Exploring stakeholder perceptions and practices regarding research in provincial health facilties.

Abstract

This thesis aimed to explore the perceptions and practices of key stakeholders regarding research conducted in provincial public health facilities. Research plays a vital role in improving health and health care globally, as well as in KwaZulu-Natal (KZN), South Africa, where it has resulted in significant health gains particularly in the field of HIV/AIDS. However, in spite of a robust regulatory framework and guiding documents, health research may be fraught with challenges. In KZN, the Provincial Health Research and Ethics Committee (PHREC) is responsible for providing final permission for researchers to access public health facilities to conduct their research, or to recruit potential participants from these facilities. This permission is based on the support of health managers of public health facilities and programmes who provide the first level of permission in the PHREC approval process. This study explored the perceptions and practices of researchers and health managers regarding research conducted in provincial public health facilities, and regarding their inter-stakeholder relationships. A qualitative study design was adopted, using in-depth interviews as the means of data collection. Eighteen interviews were conducted – eight with health managers and ten with researchers. Interviews were analysed using Thematic Analysis. Three important themes were generated from the analysis: varying perceptions around the ‘social value’ of research, strained inter-stakeholder relations, and recommendations for strengthening research and relations. Although all participants agreed that health research was valuable, researchers tended to place more emphasis on its contribution to new knowledge and future beneficiaries, whilst health managers tended to emphasise its concrete and current contribution to the functioning of the healthcare system. Respondents perceived that their relationships were strained at all stages of the research process. Particular concerns included a lack of involvement of health managers in the conceptualization of research questions, frustration of researchers with a prolonged, onerous research application process, and poor feedback of research results to health managers. Important relationship issues included lack of trust, accountability, and transparency. Both stakeholder groups had a shared view regarding how to strengthen both the research process and inter-stakeholder relations. There was strong agreement on, amongst others, improving communication through more regular, formal and informal meetings, and entrenching a culture of research within the KZN Department of Health. The study concludes that researchers and health managers had subtly differing perceptions of what makes health research in provincial health facilities valuable, and that tensions between these groups were perceived across the life-cycle of the research process. The study makes various recommendations on how to build stronger relations between stakeholders, in order to facilitate the conduct of high quality research in such settings, that is valued by affected role-players.