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Attitudes to and perceptions of research for health science lecturers
Radiography 19 (2013) 56e61
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Attitudes to and perceptions of research for health science lecturers Catherine Williams* Diagnostic Radiography, Directorate of Medical Imaging & Radiotherapy, Room 2.13 Johnston Building, The Quad, University of Liverpool, Liverpool L69 3GB, UK
a r t i c l e i n f o
a b s t r a c t
Article history: Received 9 February 2012 Received in revised form 17 July 2012 Accepted 18 August 2012 Available online 20 September 2012
Introduction: The majority of AHP/nurse lecturers are drawn from clinical practice where the opportunity to undertake research activity is limited. Employment in higher education requires the undertaking of research/scholarly activity as part of their role, but research output from this group is below that from other healthcare academics. This study explores attitudes of AHP’s/nurses in one higher educational establishment towards research activity. Method: Ethical approval was obtained from the academic ethics committee. Six focus groups were facilitated using semi structured and open grounded theory approaches. Participants included AHP’s/ nurses who are now lecturers or teachers in HE. Informed written consent was gained and each session audio recorded and transcribed. NVivo v8 was used to code data and thematic analysis carried out using the OSOP method. Findings: All groups identified previously reported barriers to research, such as lack of time, resources and skills. There was evidence of a perceived hierarchy of research within the university culture, and for some a feeling of inadequacy and inability to reach the higher levels. Those involved in research reported a feeling of isolation which reduced their output. One emergent theme highlighted that some participants did not want to undertake research and had difficulty identifying with it as part of their university role. A minority embraced research as an integral part of their work. Discussion/conclusion: When prompted participants could identify practical solutions to some of the barriers identified such as adapting working practices to release research time. The need for appropriate mentorship for inexperienced researchers is clearly demonstrated in the data however the hierarchy of research presents a barrier to accessing this. The participants are relying upon inexperienced peers for support, leading to a restricted research knowledge pool. The relative immaturity of the professions included may also be effecting research output. Participant personality may be a barrier in itself and role identification needs further investigation in future studies. Ó 2012 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
Keywords: Attitudes Perceptions Research Healthcare Barriers Personalities
Introduction The education and training of allied health professionals (AHP’s) and nurses in the UK moved into higher educational establishments in the early 1990’s.1 Prior to this clinical staff trained students within hospital placements and research activity was not a requirement of training or employment. However with the move into higher education the need for research-led teaching and practice became desirable.2,3 Over the past seven years research output from academics has been measured and used to grade universities against each other.4 This was and still is linked to funding of higher educational establishments placing pressure upon university staff to produce world ranked research. Previous studies have found that healthcare professionals have needed time * Tel.: þ44 0151 7945953. E-mail address: [email protected].
to develop research skills and establish themselves as researchers in this environment.5e7 It has also been shown that not all AHP’s have demonstrated an equivalent level of research activity even though they have a similar background and pathway into higher education.8 The aim of this project is to explore the attitudes and perceptions of a range of AHP/nurse lecturers in one university to research, using a grounded theory approach.9[a] Method Ethical approval was gained from the University committee on research ethics. Inclusion criteria stated that participants should hold an AHP/nurse qualification and currently be teaching full or part time in HE. A total of 23 participants took part and diagnostic radiography; radiotherapy; nursing; physiotherapy; occupational therapy and orthoptic professionals were represented in six mixed groups. Focus group methodology was chosen as it provides a tried and tested
1078-8174/$ e see front matter Ó 2012 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.radi.2012.08.003
C. Williams / Radiography 19 (2013) 56e61
framework to support a grounded theory approach.10 Semi-structured discussions were used initially for the pilot groups 1 and 2 using an adapted proforma of guided questions as described by Halcomb et al.11 Halcomb reported this as a method of introducing a topic using non threatening questions which enable participants to contribute freely to the discussion. It is important however, that the grounded theory paradigm is not compromised by the design of these questions or how they are presented to ensure that generated data will be representative of true reality for the participants.12 During the pilot sessions this approach became restrictive however, and seemed to create stilted responses, therefore an open grounded theory approach was used for the remaining four groups with the word “research” offered as a discussion topic in a free and open manner. The verbal responses to the questions (groups 1 & 2) and discussions (groups 3, 4, 5 & 6) were digitally recorded. The researcher personally transcribed data sets to be able to immerse herself into the issues being discussed and to begin early analysis. NVivo v8 was used to organise emergent themes into nodal groups (codes) and each node was further analysed using the OSOP13 method allowing in depth and rigorous analysis. The researcher, an AHP teacher, planned not to contribute to the discussions to help reduce bias,14 however needed to contribute to the final group as one participant could not attend. It also has to be accepted that during analysis, evaluation and identification of themes may have been influenced by the researcher’s own experiences.15,16 To address this a “participant checking” exercise was conducted as described by Charmaz (2007).9[b] This took the form of two presentations to the group members of the completed analysis together with a Q&A session.
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designed to support teaching/administration activities only. One directorate (out of five) had recognised this and made a conscious effort to release staff from the timetable to be able to carry out research, but this had placed an additional teaching burden on the remaining staff. There was recognition that the commitment to teaching was necessary to maintain the programmes currently being delivered and therefore employment for staff. During discussion about the perceived conflict between teaching and research it became apparent that although lack of time is a large barrier to research, there were other underlying factors requiring further exploration. Knowledge: Some of the participants felt they did not have the research tools to be able to even begin research activity. This was linked to a lack of time to learn new skills to change this: “with me it would be the believing that you’ve got a lack of knowledge . you don’t have.you don’t know..the methods to use.the structure of the whole thing..so you almost.you wouldn’t know where to start really..” “you have your pile of papers there but you don’t exactly know how to go about maybe analysing it..” “I maybe could do with a bit more support...just feel like you’re being a bit silly...[hushed voice] a bit thick [quiet laugh]...” Motivation: The combination of not having the time or skills to carry out research has resulted in a lack of motivation for some participants and they questioned the reward system for research activity: “It [informal research meetings] might motivate us a bit more.’cause I think we lack..we do lack motivation”
Findings General barriers Participants identified several barriers to research activity that were evaluated under five sub-nodes (Fig. 1). Evidence to support each sub-node is presented: Time: All the participants are involved in teaching, and this activity combined with supporting administrative duties were highlighted as one of the main barriers with regard to time:“We’ve been talking about teaching being a sort of constraint.a barrier to research but we all have administrative roles to do as well.and to be honest If I could just teach then I’d have time to research.if I didn’t have any administration...”
“There’s also no rewards.....why..why do we need to do it?[research].we’re not rewarded for it are we?.we’ve not got any recognition..so why bother?.........” Again a minority of participants were very self motivated and wanted to be involved in research activity for personal reward and satisfaction. Research culture: Participants discussed how the research culture in the school was not always a positive environment therefore creating a barrier: “I think that here it’s the [research] culture that’s one of the bigger ones [barriers] .”.
“well what happens if we all said “no.we’ve got to do research”.and teaching was like the hobby.and if I’ve got time I’ll do some teaching?”
“that we can say that the university agenda is to do research but you feel locally it’s kind of [speaking as someone else]... “well..I don’t mind if people do research but actually, yer know, the teachings got to come first.””
‘there’s no alteration to my teaching hours or.or anything like that so.it’s.gets a bit like.it’s (research) just something I fit in around everything else that I have to do and.it seems to be.you have to make it work yourself cause nobody else is going to make it work for you”
“...in some departments it’s..your line manager not recognising the value of research....and in some ways we need to work together...and look at this overall and see what is reasonable and what is achievable....”
All groups identified that research and teaching are mutually exclusive with regard to time, and within the school the timetable is Time
Knowledge General Barriers
OSOP 1 Research Culture
The researcher encouraged further discussion around the emergent theme of “research culture” within the university as this had evolved from the “general barrier” theme as a possible important issue. This resulted in an additional OSOP with its own sub-nodes (Fig. 2). “Mentorship” re-emerged in OSOP 2 as a strong theme under the “mentorship/isolation” sub-node and was therefore combined within it and is presented later.
Motivation Mentorship
Figure 1. OSOP 1 showing “General Barriers” main theme with five sub-nodes: Time; Knowledge; Motivation; Mentorship; Reserach Culture.
Research culture Five sub-nodes evolved within this theme and are presented with evidence.
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Confidence Research
OSOP 2 Research Hierarchy
Culture
Quality of Life VS Research Mentorship /isolation
Mysticism
Figure 2. OSOP 2 showing “Research Culture” main theme with five sub-nodes: Confidence; Quality of life vs Research; Mentorship/isolation; Mysticism; Research Hierarchy.
Research hierarchy: Participants in each focus group became very direct in suggesting that a research hierarchy exists as part of research culture, and that this in fact was a much more emotive barrier to them than “time”. There was a feeling that established researchers high in the system were inaccessible to them and therefore the research mentoring they required was not always available. Within the hierarchy, participants placed medical doctors at a higher level than themselves in research terms linking this elevation to a perceived increased intelligence. It was also interesting to note that each professional group placed themselves below each other in the research hierarchy. There was also a perception that much more research support was given to people with perceived increased intelligence e PhD students for example. “cause it was the medics who tended to do a lot of the research and I think we’ve always sort of sat under them” “I think they [Nurses] have.they’ve got weight in the NHS and they have.maybe had an opportunity [to do research]because they have such a breadth of areas that they can be involved in that they’ve probably been able to push themselves more to the top.unlike us[radiographers].” “they’re [established researchers] always too busy and you feel that you’re putting them out and that you...you’re not their focus ‘cause you...well you just feel like you’re not a PhD student” “That’s right..and if they call you research radiographer it’s a misnomer isn’t it really?.” The discussions in all groups centred for most of the allotted time (2 h) around the hierarchy issue and how this is perceived as a major barrier to most of them. In one group participants had a slightly different view as their experience of the hierarchy was positive in that they had received excellent support from established researchers. However, it did transpire that these researchers were employed at either other HR establishments or industry and had been accessed via previous employment. All participants placed themselves at the bottom of the research pyramid and this seems to link to the next sub-node e confidence. Confidence: Lack of research activity seems to be directly linked to the individual confidence of each participant in the groups, with the majority of them having very little or no self esteem in this area: “I think we compare ourselves..or I compare ourselves to some of the other university departments that do a lot of research and are very good at it.[murmured consent]..and I almost feel we’re not...we’re not on the same playing field really.[murmured consent]” Some participants who had carried out research projects were reluctant to report their findings either internally or at conferences, displaying a complete lack of confidence in their own research ability: “.you know I’m almost embarrassed to go to a big conference that’s full of doctors and present something and someone says-“ I can’t believe you’ve done something so stupid” or “you’ve got a major hole that you’ve not seen”.”
“no..erm.because I know sometimes because it’s educational research and isn’t income generating etc, etc, its not that important really.and I’ve not published on it.” This lack of personal confidence seems to be reinforced by a lack of confidence in the system to support them, generating a negative loop. This leads to isolation of the individual and a feeling of being completely alone in attempting to start research activities and an inability to approach an experienced researcher for help if needed. Some participants were unable to identify a “researcher” in the school in the first instance. Mentorship/isolation: Some participants had attempted to become research active mainly through a requirement of further study such as a master’s programme or PhD and they discussed the fact that they were expected to “just get on” with the research element of their studies with no or minimal support: “and I didn’t have a research mentor when I started here four years ago, so I sort of did it on my own really[voice drops]” “so I’ve just plodded on, on my own..and done bits..[laughs] probably bungled it!” “I find it very hard at the moment when you’re here and you’re quite isolated and there might not be anyone within your working area that has the same research interest so you feel you have to decide and study....... and do it more or less on your own”. This continued isolation led some participants to consider discontinuing their research or to carefully consider starting any new projects in the future: “the isolation leads to having to keep the whole thing going ‘cause you get to a point where you think..I don’t know if I still want to do this” “Yeh..and if you’ve got a question its hard to find out who would know the answer to that or who would be the best person to know ...to help you in that situation.....I think there’s a lot of knowledge and ability within the university but its knowing who to go to...” It was clearly identified that having a research mentor would alleviate the problem of isolation and allow development of the necessary skills to start or continue research activity. Some participants also expressed a need for peer support to prevent isolation and perhaps generate new research ideas in a familiar protected environment: “I’ve just realised if you have people helping yer that also makes your potential to do research a lot easier”. “I think that’s..I see that as almost an attitude thing..and almost..it’s like a protection thing..really, we should sit everyone around a table and say “we want to get everyone involved in research over the next three years.”” “I think I’m looking at a more lower level really [for mentorship & support]...you know...just somebody that’s published before in the department..for ethics really..how do I get an application?....how do I do this?” Mysticism: Although the previous themes seem to be the main areas for group discussion there did emerge two others that are worth including here. The first is the idea that research activity somehow has a “mystical” aura that makes it inaccessible and is therefore a barrier. The participants used “Harry Potter-esque” visual imagery to express this, linking into the hierarchy theme and a perception that established researchers withhold information from inexperienced researchers to create mysticism:
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“I have a visual picture of somebody (a researcher) being surrounded by high towers of books, and papers, and journals...” “Its [research activity] almost...like divorced from us all really...sort of like sitting around in an ivory tower...” “There’s also an element of cloak and dagger, isn’t there?.some people don’t....they keep it [their research topics]quite close to the chest and...don’t tell you the whole story.then the suspicion arises.and so on and so on and so on..”. This perception was reinforced by one participant who is research active: “I’m playing a different game altogether really it’s...cloak and dagger........nobody will reveal their act!..(laughter).....but I play the game too so...’cause I could have managed to do a whole research project without anybody else knowing!......”
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Research personality: It was found that there was polarisation amongst the participants in that some could identify themselves as a researcher but others could not: “I don’t have that drive to do research...or the challenge..I would be quite happy doing things I can do standing on me head..” “ .God..I can’t think of anything worse!..I can’t.....why on earth would I want to be that?(a professor in research)...because my image of what that is..is not who I am” “I never want to become that!(a researcher) that...yes..that’s almost when research makes you become something I don’t ever want to be!...”. “I think some of the people who get to professorial level (researcher)....are very ambitious...very pushy....and I think...... I’d rather be a nice person....”
The researcher felt it was important to allow the groups to explore solutions to the identified barriers and gave them an opportunity to offer suggestions. It was interesting that some groups found this difficult demonstrated by the long pauses between comments and the lack of solutions offered. It was obvious that most had only focussed upon the barriers and had not considered any possible solutions. The discussions moved very quickly away from solutions into another interesting emergent theme of “quality of life vs research”.
Conversely, those that longed to take on a research role would do everything they could to achieve it:
Quality of life vs research: Some participants became defensive when asked to suggest ways of removing barriers to research activity and openly challenged the need for and the value of research in their roles as academics. There was a suggestion that research and quality of life are also mutually exclusive:
Discussion
(R)“Have you got a wish list?” “[Laughs]......probably.NOT to do it [research]...” “but I don’t want to work twenty four seven just to comply to here, because at the end of the day, I am sorry, it’s just a job.[murmured assent]..and I’ve got a life.[murmured assent]” “some people..I know it is their lives and like they’ve got six or seven different projects on the go.or they’re thinking about the next one..I can’t work like that!.” Those participants who had become research active acknowledged that they had had to make sacrifices to achieve this and that their personal life had been affected: “you have to have a good work home life balance...and...if you prefer to throw that away...and work ‘till midnight every night then you can do research...do it properly and have your bids...and have all that kind of thing..but you certainly can’t have your quality of life...it’s unrealistic to have the two...” Within this discussion emerged the idea that participants would have to change in some way to be able to effectively carry out research. “I’m not research active..even though I read [laughs nervously]..I don’t fit in..research active..it just informs me......”. “but it depends whether there is the....the desire for people to want to change [to become research active] , but I...I get a sense ...and I have actually said this in our department...I just get a sense that really they don’t really want to” This prompted the researcher to revisit the transcribed data to look for evidence to indicate that personality may be affecting engagement with research activity.
“Yeah...well I just basically begged for something...some research that I can do ...or I just felt useless” “very clearly having a research job is what I want...but then deliver the teaching around research rather than getting caught up in the admin”
The evaluation of data confirmed some common barriers to research which are reported in other projects,17e19 such as lack of time and resources. In addition mentorship evolved as a very strong theme particularly for new members of staff who acknowledged the need for support in starting research projects. Those participants who had shown enthusiasm for research were becoming disillusioned by the apparent lack of identified mentorship for their particular area of interest. It is good practice for new researchers to have a mentor to guide them through the process20 but this only seems to happen if that research is part of a postgraduate programme of study and even then some of the participants were critical of the level offered. The type of mentorship and who is offering it is also important. It would be logical to assume that the best mentor would be an experienced researcher with a strong history of publication, however due to mysticism within the hierarchy of research, participants perceived that the people near the top i.e. established researchers, were inaccessible to them and in fact would not value their research ideas. This makes participants feel reluctant to approach them and leads to the solution of using peer support instead. This indicates that the participants are more comfortable communicating with people they consider lower down the hierarchy. As the majority of their peers at this level are also inexperienced researchers this creates a restricted pool of research knowledge and skills to draw from and creates a negative feedback system for research activity (Fig. 3). All of this exists within a time restricted environment and a need to deliver quality teaching programmes. Some of the groups recognised that there would be penalties imposed if the teaching/administration element was not delivered but that the same could not be said of research, leading to reluctance to sacrifice teaching time. The combination of no penalties, lack of recognition for current research/ scholarly activity and the negative feedback scenario described is a recipe for reduced research output for these participants. It could be argued that all of the issues discussed so far are really a symptom of immaturity on behalf of the professions included in the study, and that the transition into higher education is still ongoing. It was interesting that all the groups focussed immediately
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personality traits required for research are different than those for clinical practice and teaching which are similar.27,28 Although evidence based practice is essential it is also important to state that those who wish to teach only must have their contribution recognised and valued, as teaching and learning forms the backbone of all higher educational establishments and has more recently been highlighted as a future measure of grading universities.29 Conclusion
Figure 3. Negative feedback system for research activity.
upon barriers to research in their discussion almost as a defense mechanism and a way of justifying their lack of or diminished engagement in research activities. Perhaps it is not so surprising therefore that research output from these groups cannot compete at the moment with other subject areas and will not be able to do so until they become more established within the research hierarchy. It is essential therefore that those few who have already reached the research pinnacle actively encourage and support colleagues to do the same, in other words to occasionally reach down from their ivory tower to extend a helping hand. The perception of some group members seems to be that those already at the top of the hierarchy have lost their professional identity and have taken on the persona of “Researcher” or “Professor” which is not always described in a complimentary way. This could also be an attempt to create a barrier between themselves and the “researcher” persona because they do not identify with it, which again may be linked to an immature perception of what it actually is, and a fear of losing self identity. This idea of changing roles to accommodate research activity has been reported in other studies.21 Another issue to consider is the reason why some participants did not identify with research activity and others did. This may be due to their personalities and how they relate to research compared to clinical teaching. Psychology studies have developed a group of personality traits known as the “Big Five”22,23 which are used in psychometric assessment of potential candidates for jobs.24 In the UK, this assessment has been used to match newly qualified doctors to surgical posts as it has been recognised that a certain “type” of clinician is required for the surgical environment.25,26 It would be logical therefore to suggest that some nurses and AHP’s have a stronger personality trait for research than others. The evidence presented here under “research personality” supports this idea and it can be seen in the quotes provided that the personal feelings of the participants are very strongly linked to their desire to either be or not be a researcher. Such emotive responses can be understood if it is accepted that certain personalities are more suited to research activity than others. It must also be recognised that the majority of lecturers and teachers in health chose to be clinical practitioners first because presumably that role suited them at the time. In fact evidence suggests that the
This study has confirmed some practical barriers to research that can be resolved with adequate and appropriate mentorship alongside time release measures. It is clear that a more structured and overt mentor scheme and pathway would improve the research experience for all participants, however established research staff would also require support to be able to provide quality mentorship. The professions represented in this study can also aim to improve engagement with research by increasing its exposure during undergraduate and postgraduate programmes of study and by encouraging students to continue engagement when qualified. There is also a need to raise the profile and importance of small starter projects in universities and the clinical environment to allow novice researchers to build their confidence and gain experience. Greater collaboration between HEI’s and clinical researchers may help to develop such projects. As the research requirement in higher education is established and will continue it is important that those who wish to develop a research career alongside their teaching can do so. A clear research strategy for lecturers in health will facilitate this need and help professions to move forward from an immature stance to a position of confidence within the research world. It is recognised that this study is limited by the small number of participants and would benefit from expansion into other non health related university departments for comparison, and if possible into other HE establishments. This approach would be invaluable to test the idea of “research personality” against engagement with research activity and may provide evidence to support more effective management of health lecturers and teachers in the future. Conflict of interest statement The author confirms that there no financial or personal relationships with other people or organisations that could inappropriately influence (bias) this work. References 1. Sluming V. The changing world of radiography education. British Journal of Radiology 1996;69:489e90. 2. DOH. Proposed human resources plan for educators and researchers in health and social care department of health. London: DOH; 2003. 3. DOH. Best research for best health e a new national health research strategy. Department of Health. London: DOH; 2006. Pub. COI ref 272605. 4. Gross I. An impact assessment of the funding bodies proposals for research assessment, HEFCE. Assurance Service [accessed 09.04.10], http://www.rae.ac. uk/pubs/other/impact/; 2004. 5. Howarth M, Kneafsey R, Haigh C. Centralization and research governance: does it work? Journal of Advanced Nursing 2008;61(4):363e72. http://dx.doi.org/ 10.1111/j.1365-2648.2007.04524. 6. Bonner A, Sando J. Examining the knowledge, attitude and use of research by nurses. Journal of Nursing Management 2008;16(3):334e43. 7. Girot AG. The challenges facing healthcare lecturers and professors to lead and promote a research-based culture for practice. Journal of Research in Nursing 2010. http://dx.doi.org/10.1177/1744987110364572. 8. Scutt D. The research assessment exercise (RAE) 2001 revisited e the University of Liverpool UoA11 experience. Radiography 2004;10:127e30. 9. Charmaz K. Constructing grounded theory. 3rd ed. London: Sage; 2007 [a] CH 1 pg1e12; [b] CH 5 pg111. ISBN 978-0-7619-2.
C. Williams / Radiography 19 (2013) 56e61 10. Webb B. Using focus groups as a research method: a personal experience. Journal of Nursing Management 2002;10:27e35. 11. Halcomb EJ, Gholizadeh L, DiGiacomo M, Phillips J, Davidson PM. Literature review: considerations in undertaking focus group research with culturally and linguistically diverse groups. Journal of Clinical Nursing 2006. http://dx.doi.org/ 10.1111/j.1365-2702.2006.01760.x. 12. Charmaz K. Grounded theory; objectivist and constructivist methods. Chapter 8 pg 250. In: Denzin Norman K, Lincoln Yvonna S, editors. Strategies of qualitative enquiry. 2nd ed. SAGE Pub; 2003. 13. Ziebland S, McPherson A. Making sense of qualitative data analysis: an introduction with illustrations from DIPEx (personal experiences of health and illness). Medical Education 2006;40:405e14. 14. Glacken M, Chaney D. Perceived barriers and facilitators to implementing research findings in the Irish practice setting. Journal of Clinical Nursing 2004;13:731e40. 15. Parahoo K. Barriers to, and facilitators of, research utilization among nurses in Northern Ireland. Journal of Advanced Nursing 2000;31(1):89e98. 16. Carlson CL, Plonczynski DJ. Has the BARRIERS Scale changed nursing practice? An integrative review. Journal of Advanced Nursing 2008 Aug;63(4): 322e33. 17. Steiner JF, Curtis P, Lanphear BP, et al. Assessing the role of influential mentors in the research development of primary care fellows. Academic Medicine 2004;79(9):865e72. 18. Corbin J, Strauss A. Basics of qualitative research. 3rd ed. London: Sage, ISBN 978-1-4129-0643-2; 2008. p. 80e81.
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19. Braun v, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006;3:77e101. 20. Dickson-Swift V, James EL, Kippen S, Liamputtong P. Blurring the boundaries in qualitative health research on sensitive topics. Qualitative Research 2006;16(6): 853e71. 21. Segrott J, McIvor M, Green B. Challenges and strategies in developing nursing research capacity: a review of the literature. International Journal of Nursing Studies 2006;43(5):637e51. http://dx.doi.org/10.1016/j.ijnurstu.2005.07.011. 22. Goldberg LR. The development of markers for the Big Five factor structure. Psychology Assessment 1992;61(3):204e17. 23. McAdams DP, Pals JL. A new Big Five: fundamental principles for an integrative science of personality. American Psychologist 2006;61(3):204e17. 24. Ehrhart KH, Makransky G. Testing vocational interests and personality as predictors of personevocation and personejob fit. Journal of Career Assessment 2007;15(2):206e26. 25. Houghton A. Using the MyerseBriggs type indicator for career development. British Journal of Radiology 2000;320:S2-7248. 26. Thomas J. The surgical personality: fact or fiction? American Journal of Surgery 1997;174:573e7. 27. Mathers SA, Chesson R. Research governance: current issues for radiographers. The Hong Kong Radiographers Journal 2005;9(1):28e32. 28. Medical Research Council. Good research practice: policy guidance for researchers. London, http://www.mrc.ac.uk; 2000. 29. Higher education: students at the heart of the system. London: Department for Business Innovation and Skills; 2011.
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Attitudes to and perceptions of research for health science lecturers Catherine Williams* Diagnostic Radiography, Directorate of Medical Imaging & Radiotherapy, Room 2.13 Johnston Building, The Quad, University of Liverpool, Liverpool L69 3GB, UK
a r t i c l e i n f o
a b s t r a c t
Article history: Received 9 February 2012 Received in revised form 17 July 2012 Accepted 18 August 2012 Available online 20 September 2012
Introduction: The majority of AHP/nurse lecturers are drawn from clinical practice where the opportunity to undertake research activity is limited. Employment in higher education requires the undertaking of research/scholarly activity as part of their role, but research output from this group is below that from other healthcare academics. This study explores attitudes of AHP’s/nurses in one higher educational establishment towards research activity. Method: Ethical approval was obtained from the academic ethics committee. Six focus groups were facilitated using semi structured and open grounded theory approaches. Participants included AHP’s/ nurses who are now lecturers or teachers in HE. Informed written consent was gained and each session audio recorded and transcribed. NVivo v8 was used to code data and thematic analysis carried out using the OSOP method. Findings: All groups identified previously reported barriers to research, such as lack of time, resources and skills. There was evidence of a perceived hierarchy of research within the university culture, and for some a feeling of inadequacy and inability to reach the higher levels. Those involved in research reported a feeling of isolation which reduced their output. One emergent theme highlighted that some participants did not want to undertake research and had difficulty identifying with it as part of their university role. A minority embraced research as an integral part of their work. Discussion/conclusion: When prompted participants could identify practical solutions to some of the barriers identified such as adapting working practices to release research time. The need for appropriate mentorship for inexperienced researchers is clearly demonstrated in the data however the hierarchy of research presents a barrier to accessing this. The participants are relying upon inexperienced peers for support, leading to a restricted research knowledge pool. The relative immaturity of the professions included may also be effecting research output. Participant personality may be a barrier in itself and role identification needs further investigation in future studies. Ó 2012 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
Keywords: Attitudes Perceptions Research Healthcare Barriers Personalities
Introduction The education and training of allied health professionals (AHP’s) and nurses in the UK moved into higher educational establishments in the early 1990’s.1 Prior to this clinical staff trained students within hospital placements and research activity was not a requirement of training or employment. However with the move into higher education the need for research-led teaching and practice became desirable.2,3 Over the past seven years research output from academics has been measured and used to grade universities against each other.4 This was and still is linked to funding of higher educational establishments placing pressure upon university staff to produce world ranked research. Previous studies have found that healthcare professionals have needed time * Tel.: þ44 0151 7945953. E-mail address: [email protected].
to develop research skills and establish themselves as researchers in this environment.5e7 It has also been shown that not all AHP’s have demonstrated an equivalent level of research activity even though they have a similar background and pathway into higher education.8 The aim of this project is to explore the attitudes and perceptions of a range of AHP/nurse lecturers in one university to research, using a grounded theory approach.9[a] Method Ethical approval was gained from the University committee on research ethics. Inclusion criteria stated that participants should hold an AHP/nurse qualification and currently be teaching full or part time in HE. A total of 23 participants took part and diagnostic radiography; radiotherapy; nursing; physiotherapy; occupational therapy and orthoptic professionals were represented in six mixed groups. Focus group methodology was chosen as it provides a tried and tested
1078-8174/$ e see front matter Ó 2012 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.radi.2012.08.003
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framework to support a grounded theory approach.10 Semi-structured discussions were used initially for the pilot groups 1 and 2 using an adapted proforma of guided questions as described by Halcomb et al.11 Halcomb reported this as a method of introducing a topic using non threatening questions which enable participants to contribute freely to the discussion. It is important however, that the grounded theory paradigm is not compromised by the design of these questions or how they are presented to ensure that generated data will be representative of true reality for the participants.12 During the pilot sessions this approach became restrictive however, and seemed to create stilted responses, therefore an open grounded theory approach was used for the remaining four groups with the word “research” offered as a discussion topic in a free and open manner. The verbal responses to the questions (groups 1 & 2) and discussions (groups 3, 4, 5 & 6) were digitally recorded. The researcher personally transcribed data sets to be able to immerse herself into the issues being discussed and to begin early analysis. NVivo v8 was used to organise emergent themes into nodal groups (codes) and each node was further analysed using the OSOP13 method allowing in depth and rigorous analysis. The researcher, an AHP teacher, planned not to contribute to the discussions to help reduce bias,14 however needed to contribute to the final group as one participant could not attend. It also has to be accepted that during analysis, evaluation and identification of themes may have been influenced by the researcher’s own experiences.15,16 To address this a “participant checking” exercise was conducted as described by Charmaz (2007).9[b] This took the form of two presentations to the group members of the completed analysis together with a Q&A session.
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designed to support teaching/administration activities only. One directorate (out of five) had recognised this and made a conscious effort to release staff from the timetable to be able to carry out research, but this had placed an additional teaching burden on the remaining staff. There was recognition that the commitment to teaching was necessary to maintain the programmes currently being delivered and therefore employment for staff. During discussion about the perceived conflict between teaching and research it became apparent that although lack of time is a large barrier to research, there were other underlying factors requiring further exploration. Knowledge: Some of the participants felt they did not have the research tools to be able to even begin research activity. This was linked to a lack of time to learn new skills to change this: “with me it would be the believing that you’ve got a lack of knowledge . you don’t have.you don’t know..the methods to use.the structure of the whole thing..so you almost.you wouldn’t know where to start really..” “you have your pile of papers there but you don’t exactly know how to go about maybe analysing it..” “I maybe could do with a bit more support...just feel like you’re being a bit silly...[hushed voice] a bit thick [quiet laugh]...” Motivation: The combination of not having the time or skills to carry out research has resulted in a lack of motivation for some participants and they questioned the reward system for research activity: “It [informal research meetings] might motivate us a bit more.’cause I think we lack..we do lack motivation”
Findings General barriers Participants identified several barriers to research activity that were evaluated under five sub-nodes (Fig. 1). Evidence to support each sub-node is presented: Time: All the participants are involved in teaching, and this activity combined with supporting administrative duties were highlighted as one of the main barriers with regard to time:“We’ve been talking about teaching being a sort of constraint.a barrier to research but we all have administrative roles to do as well.and to be honest If I could just teach then I’d have time to research.if I didn’t have any administration...”
“There’s also no rewards.....why..why do we need to do it?[research].we’re not rewarded for it are we?.we’ve not got any recognition..so why bother?.........” Again a minority of participants were very self motivated and wanted to be involved in research activity for personal reward and satisfaction. Research culture: Participants discussed how the research culture in the school was not always a positive environment therefore creating a barrier: “I think that here it’s the [research] culture that’s one of the bigger ones [barriers] .”.
“well what happens if we all said “no.we’ve got to do research”.and teaching was like the hobby.and if I’ve got time I’ll do some teaching?”
“that we can say that the university agenda is to do research but you feel locally it’s kind of [speaking as someone else]... “well..I don’t mind if people do research but actually, yer know, the teachings got to come first.””
‘there’s no alteration to my teaching hours or.or anything like that so.it’s.gets a bit like.it’s (research) just something I fit in around everything else that I have to do and.it seems to be.you have to make it work yourself cause nobody else is going to make it work for you”
“...in some departments it’s..your line manager not recognising the value of research....and in some ways we need to work together...and look at this overall and see what is reasonable and what is achievable....”
All groups identified that research and teaching are mutually exclusive with regard to time, and within the school the timetable is Time
Knowledge General Barriers
OSOP 1 Research Culture
The researcher encouraged further discussion around the emergent theme of “research culture” within the university as this had evolved from the “general barrier” theme as a possible important issue. This resulted in an additional OSOP with its own sub-nodes (Fig. 2). “Mentorship” re-emerged in OSOP 2 as a strong theme under the “mentorship/isolation” sub-node and was therefore combined within it and is presented later.
Motivation Mentorship
Figure 1. OSOP 1 showing “General Barriers” main theme with five sub-nodes: Time; Knowledge; Motivation; Mentorship; Reserach Culture.
Research culture Five sub-nodes evolved within this theme and are presented with evidence.
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Confidence Research
OSOP 2 Research Hierarchy
Culture
Quality of Life VS Research Mentorship /isolation
Mysticism
Figure 2. OSOP 2 showing “Research Culture” main theme with five sub-nodes: Confidence; Quality of life vs Research; Mentorship/isolation; Mysticism; Research Hierarchy.
Research hierarchy: Participants in each focus group became very direct in suggesting that a research hierarchy exists as part of research culture, and that this in fact was a much more emotive barrier to them than “time”. There was a feeling that established researchers high in the system were inaccessible to them and therefore the research mentoring they required was not always available. Within the hierarchy, participants placed medical doctors at a higher level than themselves in research terms linking this elevation to a perceived increased intelligence. It was also interesting to note that each professional group placed themselves below each other in the research hierarchy. There was also a perception that much more research support was given to people with perceived increased intelligence e PhD students for example. “cause it was the medics who tended to do a lot of the research and I think we’ve always sort of sat under them” “I think they [Nurses] have.they’ve got weight in the NHS and they have.maybe had an opportunity [to do research]because they have such a breadth of areas that they can be involved in that they’ve probably been able to push themselves more to the top.unlike us[radiographers].” “they’re [established researchers] always too busy and you feel that you’re putting them out and that you...you’re not their focus ‘cause you...well you just feel like you’re not a PhD student” “That’s right..and if they call you research radiographer it’s a misnomer isn’t it really?.” The discussions in all groups centred for most of the allotted time (2 h) around the hierarchy issue and how this is perceived as a major barrier to most of them. In one group participants had a slightly different view as their experience of the hierarchy was positive in that they had received excellent support from established researchers. However, it did transpire that these researchers were employed at either other HR establishments or industry and had been accessed via previous employment. All participants placed themselves at the bottom of the research pyramid and this seems to link to the next sub-node e confidence. Confidence: Lack of research activity seems to be directly linked to the individual confidence of each participant in the groups, with the majority of them having very little or no self esteem in this area: “I think we compare ourselves..or I compare ourselves to some of the other university departments that do a lot of research and are very good at it.[murmured consent]..and I almost feel we’re not...we’re not on the same playing field really.[murmured consent]” Some participants who had carried out research projects were reluctant to report their findings either internally or at conferences, displaying a complete lack of confidence in their own research ability: “.you know I’m almost embarrassed to go to a big conference that’s full of doctors and present something and someone says-“ I can’t believe you’ve done something so stupid” or “you’ve got a major hole that you’ve not seen”.”
“no..erm.because I know sometimes because it’s educational research and isn’t income generating etc, etc, its not that important really.and I’ve not published on it.” This lack of personal confidence seems to be reinforced by a lack of confidence in the system to support them, generating a negative loop. This leads to isolation of the individual and a feeling of being completely alone in attempting to start research activities and an inability to approach an experienced researcher for help if needed. Some participants were unable to identify a “researcher” in the school in the first instance. Mentorship/isolation: Some participants had attempted to become research active mainly through a requirement of further study such as a master’s programme or PhD and they discussed the fact that they were expected to “just get on” with the research element of their studies with no or minimal support: “and I didn’t have a research mentor when I started here four years ago, so I sort of did it on my own really[voice drops]” “so I’ve just plodded on, on my own..and done bits..[laughs] probably bungled it!” “I find it very hard at the moment when you’re here and you’re quite isolated and there might not be anyone within your working area that has the same research interest so you feel you have to decide and study....... and do it more or less on your own”. This continued isolation led some participants to consider discontinuing their research or to carefully consider starting any new projects in the future: “the isolation leads to having to keep the whole thing going ‘cause you get to a point where you think..I don’t know if I still want to do this” “Yeh..and if you’ve got a question its hard to find out who would know the answer to that or who would be the best person to know ...to help you in that situation.....I think there’s a lot of knowledge and ability within the university but its knowing who to go to...” It was clearly identified that having a research mentor would alleviate the problem of isolation and allow development of the necessary skills to start or continue research activity. Some participants also expressed a need for peer support to prevent isolation and perhaps generate new research ideas in a familiar protected environment: “I’ve just realised if you have people helping yer that also makes your potential to do research a lot easier”. “I think that’s..I see that as almost an attitude thing..and almost..it’s like a protection thing..really, we should sit everyone around a table and say “we want to get everyone involved in research over the next three years.”” “I think I’m looking at a more lower level really [for mentorship & support]...you know...just somebody that’s published before in the department..for ethics really..how do I get an application?....how do I do this?” Mysticism: Although the previous themes seem to be the main areas for group discussion there did emerge two others that are worth including here. The first is the idea that research activity somehow has a “mystical” aura that makes it inaccessible and is therefore a barrier. The participants used “Harry Potter-esque” visual imagery to express this, linking into the hierarchy theme and a perception that established researchers withhold information from inexperienced researchers to create mysticism:
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“I have a visual picture of somebody (a researcher) being surrounded by high towers of books, and papers, and journals...” “Its [research activity] almost...like divorced from us all really...sort of like sitting around in an ivory tower...” “There’s also an element of cloak and dagger, isn’t there?.some people don’t....they keep it [their research topics]quite close to the chest and...don’t tell you the whole story.then the suspicion arises.and so on and so on and so on..”. This perception was reinforced by one participant who is research active: “I’m playing a different game altogether really it’s...cloak and dagger........nobody will reveal their act!..(laughter).....but I play the game too so...’cause I could have managed to do a whole research project without anybody else knowing!......”
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Research personality: It was found that there was polarisation amongst the participants in that some could identify themselves as a researcher but others could not: “I don’t have that drive to do research...or the challenge..I would be quite happy doing things I can do standing on me head..” “ .God..I can’t think of anything worse!..I can’t.....why on earth would I want to be that?(a professor in research)...because my image of what that is..is not who I am” “I never want to become that!(a researcher) that...yes..that’s almost when research makes you become something I don’t ever want to be!...”. “I think some of the people who get to professorial level (researcher)....are very ambitious...very pushy....and I think...... I’d rather be a nice person....”
The researcher felt it was important to allow the groups to explore solutions to the identified barriers and gave them an opportunity to offer suggestions. It was interesting that some groups found this difficult demonstrated by the long pauses between comments and the lack of solutions offered. It was obvious that most had only focussed upon the barriers and had not considered any possible solutions. The discussions moved very quickly away from solutions into another interesting emergent theme of “quality of life vs research”.
Conversely, those that longed to take on a research role would do everything they could to achieve it:
Quality of life vs research: Some participants became defensive when asked to suggest ways of removing barriers to research activity and openly challenged the need for and the value of research in their roles as academics. There was a suggestion that research and quality of life are also mutually exclusive:
Discussion
(R)“Have you got a wish list?” “[Laughs]......probably.NOT to do it [research]...” “but I don’t want to work twenty four seven just to comply to here, because at the end of the day, I am sorry, it’s just a job.[murmured assent]..and I’ve got a life.[murmured assent]” “some people..I know it is their lives and like they’ve got six or seven different projects on the go.or they’re thinking about the next one..I can’t work like that!.” Those participants who had become research active acknowledged that they had had to make sacrifices to achieve this and that their personal life had been affected: “you have to have a good work home life balance...and...if you prefer to throw that away...and work ‘till midnight every night then you can do research...do it properly and have your bids...and have all that kind of thing..but you certainly can’t have your quality of life...it’s unrealistic to have the two...” Within this discussion emerged the idea that participants would have to change in some way to be able to effectively carry out research. “I’m not research active..even though I read [laughs nervously]..I don’t fit in..research active..it just informs me......”. “but it depends whether there is the....the desire for people to want to change [to become research active] , but I...I get a sense ...and I have actually said this in our department...I just get a sense that really they don’t really want to” This prompted the researcher to revisit the transcribed data to look for evidence to indicate that personality may be affecting engagement with research activity.
“Yeah...well I just basically begged for something...some research that I can do ...or I just felt useless” “very clearly having a research job is what I want...but then deliver the teaching around research rather than getting caught up in the admin”
The evaluation of data confirmed some common barriers to research which are reported in other projects,17e19 such as lack of time and resources. In addition mentorship evolved as a very strong theme particularly for new members of staff who acknowledged the need for support in starting research projects. Those participants who had shown enthusiasm for research were becoming disillusioned by the apparent lack of identified mentorship for their particular area of interest. It is good practice for new researchers to have a mentor to guide them through the process20 but this only seems to happen if that research is part of a postgraduate programme of study and even then some of the participants were critical of the level offered. The type of mentorship and who is offering it is also important. It would be logical to assume that the best mentor would be an experienced researcher with a strong history of publication, however due to mysticism within the hierarchy of research, participants perceived that the people near the top i.e. established researchers, were inaccessible to them and in fact would not value their research ideas. This makes participants feel reluctant to approach them and leads to the solution of using peer support instead. This indicates that the participants are more comfortable communicating with people they consider lower down the hierarchy. As the majority of their peers at this level are also inexperienced researchers this creates a restricted pool of research knowledge and skills to draw from and creates a negative feedback system for research activity (Fig. 3). All of this exists within a time restricted environment and a need to deliver quality teaching programmes. Some of the groups recognised that there would be penalties imposed if the teaching/administration element was not delivered but that the same could not be said of research, leading to reluctance to sacrifice teaching time. The combination of no penalties, lack of recognition for current research/ scholarly activity and the negative feedback scenario described is a recipe for reduced research output for these participants. It could be argued that all of the issues discussed so far are really a symptom of immaturity on behalf of the professions included in the study, and that the transition into higher education is still ongoing. It was interesting that all the groups focussed immediately
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personality traits required for research are different than those for clinical practice and teaching which are similar.27,28 Although evidence based practice is essential it is also important to state that those who wish to teach only must have their contribution recognised and valued, as teaching and learning forms the backbone of all higher educational establishments and has more recently been highlighted as a future measure of grading universities.29 Conclusion
Figure 3. Negative feedback system for research activity.
upon barriers to research in their discussion almost as a defense mechanism and a way of justifying their lack of or diminished engagement in research activities. Perhaps it is not so surprising therefore that research output from these groups cannot compete at the moment with other subject areas and will not be able to do so until they become more established within the research hierarchy. It is essential therefore that those few who have already reached the research pinnacle actively encourage and support colleagues to do the same, in other words to occasionally reach down from their ivory tower to extend a helping hand. The perception of some group members seems to be that those already at the top of the hierarchy have lost their professional identity and have taken on the persona of “Researcher” or “Professor” which is not always described in a complimentary way. This could also be an attempt to create a barrier between themselves and the “researcher” persona because they do not identify with it, which again may be linked to an immature perception of what it actually is, and a fear of losing self identity. This idea of changing roles to accommodate research activity has been reported in other studies.21 Another issue to consider is the reason why some participants did not identify with research activity and others did. This may be due to their personalities and how they relate to research compared to clinical teaching. Psychology studies have developed a group of personality traits known as the “Big Five”22,23 which are used in psychometric assessment of potential candidates for jobs.24 In the UK, this assessment has been used to match newly qualified doctors to surgical posts as it has been recognised that a certain “type” of clinician is required for the surgical environment.25,26 It would be logical therefore to suggest that some nurses and AHP’s have a stronger personality trait for research than others. The evidence presented here under “research personality” supports this idea and it can be seen in the quotes provided that the personal feelings of the participants are very strongly linked to their desire to either be or not be a researcher. Such emotive responses can be understood if it is accepted that certain personalities are more suited to research activity than others. It must also be recognised that the majority of lecturers and teachers in health chose to be clinical practitioners first because presumably that role suited them at the time. In fact evidence suggests that the
This study has confirmed some practical barriers to research that can be resolved with adequate and appropriate mentorship alongside time release measures. It is clear that a more structured and overt mentor scheme and pathway would improve the research experience for all participants, however established research staff would also require support to be able to provide quality mentorship. The professions represented in this study can also aim to improve engagement with research by increasing its exposure during undergraduate and postgraduate programmes of study and by encouraging students to continue engagement when qualified. There is also a need to raise the profile and importance of small starter projects in universities and the clinical environment to allow novice researchers to build their confidence and gain experience. Greater collaboration between HEI’s and clinical researchers may help to develop such projects. As the research requirement in higher education is established and will continue it is important that those who wish to develop a research career alongside their teaching can do so. A clear research strategy for lecturers in health will facilitate this need and help professions to move forward from an immature stance to a position of confidence within the research world. It is recognised that this study is limited by the small number of participants and would benefit from expansion into other non health related university departments for comparison, and if possible into other HE establishments. This approach would be invaluable to test the idea of “research personality” against engagement with research activity and may provide evidence to support more effective management of health lecturers and teachers in the future. Conflict of interest statement The author confirms that there no financial or personal relationships with other people or organisations that could inappropriately influence (bias) this work. References 1. Sluming V. The changing world of radiography education. British Journal of Radiology 1996;69:489e90. 2. DOH. Proposed human resources plan for educators and researchers in health and social care department of health. London: DOH; 2003. 3. DOH. Best research for best health e a new national health research strategy. Department of Health. London: DOH; 2006. Pub. COI ref 272605. 4. Gross I. An impact assessment of the funding bodies proposals for research assessment, HEFCE. Assurance Service [accessed 09.04.10], http://www.rae.ac. uk/pubs/other/impact/; 2004. 5. Howarth M, Kneafsey R, Haigh C. Centralization and research governance: does it work? Journal of Advanced Nursing 2008;61(4):363e72. http://dx.doi.org/ 10.1111/j.1365-2648.2007.04524. 6. Bonner A, Sando J. Examining the knowledge, attitude and use of research by nurses. Journal of Nursing Management 2008;16(3):334e43. 7. Girot AG. The challenges facing healthcare lecturers and professors to lead and promote a research-based culture for practice. Journal of Research in Nursing 2010. http://dx.doi.org/10.1177/1744987110364572. 8. Scutt D. The research assessment exercise (RAE) 2001 revisited e the University of Liverpool UoA11 experience. Radiography 2004;10:127e30. 9. Charmaz K. Constructing grounded theory. 3rd ed. London: Sage; 2007 [a] CH 1 pg1e12; [b] CH 5 pg111. ISBN 978-0-7619-2.
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19. Braun v, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006;3:77e101. 20. Dickson-Swift V, James EL, Kippen S, Liamputtong P. Blurring the boundaries in qualitative health research on sensitive topics. Qualitative Research 2006;16(6): 853e71. 21. Segrott J, McIvor M, Green B. Challenges and strategies in developing nursing research capacity: a review of the literature. International Journal of Nursing Studies 2006;43(5):637e51. http://dx.doi.org/10.1016/j.ijnurstu.2005.07.011. 22. Goldberg LR. The development of markers for the Big Five factor structure. Psychology Assessment 1992;61(3):204e17. 23. McAdams DP, Pals JL. A new Big Five: fundamental principles for an integrative science of personality. American Psychologist 2006;61(3):204e17. 24. Ehrhart KH, Makransky G. Testing vocational interests and personality as predictors of personevocation and personejob fit. Journal of Career Assessment 2007;15(2):206e26. 25. Houghton A. Using the MyerseBriggs type indicator for career development. British Journal of Radiology 2000;320:S2-7248. 26. Thomas J. The surgical personality: fact or fiction? American Journal of Surgery 1997;174:573e7. 27. Mathers SA, Chesson R. Research governance: current issues for radiographers. The Hong Kong Radiographers Journal 2005;9(1):28e32. 28. Medical Research Council. Good research practice: policy guidance for researchers. London, http://www.mrc.ac.uk; 2000. 29. Higher education: students at the heart of the system. London: Department for Business Innovation and Skills; 2011.