Development, implementation and evaluation of a clinical research engagement and leadership capacity building program in a large Australian health care service

BACKGROUND: Health professionals need to be integrated more effectively in clinical research to ensure that research addresses clinical needs and provides practical solutions at the coal face of care. In light of limited evidence on how best to achieve this, evaluation of strategies to introduce, adapt and sustain evidence-based practices across different populations and settings is required. This project aims to address this gap through the co-design, development, implementation, evaluation, refinement and ultimately scale-up of a clinical research engagement and leadership capacity building program in a clinical setting with little to no co-ordinated approach to clinical research engagement and education.

METHODS/DESIGN: The protocol is based on principles of research capacity building and on a six-step framework, which have previously led to successful implementation and long-term sustainability. A mixed methods study design will be used. Methods will include: (1) a review of the literature about strategies that engage health professionals in research through capacity building and/or education in research methods; (2) a review of existing local research education and support elements; (3) a needs assessment in the local clinical setting, including an online cross-sectional survey and semi-structured interviews; (4) co-design and development of an educational and support program; (5) implementation of the program in the clinical environment; and (6) pre- and post-implementation evaluation and ultimately program scale-up. The evaluation focuses on research activity and knowledge, attitudes and preferences about clinical research, evidence-based practice and leadership and post implementation, about their satisfaction with the program. The investigators will evaluate the feasibility and effect of the program according to capacity building measures and will revise where appropriate prior to scale-up.

DISCUSSION: It is anticipated that this clinical research engagement and leadership capacity building program will enable and enhance clinically relevant research to be led and conducted by health professionals in the health setting. This approach will also encourage identification of areas of clinical uncertainty and need that can be addressed through clinical research within the health setting.

Australian PhD theses in selected professional and academic disciplines 1987–2006 and the implications for future research capacity

This commences with an overview the research methods and outcomes. It is contextualised in terms of the current Australian and international debates about the nature, substance and impact of doctoral education on nations, societies, communities and economies. Four professional disciplines (architecture and building, education, librarianship and nursing) and four academic disciplines (astronomy, chemistry, cultural studies and demography) are selected for analysis of their 1987–2006 PhD thesis records. These selections were made to reflect a range of professional and academic disciplines in Australia and to illustrate the changes that have occurred over the past two decades. The period 1987-2006 covers several major changes in Australian university education and PhD education in particular.

Building research capacity in General Practice : Incorporating research as a component of GP vocational training

Aims & rationale/Objectives : Australian research shows that most GP registrar supervisors lack confidence to support registrar research projects and themselves have little or no research experience. Assisting registrars to develop critical thinking skills and an understanding of research methods sufficient to enable active use of these tools in general practice is one of the curriculum statements in the RACGP Training Program Curriculum. A University Department of Rural Health (UDRH) and a General Practice Education and Training (GPET) organisation formed a partnership to: Engage basic term registrars in group research and concurrent research skills training program; Improve research skills, confidence, and knowledge; and Contribute research findings relevant to general practice.

Methods : Registrars' initial research knowledge and confidence was measured by a questionnaire. In addition to a final focus group, feedback via evaluation forms was sought from the 11 registrars and two GPET supervisors at the conclusion of each research training session.

Principal findings : Approaches

Implications : Research skills development training and involvement in research can be successfully integrated into a GP vocational training program.

Challenges of negotiating obesity-related findings with African migrants in Australia : lessons learnt from the African migrant capacity building and performance appraisal project

Aim: To document sub-Saharan African migrants' and teachers' reaction to and acceptance of findings from African Migrant Capacity Building and Performance Appraisal initiative, and to examine the implications for any community-based obesity prevention program.

Methods: Two community forums were organised to discuss the research findings: one with 45 African community leaders from various African communities in Melbourne; and the other with 17 primary and secondary teachers from English Language Schools and Centres across Victoria. The dissemination focused on highlighting the rapid weight gain and obesity risks observed among African migrant children.

Results: Sub-Saharan African migrants' reaction to the findings was that of pride and satisfaction with large body size, seeing it as a job well done, reflecting their perceptions that obesity is not a disease. In addition, they highlighted the intergenerational conflict related to body size ideals between parents and teenage offspring, with the latter preferring model-like Australian body sizes.

Conclusion: Further research is required to examine the association between shifting preferences in body ideals and obesity among traditional communities, such as sub-Saharan African migrants. The understanding of how changes in body image perceptions may influence eating and exercise behaviours among sub-Saharan African migrants would assist in the development of obesity-related preventive interventional programs for this at-risk population.

Capacity building for integrated health care at the local level

Aims & Rationale/Objectives
Taking a capacity building approach to research and evaluation within the context of a federally funded national program challenges the traditional paradigms of both research and evaluation. The objective of this approach was to foster attitudes and behaviours of reflection, critical inquiry and collaborative action amongst participants responsible for health care integration activities.

Methods
A series of workshops focusing on different elements of health care integration was conducted. Each workshop offered skill development in research and evaluation methods relevant to the participants' clinical practise. The workshops were multidisciplinary and cross-sectoral in order to promote discussion about shared patient care issues.

Principal Findings
Participatory action research facilitated by external agents can build the capacity of participants to identify and make changes that improve health care integration at local levels. A capacity building approach to research and evaluation can mediate tensions between top-down initiatives and on-the-ground practitioners.

Discussion
A capacity building approach was crucial to the success of this project particularly as the project proposal was developed at the corporate level. The workshops played an important role in engaging the participants and fostering the development of solutions for locally identified clinical issues. The opportunities for discussion with other health care service providers were both readily embraced and appreciated by the participants. The networks formed during the workshops are likely to be vital in sustaining integration efforts.

Implications
Education sessions such as the workshops held within this project ensure that health care integration remains on the agenda of the relevant organisations. These workshops fostered a continuous quality improvement approach whilst focusing on the skills required and the systemic barriers to achieving health care integration. The success of these workshops is evidence that the need and desire for shared education opportunities exists and the interdisciplinary focus is a powerful tool for developing an appreciation of the cultures within disciplines as well as linkages.

What's needed to increase research capacity in rural primary health care

The aim of this study is to identify ways to build research capacity within primary health. A consultation was undertaken in late 2004 using a combination of a one-page survey and a guided meeting format, in a primary health setting in rural NSW. Most (81.3%) of the 134 individuals consulted were part of an Area Health Service, with 12.7% from non-government settings. Most (80.6%) were clinicians, with a third (31.5%) nurses, 8.3% in medicine, and the remainder from a range of allied health professions. Eleven organisations were represented. The main  outcome measures were identification of support needs, processes to enhance research engagement, and barriers and enablers to clinicians’ research  involvement. The results showed that popular delivery modes for research training and support were courses and “one-to- one” advice. Writing topics were generally more popular than others. Common barriers were time and technology issues. A key enabler was a discipline-specific focus. This is one of few rural Australian  consultations on research needs in primary health conducted with a diverse  range of clinicians at the clinician level. It will direct future research capacity  building efforts towards maximising face-to-face discipline specific options and  minimising technology use.

Disciplinary differences in Australian PhD theses 1987-2006 and the implications for future research capacity

The paper, which draws on data previously presented at the 2010 World Universities Forum in Davos, Switzerland (Evans & Macauley, 2010), presents and tabulates a variety of trends from the Database of Australian Doctorates, in particular, those relating to the ebb and flow of PhDs in particular selected ‘academic’ and ‘professional’ disciplines in Australia. The paper commences with an overview of the research methods and outcomes. Four academic disciplines (astronomy, chemistry, cultural studies and demography) and four professional disciplines (architecture and building, education, librarianship and nursing) are selected for analysis of their 1987–2006 PhD thesis records. These selections were made to reflect a range of academic and professional disciplines in Australia and to illustrate the changes that have occurred over the past two decades. The period 1987-2006 covers several major changes in Australian university education and PhD education.

Ausaid and capacity building: sustainability of an education aid project

This thesis is concerned with the effects and sustainability of internationally funded schools in Indonesia that have been established by the AusAID. By exploring and reviewing the constraints in maintaining the sustainability of aid projects, this research provides an actual description of an education-based aid project in Indonesia in the post-funding period.

Principal led school improvement and teacher capacity building in the Barwon South Network : final report, May 2013

The period of interest for this report is the beginning of 2011 to the end of 2012. The period commenced when the Regional Network Leader of the Barwon South Network of schools in the Barwon South Region of the Department of Education and Early Childhood contacted the School of Education at Deakin University, Waurn Ponds Campus Geelong. The Regional Network Leader outlined a desire to engage with Deakin University to research a short-term-cycle model of school improvement to be implemented in the region. While the model was expected to be taken on by all schools in the region the research was limited to the 23 schools in the Barwon South Network with four schools to be investigated more closely for each of two years (2001 & 2012) – eight focus schools in total.

Many positive outcomes flowed from the implementation of short-term-cycle school improvement plans and their associated practices but there was wide variation in the nature and degrees of success and of the perception of the process. The research team asked the following questions of the data:

1. What aspects of the School Improvement Plan (SIP) approach were important for initiating and supporting worthwhile change?
2. What might we take from this, to provide guidance on how best to support change in teaching and learning processes in schools?

The School Improvement Plan (SIP) worked in a range of ways. At one level it was strongly focused on school leadership, and a need to improve principals’ capacity to initiate worthwhile teaching and learning processes in their schools. Underlying this intent, one might think an assumption is operation is that the leadership process involves top down decision-making and a willingness to hold staff accountable for the quality of their practice.

The second strong focus was on the translation into practice and the consequent effect on student learning, involving an emphasis on data and evidence led practice. Hence, along with the leadership focus there was a demand for the process of school improvement to reach down into students and classrooms. Thus, the SIP process inevitably involved a chain of decision-making by which student learning quality drove the intervention, and teachers responsible for this had a common view. The model therefore should not be seen as an intervention only on the principal, but rather on the school decision-making system and focus. Even though it was the principal receiving the SIP planning template, and reporting to the network, the reporting was required to include description of the operation of the school processes, of classroom processes, and of student learning. This of course placed significant constraints on principals, which may help explain the variation in responses and outcomes described above.

The findings from this study are based on multiple data sources: analysis of both open and closed survey questions which all teachers in the 23 schools in the network were invited to complete; interviews with principals, teachers and leaders in the eight case study schools; some interviews with students in the case study schools; and interviews with leaders who worked in the regional network office; and field notes from network meetings including the celebrations days. Celebrations days occurred each school term when groups of principals came together to share and celebrate the improvements and processes happening in their schools. Many of the themes emerging from the analysis of the different data sources were similar or overlapping, providing some confidence in the evidence-base for the findings.

The study, conducted over two years of data collection and analysis, has demonstrated a range of positive outcomes in at the case study schools relating to school communication and collaboration processes, professional learning of principals, leadership teams and classroom teachers. There was evidence in the survey responses and field notes from ‘celebration days’ that these outcomes were also represented in other schools in the network. The key points of change concerned the leadership processes of planning for improvement, and the rigorous attention to student data in framing teaching and learning processes. This latter point of change had the effect of basing SIP processes on a platform of evidence-based change. The research uncovered considerable anecdotal and observational evidence of improvements in student learning, in teacher accounts in interview, and presentations of student work. Interviews with students, although not as representative as the team would have liked, showed evidence of student awareness of learning goals, a key driver in the SIP improvement model. It was, however, not possible over this timescale to collect objective comparative evidence of enhanced learning outcomes.

A number of features of the short-term-cycle SIP were identified that supported positive change across the network. These were: 1) the support structures represented by the network leader and support personnel within schools, 2) the nature of the SIP model – focusing strongly on change leadership but within a collaborative structure that combined top-down and bottom-up elements, 3) the focus on data-led planning and implementation that helped drill down to explicit elements of classroom practice, and 4) the accountability regimes represented by network leader presence, and the celebration days in which principals became effectively accountable to their peers. We found that in the second year of the project, momentum was lost in the case study schools, as the network was dismantled. This raised issues also for the conduct of research in situations of systemic change.

Alongside the finding of evidence of positive outcomes in the case study schools overall, was the finding that the SIP processes and outcomes varied considerably across schools. A number of contextual factors were identified that led to this variation, including school histories of reform, principal management style, and school size and structure that made the short-term-cycle model unmanageable. In some cases there was overt resistance to the SIP model, at least in some part, and this led to an element of performativity in which the language of the SIP was conscripted to other purposes. The study found that even with functioning schools the SIP was understood differently and the processes performed differently, raising the question of whether in the study we are dealing with one SIP or many. The final take home message from the research is that schools are complex institutions, and models of school improvement need to involve both strong principled features, and flexibility in local application, if all schools’ interests in improving teaching and learning processes and outcomes are to be served.

Capacity-building in nonprofit organizations : Is there a blended learning paradigm for the sector?

Blended learning models are widely-used, successful training vehicles for e-learning and workplace training, in corporate as well as higher education environments. Increasingly, Web 2.0 applications, imbedded within blended learning models, are being recognized for their utility in these settings. Concern for the sustainability and relevance of nonprofit organizations has sharpened the interest in building effective capacity-building models for the sector. Can Web 2.0 technologies enhance capacity-building models in the Third Sector? Because blended learning is a remarkably adaptable and fluid model, its potential for transforming capacity-building models in the nonprofit sector is thought to be significant. This paper introduces the concept of transformational approaches to capacity-building and asks if blended learning paradigms that incorporate interactive next-generation technologies might strike a responsive chord in the sector. The authors present research to date on blended learning and capacity-building to lay the foundation for the introduction of one blended learning model for training and education in the nonprofit sector. While the authors suggest that blended learning, as it is evolving, is the key to driving innovation in capacity-building models, they recognize that tailoring blended learning to the audience is critical in achieving success. It is suggested that for optimal results, capacity-building efforts should be built on holistic approaches to the integration of individual self-actualization goals with mechanisms for organizational and sector empowerment, using the technologies imbedded with blended learning. © 2011 Springer-Verlag.

Civic participation for community capacity-building

The expectation that citizens, including young people, can improve their own social and economic outcomes and build the capacity of their communities is firmly woven into the public policy and culture of nations such as Australia. This expectation is at odds with the marginalisation experienced by many young people, particularly those from low socioeconomic backgrounds. This chapter relates the findings to date of my PhD study, which is being undertaken at time of writing with the Australian Youth Research Centre at the University of Melbourne. The study investigates the capacity of schools in low socioeconomic contexts to meet the policy expectation that they foster and support young people's civic participation. It also describes how young people in low socioeconomic contexts are building the capacity of their communities through the ruMAD? program implemented by Education Foundation, a division of the Foundation for Young Australians (FYA).

Capacity building for post disaster construction and demolition waste management: a case of Sri Lanka

Purpose – The purpose of this paper is to present a theoretical framework for capacity building in post disaster construction and demolition (C&D) waste management at a national level to address the identified capacity gaps in managing disaster waste resulting from natural hazards.

Design/methodology/approach – Data were gathered through pilot interviews, case studies and expert opinion surveys representing government, non-government and other sector organisations involved in post disaster waste management.

Findings – The study revealed unavailability of a single point of responsibility and provision for disaster waste in existing policies and capacity constraints in prevailing peace time solid waste management practices which were identified as major capacity gaps. Establishment of a regulatory body and enforceable rules and regulations with necessary levels of capacities was identified and presented in a theoretical framework comprising of seven identified areas for capacity building in post disaster waste management.

Research limitations/implications – This study is limited to disaster C&D waste as debris generated from totally or partially damaged buildings and infrastructure as a direct impact of natural hazards or from demolished buildings and infrastructure at rehabilitation or early recovery stages. Waste generated during reconstruction phase of post disaster management cycle is not considered as disaster C&D waste for purposes of this study.

Originality/value – The research enabled analysis of existing capacities and presents approaches for capacity building for identified gaps in post disaster C&D waste management to attain sustainable post disaster waste management for future resilience.