while a smaller proportion of students presented at conferences (6.7%) or published in journals (1.2%), these outputs were typically voluntary and often occurred outside the core curriculum. This suggests that while formal structures for dissemination may be limited, motivated students seek additional opportunities to share their work.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrengths and Limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe inclusion of studies from multiple countries and health disciplines offers a rich and well-structured view of undergraduate research activities. This review is grounded in strong methodological principles, following PRISMA 2020 guidelines, PROSPERO registration, comprehensive database searches, and systematic quality appraisal using the Mixed Methods Appraisal Tool enhances transparency, reproducibility, and credibility. By providing insights from structural, institutional, personal, and cultural perspectives, this review offers practical, context-sensitive recommendations that speak directly to the realities of undergraduate research in Sub-Saharan Africa.\u003c/p\u003e\u003cp\u003eHowever, the uneven geographical coverage limits the generalisability of the findings to the entire SSA region, and restricting the search to English-language publications may have introduced language bias by excluding potentially relevant studies in French, Portuguese, or other local languages. The heterogeneity in study designs, participant populations, and contexts necessitated a narrative rather than quantitative synthesis, the former of which is more susceptible to interpretive bias. The exclusion of grey literature and reliance solely on peer-reviewed sources may have also overlooked important but unpublished perspectives, particularly from low-resource settings. In addition, many of the included studies relied on self-reported data, which are inherently vulnerable to recall and social desirability biases. Finally, the temporal scope (2000\u0026ndash;2024) may have excluded older but still relevant evidence from countries with long-established traditions in undergraduate research.\u003c/p\u003e"},{"header":"5. CONCLUSION","content":"\u003cp\u003eThis systematic review highlights the complex interplay of barriers and enablers influencing research participation among UHS in Sub-Saharan Africa. While constraints such as limited funding, inadequate mentorship, insufficient research skills, curriculum overload, and bureaucratic challenges hinder participation, several facilitators such as early curriculum integration, quality supervision, access to research training, collaboration opportunities, and institutional support emerge as critical enablers. Notably, some factors like mentorship and resource availability function as either barriers or enablers depending on the context, underscoring the need for tailored interventions. To strengthen undergraduate research engagement in SSA, we recommend embedding research early in curricula, enhancing mentorship structures, improving access to resources and funding, simplifying ethics and administrative processes, fostering interdisciplinary collaborations, offering targeted research training, and addressing gender and cultural disparities. These efforts are essential to building sustainable research capacity and developing a future health workforce equipped to respond to local and global health challenges.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: AEB, AYA, CDN; Methodology: AEB, AYA, CDN; Protocol development and registration: AEB, CDN, UUA, AYA; Database searches: AEB; Study screening and selection: AEB, UUA, CDN, AYA; Data extraction: AEB, UUA, CDN; Quality appraisal: AEB, UUA, CDN; Data synthesis and thematic analysis: AEB, CDN, PAK, UFI; Arbitration and conflict resolution: AYA, UFI; Writing\u0026mdash;original draft: AEB, PAK, UFI; Writing\u0026mdash;review and editing: AYA, UUA, CDN; Project administration and Supervision: AEB. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe appreciate all the authors of included studies.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data analysed in this study were extracted from previously published studies, which are cited in the manuscript. No new datasets were generated. Therefore, data sharing is not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOrton L, Lloyd-Williams F, Taylor-Robinson D, O'Flaherty M, Capewell S. The use of research evidence in public health decision making processes: systematic review. PLoS ONE. 2011;6(7):e21704.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBassey AE. The health of migrants at the intersection of mpox and HIV. Lancet. 2024;404(10456):930.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBassey AE, Olisaeloka LC, Adebisi YA. 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Med Educ Online. 2010;15(1):5212.\u003c/span\u003e\u003c/li\u003e\u003c/ol\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-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Undergraduate health students, research participation, barriers, enablers, Sub-Saharan Africa, research capacity building.","lastPublishedDoi":"10.21203/rs.3.rs-7527269/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7527269/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch participation among undergraduate healthcare students (UHS) is widely recognized as key to their academic and professional development, as well as to developing future competent health workforce. However, in Sub-Saharan Africa (SSA), the participation of undergraduate health students in research remains limited. This review aims to systematically explore the barriers and enablers to research participation among UHS in SSA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA systematic search was conducted across MEDLINE, Embase, Scopus, CINAHL, and Web of Science databases for studies published in English from 2000 to 2024. Studies were screened and assessed for quality using the Mixed Methods Appraisal Tool. Data were synthesized through narrative synthesis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTen studies from Uganda, South Africa, Namibia, Rwanda, Sudan, and Nigeria were included, with quality ratings from moderate (60%) to very high (100%). Reported research activities covered early (conceptualisation, ethics approval), middle (data collection, analysis), and late (dissemination, publication) phases. Barriers were clustered into: (1) resource constraints; (2) time and curriculum pressures; (3) inadequate mentorship; (4) knowledge and skills gaps; (5) administrative and ethical hurdles; (6) perceptions, attitudes to research and (7) Gender, Language and Cultural barriers. Enablers included: (1) early research exposure; (2) strong mentorship; (3) access to funding/resources; (4) research skills training; (5) individual motivation; and (6) institutional/peer support. Some factors such as supervision and resources were reported as both barriers and enablers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUHS in SSA face intertwined structural, institutional, and personal challenges to research participation. Strengthening mentorship, integrating research early into curricula, improving access to resources, and providing skills training may enhance engagement and build sustainable research capacity in the region.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis review was prospectively registered on PROSPERO database (PROSPERO 2024 CRD42024581644).\u003c/p\u003e","manuscriptTitle":"Barriers and Enablers of Research Participation Among Undergraduate Health Students in Sub- Saharan Africa: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-16 09:39:20","doi":"10.21203/rs.3.rs-7527269/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-24T10:44:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-12T11:05:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-04T01:00:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19251706442119879355250121497263298476","date":"2025-11-01T12:03:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333002715701410872596994645569383425179","date":"2025-10-28T09:58:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"245069849204107567649735930469548507598","date":"2025-10-28T07:45:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"104278661239744657030805206656839288062","date":"2025-10-01T07:37:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149360332506463540670581840878150378170","date":"2025-10-01T05:18:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32616497465119340851757046185889312984","date":"2025-09-09T13:05:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-09T05:24:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-08T07:14:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-08T06:49:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-08T06:47:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-09-03T12:52:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"31fc736a-1842-4447-8660-a29c529160fd","owner":[],"postedDate":"September 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T16:00:25+00:00","versionOfRecord":{"articleIdentity":"rs-7527269","link":"https://doi.org/10.1186/s12909-026-08681-2","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2026-02-17 15:56:53","publishedOnDateReadable":"February 17th, 2026"},"versionCreatedAt":"2025-09-16 09:39:20","video":"","vorDoi":"10.1186/s12909-026-08681-2","vorDoiUrl":"https://doi.org/10.1186/s12909-026-08681-2","workflowStages":[]},"version":"v1","identity":"rs-7527269","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7527269","identity":"rs-7527269","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}