Understanding current research activity, research culture perceptions and research aspirations in an NHS community healthcare organisation: A mixed methods evaluation

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Growing research expectations and opportunities in community care require an understanding of community research capacity and culture. To support the shifting focus from hospital care to community care, research evidence can guide new models of care and help tackle increasing clinical demands. The healthcare professionals delivering community care - often nurses, pharmacists, allied health and mental health professionals - need the capacity to address the research priorities in their community services. The aim of this study was to understand research capacity and culture in the context of an NHS community healthcare setting. Methods. We planned four inter-related workstreams to evaluate research activity, outputs and perceptions of research culture and aspirations in a large UK Community Healthcare NHS Trust. We completed a database review to quantify studies delivered; a literature review identifying journal publications and conference abstracts authored by Trust staff/affiliates; online surveys and semi-structured interviews to explore research perceptions and aspirations across staff groups. Results . One third of services were research active, delivering research studies and/ or publishing research findings. Services with embedded clinical academics were most research active. Service-level managers’ perceptions of research capacity did not match the more optimistic perceptions of senior Trust leaders. Staff and senior Trust leaders reported an aspiration to improve the level of research attainment across all staff groups. Senior Trust leaders aspired to the highest level of research attainment (leading research to generate new knowledge) for advanced practitioners. Discussion. Whilst there was variation in research activity across services and disparities in perceptions of research culture and capability across staff groups, there was a universal aspiration to achieve higher levels of research attainment across all staff groups in this community healthcare NHS organisation. To facilitate this, a focus on developing advanced practice research capability and establishing research leadership within services may be important. Research culture capacity community healthcare Figures Figure 1 Figure 2 Figure 3 BACKGROUND Embedding research activity into the NHS across all health and care settings is a key government target ( 1 ). As the foundation of advancement in patient care ( 2 ), clinical research brings a multitude of benefits including improved quality of care ( 3 ), lower mortality rates ( 4 ), more engaged staff ( 3 ), and better informed patients who have more confidence in the staff treating them ( 5 ). To address current and anticipated healthcare challenges ( 6 ), there is growing focus on healthcare delivery in community and out-of-hospital settings ( 7 ). However, there is an unmet need for research evidence to underpin the delivery of high-quality, efficient care in these settings. Despite 90% of all NHS clinical contacts now occurring in out-of-hospital settings ( 8 ), three-quarters of research recruitment activity is still hospital-based ( 9 ). This imbalance in research activity ( 10 ) continues to be perpetuated by the current research funding structure which rewards the most research active organisations with more funding opportunities. Furthermore, whilst research should ideally be undertaken by those involved in delivering the care, community services are overstretched and are often led by nurses and Allied Health Professionals who may still be developing the necessary experience, capability and confidence to undertake research. Understanding the current research landscape in community healthcare services will help to develop effective strategies to achieve the much-needed changes in research culture ( 11 ). The aim of this study was to gain insight into research capacity and culture in the community healthcare context by capturing a snapshot in time of current research activity, outputs, perceptions of research engagement, culture and aspirations at a large community healthcare NHS Trust. METHODS Setting We undertook our research mapping exercise in a city-wide NHS community healthcare Trust in the North of England that employs over 3,000 staff and receives more than 250,000 referrals each year. The Trust’s staff deliver care to over 5,000 people per day. This equates to over 2.5 million patient contacts per year, through a range of around 60 services (with slight variation across the 3 year data capture period) largely led by nursing and allied health clinicians. This NHS Trust’s broad clinical portfolio is organised under three business units responsible for adult services, children’s services and specialist services. The Trust has a strategic vision to develop a research culture that benefits the community it serves and has been ranked 9 th for research activity (number of studies delivered) among the 18 NHS community Trusts across the UK according to data from the regional research delivery network. Research delivery and research outputs To quantify research delivery activity, we counted the number of studies over a 3-year period (2021-2023) across the three business units To quantify research outputs, we undertook a systematic literature search to identify publications (including conference abstracts) authored by Trust staff over the same 3-year period. The search strategy and process were guided by the Trust librarian and included all publications from years 2021, 2022 and 2023 that included an author affiliated with the Trust. We also mapped the formal clinical academic roles across the Trust. Surveys Online surveys were used to capture perceptions of current research capacity, capability and culture and research aspirations. The surveys were distributed electronically via internal email and via links in communication bulletins over a 6-month period from August 2023. We created three different surveys using Microsoft Forms, aimed at capturing data from three groups of staff within the organisation: 1) registered and non-registered healthcare and support staff; 2) service-level managers; and 3) senior Trust leaders. Reminder emails were sent to targeted individuals within the second two participant groups with the aim of capturing data from as many service-level managers and senior Trust leaders as possible. In addition, the survey was promoted several times through bulletins and screensavers to encourage registered and non-registered healthcare and support staff to participate. The surveys incorporated questions from two validated rating scales to capture i) research readiness and aspirations from healthcare staff and from senior Trust leaders using the Clinicians’ ‘Skills, Capability and Organisational Research Readiness’ (SCORR) tool (12) and ii) perceptions of research capacity from senior Trust leaders and service-level managers using the ‘Research Capacity and Culture’ (RCC) tool (13). The SCORR tool is designed for non-medical healthcare professionals to self-assess their level of attainment in clinical research skills. It is a single item questionnaire that uses a 6-point scale, ranging from level 0 (requires support to gain knowledge from evidence on practice/research and apply it to practice) to level 5 (leads the generation of knowledge through research activity, leads and develops clinical research, obtains research funding etc) and with an additional ‘not applicable’ category. For the purposes of our survey, we excluded level 0 as there is an expectation for all our professional staff to use evidence-based practice. We asked healthcare and support staff to rate their current attainment level and also where they would like their research skills attainment to be in 5 years’ time. We asked senior Trust leadership participants to use these same rating questions to estimate levels of current attainment for different staff groups in the organisation and to rate their aspirations for these staff groups in the next 5 years. The RCC tool is designed to evaluate research capacity and capability at organisation, team and individual levels across a range of domains. This tool is a detailed questionnaire with multiple rating questions about perceptions of research capacity and success at organisation, team and individual level. Each question is rated on a 10-point scale from least successful to most successful. This validated tool has previously been used in a range of settings, including a national survey of Allied Health Professionals working in NHS and social care settings (14). We asked senior Trust leaders and service-level managers to complete the organisation- level questions and the team-level questions respectively. Additional questions were included in each of the three surveys to capture non-personally-identifiable information about participants’ roles within the organisation. Semi-structured consultations To explore survey responses in more depth and to encourage ongoing conversations around growing a stronger research culture, we invited senior Trust leaders (via email) from the 3 business units and from the corporate teams, service-level managers (both operational and clinical) and research-interested clinical staff who completed the surveys to take part in online semi-structured consultations. Topic prompts developed by the research team for these consultations aimed to focus the discussions around current research activities/ opportunities and impacts, and to initiate discussions around developing a research engagement strategy (Additional file 1). The discussion topics were intended to be used iteratively within the semi-structured consultations, and included exploring survey responses when relevant. Consultations with senior Trust leaders were completed by the Trust’s Clinical Research Lead and Clinical Research Fellow. Consultations with the service-level managers and clinical staff were completed by clinical research advisors seconded to the research department. All consultations were completed between September 2023 and February 2024, either face-to-face or via video-conference (Microsoft Teams). These were conducted either on a one-to-one interview basis or in small groups, depending on availability and convenience (for example in some cases, we incorporated our discussion within scheduled meetings). Consultations lasted up to 60 minutes. Notes were made throughout by the study team member leading each consultation, and consultations conducted via video-conference were recorded as an aide-memoir. Analysis Research delivery and research output data were analysed descriptively (publication and research study counts), and analysed using frequency data according to business unit and individual service. For analysis of survey data, quantitative data were analysed using Microsoft Excel. Likert-scale items were summarised in accordance with convention for ordinal data using the median and Inter Quartile Range (IQR) for each item. For the SCORR tool questions, we estimated median scores for current levels of research skill and for levels of research skill aspired to in 5 years’ times for each staff group. We then compared these using difference in median scores. Inferential statistical analyses were not appropriate for this exploratory ordinal-level data. Free text items were analysed by inductive content analysis using a simple visual inspection facilitated by grouping responses within an Excel spreadsheet, and subsequent cross-checking within the study team. Interview annotations were discussed among the study team, who extracted and agreed on key themes and deductively categorised them according to potential strategic opportunities for building research engagement. RESULTS Research delivery and research outputs Forty-nine studies were delivered during the 3-year period 2021-2023 (see Figure 1), with over 1,700 study participants recruited. Of these studies, 44 were delivered by 17 services (approximately 30% services), 28 studies (57%) were delivered by services within the specialist services business unit, and 5 studies were delivered that were not associated with a specific service. Thirty-five studies were NIHR portfolio adopted studies, and 29 involved the Trust delivering recruitment (with or without intervention delivery). Research outputs were identified from staff employed in 20 different services (see Figure 2). A total of 90 research outputs in the form of publications (81) and conference abstracts (9) were found from a search covering the 3-year period 2021, 2022 and 2023. Sixty-nine of these publications (76%) were outputs from specialist services. During the study period, we identified three established clinical academics, affiliated with Musculoskeletal, Podiatry and Long-Covid services; all within the specialist services business unit. In addition, the Integrated Children's Additional Needs Service within the children’s business unit had a clinical academic member of staff in the service prior to the data collection period. The majority (66%) of identified publications were from staff affiliated with these services. Surveys and consultations Surveys were completed and submitted by each of the three targeted participant groups, representing a range of organisational departments, business units and staff groups. After data cleansing (removal of four duplicate survey responses, and four responses submitted outside the data collection period), 113 survey records were available and included in our analysis: 14 (48%) from senior Trust leadership out of 29 individuals targeted in this participant group; 25 (54%) from service-level managers out of 46 individuals targeted in this participant group; 74 from clinical and non-clinical healthcare and support staff (Additional File 2). The Research Capacity and Capability tool questions were completed by 39 participants from senior Trust leadership (n = 14) and service-level managers (n = 25). Perception of research capability/capacity on a scale of 1-10 was rated higher overall by senior Trust leaders (median 6.3, IQR 1.5) than by service-level managers (median 4.3, IQR 2.5). Senior Trust leaders rated 14 of the survey items higher, and none of the items lower, than service-level managers. Table 1 summarises responses for RCC items from senior Trust leaders and service-level managers. When looking at RCC tool questions posed to both senior Trust leaders and to service-level managers, both participant groups gave their lowest ratings for the item ‘my service/ the Trust has software available to support research activities’ (median 5.0, IQR 4.5 and 2.0, IQR 2.0 respectively) and their highest rating for the item ‘my service/ the Trust has team leaders/ senior managers who support research’ (median 7.5, IQR 2.0 and 7.0, IQR 4.0 respectively). The greatest discrepancy in perceptions related to planning research development and applying for funding, with senior Trust leaders giving high ratings in response to the survey items ‘The Trust has a plan or policy for research development (median 7.5, IQR 2.3) and ‘The Trust accesses external funds for research (median 7.0, IQR 2.5), and service-level managers giving a low rating to the survey items ‘my service does planning for research development as a team’ (median 2.0, IQR 2.0 and ‘my service has applied for external funding for research’ (median 2.0, IQR 6.0). Table 1. Research Capacity and Culture (RCC) tool survey response summary Senior Trust leadership participants (n = 14) Service-level manager participants (n = 25) Organisation level RCC tool questions (scale 1-10) Median rating/ score (IQR) Team level RCC tool questions Median rating/ score (IQR) The Trust has adequate resources to support staff research training 6 (1.5) My service has adequate resources to support staff research training 3.0 (3.3) The Trust has funds, equipment or admin to support research activities 5 (2.0) My service has funds, equipment or admin to support research activities 2.5 (1.0) The Trust has a plan or policy for research development 7.5 (2.3) My service does planning for research development as a team 2.0 (2.0) The Trust has senior managers that support research 7.5 (2.0) My service has team leaders that support research 7.0 (4.0) The Trust ensures staff career pathways are available in research 5.0 (4.3) My service provides opportunities to get involved in research 5.0 (4.0) The Trust ensures organisation planning is guided by evidence 7.0 (2.3) My service does planning (clinical or operational) that is guided by evidence 7.0 (1.8) The Trust has consumers / patients / service users involved in research 6.0 (3.0) My service has consumer/patient involvement in research activities/planning 2.5 (3.8) The Trust accesses external funding for research 7.0 (2.5) My service has applied for external funding for research 2.0 (6.0) The Trust encourages research activities relevant to practice 6.0 (2.0) My service conducts research activities relevant to practice 5.0 (4.5) The Trust has software programs for analysing research data 5.0 (4.5) My service has software available to support research activities 2.0 (2.0) The Trust has mechanisms to monitor research quality 5.5 (4.0) My service has mechanisms to monitor research quality 2.0 (5.0) The Trust has identified experts accessible for research advice 7.5 (3.0) My service has identified experts accessible for research advice 5.5 (6.3) The Trust supports a multi-disciplinary approach to research 7.0 (3.0) My service supports a multi-disciplinary approach to research 6.0 (5.5) The Trust has regular forums / bulletins / conferences to present research findings 5.0 (2.0) My service disseminates research results at research forums/seminars (conferences) 4.0 (4.0) The Trust engages external partners (eg universities) in research 6.5 (2.5) My service has external partners (eg universities) engaged in research 6.5 (5.8) The Trust supports applications for research scholarships / fellowships or degrees (PhD, MRes, MSc) 6.5 (2.3) My service supports applications for research scholarships/fellowships or degrees (PhD/MRES/MSc) 4.5 (6.0) The Trust supports the peer-reviewed publication of research 7.0 (1.5) My service supports the peer-reviewed publication of research 5.0 (6.0) RCC Items for Organisation level only RCC items for Team level only The Trust promotes clinical practice based on evidence 8.0 (2.3) My service ensures staff involvement in developing the research plan 2.0 (3.0) My service has incentives & support for research mentoring activities 2.0 (4.0) Median overall score 6.3 (1.5) 4.3 (2.5) IQR = interquartile range, RCC = Research Capacity and Culture The SCORR tool was completed by 14 senior Trust leaders who estimated current research attainment level for five different staff groups and then rated aspired-to levels for these same staff groups. It was completed by 75 registered and non-registered healthcare staff (~2.5% of Trust total) who self-rated their current research level of attainment and the level they aspired-to in 5 years. Additional file 3 summarises SCORR tool responses for senior Trust leaders and for non-clinical healthcare and support staff. On the SCORR tool, the perceived current research level of attainment across all staff groups was rated by senior Trust Leaders at a median level of 2.0 (IQR 2.0) and was self-rated by clinical and non-clinical healthcare and support staff at a median level 2.0 (IQR1.0). Levels of research attainment aspired to in 5 years’ time for all staff groups was rated at median 4.0 (IQR2.3) by senior Trust leaders, and was self-rated as 4.0 (IQR 2.0) by staff. Self-ratings and ratings from senior Trust leaders for current levels of attainment and aspired-to levels of attainment in 5 years differed for administrative staff and for non-registered healthcare staff. For advanced practice/ consultant healthcare practitioners, responses indicated a self-rated aspiration to move from a median level 3.0 (2.0) to a median level 4.0 (IQR 1.3) in 5 years and an aspiration from senior Trust leaders for this staff group to achieve median level 5.0 (IQR 0.0) in 5 years; this represents the highest level on the scale that describes leading the generation of new knowledge for example by actively participating in developing and leading clinical research (Figure 3). When analysing responses by business unit, staff from the adult services rated their level of research attainment higher than others on the SCORR tool. Service-level managers from the adult services rated their services lower, and managers from corporate services rated themselves higher than other service-level managers on the RCC tool questions. When analysing responses by professional group, allied health professionals rated their level of attainment on the SCORR tool lower than nurses, doctors and clinical scientists. A summary of analyses of RCC and SCORR scorings by staff group, profession and business unit is provided in Additional Files 4 and 5. Free text responses (summarised in Additional File 6) highlighted variation in senior Trust leader and service-level manager awareness and perceptions of responsibility for research leadership, and of current research activity and outputs. Across both participant groups, the most commonly identified motivators for research activity were improvements in clinical care and staff development and engagement. The most commonly identified barrier to research activity was lack of time/ funding and prioritisation of clinical work. Consultations Consultations were completed with 21 senior Trust leaders out of 29 invited (72%), 34 service-level managers out of 46 invited (74%), and 9 research-interested staff out of 76 invited to take part (12%). Engagement varied between business units and services (see Additional File 7). The number of participants at group consultation ranged from 1 to 5. Five key themes were identified from individual and group consultations relating to developing a stronger research culture, each with a number of subthemes summarised in Table 2. Table 2. Key themes and subthemes from consultation discussions Theme Subthemes RESEARCH PROCESSES establish research processes that are easy to use (for example, capacity & capability assessment form) ensure mechanisms exist for research activity reporting WORKFORCE DEVELOPMENT talent management, career pathways, job plans, opportunities for exposure to research (students, clinicians, managers), appraisals processes TRAINING PLAN identify gaps in research knowledge/ understanding and training needs, share training and development opportunities, develop shared learning, facilitate research exposure and mentoring LEADERSHIP develop research leadership roles (research champions/ leaders, advanced practice roles, clinical academic roles) establish and use expertise from academic partners and networks STRATEGIC PLANNING identify research priorities, strengths, gaps at Trust/ Business Unit/ Service level. Develop workforce capacity (clinical and admin) for research. Plan and map research activity. Disseminate and implement research findings. DISCUSSION All four workstreams in this study contributed to successful fulfilment of our aim of mapping research activity and outputs between the years 2021 and 2023 and capturing a snapshot within this period of perceptions of research engagement, culture and aspirations at a large NHS Community Healthcare Trust. Our findings highlighted variation in research activity in different community services across the organisation, and variation in perceptions of research culture, capability and aspirations across different staff groups. Research activity We found little or no research activity around two thirds of the community services in this organisation, reflecting the challenges of integrating research activity into working practices within community-based care where the primary clinical disciplines (ie nursing and allied health) may lack maturity in their research development ( 15 – 17 ). Importantly, we found that services providing specialist clinical care and those with established clinical academics currently or recently embedded within the team were the most research active. These findings align with qualitative evidence that clinical academic roles impact positively on the local research culture ( 18 ), and this may be easier when linked to a clearly defined healthcare specialism. Clinical academic roles are credited with bringing benefits both to patient care and to the clinical team within research active departments, but when these positive impacts are centred around individual research-active clinicians, the benefits do not necessarily translate across the wider organisation ( 19 ). RCC- organisation and team research capacity and capability Responses to RCC-tool items in our survey highlighted a gap in perceptions between senior Trust leaders and service-level managers. Senior Trust leaders seemed more optimistic, rating all research capability items higher than or equal to service-level managers. This fits with national survey data that found allied health professionals rated research success at team level lower than both individual and organisational level success ( 14 ), potentially reflecting the tensions of competing priorities at this middle-management level. This underlines the importance of developing research confidence, experience and leadership at the team level and growing a greater understanding and recognition of how research activity can support and benefit a team. SCORR- research attainment level Using the SCORR tool, the majority of staff (72%) rated their current research attainment level in the middle brackets (level 2 and 3) which relate to sharing and synthesising new knowledge – a level that would generally be considered appropriate for most clinical professionals other than those who are unregistered or newly qualified. Eighteen percent rated themselves in the highest bracket (levels 4 and 5 relating to generating new knowledge with the support of others, and relating to leading the generation of new knowledge respectively). This is comparable to findings in a recently published study, where 20% of staff primarily from nursing and allied health professions in a mental health and disability Trust self-rated themselves in this higher bracket ( 20 ). The mental health and disability Trust in this study reported more staff (25%) who self-rated themselves in the lowest bracket (levels 0–1) compared with only 9% in our survey, which might be explained by our decision to modify the SCORR scale by omitting the 0 level. Importantly, both senior Trust leaders and staff reported aspirations for improved research attainment levels over the next 5 years across all business units and professional groups. Senior Trust leaders seem more ambitious especially for the advanced practitioner workforce for whom they reported an aspiration for level 5 research attainment. This aspiration is in line with the ambitions of NHS England to expand the number of senior decision-makers through the development of advanced levels of practice, meaning that they can contribute to the evidence base as well as delivering safe, evidence-based practice and informing service design ( 21 ). Consultations Themes identified through interviews with senior Trust leaders, service-level managers and research-interested staff at all levels suggest that a range of issues may need addressing to strengthen the research culture in a community setting. These include research education and development of the workforce, research and strategic leadership, and streamlining of research processes – themes that are reflected in other studies: A recent systematic review of enablers for embedding research implementation into nursing and allied health clinical practice identified similar key themes of leadership, development of capabilities, and organisational culture ( 22 ), whilst another recent study exploring research culture in UK healthcare organisations identified a need to streamline and support research processes and infrastructure ( 10 ). Embedding research into the organisation’s workforce and organisational policies has been recommended for strengthening research culture ( 10 ), as has exploiting research as an organisational resource by aligning to national policies and priorities to compete for external research grants, infrastructure funding and support ( 10 ); Themes from our semi-structured consultations focused on more local strategic planning, such as aligning clinical and research priorities within a service or business unit as a way of facilitating research engagement and ensuring the relevance and value of research activity. This might help to move towards a more aligned perspective on research capabilities between service-level managers and senior Trust leaders. Limitations Several limitations in our study should be considered when reading our findings. Firstly, our research activity data provides a retrospective snapshot in time, but does not illustrate trends over time. We felt it was not appropriate to compare data from the 3 year period used in this study with data from the previous three years as this would have encompassed time when research activity was largely paused during the Covid-19 pandemic. Secondly, although we had a good response rate for survey completion from senior Trust leadership and service-level managers, we had less engagement from healthcare practitioners and support workers. Those who did respond were individuals with an interest in research, so their responses may not be generalisable to the rest of our workforce. It is also important to repeat that we adapted the validated research capacity and self-rating scales to make them appropriate for use in our study: Rather than using the entire RCC tool, we selected the most appropriate section for senior Trust leaders and for service-level managers to complete. Furthermore, we did not invite research-interested staff to complete the individual level section of this tool as we wanted to keep our questionnaire as brief as possible to encourage participation. Instead, we used the SCORR self-rating scale for individuals. This is a tool that has not been widely adopted. Of the two published studies we identified ( 14 , 20 ), the SCORR ratings data were not presented in a way that allowed direct comparison with our own data. Furthermore, by omitting the level 0 category when used in our survey, we likely influenced the self-rating choices. When re-evaluating research culture in our organisation in future, these factors will need to be carefully considered. Lastly, our interviews with different staff groups were carried out by different members of the study team, which may have influenced participants’ reflections and sharing. Furthermore, whilst we had agreed interview topics as an aid, our interview discussions were not standardised and were conducted as informally as possible. Whilst this meant that not all topics were covered in every interview, we felt that this approach encouraged more candid and thoughtful conversations. Despite these limitations, we feel that the triangulation of data has allowed us to build an insightful picture of community research activity, culture and aspirations across our organisation. This will inform our future research strategic planning and also provides a baseline against which we can measure the strategy’s impact. This work may also be of interest to other Trusts who wish to increase their community research activity. Implications and Conclusions Undertaking a mapping process can inform strategic planning and provide a baseline against which to evaluate the impact of strategic interventions. Including a variety of methods during the mapping process offers an opportunity for a richer understanding of the current research culture to help elucidate variation in research capacity and engagement, and different perspectives of research culture within the organisation. Embedding research to drive high quality care in community settings is challenging but lessons can be learned from more research-active services. Establishing research leadership within services and developing research leadership within the Advanced Practice workforce may be important strategies for growing a stronger community research culture. Abbreviations NHS - National Health Service; UK - United Kingdom; SCORR -Clinicians’ Skills, Capability and Organisational Research Readiness tool; RCC -Research Capacity and Culture tool; IQR- Inter Quartile Range Declarations Ethics approval and consent to participate : Our study was undertaken in accordance with the principles of the Helsinki Declaration. Formal ethical approval and consent to participate were not required as this was a service evaluation project https://www.hra-decisiontools.org.uk/research/. No personal data unrelated to professional role was collected and participation in interviews was voluntary through invitation. Consent for publication : Not applicable Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: None of the authors has any conflict of interest to declare. Funding: There were no funding sources for this work Submission Declaration: This work has been submitted for poster presentation at Physiotherapy Research Society / Community for AHP Research conference Author Contributions: Conceptualisation (CC, JHR); Data collection (CC, JHR, BF, SY, VC); Data analysis (CC, VC); Drafting manuscript (CC, BF, VC); Reviewing and editing manuscript (JHR, CC, VC, BF, SY) Acknowledgements: We would like to thank the library staff for their help in searching and compiling lists of publications, research team members who supported database reviews of research study activity, and all staff who took part in consultations. References Department of Health and Social Care D. Saving and improving lives: the future of UK clinical research delivery. https://www.gov.uk/government/publications/the-future-of-uk-clinical-research-delivery/saving-and-improving-lives-the-future-of-uk-clinical-research-delivery: GOV. UK; 2021. NHS England N. 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Validation of the research capacity and culture (RCC) tool: measuring RCC at individual, team and organisation levels. 2012;18(1):62-7. Comer C, Collings R, McCracken A, Payne C, Moore AJBHSR. Allied health professionals’ perceptions of research in the United Kingdom national health service: a survey of research capacity and culture. 2022;22(1):1094. Ilott IJTAJoOT. Challenges and strategic solutions for a research emergent profession. 2004;58(3):347-52. Pickstone C, Nancarrow S, Cooke J, Vernon W, Mountain G, Boyce RA, et al. Building research capacity in the allied health professions. 2008;4(1):53-68. Friesen EL, Comino EJJAjoph. Research culture and capacity in community health services: results of a structured survey of staff. 2017;23(2):123-31. Newington L, Alexander CM, Wells MJBo. Impacts of clinical academic activity: qualitative interviews with healthcare managers and research-active nurses, midwives, allied health professionals and pharmacists. 2021;11(10):e050679. Newington L, Wells M, Begum S, Lavender AJ, Markham S, Tracy O, et al. Development of a framework and research impact capture tool for nursing, midwifery, allied health professions, healthcare science, pharmacy and psychology (NMAHPPs). 2023;23(1):433. Dickens GL, Avantaggiato-Quinn M, Long S-J, Schoultz M, Clibbens NJSON. Mental Health Nurses’ and Allied Health Professionals’ Individual Research Capacity and Organizational Research Culture: A Comparative Study. 2024;10:23779608241250207. H NE. Multi-professional Practice-based Research Capabilities Framework. In: England HE, editor. London2024. Smith S, Johnson GJPO. A systematic review of the barriers, enablers and strategies to embedding translational research within the public hospital system focusing on nursing and allied health professions. 2023;18(2):e0281819. Additional Declarations No competing interests reported. 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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-6727682","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":493126331,"identity":"a22186bc-b9ad-4d13-aa38-58ad1ea82682","order_by":0,"name":"Christine Comer","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAqElEQVRIiWNgGAWjYBADOQYJUrUYQ7UYEK8lsYFoLfwNzA8f3ai4l75duv0Bc0HFH8JaJA6wGRvnnCnO3TnnjAHzjDNE2GLAwMMmnduWkLvhRg4DM28b0Vr+JaQb3Eh/wMz7j2gtDQkJBjcSDJh5G4jQInEY5JdjCYZAhxkc5jlmTFgLf3vzw8c5NQnyQIc9fMxTI0dYCwMzEvsAEepHwSgYBaNgFBADAHjRMVQbDoGpAAAAAElFTkSuQmCC","orcid":"","institution":"Leeds Community Healthcare NHS Trust","correspondingAuthor":true,"prefix":"","firstName":"Christine","middleName":"","lastName":"Comer","suffix":""},{"id":493126332,"identity":"2fcf78db-63a0-4647-bf6e-f6595c1b67a1","order_by":1,"name":"Jill Halstead","email":"","orcid":"","institution":"Leeds Community Healthcare NHS Trust","correspondingAuthor":false,"prefix":"","firstName":"Jill","middleName":"","lastName":"Halstead","suffix":""},{"id":493126333,"identity":"f6ed7515-5224-4805-9bb9-b167a3cc7532","order_by":2,"name":"Victoria 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2","display":"","copyAsset":false,"role":"figure","size":117561,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eResearch outputs\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6727682/v1/070c5f48aba3ce53a6beba76.png"},{"id":87987889,"identity":"47f9574c-4f84-48fb-abbd-d2e46a53db68","added_by":"auto","created_at":"2025-07-31 07:52:19","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":208451,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCurrent SCORR tool ratings and aspired-to ratings in 5 years’ time\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6727682/v1/cac3608c0839161baf5a1c70.png"},{"id":87990351,"identity":"39bf6e31-d475-40ce-b955-d7aee861c62a","added_by":"auto","created_at":"2025-07-31 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07:52:19","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":20679,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile6.docx","url":"https://assets-eu.researchsquare.com/files/rs-6727682/v1/275fd81c51d532b64312013f.docx"},{"id":87987892,"identity":"257a2a1e-dcbd-45f7-b2dd-b369e2d8af9b","added_by":"auto","created_at":"2025-07-31 07:52:19","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":17468,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile7.docx","url":"https://assets-eu.researchsquare.com/files/rs-6727682/v1/1f9483c0b50e3e1d32e2cb86.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Understanding current research activity, research culture perceptions and research aspirations in an NHS community healthcare organisation: A mixed methods evaluation","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eEmbedding research activity into the NHS across all health and care settings is a key government target (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). As the foundation of advancement in patient care (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), clinical research brings a multitude of benefits including improved quality of care (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), lower mortality rates (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), more engaged staff (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), and better informed patients who have more confidence in the staff treating them (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo address current and anticipated healthcare challenges (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), there is growing focus on healthcare delivery in community and out-of-hospital settings (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, there is an unmet need for research evidence to underpin the delivery of high-quality, efficient care in these settings. Despite 90% of all NHS clinical contacts now occurring in out-of-hospital settings (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), three-quarters of research recruitment activity is still hospital-based (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This imbalance in research activity (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) continues to be perpetuated by the current research funding structure which rewards the most research active organisations with more funding opportunities. Furthermore, whilst research should ideally be undertaken by those involved in delivering the care, community services are overstretched and are often led by nurses and Allied Health Professionals who may still be developing the necessary experience, capability and confidence to undertake research.\u003c/p\u003e\u003cp\u003eUnderstanding the current research landscape in community healthcare services will help to develop effective strategies to achieve the much-needed changes in research culture (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The aim of this study was to gain insight into research capacity and culture in the community healthcare context by capturing a snapshot in time of current research activity, outputs, perceptions of research engagement, culture and aspirations at a large community healthcare NHS Trust.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe undertook our research mapping exercise in a city-wide NHS community healthcare Trust in the North of England that employs over 3,000 staff and receives more than 250,000 referrals each year. The Trust\u0026rsquo;s staff deliver care to over 5,000 people per day. This equates to over 2.5 million patient contacts per year, through a range of around 60 services (with slight variation across the 3 year data capture period) largely led by nursing and allied health clinicians. \u0026nbsp;This NHS Trust\u0026rsquo;s broad clinical portfolio is organised under three business units responsible for adult services, children\u0026rsquo;s services and specialist services. The Trust has a strategic vision to develop a research culture that benefits the community it serves and has been ranked 9\u003csup\u003eth\u003c/sup\u003e for research activity (number of studies delivered) among the 18 NHS community Trusts across the UK according to data from the regional research delivery network.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch delivery and research outputs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo quantify research delivery activity, we counted the number of studies over a 3-year period (2021-2023) across the three business units\u003c/p\u003e\n\u003cp\u003eTo quantify research outputs, we undertook a systematic literature search to identify publications (including conference abstracts) authored by Trust staff over the same 3-year period. \u0026nbsp;The search strategy and process were guided by the Trust librarian and included all publications from years 2021, 2022 and 2023 that included an author affiliated with the Trust. We also mapped the formal clinical academic roles across the Trust.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurveys\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnline surveys were used to capture perceptions of current research capacity, capability and culture and research aspirations. The surveys were distributed electronically via internal email and via links in communication bulletins over a 6-month period from August 2023. We created three different surveys\u0026nbsp;using Microsoft Forms, aimed at capturing data from three groups of staff within the organisation: 1) registered and non-registered healthcare and support staff; 2) service-level managers; and 3) senior Trust leaders. Reminder emails were sent to targeted individuals within the second two participant groups with the aim of capturing data from as many service-level managers and senior Trust leaders as possible. In addition, the survey was promoted several times through bulletins and screensavers to encourage registered and non-registered healthcare and support staff to participate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe surveys incorporated questions from two validated rating scales to capture i) research readiness and aspirations from healthcare staff and from senior Trust leaders using the Clinicians\u0026rsquo; \u0026lsquo;Skills, Capability and Organisational Research Readiness\u0026rsquo; (SCORR) tool (12) and ii) perceptions of research capacity from senior Trust leaders and service-level managers using the \u0026lsquo;Research Capacity and Culture\u0026rsquo; (RCC) tool (13).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe SCORR tool is designed for non-medical healthcare professionals to self-assess their level of attainment in clinical research skills. It is a single item questionnaire that uses a 6-point scale, ranging from level 0 (requires support to gain knowledge from evidence on practice/research and apply it to practice)\u0026nbsp;to level 5 (leads the generation of knowledge through research activity, leads and develops clinical research, obtains research funding etc)\u0026nbsp;and with an additional \u0026lsquo;not applicable\u0026rsquo; category. \u0026nbsp;For the purposes of our survey, we excluded level 0 as there is an expectation for all our professional staff to use evidence-based practice. \u0026nbsp;We asked healthcare and support staff to rate their current attainment level and also where they would like their research skills attainment to be in 5 years\u0026rsquo; time. We asked senior Trust leadership participants to use these same rating questions to estimate levels of current attainment for different staff groups in the organisation and to rate their aspirations for these staff groups in the next 5 years.\u003c/p\u003e\n\u003cp\u003eThe RCC tool is designed to evaluate research capacity and capability at organisation, team and individual levels across a range of domains. This tool is a detailed questionnaire with multiple rating questions about perceptions of research capacity and success at organisation, team and individual level. Each question is rated on a 10-point scale from least successful to most successful. This validated tool has previously been used in a range of settings, including a national survey of Allied Health Professionals working in NHS and social care settings (14). \u0026nbsp; We asked senior Trust leaders and service-level managers to complete the organisation- level questions and the team-level questions respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditional questions were included in each of the three surveys to capture non-personally-identifiable information about participants\u0026rsquo; roles within the organisation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSemi-structured consultations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo explore survey responses in more depth and to encourage ongoing conversations around growing a stronger research culture, we invited senior Trust leaders (via email) from the 3 business units and from the corporate teams, service-level managers (both operational and clinical) and research-interested clinical staff who completed the surveys to take part in online semi-structured consultations. Topic prompts developed by the research team for these consultations aimed to focus the discussions around\u0026nbsp;current research activities/ opportunities and impacts, and to initiate discussions around developing a research engagement strategy (Additional file 1). The discussion topics were intended to be used iteratively within the semi-structured consultations, and included exploring survey responses when relevant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsultations with senior Trust leaders were completed by the Trust\u0026rsquo;s Clinical Research Lead and Clinical Research Fellow. \u0026nbsp;Consultations with the service-level managers and clinical staff were completed by clinical research advisors seconded to the research department. All consultations were completed between September 2023 and February 2024, either face-to-face or via video-conference (Microsoft Teams). These were conducted either on a one-to-one interview basis or in small groups, depending on availability and convenience (for example in some cases, we incorporated our discussion within scheduled meetings). Consultations lasted up to 60 minutes. Notes were made throughout by the study team member leading each consultation, and consultations conducted via video-conference were recorded as an aide-memoir.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch delivery and research output data were analysed descriptively (publication and research study counts), and analysed using frequency data according to business unit and individual service.\u003c/p\u003e\n\u003cp\u003eFor analysis of survey data, quantitative data were analysed using Microsoft Excel. Likert-scale items were summarised in accordance with convention for ordinal data using the median and Inter Quartile Range (IQR) for each item. For the SCORR tool questions, we estimated median scores for current levels of research skill and for levels of research skill aspired to in 5 years\u0026rsquo; times for each staff group. We then compared these using difference in median scores. Inferential statistical analyses were not appropriate for this exploratory ordinal-level data. Free text items were analysed by inductive content analysis using a simple visual inspection facilitated by grouping responses within an Excel spreadsheet, and subsequent cross-checking within the study team.\u003c/p\u003e\n\u003cp\u003eInterview annotations were discussed among the study team, who extracted and agreed on key themes and deductively categorised them according to potential strategic opportunities for building research engagement.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eResearch delivery and research outputs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eForty-nine studies were delivered during the 3-year period 2021-2023 (see Figure 1), with over 1,700 study participants recruited. \u0026nbsp;Of these studies, 44 were delivered by 17 services (approximately 30% services), 28 studies (57%) were delivered by services within the specialist services business unit, and 5 studies were delivered that were not associated with a specific service. Thirty-five studies were NIHR portfolio adopted studies, and 29 involved the Trust delivering recruitment (with or without intervention delivery).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResearch outputs were identified from staff employed in 20 different services (see Figure 2). A total of 90 research outputs in the form of publications (81) and conference abstracts (9) were found from a search covering the 3-year period 2021, 2022 and 2023. \u0026nbsp;Sixty-nine of these publications (76%) were outputs from specialist services.\u003c/p\u003e\n\u003cp\u003eDuring the study period, we identified three established clinical academics, affiliated with Musculoskeletal, Podiatry and Long-Covid services; all within the specialist services business unit. In addition, the Integrated Children\u0026apos;s Additional Needs Service within the children\u0026rsquo;s business unit had a clinical academic member of staff in the service prior to the data collection period. The majority (66%) of identified publications were from staff affiliated with these services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurveys and consultations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSurveys were completed and submitted by each of the three targeted participant groups, representing a range of organisational departments, business units and staff groups. After data cleansing (removal of four duplicate survey responses, and four responses submitted outside the data collection period), 113 survey records were available and included in our analysis: 14 (48%) from senior Trust leadership out of 29 individuals targeted in this participant group; 25 (54%) from service-level managers out of 46 individuals targeted in this participant group; 74 from clinical and non-clinical healthcare and support staff (Additional File 2).\u003c/p\u003e\n\u003cp\u003eThe Research Capacity and Capability tool questions were completed by 39 participants from senior Trust leadership (n = 14) and service-level managers (n = 25). Perception of research capability/capacity on a scale of 1-10 was rated higher overall by senior Trust leaders (median 6.3, IQR 1.5) than by service-level managers (median 4.3, IQR 2.5). \u0026nbsp;Senior Trust leaders rated 14 of the survey items higher, and none of the items lower, than service-level managers. Table 1 summarises responses for RCC items from senior Trust leaders and service-level managers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen looking at RCC tool questions posed to both senior Trust leaders and to service-level managers, both participant groups gave their lowest ratings for the item \u0026lsquo;my service/ the Trust has software available to support research activities\u0026rsquo; (median 5.0, IQR 4.5 and 2.0, IQR 2.0 respectively) and their highest rating for the item \u0026lsquo;my service/ the Trust has team leaders/ senior managers who support research\u0026rsquo; (median 7.5, IQR 2.0 and 7.0, IQR 4.0 respectively). The greatest discrepancy in perceptions related to planning research development and applying for funding, with senior Trust leaders giving high ratings in response to the survey items \u0026lsquo;The Trust has a plan or policy for research development (median 7.5, IQR 2.3) and \u0026lsquo;The Trust accesses external funds for research (median 7.0, IQR 2.5), and service-level managers giving a low rating to the survey items \u0026lsquo;my service does planning for research development as a team\u0026rsquo; (median 2.0, IQR 2.0 and \u0026lsquo;my service has applied for external funding for research\u0026rsquo; (median 2.0, IQR 6.0).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;Research Capacity and Culture (RCC) tool survey response summary\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSenior Trust leadership participants (n \u0026nbsp;= 14)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eService-level manager participants (n = 25)\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eOrganisation level RCC tool questions (scale 1-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eMedian rating/ score (IQR)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eTeam level RCC tool questions\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMedian rating/ score (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust has adequate resources to support staff research training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 (1.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service has adequate resources to support staff research training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.0 (3.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust\u0026nbsp;has funds, equipment or admin to support research activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5 (2.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service has funds, equipment or admin to support research activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.5 (1.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust has a plan or policy for research development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.5 (2.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service does planning for research development as a team\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.0 (2.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust has senior managers that support research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.5 (2.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service has team leaders that support research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.0 (4.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust ensures staff career pathways are available in research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.0 (4.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service provides opportunities to get involved in research\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.0 (4.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust ensures organisation planning is guided by evidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.0 (2.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service does planning (clinical or operational) that is guided by evidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.0 (1.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust has consumers / patients / service users involved in research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.0 (3.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service has consumer/patient involvement in research activities/planning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.5 (3.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust accesses external funding for research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.0 (2.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service has applied for external funding for research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.0 (6.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust encourages research activities relevant to practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.0 (2.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service conducts research activities relevant to practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.0 (4.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust has software programs for analysing research data\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.0 (4.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service has software available to support research activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.0 (2.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust has mechanisms to monitor research quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.5 (4.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service has mechanisms to monitor research quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.0 (5.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust has identified experts accessible for research advice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.5 (3.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service has identified experts accessible for research advice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.5 (6.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust supports a multi-disciplinary approach to research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.0 (3.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service supports a multi-disciplinary approach to research\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.0 (5.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust has regular forums / bulletins / conferences to present research findings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.0 (2.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service disseminates research results at research forums/seminars (conferences)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.0 (4.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust engages external partners (eg universities) in research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.5 (2.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service has external partners (eg universities) engaged in research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.5 (5.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust supports applications for research scholarships / fellowships or degrees (PhD, MRes, MSc)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.5 (2.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service supports applications for research scholarships/fellowships or degrees (PhD/MRES/MSc)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.5 (6.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust supports the peer-reviewed publication of research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.0 (1.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service\u0026nbsp;supports the peer-reviewed publication of research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.0 (6.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRCC Items for Organisation level only\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRCC items for Team level only\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eThe Trust promotes clinical practice based on evidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8.0 (2.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service ensures staff involvement in developing the research plan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.0 (3.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMy service has incentives \u0026amp; support for research mentoring activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.0 (4.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMedian overall score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.3 (1.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.3 (2.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eIQR = interquartile range, RCC = Research Capacity and Culture\u0026nbsp;\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe SCORR tool was completed by 14 senior Trust leaders who estimated current research attainment level for five different staff groups and then rated aspired-to levels for these same staff groups. It was completed by 75 registered and non-registered healthcare staff (~2.5% of Trust total) who self-rated their current research level of attainment and the level they aspired-to in 5 years. Additional file 3 summarises SCORR tool responses for senior Trust leaders and for non-clinical healthcare and support staff.\u003c/p\u003e\n\u003cp\u003eOn the SCORR tool, the perceived current research level of attainment across all staff groups was rated by senior Trust Leaders at a median level of 2.0 (IQR 2.0) and was self-rated by clinical and non-clinical healthcare and support staff at a median level 2.0 (IQR1.0). Levels of research attainment aspired to in 5 years\u0026rsquo; time for all staff groups was rated at median 4.0 (IQR2.3) by senior Trust leaders, and was self-rated as 4.0 (IQR 2.0) by staff. \u0026nbsp;Self-ratings and ratings from senior Trust leaders for current levels of attainment and aspired-to levels of attainment in 5 years differed for administrative staff and for non-registered healthcare staff. For advanced practice/ consultant healthcare practitioners, responses indicated a self-rated aspiration to move from a median level 3.0 (2.0) to a median level 4.0 (IQR 1.3) in 5 years and an aspiration from senior Trust leaders for this staff group to achieve median level 5.0 (IQR 0.0) in 5 years; this represents the highest level on the scale that describes leading the generation of new knowledge for example by actively participating in developing and leading clinical research (Figure 3).\u003c/p\u003e\n\u003cp\u003eWhen analysing responses by business unit, staff from the adult services rated their level of research attainment higher than others on the SCORR tool. Service-level managers from the adult services rated their services lower, and managers from corporate services rated themselves higher than other service-level managers on the RCC tool questions. When analysing responses by professional group, allied health professionals rated their level of attainment on the SCORR tool lower than nurses, doctors and clinical scientists. A summary of analyses of RCC and SCORR scorings by staff group, profession and business unit is provided in Additional Files 4 and 5.\u003c/p\u003e\n\u003cp\u003eFree text responses (summarised in Additional File 6) highlighted variation in senior Trust leader and service-level manager awareness and perceptions of responsibility for research leadership, and of current research activity and outputs. Across both participant groups, the most commonly identified motivators for research activity were improvements in clinical care and staff development and engagement. The most commonly identified barrier to research activity was lack of time/ funding and prioritisation of clinical work. \u0026nbsp;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsultations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsultations were completed with 21 senior Trust leaders out of 29 invited (72%), 34 service-level managers out of 46 invited (74%), and 9 research-interested staff out of 76 invited to take part (12%). \u0026nbsp;Engagement varied between business units and services (see Additional File 7).\u003c/p\u003e\n\u003cp\u003eThe number of participants at group consultation ranged from 1 to 5.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFive key themes were identified from individual and group consultations relating to developing a stronger research culture, each with a number of subthemes summarised in Table 2.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Key themes and subthemes from consultation discussions\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTheme\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 469px;\"\u003e\n \u003cp\u003eSubthemes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eRESEARCH PROCESSES\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 469px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eestablish research processes that are easy to use (for example, capacity \u0026amp; capability assessment form)\u003c/li\u003e\n \u003cli\u003eensure mechanisms exist for research activity reporting\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eWORKFORCE DEVELOPMENT\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 469px;\"\u003e\n \u003cul\u003e\n \u003cli\u003etalent management,\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ecareer pathways,\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ejob plans,\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eopportunities for exposure to research (students, clinicians, managers),\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eappraisals processes\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTRAINING PLAN \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 469px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eidentify gaps in research knowledge/ understanding and training needs,\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eshare training and development opportunities,\u0026nbsp;\u003c/li\u003e\n \u003cli\u003edevelop shared learning,\u0026nbsp;\u003c/li\u003e\n \u003cli\u003efacilitate research exposure and mentoring\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eLEADERSHIP\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 469px;\"\u003e\n \u003cul\u003e\n \u003cli\u003edevelop research leadership roles (research champions/ leaders, advanced practice roles, clinical academic roles)\u003c/li\u003e\n \u003cli\u003eestablish and use expertise from academic partners and networks\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSTRATEGIC PLANNING\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 469px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eidentify research priorities, strengths, gaps at Trust/ Business Unit/ Service level.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDevelop workforce capacity (clinical and admin) for research. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePlan and map research activity.\u003c/li\u003e\n \u003cli\u003eDisseminate and implement research findings.\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAll four workstreams in this study contributed to successful fulfilment of our aim of mapping research activity and outputs between the years 2021 and 2023 and capturing a snapshot within this period of perceptions of research engagement, culture and aspirations at a large NHS Community Healthcare Trust.\u003c/p\u003e\u003cp\u003eOur findings highlighted variation in research activity in different community services across the organisation, and variation in perceptions of research culture, capability and aspirations across different staff groups.\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eResearch activity\u003c/h2\u003e\u003cp\u003eWe found little or no research activity around two thirds of the community services in this organisation, reflecting the challenges of integrating research activity into working practices within community-based care where the primary clinical disciplines (ie nursing and allied health) may lack maturity in their research development (\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Importantly, we found that services providing specialist clinical care and those with established clinical academics currently or recently embedded within the team were the most research active. These findings align with qualitative evidence that clinical academic roles impact positively on the local research culture (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), and this may be easier when linked to a clearly defined healthcare specialism. Clinical academic roles are credited with bringing benefits both to patient care and to the clinical team within research active departments, but when these positive impacts are centred around individual research-active clinicians, the benefits do not necessarily translate across the wider organisation (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eRCC- organisation and team research capacity and capability\u003c/h2\u003e\u003cp\u003eResponses to RCC-tool items in our survey highlighted a gap in perceptions between senior Trust leaders and service-level managers. Senior Trust leaders seemed more optimistic, rating all research capability items higher than or equal to service-level managers. This fits with national survey data that found allied health professionals rated research success at team level lower than both individual and organisational level success (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), potentially reflecting the tensions of competing priorities at this middle-management level. This underlines the importance of developing research confidence, experience and leadership at the team level and growing a greater understanding and recognition of how research activity can support and benefit a team.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eSCORR- research attainment level\u003c/h2\u003e\u003cp\u003eUsing the SCORR tool, the majority of staff (72%) rated their current research attainment level in the middle brackets (level 2 and 3) which relate to sharing and synthesising new knowledge \u0026ndash; a level that would generally be considered appropriate for most clinical professionals other than those who are unregistered or newly qualified. Eighteen percent rated themselves in the highest bracket (levels 4 and 5 relating to generating new knowledge with the support of others, and relating to leading the generation of new knowledge respectively). This is comparable to findings in a recently published study, where 20% of staff primarily from nursing and allied health professions in a mental health and disability Trust self-rated themselves in this higher bracket (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The mental health and disability Trust in this study reported more staff (25%) who self-rated themselves in the lowest bracket (levels 0\u0026ndash;1) compared with only 9% in our survey, which might be explained by our decision to modify the SCORR scale by omitting the 0 level.\u003c/p\u003e\u003cp\u003eImportantly, both senior Trust leaders and staff reported aspirations for improved research attainment levels over the next 5 years across all business units and professional groups. Senior Trust leaders seem more ambitious especially for the advanced practitioner workforce for whom they reported an aspiration for level 5 research attainment. This aspiration is in line with the ambitions of NHS England to expand the number of senior decision-makers through the development of advanced levels of practice, meaning that they can contribute to the evidence base as well as delivering safe, evidence-based practice and informing service design (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eConsultations\u003c/h2\u003e\u003cp\u003eThemes identified through interviews with senior Trust leaders, service-level managers and research-interested staff at all levels suggest that a range of issues may need addressing to strengthen the research culture in a community setting. These include research education and development of the workforce, research and strategic leadership, and streamlining of research processes \u0026ndash; themes that are reflected in other studies: A recent systematic review of enablers for embedding research implementation into nursing and allied health clinical practice identified similar key themes of leadership, development of capabilities, and organisational culture (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), whilst another recent study exploring research culture in UK healthcare organisations identified a need to streamline and support research processes and infrastructure (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEmbedding research into the organisation\u0026rsquo;s workforce and organisational policies has been recommended for strengthening research culture (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), as has exploiting research as an organisational resource by aligning to national policies and priorities to compete for external research grants, infrastructure funding and support (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e); Themes from our semi-structured consultations focused on more local strategic planning, such as aligning clinical and research priorities within a service or business unit as a way of facilitating research engagement and ensuring the relevance and value of research activity. This might help to move towards a more aligned perspective on research capabilities between service-level managers and senior Trust leaders.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eSeveral limitations in our study should be considered when reading our findings.\u003c/p\u003e\u003cp\u003eFirstly, our research activity data provides a retrospective snapshot in time, but does not illustrate trends over time. We felt it was not appropriate to compare data from the 3 year period used in this study with data from the previous three years as this would have encompassed time when research activity was largely paused during the Covid-19 pandemic.\u003c/p\u003e\u003cp\u003eSecondly, although we had a good response rate for survey completion from senior Trust leadership and service-level managers, we had less engagement from healthcare practitioners and support workers. Those who did respond were individuals with an interest in research, so their responses may not be generalisable to the rest of our workforce. It is also important to repeat that we adapted the validated research capacity and self-rating scales to make them appropriate for use in our study: Rather than using the entire RCC tool, we selected the most appropriate section for senior Trust leaders and for service-level managers to complete. Furthermore, we did not invite research-interested staff to complete the individual level section of this tool as we wanted to keep our questionnaire as brief as possible to encourage participation. Instead, we used the SCORR self-rating scale for individuals. This is a tool that has not been widely adopted. Of the two published studies we identified (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), the SCORR ratings data were not presented in a way that allowed direct comparison with our own data. Furthermore, by omitting the level 0 category when used in our survey, we likely influenced the self-rating choices. When re-evaluating research culture in our organisation in future, these factors will need to be carefully considered.\u003c/p\u003e\u003cp\u003eLastly, our interviews with different staff groups were carried out by different members of the study team, which may have influenced participants\u0026rsquo; reflections and sharing. Furthermore, whilst we had agreed interview topics as an aid, our interview discussions were not standardised and were conducted as informally as possible. Whilst this meant that not all topics were covered in every interview, we felt that this approach encouraged more candid and thoughtful conversations.\u003c/p\u003e\u003cp\u003eDespite these limitations, we feel that the triangulation of data has allowed us to build an insightful picture of community research activity, culture and aspirations across our organisation. This will inform our future research strategic planning and also provides a baseline against which we can measure the strategy\u0026rsquo;s impact. This work may also be of interest to other Trusts who wish to increase their community research activity.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eImplications and Conclusions\u003c/h2\u003e\u003cp\u003eUndertaking a mapping process can inform strategic planning and provide a baseline against which to evaluate the impact of strategic interventions. Including a variety of methods during the mapping process offers an opportunity for a richer understanding of the current research culture to help elucidate variation in research capacity and engagement, and different perspectives of research culture within the organisation. Embedding research to drive high quality care in community settings is challenging but lessons can be learned from more research-active services. Establishing research leadership within services and developing research leadership within the Advanced Practice workforce may be important strategies for growing a stronger community research culture.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eNHS - National Health Service; UK - United Kingdom; SCORR -Clinicians\u0026rsquo; Skills, Capability and Organisational Research Readiness tool; RCC -Research Capacity and Culture tool; IQR- Inter Quartile Range\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: Our study was undertaken in accordance with the principles of the Helsinki Declaration. Formal ethical approval and consent to participate were not required as this was a service evaluation project https://www.hra-decisiontools.org.uk/research/. \u0026nbsp;No personal data unrelated to professional role was collected and participation in interviews was voluntary through invitation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eNone of the authors has any conflict of interest to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e There were no funding sources for this work\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubmission Declaration:\u0026nbsp;\u003c/strong\u003eThis work has been submitted for poster presentation at Physiotherapy Research Society / Community for AHP Research conference\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eConceptualisation (CC, JHR); Data collection (CC, JHR, BF, SY, VC); Data analysis (CC, VC); Drafting manuscript (CC, BF, VC); Reviewing and editing manuscript (JHR, CC, VC, BF, SY)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We would like to thank the library staff for their help in searching and compiling lists of publications, research team members who supported database reviews of research study activity, and all staff who took part in consultations.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDepartment of Health and Social Care D. Saving and improving lives: the future of UK clinical research delivery. https://www.gov.uk/government/publications/the-future-of-uk-clinical-research-delivery/saving-and-improving-lives-the-future-of-uk-clinical-research-delivery: GOV. UK; 2021.\u003c/li\u003e\n\u003cli\u003eNHS England N. Maximising the Benefits of Research: Guidance for Integrated Care Systems. https://www.england.nhs.uk/long-read/maximising-the-benefits-of-research/2023.\u003c/li\u003e\n\u003cli\u003eJonker L, Fisher S, Badgett RJJohqr. Relationship between staff thriving, through engagement and research activity, and hospital-related outcome measures: A retrospective cross-sectional study. 2021;36(3):128-35.\u003c/li\u003e\n\u003cli\u003eJonker L, Fisher SJJPH. The correlation between National Health Service trusts\u0026apos; clinical trial activity and both mortality rates and care quality commission ratings: a retrospective cross-sectional study. 2018;157:1-6.\u003c/li\u003e\n\u003cli\u003eJonker L, Fisher SJ, Dagnan DJJoeicp. Patients admitted to more research‐active hospitals have more confidence in staff and are better informed about their condition and medication: results from a retrospective cross‐sectional study. 2020;26(1):203-8.\u003c/li\u003e\n\u003cli\u003eDarzi A. Independent investigation of the national health service in England: Department of Health and Social Care; 2024.\u003c/li\u003e\n\u003cli\u003eProviders N. shifting care upstream Providers Deliver. 2024.\u003c/li\u003e\n\u003cli\u003eHobbs FR, Bankhead C, Mukhtar T, Stevens S, Perera-Salazar R, Holt T, et al. Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007\u0026ndash;14. 2016;387(10035):2323-30.\u003c/li\u003e\n\u003cli\u003eNational Institue for Health and Care Reseach N. Annual statistics. https://wwwnihracuk/about-us/who-we-are/reports-and-performance/annual-statistics. 2024.\u003c/li\u003e\n\u003cli\u003ePeckham S, Zhang W, Eida T, Hashem F, Kendall SJJoho, management. Research engagement and research capacity building: a priority for healthcare organisations in the UK. 2023;37(3):343-59.\u003c/li\u003e\n\u003cli\u003eInnovation NIf, Improvement. The how-to guide for measurement for improvement: NHS Institute for Innovation and Improvement; 2010.\u003c/li\u003e\n\u003cli\u003eIles-Smith H, Burnett C, Ross DH, Siddle HJJIJoP-BLiH, Care S. The Clinicians\u0026rsquo; Skills, Capability, and Organisational Research Readiness (SCORR) Tool. 2019;7(2):57-68.\u003c/li\u003e\n\u003cli\u003eHolden L, Pager S, Golenko X, Ware RSJAjoph. Validation of the research capacity and culture (RCC) tool: measuring RCC at individual, team and organisation levels. 2012;18(1):62-7.\u003c/li\u003e\n\u003cli\u003eComer C, Collings R, McCracken A, Payne C, Moore AJBHSR. Allied health professionals\u0026rsquo; perceptions of research in the United Kingdom national health service: a survey of research capacity and culture. 2022;22(1):1094.\u003c/li\u003e\n\u003cli\u003eIlott IJTAJoOT. Challenges and strategic solutions for a research emergent profession. 2004;58(3):347-52.\u003c/li\u003e\n\u003cli\u003ePickstone C, Nancarrow S, Cooke J, Vernon W, Mountain G, Boyce RA, et al. Building research capacity in the allied health professions. 2008;4(1):53-68.\u003c/li\u003e\n\u003cli\u003eFriesen EL, Comino EJJAjoph. Research culture and capacity in community health services: results of a structured survey of staff. 2017;23(2):123-31.\u003c/li\u003e\n\u003cli\u003eNewington L, Alexander CM, Wells MJBo. Impacts of clinical academic activity: qualitative interviews with healthcare managers and research-active nurses, midwives, allied health professionals and pharmacists. 2021;11(10):e050679.\u003c/li\u003e\n\u003cli\u003eNewington L, Wells M, Begum S, Lavender AJ, Markham S, Tracy O, et al. Development of a framework and research impact capture tool for nursing, midwifery, allied health professions, healthcare science, pharmacy and psychology (NMAHPPs). 2023;23(1):433.\u003c/li\u003e\n\u003cli\u003eDickens GL, Avantaggiato-Quinn M, Long S-J, Schoultz M, Clibbens NJSON. Mental Health Nurses\u0026rsquo; and Allied Health Professionals\u0026rsquo; Individual Research Capacity and Organizational Research Culture: A Comparative Study. 2024;10:23779608241250207.\u003c/li\u003e\n\u003cli\u003eH NE. Multi-professional Practice-based Research Capabilities Framework. In: England HE, editor. London2024.\u003c/li\u003e\n\u003cli\u003eSmith S, Johnson GJPO. A systematic review of the barriers, enablers and strategies to embedding translational research within the public hospital system focusing on nursing and allied health professions. 2023;18(2):e0281819.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Research, culture, capacity, community healthcare","lastPublishedDoi":"10.21203/rs.3.rs-6727682/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6727682/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground.\u003c/strong\u003eGrowing research expectations and opportunities in community care require an understanding of community research capacity and culture. To support the shifting focus from hospital care to community care, research evidence can guide new models of care and help tackle increasing clinical demands. The healthcare professionals delivering community care - often nurses, pharmacists, allied health and mental health professionals - need the capacity to address the research priorities in their community services. The aim of this study was to understand research capacity and culture in the context of an NHS community healthcare setting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods.\u003c/strong\u003eWe planned four inter-related workstreams to evaluate research activity, outputs and perceptions of research culture and aspirations in a large UK Community Healthcare NHS Trust. We completed a database review to quantify studies delivered; a literature review identifying journal publications and conference abstracts authored by Trust staff/affiliates; online surveys and semi-structured interviews to explore research perceptions and aspirations across staff groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e. One third of services were research active, delivering research studies and/ or publishing research findings. Services with embedded clinical academics were most research active. Service-level managers’ perceptions of research capacity did not match the more optimistic perceptions of senior Trust leaders. Staff and senior Trust leaders reported an aspiration to improve the level of research attainment across all staff groups. Senior Trust leaders aspired to the highest level of research attainment (leading research to generate new knowledge) for advanced practitioners.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion. \u003c/strong\u003eWhilst there was variation in research activity across services and disparities in perceptions of research culture and capability across staff groups, there was a universal aspiration to achieve higher levels of research attainment across all staff groups in this community healthcare NHS organisation. To facilitate this, a focus on developing advanced practice research capability and establishing research leadership within services may be important.\u003c/p\u003e","manuscriptTitle":"Understanding current research activity, research culture perceptions and research aspirations in an NHS community healthcare organisation: A mixed methods evaluation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-31 07:52:14","doi":"10.21203/rs.3.rs-6727682/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-08-23T16:09:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204045592685681821121679909465029544594","date":"2025-08-13T15:09:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-29T11:42:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-02T18:57:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-07T03:19:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-27T21:29:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-05-27T21:28:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"25482ee5-a59d-4156-8bb4-27b65e6d8cad","owner":[],"postedDate":"July 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-31T07:52:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-31 07:52:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6727682","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6727682","identity":"rs-6727682","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}