Developing strategies to enhance health services research capacity in a predominantly rural Canadian health authority

Context: This article outlines the planning, implementation and preliminary evaluation of a research capacity building (RCB) initiative within a predominantly rural Canadian health authority, Interior Health (IH), including initiative characteristics and key activities designed to initiate and enhance health services research capacity within the organization. Interior Health is one of 5 geographic health authorities in British Columbia. Over half of the population IH serves is considered to be rural/remote (approximately 3 people/km 2 ), contributing to difficulties in sharing research information (ie geographical distance to meet inperson and a diverse set of needs and/or priority topics that warrant research support). An initial assessment of IH research capacity in 2006, using an organizational self-assessment tool and discussions with key stakeholders, revealed a need for enhanced communication of health research results, research education and networking opportunities for staff at all levels of the organization. Staff noted barriers to using and sharing research such as lack of time, resources and skills for, and value placed on, participating in research, as well as lack of awareness of linkages with local academic health researchers, including faculty located at two universities within the region. In response to this baseline assessment and stakeholder feedback, short-term funding has allowed for the initial development of RCB strategies in both urban and rural/remote areas of the region, including: IH Research Brown Bag Lunch Seminars; IH Research Skills Workshop Series; literature syntheses/summaries on priority topic areas; research

collaboration/partnerships with health authorities, research networks and academic researchers; and an annual IH Research Conference.
Issue: Although currently a poorly defined term, RCB is a concept that speaks to the need for improvement in the skills and assets that can facilitate the production and application research.It is difficult to gauge the progress of RCB initiatives when there is debate as to what the optimal outcomes and indicators of success are.Most definitions of RCB have focused on enhancing the ability to do research; however, there appears to be growing support for a more inclusive definition that also addresses the ability to use and apply research.The use and application of existing research findings, often referred to as knowledge translation and exchange (KTE), is one means of building organizational research capacity, and is particularly important within a rural health region where time, resources, and research skills are often limited.
Lessons learned: Dedicated RCB resources and staff support, as well as enthusiasm, academic partnerships, and identification of research 'champions' within the organization, have been critical in building research capacity within the region.Video-and teleconferencing, as well as webcasts, have allowed for expansion of RCB activities to rural/remote communities.Preliminary evaluation parameters to date suggest that the information translated during the RCB activities is motivating different groups within IH to initiate their own research and/or KTE strategies.Although preliminary results indicate improvements in research capacity within the organization, barriers to research participation such as time, funding, and communication are still evident 3 years post-implementation.Additional challenges to building research capacity within a rural health authority include geographical distances, diverse 'hot'/priority topics in need of research support, lack of protected time and limited research-related human resource capacity.The translation of research evidence and enhancement of staff research skills through the IH RCB initiatives has helped to achieve new standards of excellence in the planning, management and delivery of all health services across the predominantly rural health authority.Key words: Canada, facilitation, health authority, health services research, knowledge translation, research capacity.

Context
A strong healthcare system is driven by solid, researchinformed management and policy decisions 1 .However, current literature on the use of existing research demonstrates haphazard, inconsistent, and unpredictable uptake of evidence in the clinical setting 2 , in part due to a lack of capacity to participate in research activities.Successful translation of research to practice or decisionmaking considers the level and/or type of evidence, the context in which it is transferred and the method of facilitation 3,4 : the latter two factors create key challenges in rural settings (ie geographical distance to meet in-person and a diverse set of needs and/or priority topics that warrant research support).This article outlines the planning, implementation and preliminary evaluation of a Research Capacity Building (RCB) initiative in Interior Health (IH), a predominantly rural health authority in British Columbia (BC), Canada.This article describes the key characteristics and activities of the initiative that are designed to initiate and enhance research capacity within the organization and may be translated to and/or adopted by other rural/remote health regions.
Interior Health is one of 5 geographic regional health authorities in BC, serving over 737 000 residents 5  opportunities for staff at all levels of the organization.Staff noted barriers to using and sharing research such as lack of time, resources and skills for, as well as value placed on participating in research activities in agreement with previous literature [10][11][12][13] .The majority of staff were unaware of possible linkages with local academic health researchers, including faculty located at two universities within the region.In response to this initial assessment, numerous RCB activities within the health authority were implemented and are currently being evaluated by the IH RCB team.Building research capacity within a regional health authority reflects the value of participating in research activities in addition and prior to publication in a high impact, peerreviewed journal.As one RCB participant comments:

Research [participation] provides an opportunity for life-long learning, it will help with staff retention and empower individuals…in acute and in residential
[settings].
More recent evaluation parameters, including those monitored by the IH RCB team, are assessing the capacity to both use and apply research.These approaches determine, for example, the productivity and impact of research by measuring the extent to which results are incorporated into practice and influence policy development 17 .The team has begun to modify an existing evaluation framework 14 in order to evaluate its RCB initiatives with a rural lens.As part of this evaluation, the team redistributed its self-assessment tool in order to begin to gauge its progress.Results from the 2008 needs assessment indicate small improvements in research capacity within the organization (ie increased knowledge of academic linkages).However, barriers to research participation such as time, funding, and communication are still evident 3 years post-implementation.These barriers are not surprising given that, on average, it takes several years to build research capacity 18,19 .
Additional evaluation components assess the impact to date of various RCB activities on IH health service policies and

Lessons learned
Although difficult to gauge success due to a lack of standard RCB definitions and evaluation methods, preliminary findings suggest that the provision of RCB opportunities is critical to enhancing health services research capacity within a regional health authority.Key findings from the needs assessment initially noted and continue to reveal a lack of resources for (specifically) time and funding, and A dedicated RCB team has helped to increase the awareness and use of research within the organization.The majority (90%) of needs assessment respondents felt well prepared to use research evidence in their decisions/practice as a result of the HACB funding.One stakeholder in the organization states: …interacting with the staff of the research team has stimulated my thinking in ways that no other individual in the organization has been able to.
Although I want my staff to be pulling the literature together and frequently distilling it into very useful information upon which to build decisions as a routine part of their work, there are times where the skills and abilities of the staff in the research department get to a much broader depth.
practices via immediate as well as follow-up activity-specific survey feedback is gathered from the RCB activity participants.Initial survey responses (n >700), along with key informant interview feedback, have been extremely positive regarding RCB activities over its initial period of implementation.The research skills training workshop series and Brown Bag Lunch research seminars consistently receive high scores with respect to evaluating the sessions' relevance and importance to participants' work as well as the value gained for the time spent at the session.
communication of research within the organization; however, staff are enthusiastic about applying research findings to their work in lieu of the fact that very few positions have protected time for research activities.This enthusiasm has been instrumental to the success of RCB activities to date, as evidenced by a high level of interest and demand/wait lists for RCB sessions.Identification of research 'champions' within the organization, particularly those in leadership roles, has been critical in building capacity.
Needs assessment respondents agree that local training events have increased the visibility of research within the region, for example the RCB team brought the workshops 'on the road' to staff in rural and remote communities.Technology have implemented research strategies in their program planning or consulted with the RCB team to review surveys, project charters and other planning documents.Based on the more recent evaluation work, staff in the organization cite examples of where evidence led to changes in the following IH programs and/or practices: RCB initiatives, targeting the activities to the appropriate audience, managing an increasing number of requests, and the detailed evaluation of RCB strategies employed thus far.Given the current economic climate, acquiring sustainable funding for RCB initiatives remains challenging not only within healthcare, but also in a number of different sectors.Although research governance (or lack thereof) often limits clinical staffs' participation in research activities, moreover a lack of human resource capacity to backfill positions is a key barrier for front line staff participation within Interior Health.Future initiatives will aim to address gaps identified by the second distribution of the self-assessment survey, stakeholder and activity feedback, with a particular focus on effective knowledge translation strategies for the communication of high priority and relevant research evidence to decision makers.Reflecting on the lack of evaluation and best practices/methodology for studying research capacity building, this article provides an overview of activities and preliminary successes in a predominantly rural Canadian health authority.Interior Health supports an organizational culture that strives for continual service improvement.Translating research evidence and building the research skills of IH staff through the RCB initiatives has helped to achieve new standards of excellence in the planning, management and delivery of all health services across the health authority.The use of evidence-informed decision making by IH in both policy and practice will have a significant impact on the communities it serves, ultimately raise the profile of health services research within the rural health authority, and promote a stronger health care organization.