Embedding research capacity strengthening in multi-country studies in low-and middle-income countries: learnings from sexual and reproductive health research

Figures & data

Figure 1. Modified conceptual framework for multi-county embedded RCS initiative [35].

Table 1. Concepts included in the framework for embedded research capacity strengthening.

Concept	Definition
Research capacity needs	Refers to the expressed needs for developing individual knowledge and skills in conducting research and actively engaging in the research process. It includes conducting local research capacity needs assessments and establishing a national research agenda. It helps country teams to develop their priority agenda-setting skills and assess their needs for theoretical and technical knowledge for conducting the research. Specific attention should be made for needs relating to SRHR-related research topics and areas. As an example, coordinators/conveners of a multi-country study may want to implement a needs assessment survey with all country research teams (including data collectors) to understand potential training needs and knowledge gaps to allow for development of courses or workshops or secure access to training programmes available to all. This should go beyond training specific to the study (i.e. training on protocol implementation).
Support for researchers	Speaks to the need for having an enabling environment for the implementation of research. These include national and sub-national policies that support research, and especially as these relate to SRHR when applicable. Oftentimes, study implementers in a multi-country study have to juggle multiple tasks and obligations, including but not limited to clinical practice. Research teams can include funds and time allocation in their study workplans for research-related activities (i.e. data analysis, manuscript writing, dissemination) to ensure researchers have the time and space to conduct all these actions.
Feedback	Refers to the need for all stakeholders in the research study (e.g. community members participants including women, individuals with diverse sexual orientation, gender identity, gender expression and sex characteristics (SOGIESC), as well as PIs, project managers, data collectors, policymakers) to be included in results dissemination activities in a timely manner and to support sharing of the same to the communities being researched. Research teams set aside time and funds for dissemination activities that go beyond academic (i.e. through peer-reviewed manuscripts) or institutional circles (i.e. through internal reports) to include the broader community ensuring everyone participating in the study is privy to the findings and can provide input on what is being studied and found.
Ownership	Relates to the relevance of the study to the researchers’ context and to the fact that their participation in the study design and implementation was deemed critical to the overall execution. This relates to involvement throughout the entire research process from conceptualization of grant proposal or fundraising, planning and designing the study protocol, implementation of study and fieldwork, to data analysis, writing, and dissemination of findings via publication in journals and other outlets. For example, through open calls for research prioritization and protocol development processes with a mandate to include communities impacted by the study aims, as well as country researchers and policymakers. These would then make up the broader research study team engaged throughout the research process from conceptualization to dissemination of results.
Power dynamics	This relates to considerations for the potential effect of power differentials (e.g. in funding and roles) that can influence project design and implementation, and in individual RCS. Among others, one example could focus on ensuring conversations around team composition and roles, and manuscript authorship from the very start that include considerations for equitable representation according to gender, seniority, and affiliation.

Table 2. Suggested actions for embedding RCS into multi-country research, including sexual and reproductive health and rights (SRHR) research.

1. Involve local researchers and communities throughout all research process, from research question, proposal planning, to protocol development that, in turn, respond to national health needs and priorities.	● Ensure engagement of investigators and the community in all aspects of the research process, aiming for co-creation of research agenda setting, research proposals, grant applications, and protocol development. ● Support local researchers aiming to address critical SRHR topics that may not be reflected in national priorities (e.g. abortion or female genital mutilation). ● Conduct a needs assessment to understand and adapt research projects that respond to the health needs of each context, including on SRHR topics that may not be initially prioritized. ● Advocate for funding agencies to support SRHR research that responds to local needs and not institutional priorities such that the above can be executed.
2. Integrate SRHR research training activities into study design and allocate sufficient resources for it.	● Include RCS objectives into the research protocol to ensure activities are both conducted and reported on. ● Consider attaching local masters or doctoral students in the implementation of the study in their country, to conduct further analyses and lead in publications, as part of their degree programmes. ● Conduct needs assessments prior to research implementation to inform how best to tailor training offerings to bridge identified gaps and include opportunities for learning on intersectional aspects relating to SRHR issues including gender equality and human rights. Training should be made available to all cadres and genders of study teams and on topics covering the entire research process, from conception to dissemination of results, as well as on SRHR subject areas. ● Include financial resources for training and to allow for protected time for those involved in research training when budgeting for study costs. ● Consider online platforms for training activities that are affordable, more time efficient, and can overcome difficulties in travelling. ● Consider involving relevant research study members in the development of training materials and manuals, including leading development of versions in local languages, essential in ensuring SRHR aspects are addressed in a culturally relevant way. ● Plan to measure the effectiveness of the training activities, using rigorous methods depending on appropriateness and need. For example, pre- and post-test surveys can be used to measure short-term impact and satisfaction, while ongoing monitoring – including but not limited to assessing research production from local research teams – can shed light on longer-term and sustainable strengthened capacity. We encourage issuing training certificates to participants who meet pre-specified level of achievement in these activities.
3. Support country-led publication of results in international, peer-reviewed, highly respected journals.	● Ensure authorship is discussed and joint terms of reference for manuscript preparation are formulated before implementing the study, based on guidance provided by the ICMJE [49], while promoting gender equality in authorship and offering opportunities for junior researchers to lead in publications. ● Include financial provisions to support country teams to obtain access to online peer-reviewed journals and for publishing open-access manuscripts to support wider access to knowledge. ● Consider language barriers in both access to publications and writing of results for peer-reviewed journals, promoting diverse manuscript writing groups where identified barriers can be overcome by leveraging group members’ individual capacities. ● Advocate for the removal of publication barriers posed by journals through article processing charges and language requirements. For example, consider abiding by Coalition S requirement that scientific publications resulting from research funded by public grants be published as open access publications [50]. ● Request that all publications resulting from the study include authors from the participating countries, including in first and last author positions. No publications should ignore participating country researchers.
4. Support activities to strengthen research infrastructure and provide an enabling SRHR research environment.	● Allocate funding for “protected time” for sexual and reproductive health clinicians (e.g. medical doctors, nurses, midwives) engaging in research studies beyond their clinical responsibilities so that they can truly engage in the research study. ● Support and collaborate with national institutions in fundraising for country led SRHR research studies. ● Include provisions for building the local research infrastructure, such as the capacity of research ethics committees to best respond to SRHR research needs and different research methods, and availability of resources needed for research (e.g. access to peer-reviewed literature, data analysis software). ● Advocate for a more SRHR research enabling environment among funders, parliamentarians, civil society organizations, among others.
5. Address power dynamics in local research teams.	● Ensure local data sets are owned by countries, allowing country study teams to access, manage, and analyse the data as fully as possible. ● Promote the development and strengthening of SRHR networks and exchanges within and across country research teams. ● Ensure gender equality and balance, as well as opportunities for junior researchers, in research leadership and decision-making positions. ● Secure feedback mechanisms throughout project planning and implementation to ensure that researchers are abreast of research progress and results. ● Support the search for national or regional financial sponsorship to break the imbalance between researchers from HIC and LMIC and increase autonomy. ● Include reflexivity statements such as the one suggested by Morton and colleagues [51] that openly address existing power imbalances in research results write-ups.
6. Monitor and evaluate the implementation of embedded RCS.	● Evaluate the RCS interventions for efficacy and impact and develop indicators for measurement of impact. ● Share the lessons learnt and evidence generated with the global communities of practice via various dissemination platforms. ● Design an overarching theory of change for RCS to guide the change process and generate more evidence of change occasioned by the intervention in long-term embedded RCS projects. ● Assess engagement in SRHR research by national institutions following participation in RCS activities.
7. Designate specified funds for RCS support in all SRHR research study budgets.	● Ensure funds are set aside or specific fundraising is initiated to support teams in conducting secondary analyses or ancillary studies that extend beyond the primary data collection phase. ● Facilitate linkages between teaching and research institutions for sustained local skills building in research methodology and analysis, especially for understudied SRHR topics. ● Foster the building of sustainable research networks among country teams to implement subsequent multi-site research. ● Advocate for investments in national health research institutions and researchers as a way to stimulate them as protagonists for gaining scientific independence, especially by governments and national agencies from LMICs.

Table 3. Checklist for planning and evaluating embedded research capacity strengthening (RCS) in multi-country studies, including sexual and reproductive health and rights (SRHR) studies.

Level	Suggested Action	Completed?	N/A
1. Individual level RCS actions	1. Develop embedded RCS activities that both contribute to agenda setting and the study goal and RCS objective	□	□
	2. Include a training needs assessment for researchers before study initiation	□	□
	3. Tailor activities to meet specific training needs of different cadres of researchers from the data collection team to senior researchers with considerations of SRHR specific issues	□	□
	4. Empower country researchers, including junior researchers and individuals from underrepresented groups as leaders for their teams as appropriate	□	□
	5. Promote gender equality and balance in study research leadership and decision-making positions	□	□
	6. Promote networks and exchanges across country research teams and across multiple countries	□	□
2. Institutional level RCS actions	7. Design project with a theory of change explaining how institutional level RCS will occur	□	□
	8. Evaluate the implementation of RCS interventions and their impact.	□	□
	9. Build the capacity of research ethics committees to assess research protocols and to improve ethics knowledge of research teams	□	□
	10. Assign master’s and PhD students to conduct the analyses and publications in ongoing multi-country studies for sustainable capacity building	□	□
3. National context RCS actions	11. Strengthen national research systems when designing embedded SRHR RCS interventions in LMIC	□	□
	12. Asses the national research capacity strengthening needs and priorities for research including on SRHR critical topics	□	□
	13. Share the lessons learnt with the global community via various dissemination platforms	□	□
	14. Generate and disseminate evidence regarding effectiveness of the planned RCS intervention at national and regional level (including dissemination to civil society organizations)	□	□
	15. Assess uptake of SRHR research by institutions participating in the multi-country studies including embedded RCS activities	□	□

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