Abstract
Background This 2-year study explored the experiences of clinical physical therapists who used a participatory action research (PAR) approach to learn about the practice of clinical research.
Objectives The aim of this study was to explore the experiences of physical therapists who were conducting clinical research, facilitated by a PAR approach.
Design A mixed-methods research design was used.
Methods Physical therapists completed questionnaires, were interviewed, and participated in focus groups prior to and after the 1-year intervention and 1 year later. The research facilitator took field notes. Questionnaire data were analyzed descriptively, and themes were developed from the qualitative data. Twenty-five therapists took part in 4 self-selected groups.
Results Three groups actively participated in the PAR research projects (n=14). The remaining 11 therapists decided not to be involved in clinical research projects but took part in the study as participants. After 1 year, one group completed the data collection phase of their research project, and a second group completed their ethics application. The third group ceased their research project but hosted a journal club session. At completion of the study, the experiences of the physical therapists were positive, and their confidence in conducting research and orientation toward research had increased. The perceptions of physical therapists toward research, relationships among individuals, and how the clinical projects were structured influenced the success of the projects.
Limitations Only physical therapists of one hospital and no other health care practitioners were included in this study.
Conclusions Fourteen physical therapists divided among 3 PAR groups were overall positive about their experiences when they conducted a research project together. This finding shows that a PAR approach can be used as a novel tool to stimulate research participation in clinics.
Over the past 30 years, physical therapy has evolved into a more research-oriented profession.1,2 This path toward becoming more research-active encompasses several stages; first, clinicians need to be able to implement evidence of research findings in their clinical practice (research utilization), then they need to play a crucial role in participating in research projects (research participation) before finally they can become leaders in their area.3 Evidence-based medicine was adopted around the world to improve health care outcomes and facilitated the first stage of this process. Sackett et al defined evidence-based medicine as a means of “integrating individual clinical expertise with the best available external clinical evidence from systematic research.”4(p71) As a result, physical therapists are currently encouraged to become evidence-based practitioners by professional boards5 and insurers,6 and considerable research on this topic has been published.7–10 In this article, however, the next stage of becoming more research-active, the active participation in research will be explored.
Clinicians understand the importance of research for their profession11,12; however, it appears that few actively engage in research. In 1980, a mixed-methods study showed 0.6% of 116 physical therapists to be involved in research for more than 50% of the time and 84% not to be involved in research at any given time.13 Limited time, inadequate funding, and a lack of research skills were believed to contribute to a lack of involvement.13 Thirty years later, involvement in clinical research has changed to some extent. A 2009 survey of 132 health care professionals (including social workers, speech therapists, physical therapists, occupational therapists, dietitians, and podiatrists) reported higher involvement levels of health care professionals in collaborative research (32%).14 This survey also reported health care professionals (n=132) to be more interested in building their research utilization skills, such as critiquing articles (50% of 132), than their research participation skills, such as applying for research funding and ethical approval (15% of 132).14 This outcome was congruent with Kamwendo's 2002 findings15 in 343 physical therapists who expressed more interest in using research than in initiating research projects. Interestingly, dietitians and physical therapists were found to be less interested in conducting research than other health care professionals.14
Despite the importance of research to the profession, very little is known regarding how to stimulate clinicians to conduct research in their clinical setting. To date, workshops and collaborative research projects are the main methods or interventions used to stimulate research participation.16–19 However, the quality of this research is poor, and no systematic review on the involvement of clinicians in research has been conducted. Only one article used a pretest-posttest design to evaluate an intervention intended to stimulate engagement in research (workshops and collaborative research projects),16 and one other article reported on a case-control study (workshops).17 Two studies used triangulation of multiple data sources to strengthen findings of using a research facilitator to build research capacity.18,19 Workshops proved valuable when they were combined with a practical application, such as a collaborative research project, whereas studies with a dedicated research facilitator encouraging the processes of research were more successful in sustaining the participation of clinicians in research. Generally, positive findings relating to building research capacity were reported when clinicians had been actively involved in conducting research, despite a number of obstacles they had to overcome to achieve success.
Building on these findings, this article describes a study that aimed to stimulate clinical physical therapists to conduct research in their own setting. The setting was a New Zealand rehabilitation hospital that encompassed a range of clinical specialties. A participatory action research (PAR) approach underpinned the intervention to engage physical therapists in research, from now onward referred to as the “engagement intervention.” The PAR approach encouraged physical therapists to initiate and lead research projects in their areas of interest, aided by a research facilitator (J.J.). As the physical therapists conducted the projects themselves and the projects were relevant to their clinical physical therapist practice, we postulated that this active involvement would enable the physical therapists to learn about research processes. The aim of the study was to explore the experiences of physical therapists conducting research facilitated by a PAR approach.
Method
Design
The study incorporated a concurrent mixed-method research design20 to collect qualitative (semi-structured interviews, field notes, and reflections of PAR groups) and quantitative (3 questionnaires) data. In a concurrent mixed-method design, both qualitative and quantitative data are used to answer the research question.20 A pragmatic paradigm21,22 underpinned this study. A pragmatic paradigm allows the research to switch between viewpoints in order to answer the research question. Therefore, it allows combining elements from the PAR projects with the quantitative and qualitative elements. Furthermore, it suited the background of the first author, who was involved in the daily data collection, in that this researcher was a physical therapist and had an applied research background. In this study, priority was given to the qualitative data.
Participant Recruitment
We invited all physical therapists and clinical managers working in the physical therapy department of the rehabilitation hospital to participate. Potential participants were included if they: worked either as a physical therapist or as a physical therapy or health care professions manager at the hospital, were registered with the New Zealand Board of Physiotherapy, and held a current practicing certificate.
In consultation with management, we held 2 oral presentations explaining the study to inform all of the physical therapists. In the oral presentations, we explained the participatory, active, and political nature of the PAR approach. This approach meant that if participants consented to be part of the study, they were stimulated to become actively engaged with the PAR project and contributed to a sustainable research culture in the hospital setting. Additional information on the PAR principles is presented in the “Engagement Intervention” section. Additionally, we distributed invitations to participate along with information sheets and consent forms to all potential participants through the internal mail system of the hospital. During and after the presentations, potential participants were encouraged to ask questions about the study.
Participants
Twenty-five of the 32 potential participants (22 physical therapists and 3 managers) consented. The 7 physical therapists who did not provide consent for the study were still able, if they desired, to be involved in the engagement intervention, as described below; 3 chose this option.
Engagement Intervention
The engagement intervention was based on the principles of the PAR approach as described by Kemmis and McTaggart,23 namely, social, participatory, practical and collaborative, emancipatory, critical, reflective, and aiming to transform theory and practice. Adhering to the social principle, the engagement intervention took place in the hospital where the participants worked, allowing for interactions among the physical therapists, between the physical therapists and their managers and other health care professionals, between the physical therapists and their patients, and between the physical therapists and the culture in which they worked, thus keeping the social context real. Emancipatory and transformative principles were upheld as the involved physical therapists wanted to learn more about, and become clinically engaged in, research, thus changing their current situation. Managers or others in authority did not impose the process upon the physical therapists, although they encouraged the project. Integrating the practical, participatory, critical, and reflective principles of PAR involved an iterative cycle of planning, acting, observing, and reflecting on the research projects the physical therapists initiated.23 Figure 1 shows these 4 stages of the PAR cycle.
The participatory action research (PAR) cycle used in this study to stimulate research participation of physical therapists working in a rehabilitation hospital.
In keeping with PAR, interested physical therapists divided themselves into PAR groups. The physical therapists decided the topic, design, and processes of the research projects within their own setting (practical principle), with help from a research facilitator (J.J.). As they worked in groups and initiated and conducted the research projects, there was a high level of participation of the physical therapists (participatory principle). In the last 2 stages (observe and reflect) of the PAR cycle, the physical therapists looked critically at their actions and reflected on their observations. Once every month, each PAR group organized a formal group reflection to allow them to discuss and reflect on their observations and progress.
The research facilitator facilitated, guided, and encouraged the whole process on a daily basis. She ran informative research sessions and assisted groups in the steps of research (eg, conducting a review of the literature, completing ethical applications); however, at all times the researcher ensured she was an equal member of each group so that the participatory principle was upheld.
Data Collection
We used qualitative and quantitative data sources. In-depth face-to-face individual interviews formed the main qualitative data source. The questions were semistructured and allowed for exploratory questions. Physical therapists and their managers were purposefully sampled to capture the maximum variation24 of perceptions toward research existing in the physical therapy department and included participants and nonparticipants of the PAR groups. The in-depth interviews took place at the end of the engagement intervention and at the 1-year follow-up. Fifteen physical therapists and managers had been interviewed when data saturation was reached. Each interview was held in separate rooms within the hospital to create a space of reflection and trust and lasted from 20 to 60 minutes. All interviews were audio-recorded and transcribed verbatim.
The second qualitative data sources were the recorded observations and reflections of the PAR groups. Once a month, time was allocated within each PAR group for participants to sit down as a group and observe what they had been doing and reflect together on the progress or issues that arose during the planning and action phases. The research facilitator attended all evaluation meetings of the separate PAR groups and audio-recorded the 10- to 20-minute-long group reflections (n>25). The third qualitative data source consisted of the first author's written field notes of observations, dilemmas, and reflections from her interactions with the physical therapists and managers (n>200).
The quantitative data were collected with 3 questionnaires. The first questionnaire collected demographic data, such as age, sex, and number of years of physical therapy experience, at the start of the intervention. The other 2 questionnaires were administered prior to commencement of the study (start), after the 1-year study was completed (end), and 1 year after the study was completed (1-year follow-up) and are described below. Timing of the data collection is illustrated in Figure 2.
Visualization of the data collection process. PAR=participatory action research, 1 year FU=1-year follow-up.
The second questionnaire was the Edmonton Research Orientation Survey (EROS).25 The EROS consisted of 3 parts answered on a 5-point Likert scale, ranging from 1 (“strongly disagree”) to 5 (“strongly agree”); a higher score indicated a more positive orientation toward research. Internal reliability was high (Cronbach alpha=.93),25 and construct validity showed the overall EROS score to be associated with formal research education, understanding of research, and participation in research among nurses.26
The third questionnaire consisted of 2 visual analog scales to measure motivation and confidence in conducting research. The 2 questions asked were: (1) How confident are you with doing research? and (2) How motivated are you to do research? Answers were registered on a 100-mm visual analog scale ranging from, respectively, “not confident” and “not motivated” to “very confident” and “very motivated.” Reliability and validity of this last questionnaire have not been established.
Data Analysis
The mixed-methods data were analyzed with a parallel mixed-data analysis.22 Qualitative and quantitative data first were analyzed separately.22 More information on the separate analysis processes is shown below. Parallel analysis allows for a more complete understanding of the separate qualitative and quantitative understanding before findings of the quantitative analysis are compared and contrasted to the qualitative findings. Where the quantitative data provided new or deeper insights into the findings from the qualitative study, these findings are reported.
The in-depth interviews were transcribed verbatim and checked for accuracy by one researcher and for authenticity by the participants. After the transcripts were anonymized, they were imported into the NVivo8 software package (QSR International Pty Ltd, Doncaster, Victoria, Australia). Three authors (J.J., L.H., and B.M-V.) analyzed and discussed the transcripts thematically according to the guidelines of Braun and Clarke27 until consensus was reached regarding codes and themes. This analysis was presented to the fourth researcher (T.H.) to ensure a comprehensive understanding of the data without bias had been reached. Interpretative bias was reduced by the varying backgrounds of the researchers involved: 2 researchers (J.J. and L.H.) are physical therapists, 1 researcher (B.M-V.) is a disability sociologist, and the fourth researcher (T.H.) works in the higher education research field. Three researchers (L.H., B.M-V., and T.H.) are experienced qualitative researchers.
Data triangulation was done by combining all qualitative data collected; more detailed information is presented in Table 1. This study focused on the experiences of the physical therapists; therefore, individual interview data were analyzed first, and the other sources (field notes and reflections of PAR groups) were used to verify the themes arising from the interview data.24 To further ensure rigor and trustworthiness, the themes found were discussed and verified in 2 focus groups consisting of participants (n=2 and n=4) and were presented to the physical therapy department of the hospital for comment.
Protocol for Thematic Analysis
In this article, quotes of the individual physical therapists (PT) are referenced by the level of clinical experience (CE) and the level of their education in research (RE). A high CE is listed when a physical therapist had more than 10 years of clinical experience, and a high RE means that the clinician held a bachelor's degree or higher.
Quantitative data are presented as means, standard deviation, medians, and ranges. Missing values were treated as missing: when a value was missing, it was not included in the calculation of the median or the range. When a value was missing in the EROS scale, the completed answers were totaled and divided by the number of completed answers. Due to the small sample size of this study, further analysis was not appropriate.
Role of the Funding Sources
Funding for this project was provided by Burwood Academy of Independent Living and the University of Otago.
Results
Four men and 21 women (mean age=38 years, range=22–57) were included. They were registered as a physical therapist for a mean period of 15 years (range=0–34) and had varied experience in research and clinical experience. More information is presented in Table 2. Interested participants (13 physical therapists and 1 manager) formed 3 PAR groups, and each group conducted its own research project (presented as cases 1–3). The 11 remaining participants who decided not to participate in a PAR project also were collated in a group (presented as case 4). Interestingly, this latter case reported the highest levels of confidence in research at the start of the study (median=54) compared with the other 3 cases (median=24, 28, and 19, respectively, for cases 1, 2, and 3) (Tab. 3).
Demographic Details of Participants Prior to the Intervention
Overview of Measurements for Quantitative Questionnaires
During the 1-year engagement intervention, the research facilitator assumed different roles. These roles varied from providing examples for grants applications to discussing options with management to providing encouragement and motivation throughout the project. The practical input from the research facilitator also varied among cases due to different interests of the participants. In case 1 (n=3), attention was focused on the academic aspects of research, such as completing a human ethics application form (research participation), whereas in case 3 (n=3), attention was concentrated on the use of research in practice, such as retrieving an article from a database (research utilization). In case 2 (n=8), assistance was required regarding the research utilization and participation aspects. Cases 1 and 4 contained more full-time working physical therapists with bachelor's degrees than cases 2 and 3. In cases 2 and 3, this situation was inversed: the majority of participants were working part-time with a diploma. Case 1 included physical therapists within the same age range and years of experience, whereas there was large variation in age and clinical experience within cases 2, 3, and 4.
After the 1-year engagement intervention was completed, one PAR group (case 1) had completed their research project and started the write-up phase of their project, one PAR group (case 2) had applied for all of the processes required to begin their research project but had not yet begun, and the last PAR group (case 3) had ceased working on their project but instead had hosted a journal club session. The remaining participating physical therapists (case 4, n=11) did not participate in any PAR project.
Table 3 and eFigures 1, 2, and 3 show the changes in participating physical therapists' confidence, motivation, and orientation toward research over the 2 years. The greatest increase in confidence and orientation toward research was observed in case 1 (eFigs. 1 and 3). With regard to confidence in research, cases 1, 2, and 3 showed an increase from the start of the project, whereas very little difference was evident in case 4. In contrast, all 4 cases demonstrated an increase in orientation toward research. Motivation declined slightly in case 1 where research was undertaken and in case 2 where the group had gotten ready to do research. However, for those participants who utilized research (case 3), motivation stayed the same, and for the participants in case 4, who did not do any research, motivation increased slightly.
Fifteen participants were interviewed (2 in case 1, 6 in case 2, 2 in case 3, and 5 in case 4). Thematic analysis revealed 3 important themes (mind-set, relationships, and structure) regarding the success of the engagement intervention, the subthemes of which are displayed in Table 4. In the following sections, these themes are presented.
Themes and Subthemes From Thematic Analysis
Theme 1: Mind-set
The mind-set of the hospital and the physical therapists toward research proved to be important. The hospital where the intervention took place was not in an academic setting, and conducting research was not part of daily practice, although some physical therapists of case 4 were active in research. Despite the fact that the engagement intervention was approved and seen as beneficial, the option to reduce participants' workload was not available, and physical therapists conducted their study in addition to their clinical load.
The participants perceived conducting a research project as a “big and complicated” process (reflective meetings, cases 1–4) and experienced difficulties commencing a project, but openness to become involved varied among the physical therapists. The physical therapists in case 1 and half those in case 2 acknowledged that they “would like to have a go at doing something from start to finish” (reflective meetings, cases 1 and 2) and were curious to learn about conducting a research project, whereas the physical therapists in case 3 and half of those in case 2 were more interested “to help” (reflective meetings, cases 2 and 3) and wanted to learn more basic research skills first.
The level of physical therapists' research skills also appeared to play a role in the openness to participate in a research project, as most of the physical therapists willing to participate in a research project were junior physical therapists with bachelor's degrees. Most of the physical therapists of case 3 and some of case 2 were senior physical therapists with diplomas. The difference in research training showed when one of the senior physical therapists had asked a student to find certain articles:
It took her about an hour to find what she wanted, and it took me weeks when I was doing the research…30 years ago, I just didn't train like that. (participant, case 2, CE high, RE low, PT 18)
In contrast, some physical therapists of case 4 chose not to participate in the PAR projects, despite the fact that they were experienced in conducting research. Relationships among physical therapists and between physical therapists and managers or leaders in their area (presented in the theme “relationships”) and the lack of time (presented in the theme “structure”) appeared to have played a role in this result.
In summary, the perceptions of the hospital and the physical therapists toward research and level of physical therapists' research skills proved to be crucial to the success of the projects undertaken.
Theme 2: Relationships
Relationships among physical therapists and between physical therapists and managers appeared important. Where physical therapists felt supported by management in daily practice, as in case 1, participation in research was more successful than for physical therapists who felt let down by management (case 4). For example, a negative outcome of a pay review was frequently mentioned by case 4 participants as a reason not to participate in the PAR projects.
I guess I'm expecting managers to show some support. Not just that they encourage the idea of research, but that there's value placed on it within the service, within physical therapy. So that needs time, which means time away from patients. (participant, case 4, CE high, RE high, PT 3)
Not only relationships with management, but also relationships among physical therapists proved to be very influential. Differences in research skills between senior and junior physical therapists clashed with the existing relationships and hierarchies in the hospital. For example, normally, more clinically experienced physical therapists were in charge of daily practice; however, in the case of the research projects, the less clinically experienced physical therapists were often more knowledgeable, sometimes resulting in frustration.
There we are with 6 or 7 clinicians, can't even make a decision 9 months down the track. That's before we've even gone on to the research. (participant, case 2, CE high, RE low, PT 15)
The relationships in the PAR groups also appeared to be less challenged when research projects were conducted by participants who were of a similar mind-set, as is demonstrated by a quote from one of the physical therapists in case 1.
Working with the team has been really successful. So I feel that that's part of the reason why it became doable because there were 3 of us working on it, as well as your guidance, being the fourth. But…we were able to brainstorm, bounce ideas [off each other], and dish out work. So it wasn't all on your shoulders to finish the…you know. (participant case 1, CE low, RE high, PT 2)
Observational data noted that managers or physical therapists who were leaders in their area also played a major role in the uptake of the PAR projects. In cases where the manager or lead physical therapists were interested in the PAR projects, more junior staff followed (case 2). In cases where the manager or lead physical therapists were less interested, independent of the fact of whether they were already research- active or not, junior staff tended not to participate in a PAR project.
In summary, relationships between physical therapists and managers or leaders in the physical therapists' area play an important role in the participation in research.
Theme 3: Structure
The theme “structure” became apparent in the hospital and in the PAR cases. Participants in cases 2, 3, and 4 saw the structure of the hospital as restricting (reflective meetings). It was not possible for some participants to make time for a research project because they were working on a ward (“From the moment I get here, I'm kind of working, the time factor is very very big and I cannot commit to anything outside of my working hours.” [participant, case 3, CE high, RE low, PT 19]) or on other research activities (“When you've got your head full of your own research, there's only so much you can take on board of what everyone else is doing.” [participant, case 4, CE high, RE high, PT 23]).
Others experienced that the bureaucracy within the hospital limited the development of the research project (“It almost suffocates itself really with the red tape and how many people it has to go through, and then you have to wait for it all to come back again.” [participant Case 2, CE low, RE high, PT 13]). On the other hand, some participants were grateful for the time being allowed to be allocated to the project (“We were allowed to prioritise this as something we wanted to do, and we were allowed to allocate time.” [participant, case 1, CE low, RE high, PT 2]).
Within the PAR projects, 3 structures were important for the success of the studies: (1) keeping an agenda for the meetings, (2) appointing a leader, and (3) breaking the research processes into smaller, more manageable steps. In case 1, all 3 structures were implemented at the start of the project, and the project was well executed, as one of the participants acknowledged:
Our research leader has been really instrumental with taking the minutes as part of her objective, so she's minuted every meeting; she's e-mailed them to all of us. It's kept us up to date, it's reminded us about what we needed to and when we're meeting next. That's good communication.” (participant, case 1, CE low, RE high, PT 2)
In case 2, this leadership was lacking at the commencement of the project, and the overall progress of the project was limited. These findings were possibly a result of changed relationships among clinical colleagues. However, when some of the participants stepped down and a leader was chosen, the project took shape and participants became excited.
Once that everyone knew their role, they worked hard to achieve that role, and I think it was more manageable. I think it was more bite-size, and we were trying to not do as big jumps. We were trying to keep it more manageable; it worked. Phenomenal. (participant, case 2, CE low, RE high, PT 13)
In summary, the existing structure of the hospital as well as the newly created structure within the PAR groups can have an effect on the success of the projects.
Discussion
This study, using a concurrent mixed-method research design, demonstrated that a PAR approach to engage physical therapists in clinic research was mostly successful. The qualitative findings of this study showed a 1-year PAR approach positively encouraged some physical therapists to stimulate research participation in a hospital setting; one PAR group of clinicians completed their study (case 1), and another PAR group managed to get organized to start (case 2). The quantitative data complemented the qualitative findings by showing an increase in the physical therapists' orientation toward research and confidence in conducting research (in case 1, confidence doubled over the 1-year intervention, from 26 to 67 on a 100-mm VAS).
Interestingly, in cases 3 and 4, participants also showed an increase in orientation toward research (EROS scores increased from 3.4 to 3.6), despite not being directly involved in research; one PAR group failed to initiate a research project and focused on research utilization instead (case 3), and one group did not participate in any PAR study (case 4). An argument can be made that the presence of a research facilitator in this hospital for 1 year might have had an effect on the physical therapists' improved perception of research and that the PAR studies were not necessary. Relationships between managers and the physical therapists improved over the course of the research study, implying that the change in orientation toward research was not solely attributable to the presence of a research facilitator.
The thematic analysis revealed 3 themes that appear important for successful implementation of the PAR approach to increase research productivity: mind-set, relationships, and structure. These themes are discussed below.
The mind-set of the physical therapists was important; some therapists appeared ready to conduct research and successfully engaged with the research process, whereas others were not ready, and their projects floundered. Literature from evidence-based practice and the use of research in practice also showed the attitude of the clinicians to be crucial for the introduction of research in clinical settings.7,28,29 A theory frequently used in the research utilization literature, Rogers' theory,30 argues that people in a system adopt an innovation at different rates, which appeared to be the case in this study, as some participants were in a mind-set ready to start, whereas others were not.
Furthermore, in the present study, a PAR group proved to be most successful when physical therapists shared a similar mind-set, as in case 1. Having differing mind-sets, such as in case 2, delayed the research process, as the physical therapists working together needed to first agree on the meaning of research, a process described by Wenger as “negotiation of the meaning” of practice.31(p64)
The second theme related to relationships among physical therapists and between physical therapists and managers. The organizational culture of a hospital has been shown to influence the uptake of research.32–35 Barnard and Wiles34 found that junior physical therapists sometimes felt discouraged by peers or managers to change certain aspects of practice when new evidence was published. LeGris et al35 found that the managers and clinicians with a lot of clinical experience who had spent a considerable amount of time in the hospital setting had less experience and knowledge of the research processes, and this limitation negatively influenced the instigation of research.
The type and quality of the relationships among physical therapists were found to affect the success of the research projects, epitomized by case 2. The junior physical therapists in case 2 held research skills and knowledge of how to set up a research project (these physical therapists held bachelor's degrees and scored higher in confidence and orientation toward research than their senior colleagues); however, they did not feel able to lead the project because they did not want to change the relationship they had with their more senior colleagues (data from interviews and observations). On the other hand, the senior physical therapists knew how to lead a project but were unfamiliar with the steps to conduct research (these physical therapists held diplomas and scored lower in confidence and orientation toward research than their junior colleagues).
Paradoxically, we saw the opposite in case 4, where some senior physical therapists were knowledgeable about research and had research confidence (quantitative data) but did not participate in the PAR project because of other relational and structural issues (qualitative data). Their staff was seen to be less involved in the PAR projects as well (case 4). This finding emphasizes the important effect a leader can have on his or her colleagues.30
The final theme concerned the structure of the hospital and the implementation of structure to guide the research process. The influence of hospital policies and processes on research involvement also has been reported by other authors.11,15,29 A lack of time and high workload (set by the hospital) were frequently mentioned by physical therapists from Sweden and Australia.11,15,29 Despite the barrier of structure in the hospital, the physical therapists found the implementation of structure in the PAR project to be crucial for success. A group of clinical nurses who conducted their first research study recommended applying structure in the form of prearranged meetings and the development of documents as important for the success of their study.36 Other authors37 identified structures such as setting time limitations for discussion points and keeping minutes as crucial to keep the research project progressing. The findings from this study appear to be in line with these findings.
The themes “relationship” and “structure” have been linked by Wenger.31 He argued that in order to create a sustainable (research) community, participants need to be able to participate in the group (relationships) and they require appropriate structure.
This study was strengthened by the use of multiple qualitative and quantitative data sources. The use of a PAR approach to stimulate research participation further created the opportunity for an in-depth description of the events that occurred during the study,24 in addition to a lasting research experience in the physical therapy profession of this hospital. Limitations included the fact that only physical therapists, and no other health care professionals, were included in this study and the fact that the physical therapists all worked at the same hospital. Thus, the findings of this study pertain to the characteristics of this hospital, as well as the cultural aspects of the country where this research was conducted. Other hospitals in the same country or in different countries might not have the same characteristics.
Further research in this area is needed. Due to the lack of research on physical therapists' attitudes toward research and research capacity, the profession would benefit from more in-depth qualitative research into these characteristics. As the initial EROS measurements reported in the current study bordered on the lower margins of the findings presented in the literature and confirmed the findings of Stephens et al,14 which documented that physical therapists held one of the lowest attitude scores toward research in the health care professions, more in-depth research as to why these findings occur is needed. Also, current research advises the building of research capacity in multidisciplinary teams,38 as this is the environment in which physical therapists work. The utility of using a PAR approach to facilitate physical therapists (but also other clinicians) to conduct research in their setting needs to be explored in multiple clinical environments.
Conclusion
A PAR approach can be used to stimulate the research participation of clinical physical therapists. Physical therapists held the most positive experiences when they had some prior research knowledge, they were working with others holding the same mind-set, their leaders were positive about research, structures in the hospital were not seen as restricting, and a research structure to adhere to was implemented. Therefore, mind-set, relationships, and structure play a crucial role in stimulating physical therapists to become research-active. As these factors can limit the potential of commencing a research project, we advise clinicians to start the project with a small group of people who have the same commitments and ideas. Before starting, some decisions must be made, such as who will lead the group, assigning roles to all group members, and deciding on the ranking of authors on possible publications. Discussion with management to negotiate resource issues (eg, time and funding) is essential.
Footnotes
All authors supplied concept/idea/research design and data analysis. Dr Janssen, Dr Hale, and Dr Harland provided writing. Dr Janssen provided data collection and study participants. Dr Janssen and Dr Harland provided project management. Dr Janssen and Dr Hale provided fund procurement. Dr Hale and Dr Mirfin-Veitch provided consultation (including review of manuscript before submission). The authors thank the physical therapists who participated in this project.
Funding for this project was provided by Burwood Academy of Independent Living and the University of Otago.
The Upper South A Regional Ethics Committee, New Zealand, approved this study.
- Received January 20, 2012.
- Accepted April 1, 2013.
- © 2013 American Physical Therapy Association
References
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