Background

Primary health care systems around the world are going through reforms to adapt to the changing needs of the populations and their workforce [Macinko et al., Reference Macinko, de Fátima Marinho de Souza, Guanais and da Silva Simões2007; Canadian Institutes of Health Research (CIHR), 2013]. The term ‘community-based primary health care’ (CBPHC) emphasizes this important evolution to a more inclusive person-centered approach to primary health care delivered by multidisciplinary providers in diverse community-based settings. Research and innovation play a critical role in helping primary health care adapt to the increased need for complex management for chronic conditions and toward the vision of interdisciplinary team-based primary care homes. Effective training and mentorship for the next generation of CBPHC researchers are key for this movement to continue, and it is important for interdisciplinary and transdisciplinary research capacity (Choi and Pak, Reference Choi and Pak2006) to be developed strategically in the field of CBPHC.

Research mentoring programs and experiences have become increasingly recognized as important by those engaged in health research capacity building (Bennett et al., Reference Bennett, Paina, Kim, Agyepong, Chunharas, McIntyre and Nachuk2010; Stewart et al., Reference Stewart, Reid, Brown, Burge, Dicenso, Watt, McWilliam, Beaulieu and Meredith2010; Reference Stewart, Wuite, Ramsden, Burge, Beaulieu, Fortin, Godwin, Harris, Reid, Haggerty, Brown, Thomas and Wong2014). As a result, many studies have explored the role of mentorship in research training to learn about strategies for successful mentoring relationships, to understand the characteristics and actions of effective mentors and mentees, and to identify the characteristics of successful and failed mentoring relationships (Sambunjak et al., Reference Sambunjak, Straus and Marusic2006; Detsky and Baerlocher, Reference Detsky and Baerlocher2007; Straus et al., Reference Straus, Johnson, Marquez and Feldman2014). The findings demonstrate that successful mentoring relationships use a reciprocal model based on mutual respect and shared common values, with clear communication of needs, goals and expectations, and the planning of adequate time and methods for meaningful connection between mentor and mentee (Lach et al., Reference Lach, Hertz, Pomeroy, Resnick and Buckwalter2013). Whereas unsuccessful relationships are often characterized by poor communication, a lack of commitment to the mentorship, personality differences, conflicts of interest, and/or a mentor’s lack of experience (Straus et al., Reference Straus, Johnson, Marquez and Feldman2014). Incorporating these findings in the development and implementation of research training programs and initiatives to build CBPHC researchers’ capacity building programs is influential to their success.

Over the last 15 years, several important funding initiatives have been implemented to address the need to build primary health care researcher capacity. For example, the Transdisciplinary Understanding and Training on Research–Primary Health Care (TUTOR-PHC) program has been funded since 2003 to address this recognized need (Stewart et al., Reference Stewart, Reid, Brown, Burge, Dicenso, Watt, McWilliam, Beaulieu and Meredith2010). This transdisciplinary research capacity building program trains health care researchers and decision-makers from diverse disciplines and many geographic locations across Canada and abroad (Stewart et al., Reference Stewart, Reid, Brown, Burge, Dicenso, Watt, McWilliam, Beaulieu and Meredith2010) to develop interdisciplinary approaches to CBPHC research that actively integrate a variety of approaches to ensure positive outcomes (Choi and Pak, Reference Choi and Pak2006). Other organizations with a focus on health services and policy research have developed core competencies that have helped frame educational programs to prepare the next generation of leaders. Specifically, leaders in health services research have recommended a diverse array of competencies ranging from study design and data analysis to project management and knowledge translation (Bornstein et al., Reference Bornstein, Heritage, Chudak, Tamblyn, McMahon and Brown2018; Burgess et al., Reference Burgess, Menachemi and Maciejewski2018). Not as clear in such research mentorship programs are the roles to be played by the trainees themselves. While trainees receive guidance and teaching from their mentors, effective and meaningful capacity for responding adequately to the dynamic nature of CBPHC requires that trainees play a more active role in their education and preparation (Zea and Belgrave, Reference Zea and Belgrave2009). For example, peer-to-peer mentorship and advances in information technology provide suitable platforms for geographically dispersed trainees to be more connected and to form a supportive community.

In Spring 2013, the CIHR and its provincial partners funded a five-year Community-Based Primary Health Care Signature Initiative to support highly innovative approaches to improving the delivery of appropriate and high-quality CBPHC to Canadians (CIHR, 2013; Ben Charif et al., Reference Ben Charif, Hassani, Wong, Zomahoun, Fortin, Freitas, Katz, Kendall, Liddy, Nicholson, Petrovic, Ploeg and Légaré2018; Wong et al., Reference Wong, Langton, Katz, Fortin, Godwin, Green, Grunfeld, Hassani, Kendall, Liddy, Ploeg, Wodchis and Haggerty2018; Kendall et al., Reference Kendall, Fitzgerald, Kang, Wong, Katz, Fortin, Dionne, Kuluski, O’Brien, Ploeg, Crowe and Liddy2018). The CBPHC Signature Initiative supported 12 cross-jurisdictional and multidisciplinary research teams (12-Teams) with programs of research across Canada, which aimed to achieve four main objectives: (1) develop and compare innovative models for CBPHC delivery within Canada or internationally; (2) catalyze effective knowledge translation approaches to improve delivery of CBPHC in Canada or internationally; (3) evaluate and improve the impact of innovations for CBPHC; and (4) build interdisciplinary and interprofessional capacity for the generation, synthesis, and application of CBPHC research (CIHR, 2013). The 12-Teams were mandated to cross-collaborate and produce knowledge beyond what would be feasible by any one team, including collection of data and reporting on a set of agreed common indicators (Wong et al., Reference Wong, Langton, Katz, Fortin, Godwin, Green, Grunfeld, Hassani, Kendall, Liddy, Ploeg, Wodchis and Haggerty2018).

The 12-Teams included a large and diverse group of ‘trainees’, defined as individuals being trained at the undergraduate, graduate, postdoctoral, or professional level or individuals who were early career researchers. These individuals could also be completing their academic training, while assisting a CBPHC Team as a research coordinator, research assistant, or research associate. In line with their cross-team activities, the 12-Teams’ principal investigators initiated a capacity building committee and a trainee-led working group. The role of the capacity building committee was to provide mentorship for the working group as they organized activities, and this work took place within the broader context of the teams to which the trainees belonged (Figure 1). This paper specifically reports on the activities and outcomes of the capacity building strategy for CBPHC trainees.

Figure 1. The structure and relationship of the capacity building strategy by the 12-Teams capacity building committee and the trainee-led working group, within the broader context of the CBPHC Teams

Data collection

In Summer 2017, the committee administered an online semistructured survey to identify activities and outcomes of capacity building and mentorship efforts as part of the CBPHC Signature Initiative. The survey was developed by the trainee-led working group and included both open- and closed-ended questions. The survey was posted using Google Forms, and responses were anonymized to protect participant identity. The invitation included all active CBPHC trainees. The 12-Teams trainee membership (and therefore the sampling frame) changed over time, from 85 trainees in Summer 2015 to 65 trainees in Summer 2017 due to completion of education programs or completion of affiliation with CBPHC Team. The sampling frame included a range of disciplines, training levels (undergraduate, graduate, postdoctoral, and early career), geographic locations, and all CBPHC Teams. The working group members pretested the survey, and the final version was administered via personalized emails and reminder emails to increase response rates (Dillman et al., Reference Dillman, Smyth and Christian2014). To further encourage trainee participation, senior researchers or the principal investigators from the CBPHC Teams sent emails to their respective trainees. The online survey remained opened for a two-month period to allow sufficient time for completion by interested trainee respondents.

Data analysis

K.N. and Z.M. conducted the quantitative descriptive analyses for the closed-ended survey questions to explore trends pertaining to the characteristics of respondents and response distribution across questions. The thematic analysis of open-ended survey questions (conducted by A.I.K. and Z. M.) explored respondent perspectives on the perceived benefits of their involvement, unaddressed needs, and topics for future training sessions (Braun and Clarke, Reference Braun and Clarke2006; Green and Thorogood, Reference Green and Thorogood2009; Vaismoradi et al., Reference Vaismoradi, Turunen and Bondas2013). Coding of the data conducted by A.I.K. identified common ideas emerging from participant responses that were then categorized into themes as trends emerged (Braun and Clarke, Reference Braun and Clarke2006). A.I.K. and K.N. reviewed the themes to ensure appropriate categorization, mutual exclusion, and exhaustivity. All authors validated an overview of themes and key ideas under each emerging theme (Braun and Clarke, Reference Braun and Clarke2006). Due to the limited number of responses, no statistical software was needed for these analyses. Instead, the core competencies recently identified by the CIHR Canadian Health Services and Policy Research Alliance (Bornstein et al., Reference Bornstein, Heritage, Chudak, Tamblyn, McMahon and Brown2018; Burgess et al., Reference Burgess, Menachemi and Maciejewski2018) were used as a framework to contextualize the results from the thematic analysis. This was done by comparing the core competencies identified by the CIHR Canadian Health Services and Research Policy Alliance with the trainee responses.

Findings

Characteristics and capacity building activities

The characteristics of the trainee-led working group are presented in Table 1, and the details of the completed capacity building activities are presented in Table 2. Since 2015 when the working group was established, the membership of the working group included a total of seven CBPHC Teams and several disciplines, jurisdictions, and institutions. As seen in Figure 1, the capacity building activities were purposefully planned using three complementary dimensions: structure (e.g., formal webinars and workshops, virtual and in-person networking, and informal social media community); primary health care content (e.g., patient-centeredness, multimorbidity, home care, access, equity, and innovative research designs); and process (e.g., encouraging learning through explicit knowledge sharing and implicit mentorship opportunities). At the outset of this initiative, the working group determined that application of open-source virtual communication technology would be critical to build a meaningful network of colleagues, particularly because of the geographic distribution and the competing demands of completing graduate and postdoctoral training programs. As such, many of the capacity building activities (e.g., webinars and workshops) took place online, without any associated costs, and were recorded and available for trainees after the session.

Table 1. Characteristics of the trainee-led working group

Table 2. Capacity building activities of the trainee-led working group

Responses from survey

A total of 27 trainees responded to the survey (response rate: 41.5%). Among these respondents, 44.0% were doctoral students, 22.0% were postdoctoral fellows, 19.0% were research coordinators, 19.0% were research assistants or research associates, 15.0% were Master’s students, and 4.0% were undergraduate students. Based on our definition of trainee, respondents may have identified as both graduate student and research coordinator, research assistant, or research associate. These trainees represented various clinical (family medicine, nursing, and social work) and nonclinical (epidemiology and health policy) disciplines. As seen in Table 3, participants identified key forms of learning in their roles within their CBPHC Team: (1) tacit knowledge; (2) knowledge gained from engaging in research activities; and (3) knowledge gained through teamwork within and across the CBPHC Teams. Tacit knowledge consisted of knowledge that was gained through implicit learning and personal observation, as opposed to knowledge that was gained in didactic workshops and webinars.

Table 3. Summary of responses from survey participants (n = 27)

Among the three categories (tacit, research, and teamwork), research activities were experienced most by the respondents. More specifically, the majority of respondents indicated that they had learned the importance of context in research design, implementation, and reporting (96.3%); how to develop conference abstracts for submission (92.6%); and how to develop poster and oral conference presentations (92.6%). The trainees were then most likely to gain knowledge from teamwork activities including working with the contributions from different disciplines within a team (92.6%) and learning about effective team communication strategies (81.5%). Finally, the most common tacit learning was how to establish interdisciplinary research teams (85.2%) and how to lead and manage diverse teams (74.1%). In terms of the activities that the trainees would like to experience to build capacity, the top three activities were from each of the three categories (tacit, research, and teamwork). Respondents sought more experience in grant writing and submission (66.7%); effective approaches to conflict management (44.4%); and the opportunity to learn new teaching methods (40.7%). Trainees were also interested in learning more about academic career development or promotion (29.6%).

Based on the qualitative thematic analyses, both the competencies achieved during the CBPHC Signature Initiative and the areas for further capacity development are presented in Table 4. These competencies were aligned with the core competencies recommended by CIHR Canadian Health Services and Policy Research Alliance (Bornstein et al., Reference Bornstein, Heritage, Chudak, Tamblyn, McMahon and Brown2018). Competencies that were enhanced through the CBPHC capacity building initiatives included: analysis of data, evidence, and critical thinking; knowledge translation, communication, and brokerage; leadership, mentorship, and collaboration; interdisciplinary work; networking; research productivity; and peer-to-peer support and knowledge sharing. Overall, trainees indicated that they received advanced training in statistical or analysis software; learned skills for knowledge translation to different kinds of audiences; worked collaboratively with fellow trainees; developed and maintained productive relationships through virtual and in-person relationship building; presented and published completed and in-progress research; and participated in peer-to-peer support and knowledge sharing. In addition to advancing these competencies, trainees desired opportunities to expand skills in the leadership and management of an interdisciplinary research project. Trainees also expressed interest in developing experience and skills in group facilitation and to continue peer-to-peer support and knowledge sharing, importantly to address newly arising issues including career progression and establishing work–life balance.

Table 4. The core competencies recommended from the CIHR Canadian Health Services and Policy Research Alliance and acknowledged from the CBPHC trainee capacity building working group

CIHR = Canadian Institutes of Health Research; CBPHC = community-based primary health care; KTE = knowledge translation and exchange.

Throughout these capacity building initiatives, the working group experienced several process and data analysis challenges. The ongoing challenges included engaging all trainees from each of the 12-Teams (e.g., instead of a small group of already invested few); balancing information overload for busy trainees (e.g., emails, webinars, and workshops); and membership transition during the five-year funding program. Capacity building activities (particularly, webinars and workshops) needed to be accessible via internet or phone without any associated cost to the trainees and recorded and archived for those unable to participate in real time. Membership transition during this funding program impacted the total number of CBPHC trainees, the familiarity with the working group, and perhaps the response rate achieved for the final survey. The data analysis limitations were due to the small sample sizes as this did not allow for stratification of results by CBPHC Team, level of training, or academic discipline. Experiences from this capacity building initiative may have been different based on a trainee’s specific characteristics or affiliation with a specific CBPHC Team.