title: What factors influence the production of orthopaedic research in East Africa? A qualitative analysis of interviews.
abstract: BACKGROUND
  Research addressing the burden of musculoskeletal disease in low- and middle-income countries does not reflect the magnitude of the epidemic in these countries as only 9% of the world's biomedical resources are devoted to addressing problems that affect the health of 90% of the world's population. Little is known regarding the barriers to and drivers of orthopaedic surgery research in such resource-poor settings, the knowledge of which would help direct specific interventions for increasing research capacity and help surgeons from high-income countries support the efforts of our colleagues in low- and middle-income countries.
  
  
  OBJECTIVE
  We sought to identify through surveying academic orthopaedic surgeons in East Africa: (1) barriers impeding research, (2) factors that support or drive research, and (3) factors that were identified by some surgeons as barriers and others as drivers (what we term barrier-driver overlap) as they considered the production of clinical research in resource-poor environments.
  
  
  METHODS
  Semistructured interviews were conducted with 21 orthopaedic surgeon faculty members at four academic medical centers in Ethiopia, Kenya, Tanzania, and Uganda. Qualitative content analysis of the interviews was conducted using methods based in grounded theory. Grounded theory begins with qualitative data, such as interview transcripts, and analyzes the data for repeated ideas or concepts which then are coded and grouped into categories which allow for identification of subjects or problems that may not have been apparent previously to the interviewer.
  
  
  RESULTS
  We identified and quantified 19 barriers to and 21 drivers of orthopaedic surgery research (mentioned n = 1688 and n = 1729, respectively). Resource, research process, and institutional domains were identified to categorize the barriers (n = 7, n = 5, n = 7, respectively) and drivers (n = 7, n = 8, n = 6, respectively). Resource barriers (46%) were discussed more often by interview subjects compared with the research process (26%) and institutional barriers (28%). Drivers of research discussed at least once were proportionally similar across the three domains. Some themes such as research ethics boards, technology, and literature access occurred with similar frequency as barriers to and drivers of orthopaedic surgery research.
  
  
  CONCLUSIONS
  The barriers we identified most often among East African academic orthopaedic faculty members focused on resources to accomplish research, followed by institutional barriers, and method or process barriers. Drivers to be fostered included a desire to effect change, collaboration with colleagues, and mentorship opportunities. The identified barriers and drivers of research in East Africa provide a targeted framework for interventions and collaborations with surgeons and organizations from high-resource settings looking to be involved in global health.
authors: Institute for Global Orthopaedics and Traumatology (IGOT), San Francisco General Hospital, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA, elliott.iain@gmail.com.
authors: Iain S
authors: IS
authors: Elliott
authors: Daniel B
authors: DB
authors: Sonshine
authors: Sina
authors: S
authors: Akhavan
authors: Angelique
authors: A
authors: Slade Shantz
authors: Amber
authors: A
authors: Caldwell
authors: Jesse
authors: J
authors: Slade Shantz
authors: Richard A
authors: RA
authors: Gosselin
authors: R Richard
authors: RR
authors: Coughlin
mesh_terms: D000328:Adult; D000351:Africa, Eastern / Q000453:epidemiology; D001291:Attitude of Health Personnel; D035843:Biomedical Research / Q000191:economics; D003299:Cooperative Behavior; D003906:Developing Countries / Q000191:economics; D006801:Humans; D033183:Interdisciplinary Communication; D007391:International Cooperation; D007407:Interviews as Topic; D008297:Male; D008611:Mentors; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D009985:Orthopedics / Q000191:economics; D036301:Qualitative Research; D012108:Research Personnel / Q000191:economics / Q000523:psychology; D012109:Research Support as Topic / Q000191:economics