Clinical engagement in NHS research

Research is at the heart of the NHS. The NHS prides itself on using evidence-based practice by integrating best research evidence with clinical expertise and patient values. Research is central to identifying new treatments and making services more effective, ensuring maximum benefits from limited, precious resources. However, research would be impossible without study participant engagement, which is very often dependent on clinician support. An important part of research involvement, which often is overlooked, is the advantage of research participation for the service user. Some participants state that being involved in research gives them a feeling of purpose and empowerment through helping others.

Recruiting participants to research in mental health services presents several challenges including protocol design, gatekeeping and clinical priorities. Many research protocols require the first contact with service users to come from the routine clinical team, meaning that researchers heavily rely on clinicians to engage with recruitment. Accurate interpretation of study inclusion/exclusion criteria is vital to ensure clinical gatekeeping is valid and effective to allow all eligible consenting participants to be recruited. However, some clinicians inappropriately filter their caseload based on factors such as service users' risk, age, diagnosis and assumptions about their interest in research. For example, clinicians have said they 'won't be interested in a sexual health study because they are married'.

Finally, some clinicians do not see research as part of their job role or as precedence. With the increasing pressures and demands in the NHS unfortunately research slips down their priorities list. Several research studies have explored the levels of clinician awareness, engagement and participation in health research. In one study, nurses were receptive to being involved in research but felt unable due to time constraints, lack of team support and limited knowledge about the research process (Roxburgh, 2006). Within a GP setting, barriers to research included the irrelevance of research to clinical practice, the need to protect their patients and their lack of skills and time constraints (Salmon et al., 2007).

So how do we improve clinician and participant engagement in research? Clearly, there are challenges within the working systems clinicians operate in. A good start would be a cultural shift to ensure research is embedded systemically in the way clinicians work. To make this easier for clinicians, raising awareness of the research systems in place to help clinicians engage is vital. Research teams need to work collaboratively with clinicians to foster an environment where service users feel comfortable discussing research with clinicians.

In conclusion, if you are a service user, you could ask your clinical team about research opportunities in your local area. If you are a clinician, speak to your local research department about studies in your area. Perhaps it is simply a case of feeling more confident informing your service users about a study and pointing them in the right direction for this. Working with a research team to access caseloads for eligibility screening, granting permission for them to attend clinics and meet face to face will all enhance engagement in research for both you and your service users.

Emma Sellers
Research Assistant
Leeds and York NHS Foundation Trust

References
Roxburgh, M. (2006). An exploration of factors which constrain nurses from research participation. Journal of Clinical Nursing, 15, 535–545.
Salmon, P., Peters, S., Rogers, A. et al. (2007). Peering through the barriers in GPs' explanations for declining to participate in research: The role of professional autonomy and the economy of time. Family Practice, 24(3), 269–275.