‘We always find things to learn from.’ Lessons from the implementation of the global maternal sepsis study on research capacity: a qualitative study

BACKGROUND: Research capacity strengthening could be an indirect outcome of implementing a research project. The objective of this study was to explore the ability of the global maternal sepsis study (GLOSS), implemented in 52 countries, to develop and strengthen sexual and reproductive health research capacity of local participants in low- and middle- income participating countries. METHODS: We carried out a qualitative study employing grounded theory in sixteen countries in Africa and Latin America. We used inductive and deductive methods through a focus group discussion and semi-structured interviews for the emergence of themes. Participants of the focus group discussion (n = 8) were GLOSS principal investigators (PIs) in Latin America. Interviewees (n = 63) were selected by the country GLOSS PIs in both Africa and Latin America, and included a diverse sample of participants involved in different aspects of study implementation. Eighty-two percent of the participants were health workers. We developed a conceptual framework that took into consideration data obtained from the focus group and refined it based on data from the interviews. RESULTS: Six themes emerged from the data analysis: recognized need for research capacity, unintended effects of participating in research, perceived ownership and linkage with the research study, being just data collectors, belonging to an institution that supports and fosters research, and presenting study results back to study implementers. Research capacity strengthening needs were consistently highlighted including involvement in protocol development, training and technical support, data analysis, and project management. The need for institutional support for researchers to conduct research was also emphasised. CONCLUSION: This study suggests that research capacity strengthening of local researchers was an unintentional outcome of the large multi-country study on maternal sepsis. However, for sustainable research capacity to be built, study coordinators and funders need to deliberately plan for it, addressing needs at both the individual and institutional level. This was a qualitative study based on concepts from grounded theory which used a focus group discussion and semi-structured interviews to gather in-depth insights from participants [11]. We have used the Consolidated Criteria for Reporting Qualitative research (COREQ) for qualitative studies for this report [12] (Additional file 2). Sixteen countries were purposively selected from those participating in GLOSS across three of the study regions: Anglophone Africa, Francophone Africa, and Latin America. The selection of countries within those regions was based on the following criteria: was a GLOSS participating country [9], was a priority country for research capacity strengthening for the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) [13], had previous experience in multi-country research with HRP, feasibility and ease of travel, interest and availability to participate, and representability for each region in terms of geographic and language diversities. Participants in this study were members of local research teams that took part in GLOSS. For the focus group discussion (FGD), we selected a convenience sample of participants who were GLOSS principal investigators (PI) for Latin America. The FGD participants were taking part in a study results workshop in Brazil in 2018. For the interviews we first selected three countries per study region: Anglophone Africa (Kenya, Malawi, and Zimbabwe), Francophone Africa (Benin, Mali, and Senegal) and Latin America (Guatemala, Honduras, and Nicaragua). Then, participants were selected by each country PI and included a diverse sample of interviewees involved in different aspects of study implementation, ranging from data collectors to study coordinators, and from different health facilities, oftentimes located in different country localities. We sought for gender diversity and aimed to interview at least five people per country until we achieved data saturation. A thematic guide for the FGD was developed based on existing frameworks for evaluation of RCS [3, 14–16]. The following a priori themes based on the existing literature were identified as specific areas for exploration during the FGDs: opportunities and challenges with regards to embedded RCS, experience with research, and institutional support. The FGD was moderated by a senior researcher who had not been part of GLOSS and observed by a member of the GLOSS research team. The FGD was conducted in Spanish and had eight participants. It lasted 2 h, and was audio recorded and transcribed verbatim into Spanish. Additional notes taken by the moderator and observer were used in the interpretation of findings. See Additional file 3 for a copy of the FGD guide. Preliminary findings from the focus group discussion were used to develop the semi-structured interview guide. All interviewers participated in an online workshop to standardize data collection. Three researchers conducted 63 semi-structured interviews in total, each lasting on average 42 min (range 21–65 min) and completed during site visits to interviewees’ respective work settings. Twenty interviews were in English (8 in Kenya, 6 in Malawi, and 6 in Zimbabwe), 26 in French (9 in Benin, 11 in Mali, and 6 in Senegal), and 17 in Spanish (5 in Guatemala, 5 in Honduras, and 7 in Nicaragua). Sixty-one interviews were conducted face-to-face and two over the phone. The latter were not recorded because of technical difficulties but hand-written notes were used for the analysis. Interviews in Latin America were conducted in December 2018, in Francophone Africa between March and June 2019, and in Anglophone Africa between April and September 2019. Interviews covered broad questions on participants’ role with GLOSS and prior experience with research, and about opportunities and challenges faced with study implementation and its ability to strengthen research and clinical capacity. Certain socio-demographic data were collected for all focus group participants and interviewees (sex, occupation, place of work) for categorization purposes only. See Additional file 4 for a copy of the interview guide. VB knew all PIs in Latin America participating in the FGD; VB also knew two PIs and two project managers interviewed by her from her role in GLOSS. RC knew all the PIs in Francophone Africa from previous WHO projects (N = 3). None of the other interviewees (N = 56) were known to any of the interviewers. All interviewers and FGD moderator had experience with qualitative research and in leading these activities. Interviews were conducted individually and confidentially in a private space within participants’ work settings and in the native or the official language spoken in each of the countries (English, French or Spanish) and by each of the interviewers. Interviews were recorded using a digital voice recorder to facilitate analysis after obtaining participants’ permission, and transcribed verbatim. Excerpts of the transcripts in French and Spanish were translated into English to enable joint team analysis. All transcripts were anonymised to remove identifying information for participants before uploading to a central secure portal for the team to access. We used inductive and deductive methods using thematic data analysis starting with a priori themes identified from existing literature and refined in a first instance with findings from the FGD and further, at a second stage, with additional emergent themes that arose from the interviews. Examples of emergent themes were: “we were just data collectors” and unintended effects of research. These then informed the final coding used for the analysis of all FGD and interview data. Atlas.ti (version 8.4.18.0 for Windows) was used for the analysis. To ensure rigour, initial coding and analyses were done by each researcher who led the activity in the respective countries and in the original language after verifying the accuracy of transcripts. Transcripts were coded to identify quotes corresponding to the initial themes in our analysis framework. This coding was then cross-checked by another team member fluent in the language: focus group discussions (ALG and VB), interviews in Spanish (ALG, MB, and VB), interviews in French (MB and RC), and interviews in English (AB and AK), during a validation workshop. A final check was done by four researchers (AB, AK, RC, and VB) to ensure the consistency of the quotes included in this manuscript. We did not involve participants directly in this study. However, PIs in each study country helped in organizing site visits, getting needed approvals, and in selecting and contacting participants. Initial findings from this study were shared with all country PIs so that they could extend to the study participants to ensure that everyone agreed with our findings before manuscript submission.