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Exploring the characteristics of the research workforce in Aboriginal and Torres Strait Islander health

Exploring the characteristics of the research workforce in Aboriginal and Torres Strait Islander... T he health disadvantage of Aboriginal and Torres Strait Islander people relative to other Australians has been well documented. Research that is priority‐driven and participatory can contribute to health gain for Indigenous people by guiding the provision of health services and informing the evidence base for health and social policy. Increasing Indigenous leadership of research is critical to maximising the health gains from Indigenous health research. However, there remain significant challenges to achieving this, given the recognised shortage of trained Indigenous researchers. Addressing this issue will require long‐term strategies to improve Indigenous educational attainment. In the meantime, there is a need to ensure that research continues to be undertaken to meet the immediate priorities of Indigenous people. This will require further development of the existing, largely non‐Indigenous research workforce in Indigenous health, to ensure research practices are acceptable and responsive to community needs. However, little is known about the characteristics and competencies of individuals involved in Indigenous health research. This study was conducted as part of the Capacity‐building in Indigenous Policy‐relevant Health Research (CIPHER) program, a National Health and Medical Research Council (NHMRC) funded program that aims to develop researchers capable of undertaking the type of research and critical analysis necessary to improve the evidence base for Indigenous health policy. Discussions within this program regarding capacity‐building strategies revealed a need to understand the career paths of researchers and barriers and incentives to working in research in Indigenous health. The aim of this study was to survey present and past researchers in Indigenous health to better understand their demographic and professional characteristics and the factors that may influence decisions about working in this field. The study represents the first stage of an investigation of the research workforce in Indigenous health; the findings are intended to help inform future investigations including in‐depth discussions with researchers. Methods The study involved administering a survey to individuals who were either listed as an author on an identified published paper or who completed a PhD or masters research degree in the field of Indigenous health during a 10‐year period. The latter group was included to identify early career researchers who may not have published their thesis work. We searched the following databases to identify publications about Indigenous health research published between 1995 and 2004: PubMed, Aboriginal and Torres Strait Islander Health Bibliography, Australian Public Affairs Information Service – Aboriginal and Torres Strait Islander Subset, and Australian Medical Index. The search strategy employed has been published previously. Abstracts of all publications identified were reviewed by two investigators and papers were excluded if the focus was not Indigenous health or not human health, or if the methodology indicated it was not an original research report. A separate review of the thesis listing on the Australian Indigenous Health InfoNet ( http://www.healthinfonet.ecu.edu.au ) was undertaken to identify individuals who completed a PhD or masters research degree in the time period. Health InfoNet staff conduct regular and exhaustive searches to identify relevant theses (personal communication, Natalie Weissofner, Australian Indigenous Health InfoNet ). We aimed to contact all authors listed on all eligible publications or theses. A range of strategies was employed to confirm the contact details for authors, including: contacting the institution listed on the most recent publication(s); searching academic institutions’ websites; Google searches ( http://www.google.com.au ); contacting co‐authors; and contacting key researchers in the relevant sub‐field. After confirmation of contact details, authors were contacted either via e‐mail or post and provided with a letter of invitation and a copy of the survey. Authors were assigned a unique identification number that was present on the survey form to enable targeted follow‐up of non‐responders. Non‐responders were followed up by e‐mail or mail; in general, a maximum of three attempts were made to reach authors. However, in some cases (e.g. new contact information) more attempts were made. Authors were considered to provide consent to participate in the study if they returned a completed survey. The content of the survey was developed through consultations with CIPHER leaders and other individuals involved in Indigenous health research at the authors’ institutions. The resulting survey form was piloted among Indigenous and non‐Indigenous colleagues. The survey asked about demographic characteristics, current involvement in research, factors that make Indigenous health research either attractive or unattractive as an area of work (based on a set list of factors with the option to indicate ‘other’ factors), views about recommending a career in Indigenous health research to an early career researcher, and what is required to attract researchers into this field. Respondents were asked to select the factors that make Indigenous health research either attractive or unattractive overall and to indicate the single most important attractive and unattractive factor. A copy of the survey is available on request. Returned surveys were entered into a database as de‐identified data. Analyses were performed using STATA 8.0 for Windows (STATA Corporation, College Station Texas). Response frequencies were calculated and compared using the χ test. Data gathered from open‐ended questions were analysed using a grounded theory approach, which involves developing analytical categories as they emerge from the data. The lead author (AR) reviewed all responses and identified key themes; relevant responses were grouped under these themes. A second researcher (JC) reviewed the responses to ensure consistency in the identified themes. This study was approved by the Human Research Ethics Committee (HREC) and the Aboriginal Ethics Sub‐Committee of the Northern Territory Department of Health and Community Services and Menzies School of Health Research; and the HREC at the University of Adelaide. Results We identified 472 eligible publications and 151 eligible theses. From these, a total of 1,074 authors were identified: 923 from a publication, 47 from a publication and a completed thesis, and 104 from a thesis only. The latter group included individuals who had completed a thesis but with no eligible publication identified in the time period. Of the 970 authors identified from an eligible publication, the majority (69%) were listed on only one eligible publication; only 5% were listed on five or more eligible publications. Of the 1,074 authors identified, seven were known to be deceased; these individuals are not included in the final denominator. Current contact details could not be confirmed for 108 eligible authors (10%). Overall, 392/1,067 (37%) authors responded. The response rate was higher for first authors (55%) and at least one listed author responded for 403 (85%) eligible publications. Nineteen authors responded stating they did not wish to be involved in the survey for a variety of reasons including: being only “peripherally involved” in the published research; no longer having involvement with Indigenous health research; personal reasons; and difficulties completing the survey. Completed questionnaires were returned by 373 eligible authors (35%). Their characteristics are listed in Table 1 . 1 Characteristics of responders. a Characteristics All n=373 % Core b n=63 % Indigenous n=32 % Early career c n=37 % Age <35 7 10 13 14 35‐54 63 71 56 65 ≥55 28 19 28 22 Sex – Male 50 48 38 35 Australian born 64 63 100 f 70 Aboriginal and/or Torres Strait Islander 9 21 f 100 f 14 Place of residence Queensland 19 24 34 d 30 Western Australia 17 13 6 14 New South Wales 16 11 13 19 Northern Territory 14 29 f 28 d 0 e Victoria 11 11 9 8 South Australia 9 8 6 16 Australian Capital Territory 4 0 0 5 Tasmania 1 0 3 0 Outside of Australia 8 5 0 8 Highest qualification PhD/DSc/MD 50 44 19 f 49 Masters 24 31 25 46 e Postgraduate diploma/certificate g 16 16 13 0 e Undergraduate degree/diploma/certificate 9 8 38 f 5 Secondary school or lower 1 4 3 f 0 Clinical training h Medicine 43 51 13 f 16 e Nursing 13 13 25 d 22 Allied health 10 10 9 11 Other practitioner training 8 16 e 34 f 14 No clinical training 27 19 25 35 Research support Awarded a research grant as a CI 62 70 41 e 46 d Awarded a research scholarship 40 46 38 51 Awarded a research fellowship 29 30 6 e 24 Main employer i University 39 43 38 41 Government agency 28 26 22 35 Other employer j 20 13 6 24 Research centre 12 18 9 8 Aboriginal Health Service 3 6 16 f 5 Not in paid employment 3 0 6 0 Main field of work i Clinical medicine/health 36 40 34 30 Epidemiology/statistics 29 29 19 8 e Health systems/policy 10 22 f 19 16 Social science 9 21 e 22 d 32 f Biomedical science/laboratory 8 3 3 3 Behavioural science 7 6 16 d 19 e Environmental science 1 2 0 5 e Other fields 18 14 22 22 Notes: (a) Data are missing for between 1‐2% of respondents. (b) Includes respondents who indicated they were currently involved in Indigenous health research, that it is their primary area of research and that they expect to be involved in five years’ time. (c) Includes individuals who had completed a thesis but with no eligible publication identified in the time period. (d) p<0.05 or (e) p<0.01 or (f) p<0.001 when compared with other respondents (for example Indigenous respondents compared with non‐Indigenous respondents). (g) Includes respondents with medical training and a college fellowship. (h) Categories are not mutually exclusive. (i) Although the survey asked respondents to indicate their main employer and field of work, some respondents indicated more than one employer and field of work, and therefore categories are not mutually exclusive. (j) Includes non‐government organisations and self‐employed individuals. Involvement in research The majority (80%) of respondents were active in research but only 38% considered Indigenous health to be their primary area of research. A wide range of other primary research fields were nominated, including: infectious disease (5%), public health (5%), women's health (4%) and health services research (4%). Just under half (46%) of respondents were active in Indigenous health research. Forty‐two per cent indicated that they expected to be involved in Indigenous health research in five years’ time, 39% were uncertain about their future involvement and 18% did not expect to be involved in five years’ time. Sixty‐three (17%) respondents indicated they were involved in Indigenous health research, that it was their primary area of research and that they expected to be involved in five years’ time. These individuals, for whom Indigenous health research is likely to represent their core business, were more likely to be Indigenous ( p <0.0001), be a first author on a publication ( p <0.0001) and have multiple publications in the time period ( p =0.001). The characteristics of this subgroup, and other subgroups including Indigenous and early career respondents, are listed in Table 1 . These subgroups are not mutually exclusive. Factors that make Indigenous health research attractive and unattractive Overall, the factor most frequently selected as attractive by respondents was “important area/national priority” (84%), followed closely by “opportunity to make a difference” (73%) and “opportunity to contribute to social justice” (73%) (see Table 2 ). When respondents were asked to rank the single most important attractive factor, “important area/national priority” was most frequently selected (35%). Most subgroups based on participant characteristics responded in similar ways about the attractive factors (see Table 2 ). 2 Factors that make Indigenous health research attractive as an area of work overall. Attractive factors a All n=373 % Core b n=63 % Indigenous n=32 % Early career c n=37 % Important area/national priority 84 92 62 f 91 Opportunity to contribute to social justice 73 87 d 72 91 d Opportunity to make a difference 73 84 69 86 Interesting research area 72 84 d 52 e 71 Opportunity to work with Indigenous people and communities 58 76 e 66 66 Multidisciplinary area 46 48 45 51 Opportunities for collaboration with service providers/policy makers 46 60 d 59 54 Availability of funding 21 29 21 23 Other factors g 6 13 d 17 d 11 Easy to publish work 6 8 21 f 3 Lack of competition means relatively quick advancement 5 10 17 e 6 Availability of jobs/job security 5 3 14 d 9 No response 3 2 9 5 Notes: (a) Respondents could select more than one attractive factor overall. (b) Includes respondents who indicated they were currently involved in Indigenous health research, that it is their primary area of research and that they expect to be involved in five years’ time. (c) Includes individuals who had completed a thesis but with no eligible publication identified in the time period. (d) p<0.05 or (e) p<0.01 or (f) p<0.001 when compared with other respondents (for example Indigenous respondents compared with non‐Indigenous respondents). (g) For example: “intellectual challenges of working with different (cultural) values”; “family involvement”; “community empowerment”, etc. “Politics” was the most frequently selected unattractive factor about Indigenous health research (73%) (see Table 3 ) and the most commonly named single most important unattractive factor (30%). Responses differed between subgroups for the unattractive factors (see Table 3 ). For example, Indigenous, core business and early career respondents were more likely to select factors related to a lack of institutional support and critical mass than other respondents. Nevertheless, for all subgroups, the single most important unattractive factor selected was “politics”. 3 Factors that make Indigenous health research unattractive as an area of work. Unattractive factors a All n=373 % Core b n=63 % Indigenous n=32 % Early career c n=37 % Politics 73 74 76 76 Hard to make progress/see a difference 62 53 d 55 62 Time and effort required to undertake community consultation 53 52 31 e 43 Not enough institutional support 33 48 d 52 d 54 e Lack of critical mass 23 37 d 41 d 30 Discrimination/racism 23 19 38 46 e Hard to get funding 22 35 d 24 38 d Professional isolation/lack of collaborators 21 23 31 35 d Less reward for effort than other fields 20 34 e 34 24 Not enough mentors 16 29 e 34 d 24 Lack of job security/number of jobs available 16 32 f 28 19 Inadequate salary and/or conditions 15 31 f 24 30 d Working in a cross‐cultural environment 13 21 d 17 14 Hard to publish work 12 26 e 17 14 Other factors g 15 24 d 14 27 d No response 5 2 9 0 Notes: (a) Respondents could select more than one unattractive factor overall. (b) Includes respondents who indicated they were currently involved in Indigenous health research, that it is their primary area of research and that they expect to be involved in five years’ time. (c) Includes individuals who had completed a thesis but with no eligible publication identified in the time period. (d) p<0.05 or (e) p<0.01 or (f) p<0.001 when compared with other respondents (for example Indigenous respondents compared with non‐Indigenous respondents). (g) For example: “difficulties and vagaries of the ethics process”; “logistics/cost of working in remote areas – lots of travel”; “hard to attract qualified Indigenous staff, PhD students and PostDocs”; “not enough action”, etc. Preparation to work in Indigenous health research Most (59%) respondents did not feel that their education and training prepared them to work in Indigenous health research. Lack of exposure to Indigenous health issues during tertiary education was a common explanation for not being prepared, as well as inadequate cultural training. Other respondents queried whether formal training can provide the skills required to work in this field. Willingness to recommend a career in Indigenous health research One‐hundred and sixty‐eight (45%) respondents would recommend a career in Indigenous health research to an early career researcher. Many (39%) were unsure about recommending a career; only 50 (13%) stated they would not recommend it. A variety of explanations about the uncertainty or unwillingness to recommend a career were offered; emergent themes are discussed below. Implications for career development Some respondents commented on the long timelines involved in research in this area and the potential implications for productivity for early career researchers. Explanations included: “long timeframes needed to establish contacts and credibility…” and “practicalities of advancement necessary for young researchers”. Diversification Others referred to the need to develop expertise in other research fields before working in Indigenous health research, with statements such as: “establish high quality credentials in another main field first, then bring expertise to this field; field needs superior talents not ‘average’ abilities”. Some spoke of the need to diversify for the individual's sake, for example: “I would recommend a career partially involving Indigenous health research, but not exclusively in Indigenous health (for Indigenous or non‐Indigenous early career researchers), because of the slow progress in developing and undertaking research projects, the suspicious and antagonistic rhetoric about research in Indigenous health, the lack of senior researchers to act as leaders and mentors, and the impediments to career advancement for non‐Indigenous people.” Individual characteristics Other responses were conditional on individual characteristics, such as: “for some I would recommend it highly (but they would probably be the minority). It would depend on the person, their level of research experience, their understanding of Indigenous issues and politics, their level of maturity and personal confidence/resilience”. Many indicated they would only recommend a career to Indigenous people: “as a non‐Indigenous researcher I feel that it is now more appropriate to train Indigenous researchers”. Politics For other respondents, their views were influenced by “politics” and perceived difficulties in conducting research in the area, with reasons such as: “Too much ‘politics’; hard to get the project going”; and “not the right political climate”. Attracting researchers into Indigenous health research Two‐hundred and ninety‐eight (80%) respondents commented on what they believe is required to attract individuals into this area. Responses centred on two interrelated ideas: requirements to help attract researchers into the field; and factors critical to the successful conduct of research in Indigenous health. Key themes identified are listed below. Institutional support Many respondents commented on the need for better support from institutions for the research processes in Indigenous health, with requirements such as: “support and recognition within academic structures for the kind of community consultation that is required; i.e. recognition that there may be less ‘output’ (papers) per unit because of this … support from Indigenous agencies themselves for research work” and “a better understanding among the research hierarchy (e.g. NHMRC, academic institutions) of the difficulty of the work (so that this can then be recognised in assessments of track record etc)”. Mentoring Others cited the need for mentoring for all researchers. For example: “good mentoring by a researcher experienced in Aboriginal health and Aboriginal mentor who may not be a researcher …” and “an Indigenous co‐researcher who would be there to mentor an non‐ATSI (sic) researcher about the best way for working with a community”. Research transfer Some responders referred to a lack of research transfer, remarking on the need for better implementation of research evidence and increased public awareness of the potential contribution of research. Comments identified the need for “policy and funding commitment to implementing ‘evidence‐based’ policy” and for governments to “give reward to those involved by responding and publicly acknowledging the efforts of the researchers in the area”. Job security, funding and continuous career pathways Better funding and working conditions were emphasised by many respondents. Responders appealed for a long‐term commitment to research: “project based funding … this is no way to build a sustainable research workforce in an area of such importance. Stable research organisations with long‐term commitments to the area are required rather than project‐to‐project funding bases which make research activity (and careers) highly vulnerable”. Others identified the need for structured “career pathways” and “job security and adequate salary, recognition of Indigenous professionalism”. Indigenous researchers Many advocated for more Indigenous researchers, although strategies for achieving this were rarely stated. Concern was expressed about achieving this in a supportive and sustainable way, for example: “more early and mid‐career positions for Indigenous people wanting to be researchers – stop promoting people to top jobs the instant they get any qualification. Researchers to do grant research work first – learn the trade.” Research approaches and processes Other respondents saw different approaches as an essential part of effective Indigenous health research, stating that: “some methodologies are not effective in Aboriginal research” and “… more collaborations between researchers and community controlled and government organisations would allow research to be part of service quality improvement and guiding planning and action”. Others appealed for assistance and training to overcome perceived difficulties of conducting research in this area, with comments like: “learning how to strategically deal with Indigenous politics” and “assistance with gaining ethics approval and community support”. Discussion To our knowledge, this is the largest national survey of individuals involved in Australian Indigenous health research. Clear themes around potential barriers and enablers to research capacity building in Indigenous health were identified. “Politics”, lack of institutional support, short‐term funding and a lack of training relevant to Indigenous health were significant issues for respondents. Furthermore, greater access to mentoring and professional networking were identified as key requirements for developing a sustainable career in this field. Inclusion in this survey was based on having a research publication or a completed higher‐degree research thesis in Indigenous health in a 10‐year period. This approach has some limitations. Our sampling strategy (primarily based on journal articles) may not have captured all individuals working in the field. Few Indigenous people have been identified as authors on peer‐reviewed publications about Indigenous health, despite a substantial rise in publications in this field in recent years. This may explain the small proportion of Indigenous respondents in this survey (9%). It is also possible that other forms of publication such as research monographs were not identified, leading to the exclusion of some social science and policy researchers. We attempted to overcome these issues by identifying authors over a 10‐year period, using a range of electronic databases and including individuals who had completed a research higher degree but who may not have published their thesis findings in a peer‐reviewed journal. Our strategy for detecting researchers identified a large number of individuals who had published in Indigenous health research in the 10‐year period, although most (69%) had only one eligible publication about Indigenous health in that time. Most respondents did not see Indigenous health as their primary area of research. These findings are likely to reflect the multidisciplinary nature of Indigenous health research and suggest that initiatives to further develop the research workforce in Indigenous health should be targeted across a range of disciplines. Increasing the number of trained Indigenous researchers is a priority for strengthening the Indigenous health research workforce; this was acknowledged by many respondents. Achieving this will ultimately require strategies to increase Indigenous participation in undergraduate and postgraduate training. However, in the interim, providing access to mentoring and professional networking may help to attract and retain individuals; this was an identified need, particularly by Indigenous and early career respondents, and is likely to be an ongoing requirement. While there are some Indigenous research networks (e.g. Wirraway Mirrim in Victoria and the Cooperative Research Centre for Aboriginal Health), clearly more are needed for both Indigenous researchers and all researchers in Indigenous health. Institutions (academic, funding and Indigenous) should reflect on the perceived lack of training and institutional support for Indigenous health research voiced by many respondents. Support is likely to be required at many levels, such as provision of research infrastructure, cultural training in tertiary education, and support for the approaches that foster Indigenous knowledge and control. Some capacity‐building issues identified in this survey are not necessarily specific to research in Indigenous health. For example, the lack of institutional support may reflect a general lack of support for applied research, in part due to the implications this type of research has on the measurement of research performance. Similarly, concerns about sustainable career pathways and funding have been identified by individuals working across all areas of health research. In this survey, it is unclear if respondents cited these concerns as unattractive relative to other fields of research or in absolute terms. Addressing these factors will likely require greater research investment and policy action. Recent short‐term increases in funding for health research and ongoing initiatives such as the CIPHER program (funded through the Population Health Capacity Building Program) provide encouragement. Many of the recommendations by respondents, including those related to mentoring, collaborative approaches and greater institutional responsibility, align with the principles of the Indigenous Research Reform Agenda (IRRA). This suggests there is broad support for the elements of the IRRA among researchers; however, ongoing efforts are still required to implement the reform initiatives. “Politics” emerged as the most salient negative factor and potential barrier to research in this field; however, few respondents attempted to deconstruct the meaning of “politics”. Politics may relate to the contested nature of Indigenous affairs in the wider political arena or the potentially conflicting allegiances between Indigenous communities and agencies, both locally and nationally. “Politics” can also envelop the research processes involved in working with Aboriginal communities; this was a key reason for including “politics” as a potential unattractive factor in this survey. Further exploring the implications of “politics” is an area for future research, to better identify strategies to support researchers to overcome this barrier. The findings of this survey may be limited by the low response rate (37%). This was below what was expected, given that the target group are researchers, and was despite follow‐up reminders being provided. Although disappointing, the response rate is similar to that achieved in a recent national survey of 1,879 recipients of NHMRC People Support Awards, in which only 32% of researchers responded. The representativeness of respondent views in this survey is unknown and caution should be exercised in extrapolating the findings of this survey to all individuals working in Indigenous health research. Several issues have not been addressed in this survey, including the factors that are required to permit fuller Indigenous participation in the design and control of research. Equally important is the need to redress the dominance of descriptive research in Indigenous health at the expense of the evaluation of interventions to produce health gain. Improving research capacity must be linked closely with reform that addresses these issues; these were beyond the scope of this study. Conclusion This study is a step towards better understanding the research workforce in Indigenous health. It provides evidence of a strongly perceived need for institutional reform that supports Indigenous health research, for sustainable approaches to funding and for mentoring initiatives for early career researchers. The findings also provide a platform for further in‐depth investigation into the experiences of researchers to better understand the challenges to effective Indigenous health research. Acknowledgements Alice Rumbold is supported by a NHMRC Population Health Capacity Building Grant (No. 236235), which provides funding for the CIPHER Program. This program is recognised as an in‐kind contribution to the Co‐operative Research Centre for Aboriginal Health. Joan Cunningham is supported by a NHMRC Career Development Award (No. 283310) and Ross Bailie by a NHMRC Fellowship Grant (No. 283303). http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

Exploring the characteristics of the research workforce in Aboriginal and Torres Strait Islander health

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Publisher
Wiley
Copyright
2008 The Authors. Journal Compilation © 2008 Public Health Association of Australia
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1753-6405.2008.00159.x
pmid
18290907
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Abstract

T he health disadvantage of Aboriginal and Torres Strait Islander people relative to other Australians has been well documented. Research that is priority‐driven and participatory can contribute to health gain for Indigenous people by guiding the provision of health services and informing the evidence base for health and social policy. Increasing Indigenous leadership of research is critical to maximising the health gains from Indigenous health research. However, there remain significant challenges to achieving this, given the recognised shortage of trained Indigenous researchers. Addressing this issue will require long‐term strategies to improve Indigenous educational attainment. In the meantime, there is a need to ensure that research continues to be undertaken to meet the immediate priorities of Indigenous people. This will require further development of the existing, largely non‐Indigenous research workforce in Indigenous health, to ensure research practices are acceptable and responsive to community needs. However, little is known about the characteristics and competencies of individuals involved in Indigenous health research. This study was conducted as part of the Capacity‐building in Indigenous Policy‐relevant Health Research (CIPHER) program, a National Health and Medical Research Council (NHMRC) funded program that aims to develop researchers capable of undertaking the type of research and critical analysis necessary to improve the evidence base for Indigenous health policy. Discussions within this program regarding capacity‐building strategies revealed a need to understand the career paths of researchers and barriers and incentives to working in research in Indigenous health. The aim of this study was to survey present and past researchers in Indigenous health to better understand their demographic and professional characteristics and the factors that may influence decisions about working in this field. The study represents the first stage of an investigation of the research workforce in Indigenous health; the findings are intended to help inform future investigations including in‐depth discussions with researchers. Methods The study involved administering a survey to individuals who were either listed as an author on an identified published paper or who completed a PhD or masters research degree in the field of Indigenous health during a 10‐year period. The latter group was included to identify early career researchers who may not have published their thesis work. We searched the following databases to identify publications about Indigenous health research published between 1995 and 2004: PubMed, Aboriginal and Torres Strait Islander Health Bibliography, Australian Public Affairs Information Service – Aboriginal and Torres Strait Islander Subset, and Australian Medical Index. The search strategy employed has been published previously. Abstracts of all publications identified were reviewed by two investigators and papers were excluded if the focus was not Indigenous health or not human health, or if the methodology indicated it was not an original research report. A separate review of the thesis listing on the Australian Indigenous Health InfoNet ( http://www.healthinfonet.ecu.edu.au ) was undertaken to identify individuals who completed a PhD or masters research degree in the time period. Health InfoNet staff conduct regular and exhaustive searches to identify relevant theses (personal communication, Natalie Weissofner, Australian Indigenous Health InfoNet ). We aimed to contact all authors listed on all eligible publications or theses. A range of strategies was employed to confirm the contact details for authors, including: contacting the institution listed on the most recent publication(s); searching academic institutions’ websites; Google searches ( http://www.google.com.au ); contacting co‐authors; and contacting key researchers in the relevant sub‐field. After confirmation of contact details, authors were contacted either via e‐mail or post and provided with a letter of invitation and a copy of the survey. Authors were assigned a unique identification number that was present on the survey form to enable targeted follow‐up of non‐responders. Non‐responders were followed up by e‐mail or mail; in general, a maximum of three attempts were made to reach authors. However, in some cases (e.g. new contact information) more attempts were made. Authors were considered to provide consent to participate in the study if they returned a completed survey. The content of the survey was developed through consultations with CIPHER leaders and other individuals involved in Indigenous health research at the authors’ institutions. The resulting survey form was piloted among Indigenous and non‐Indigenous colleagues. The survey asked about demographic characteristics, current involvement in research, factors that make Indigenous health research either attractive or unattractive as an area of work (based on a set list of factors with the option to indicate ‘other’ factors), views about recommending a career in Indigenous health research to an early career researcher, and what is required to attract researchers into this field. Respondents were asked to select the factors that make Indigenous health research either attractive or unattractive overall and to indicate the single most important attractive and unattractive factor. A copy of the survey is available on request. Returned surveys were entered into a database as de‐identified data. Analyses were performed using STATA 8.0 for Windows (STATA Corporation, College Station Texas). Response frequencies were calculated and compared using the χ test. Data gathered from open‐ended questions were analysed using a grounded theory approach, which involves developing analytical categories as they emerge from the data. The lead author (AR) reviewed all responses and identified key themes; relevant responses were grouped under these themes. A second researcher (JC) reviewed the responses to ensure consistency in the identified themes. This study was approved by the Human Research Ethics Committee (HREC) and the Aboriginal Ethics Sub‐Committee of the Northern Territory Department of Health and Community Services and Menzies School of Health Research; and the HREC at the University of Adelaide. Results We identified 472 eligible publications and 151 eligible theses. From these, a total of 1,074 authors were identified: 923 from a publication, 47 from a publication and a completed thesis, and 104 from a thesis only. The latter group included individuals who had completed a thesis but with no eligible publication identified in the time period. Of the 970 authors identified from an eligible publication, the majority (69%) were listed on only one eligible publication; only 5% were listed on five or more eligible publications. Of the 1,074 authors identified, seven were known to be deceased; these individuals are not included in the final denominator. Current contact details could not be confirmed for 108 eligible authors (10%). Overall, 392/1,067 (37%) authors responded. The response rate was higher for first authors (55%) and at least one listed author responded for 403 (85%) eligible publications. Nineteen authors responded stating they did not wish to be involved in the survey for a variety of reasons including: being only “peripherally involved” in the published research; no longer having involvement with Indigenous health research; personal reasons; and difficulties completing the survey. Completed questionnaires were returned by 373 eligible authors (35%). Their characteristics are listed in Table 1 . 1 Characteristics of responders. a Characteristics All n=373 % Core b n=63 % Indigenous n=32 % Early career c n=37 % Age <35 7 10 13 14 35‐54 63 71 56 65 ≥55 28 19 28 22 Sex – Male 50 48 38 35 Australian born 64 63 100 f 70 Aboriginal and/or Torres Strait Islander 9 21 f 100 f 14 Place of residence Queensland 19 24 34 d 30 Western Australia 17 13 6 14 New South Wales 16 11 13 19 Northern Territory 14 29 f 28 d 0 e Victoria 11 11 9 8 South Australia 9 8 6 16 Australian Capital Territory 4 0 0 5 Tasmania 1 0 3 0 Outside of Australia 8 5 0 8 Highest qualification PhD/DSc/MD 50 44 19 f 49 Masters 24 31 25 46 e Postgraduate diploma/certificate g 16 16 13 0 e Undergraduate degree/diploma/certificate 9 8 38 f 5 Secondary school or lower 1 4 3 f 0 Clinical training h Medicine 43 51 13 f 16 e Nursing 13 13 25 d 22 Allied health 10 10 9 11 Other practitioner training 8 16 e 34 f 14 No clinical training 27 19 25 35 Research support Awarded a research grant as a CI 62 70 41 e 46 d Awarded a research scholarship 40 46 38 51 Awarded a research fellowship 29 30 6 e 24 Main employer i University 39 43 38 41 Government agency 28 26 22 35 Other employer j 20 13 6 24 Research centre 12 18 9 8 Aboriginal Health Service 3 6 16 f 5 Not in paid employment 3 0 6 0 Main field of work i Clinical medicine/health 36 40 34 30 Epidemiology/statistics 29 29 19 8 e Health systems/policy 10 22 f 19 16 Social science 9 21 e 22 d 32 f Biomedical science/laboratory 8 3 3 3 Behavioural science 7 6 16 d 19 e Environmental science 1 2 0 5 e Other fields 18 14 22 22 Notes: (a) Data are missing for between 1‐2% of respondents. (b) Includes respondents who indicated they were currently involved in Indigenous health research, that it is their primary area of research and that they expect to be involved in five years’ time. (c) Includes individuals who had completed a thesis but with no eligible publication identified in the time period. (d) p<0.05 or (e) p<0.01 or (f) p<0.001 when compared with other respondents (for example Indigenous respondents compared with non‐Indigenous respondents). (g) Includes respondents with medical training and a college fellowship. (h) Categories are not mutually exclusive. (i) Although the survey asked respondents to indicate their main employer and field of work, some respondents indicated more than one employer and field of work, and therefore categories are not mutually exclusive. (j) Includes non‐government organisations and self‐employed individuals. Involvement in research The majority (80%) of respondents were active in research but only 38% considered Indigenous health to be their primary area of research. A wide range of other primary research fields were nominated, including: infectious disease (5%), public health (5%), women's health (4%) and health services research (4%). Just under half (46%) of respondents were active in Indigenous health research. Forty‐two per cent indicated that they expected to be involved in Indigenous health research in five years’ time, 39% were uncertain about their future involvement and 18% did not expect to be involved in five years’ time. Sixty‐three (17%) respondents indicated they were involved in Indigenous health research, that it was their primary area of research and that they expected to be involved in five years’ time. These individuals, for whom Indigenous health research is likely to represent their core business, were more likely to be Indigenous ( p <0.0001), be a first author on a publication ( p <0.0001) and have multiple publications in the time period ( p =0.001). The characteristics of this subgroup, and other subgroups including Indigenous and early career respondents, are listed in Table 1 . These subgroups are not mutually exclusive. Factors that make Indigenous health research attractive and unattractive Overall, the factor most frequently selected as attractive by respondents was “important area/national priority” (84%), followed closely by “opportunity to make a difference” (73%) and “opportunity to contribute to social justice” (73%) (see Table 2 ). When respondents were asked to rank the single most important attractive factor, “important area/national priority” was most frequently selected (35%). Most subgroups based on participant characteristics responded in similar ways about the attractive factors (see Table 2 ). 2 Factors that make Indigenous health research attractive as an area of work overall. Attractive factors a All n=373 % Core b n=63 % Indigenous n=32 % Early career c n=37 % Important area/national priority 84 92 62 f 91 Opportunity to contribute to social justice 73 87 d 72 91 d Opportunity to make a difference 73 84 69 86 Interesting research area 72 84 d 52 e 71 Opportunity to work with Indigenous people and communities 58 76 e 66 66 Multidisciplinary area 46 48 45 51 Opportunities for collaboration with service providers/policy makers 46 60 d 59 54 Availability of funding 21 29 21 23 Other factors g 6 13 d 17 d 11 Easy to publish work 6 8 21 f 3 Lack of competition means relatively quick advancement 5 10 17 e 6 Availability of jobs/job security 5 3 14 d 9 No response 3 2 9 5 Notes: (a) Respondents could select more than one attractive factor overall. (b) Includes respondents who indicated they were currently involved in Indigenous health research, that it is their primary area of research and that they expect to be involved in five years’ time. (c) Includes individuals who had completed a thesis but with no eligible publication identified in the time period. (d) p<0.05 or (e) p<0.01 or (f) p<0.001 when compared with other respondents (for example Indigenous respondents compared with non‐Indigenous respondents). (g) For example: “intellectual challenges of working with different (cultural) values”; “family involvement”; “community empowerment”, etc. “Politics” was the most frequently selected unattractive factor about Indigenous health research (73%) (see Table 3 ) and the most commonly named single most important unattractive factor (30%). Responses differed between subgroups for the unattractive factors (see Table 3 ). For example, Indigenous, core business and early career respondents were more likely to select factors related to a lack of institutional support and critical mass than other respondents. Nevertheless, for all subgroups, the single most important unattractive factor selected was “politics”. 3 Factors that make Indigenous health research unattractive as an area of work. Unattractive factors a All n=373 % Core b n=63 % Indigenous n=32 % Early career c n=37 % Politics 73 74 76 76 Hard to make progress/see a difference 62 53 d 55 62 Time and effort required to undertake community consultation 53 52 31 e 43 Not enough institutional support 33 48 d 52 d 54 e Lack of critical mass 23 37 d 41 d 30 Discrimination/racism 23 19 38 46 e Hard to get funding 22 35 d 24 38 d Professional isolation/lack of collaborators 21 23 31 35 d Less reward for effort than other fields 20 34 e 34 24 Not enough mentors 16 29 e 34 d 24 Lack of job security/number of jobs available 16 32 f 28 19 Inadequate salary and/or conditions 15 31 f 24 30 d Working in a cross‐cultural environment 13 21 d 17 14 Hard to publish work 12 26 e 17 14 Other factors g 15 24 d 14 27 d No response 5 2 9 0 Notes: (a) Respondents could select more than one unattractive factor overall. (b) Includes respondents who indicated they were currently involved in Indigenous health research, that it is their primary area of research and that they expect to be involved in five years’ time. (c) Includes individuals who had completed a thesis but with no eligible publication identified in the time period. (d) p<0.05 or (e) p<0.01 or (f) p<0.001 when compared with other respondents (for example Indigenous respondents compared with non‐Indigenous respondents). (g) For example: “difficulties and vagaries of the ethics process”; “logistics/cost of working in remote areas – lots of travel”; “hard to attract qualified Indigenous staff, PhD students and PostDocs”; “not enough action”, etc. Preparation to work in Indigenous health research Most (59%) respondents did not feel that their education and training prepared them to work in Indigenous health research. Lack of exposure to Indigenous health issues during tertiary education was a common explanation for not being prepared, as well as inadequate cultural training. Other respondents queried whether formal training can provide the skills required to work in this field. Willingness to recommend a career in Indigenous health research One‐hundred and sixty‐eight (45%) respondents would recommend a career in Indigenous health research to an early career researcher. Many (39%) were unsure about recommending a career; only 50 (13%) stated they would not recommend it. A variety of explanations about the uncertainty or unwillingness to recommend a career were offered; emergent themes are discussed below. Implications for career development Some respondents commented on the long timelines involved in research in this area and the potential implications for productivity for early career researchers. Explanations included: “long timeframes needed to establish contacts and credibility…” and “practicalities of advancement necessary for young researchers”. Diversification Others referred to the need to develop expertise in other research fields before working in Indigenous health research, with statements such as: “establish high quality credentials in another main field first, then bring expertise to this field; field needs superior talents not ‘average’ abilities”. Some spoke of the need to diversify for the individual's sake, for example: “I would recommend a career partially involving Indigenous health research, but not exclusively in Indigenous health (for Indigenous or non‐Indigenous early career researchers), because of the slow progress in developing and undertaking research projects, the suspicious and antagonistic rhetoric about research in Indigenous health, the lack of senior researchers to act as leaders and mentors, and the impediments to career advancement for non‐Indigenous people.” Individual characteristics Other responses were conditional on individual characteristics, such as: “for some I would recommend it highly (but they would probably be the minority). It would depend on the person, their level of research experience, their understanding of Indigenous issues and politics, their level of maturity and personal confidence/resilience”. Many indicated they would only recommend a career to Indigenous people: “as a non‐Indigenous researcher I feel that it is now more appropriate to train Indigenous researchers”. Politics For other respondents, their views were influenced by “politics” and perceived difficulties in conducting research in the area, with reasons such as: “Too much ‘politics’; hard to get the project going”; and “not the right political climate”. Attracting researchers into Indigenous health research Two‐hundred and ninety‐eight (80%) respondents commented on what they believe is required to attract individuals into this area. Responses centred on two interrelated ideas: requirements to help attract researchers into the field; and factors critical to the successful conduct of research in Indigenous health. Key themes identified are listed below. Institutional support Many respondents commented on the need for better support from institutions for the research processes in Indigenous health, with requirements such as: “support and recognition within academic structures for the kind of community consultation that is required; i.e. recognition that there may be less ‘output’ (papers) per unit because of this … support from Indigenous agencies themselves for research work” and “a better understanding among the research hierarchy (e.g. NHMRC, academic institutions) of the difficulty of the work (so that this can then be recognised in assessments of track record etc)”. Mentoring Others cited the need for mentoring for all researchers. For example: “good mentoring by a researcher experienced in Aboriginal health and Aboriginal mentor who may not be a researcher …” and “an Indigenous co‐researcher who would be there to mentor an non‐ATSI (sic) researcher about the best way for working with a community”. Research transfer Some responders referred to a lack of research transfer, remarking on the need for better implementation of research evidence and increased public awareness of the potential contribution of research. Comments identified the need for “policy and funding commitment to implementing ‘evidence‐based’ policy” and for governments to “give reward to those involved by responding and publicly acknowledging the efforts of the researchers in the area”. Job security, funding and continuous career pathways Better funding and working conditions were emphasised by many respondents. Responders appealed for a long‐term commitment to research: “project based funding … this is no way to build a sustainable research workforce in an area of such importance. Stable research organisations with long‐term commitments to the area are required rather than project‐to‐project funding bases which make research activity (and careers) highly vulnerable”. Others identified the need for structured “career pathways” and “job security and adequate salary, recognition of Indigenous professionalism”. Indigenous researchers Many advocated for more Indigenous researchers, although strategies for achieving this were rarely stated. Concern was expressed about achieving this in a supportive and sustainable way, for example: “more early and mid‐career positions for Indigenous people wanting to be researchers – stop promoting people to top jobs the instant they get any qualification. Researchers to do grant research work first – learn the trade.” Research approaches and processes Other respondents saw different approaches as an essential part of effective Indigenous health research, stating that: “some methodologies are not effective in Aboriginal research” and “… more collaborations between researchers and community controlled and government organisations would allow research to be part of service quality improvement and guiding planning and action”. Others appealed for assistance and training to overcome perceived difficulties of conducting research in this area, with comments like: “learning how to strategically deal with Indigenous politics” and “assistance with gaining ethics approval and community support”. Discussion To our knowledge, this is the largest national survey of individuals involved in Australian Indigenous health research. Clear themes around potential barriers and enablers to research capacity building in Indigenous health were identified. “Politics”, lack of institutional support, short‐term funding and a lack of training relevant to Indigenous health were significant issues for respondents. Furthermore, greater access to mentoring and professional networking were identified as key requirements for developing a sustainable career in this field. Inclusion in this survey was based on having a research publication or a completed higher‐degree research thesis in Indigenous health in a 10‐year period. This approach has some limitations. Our sampling strategy (primarily based on journal articles) may not have captured all individuals working in the field. Few Indigenous people have been identified as authors on peer‐reviewed publications about Indigenous health, despite a substantial rise in publications in this field in recent years. This may explain the small proportion of Indigenous respondents in this survey (9%). It is also possible that other forms of publication such as research monographs were not identified, leading to the exclusion of some social science and policy researchers. We attempted to overcome these issues by identifying authors over a 10‐year period, using a range of electronic databases and including individuals who had completed a research higher degree but who may not have published their thesis findings in a peer‐reviewed journal. Our strategy for detecting researchers identified a large number of individuals who had published in Indigenous health research in the 10‐year period, although most (69%) had only one eligible publication about Indigenous health in that time. Most respondents did not see Indigenous health as their primary area of research. These findings are likely to reflect the multidisciplinary nature of Indigenous health research and suggest that initiatives to further develop the research workforce in Indigenous health should be targeted across a range of disciplines. Increasing the number of trained Indigenous researchers is a priority for strengthening the Indigenous health research workforce; this was acknowledged by many respondents. Achieving this will ultimately require strategies to increase Indigenous participation in undergraduate and postgraduate training. However, in the interim, providing access to mentoring and professional networking may help to attract and retain individuals; this was an identified need, particularly by Indigenous and early career respondents, and is likely to be an ongoing requirement. While there are some Indigenous research networks (e.g. Wirraway Mirrim in Victoria and the Cooperative Research Centre for Aboriginal Health), clearly more are needed for both Indigenous researchers and all researchers in Indigenous health. Institutions (academic, funding and Indigenous) should reflect on the perceived lack of training and institutional support for Indigenous health research voiced by many respondents. Support is likely to be required at many levels, such as provision of research infrastructure, cultural training in tertiary education, and support for the approaches that foster Indigenous knowledge and control. Some capacity‐building issues identified in this survey are not necessarily specific to research in Indigenous health. For example, the lack of institutional support may reflect a general lack of support for applied research, in part due to the implications this type of research has on the measurement of research performance. Similarly, concerns about sustainable career pathways and funding have been identified by individuals working across all areas of health research. In this survey, it is unclear if respondents cited these concerns as unattractive relative to other fields of research or in absolute terms. Addressing these factors will likely require greater research investment and policy action. Recent short‐term increases in funding for health research and ongoing initiatives such as the CIPHER program (funded through the Population Health Capacity Building Program) provide encouragement. Many of the recommendations by respondents, including those related to mentoring, collaborative approaches and greater institutional responsibility, align with the principles of the Indigenous Research Reform Agenda (IRRA). This suggests there is broad support for the elements of the IRRA among researchers; however, ongoing efforts are still required to implement the reform initiatives. “Politics” emerged as the most salient negative factor and potential barrier to research in this field; however, few respondents attempted to deconstruct the meaning of “politics”. Politics may relate to the contested nature of Indigenous affairs in the wider political arena or the potentially conflicting allegiances between Indigenous communities and agencies, both locally and nationally. “Politics” can also envelop the research processes involved in working with Aboriginal communities; this was a key reason for including “politics” as a potential unattractive factor in this survey. Further exploring the implications of “politics” is an area for future research, to better identify strategies to support researchers to overcome this barrier. The findings of this survey may be limited by the low response rate (37%). This was below what was expected, given that the target group are researchers, and was despite follow‐up reminders being provided. Although disappointing, the response rate is similar to that achieved in a recent national survey of 1,879 recipients of NHMRC People Support Awards, in which only 32% of researchers responded. The representativeness of respondent views in this survey is unknown and caution should be exercised in extrapolating the findings of this survey to all individuals working in Indigenous health research. Several issues have not been addressed in this survey, including the factors that are required to permit fuller Indigenous participation in the design and control of research. Equally important is the need to redress the dominance of descriptive research in Indigenous health at the expense of the evaluation of interventions to produce health gain. Improving research capacity must be linked closely with reform that addresses these issues; these were beyond the scope of this study. Conclusion This study is a step towards better understanding the research workforce in Indigenous health. It provides evidence of a strongly perceived need for institutional reform that supports Indigenous health research, for sustainable approaches to funding and for mentoring initiatives for early career researchers. The findings also provide a platform for further in‐depth investigation into the experiences of researchers to better understand the challenges to effective Indigenous health research. Acknowledgements Alice Rumbold is supported by a NHMRC Population Health Capacity Building Grant (No. 236235), which provides funding for the CIPHER Program. This program is recognised as an in‐kind contribution to the Co‐operative Research Centre for Aboriginal Health. Joan Cunningham is supported by a NHMRC Career Development Award (No. 283310) and Ross Bailie by a NHMRC Fellowship Grant (No. 283303).

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Feb 1, 2008

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