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Using knowledge brokering activities to promote allied health clinicians’ engagement in research: a qualitative exploration

Introduction Engaging clinicians in research can improve healthcare organisational performance, patient and staff satisfaction. Emerging evidence suggests that knowledge brokering activities potentially support clinicians’ research engagement, but it is unclear how best they should be used. Objectives This study explores how embedded researchers utilised knowledge brokering activities to engage research interested clinicians in research. Design A longitudinal qualitative interview based study was co-designed to investigate how experienced research fellows utilise knowledge brokering activities to facilitate allied health clinicians’ engagement in research. Setting In one large tertiary level, regional Australian health service, research fellows were matched with research interested clinicians. Methods Qualitative analysis of three longitudinal semi-structured interviews for each research fellow was undertaken. Initial descriptions of their utilisation of knowledge brokering activities were deductively coded. Reflexive thematic analysis was utilised to generate a shared explanation of clinicians’ engagement in research. Results Three research fellows facilitated 21 clinicians’ participation in and leadership of clinical research projects over 12 months. They utilised all ten key knowledge brokering activities with each clinician, with differing patterns and examples. Research fellows described using linkage and exchange activities of communicating and collaborating with key stakeholders, and they tailored knowledge management products for individual’s engagement. Further, they described a broader learning journey where they clarified and monitored individuals’ capabilities, motivation and their contextual support for research engagement. Conclusion When research fellows chose and tailored knowledge brokering activities to align and extend clinicians’ research capabilities and motivation, they created individualised learning curriculums to support clinicians’ participation in and leadership of local research projects. Health and academic leaders should consider structuring embedded researcher positions to include knowledge brokering roles and activities, specifically for research interested clinicians who are ready to participate in and lead research projects.

Objectives: You describe the objectives of the study as "to explore how embedded researchers utilised knowledge brokering activities to engage research interested clinicians in research", while I would describe this study as "to explore how embedded researchers can act as knowledge brokers to engage research interested clinicians in research" Material and Methods: Study design: You stated "This longitudinal, qualitative interviewbased study", while I would state it as "A longitudinal qualitative study using structured/ semi-structured interviews". You may need to clarify if your interview is structured or semi-structured.
Setting: You stated that "experienced embedded allied health researchers (referred to as research fellows) were matched with research interested allied health clinicians (referred to as clinicians) who volunteered to participate in and/or lead a local clinically relevant research project" However, it is better to clarify how the matching process was done (based on what?). Was it based on the area of clinical expertise, area of research interest, time availability, etc..? Please, clarify the matching process to guide future researchers who may need to replicate the study at their clinical settings.

Participants:
You have mentioned that three research fellows were invited to participate in this study and matched with 21 clinicians. I would ask you to provide more explanation on how the clinicians were invited (based on which criteria? Based on their willingness to participate only?) Also, what kind of incentive you have offered to clinicians to encourage them to participate, given that clinicians have limited time and a heavy clinical caseload that usually act as barriers for clinicians to participate in research projects! The same question goes to the research fellows as well, how do you convince them to participate in this study during which they performed many tasks (which is much time-consuming for researchers) rather than research activities. Please, clarify what kind of incentive or motive do you offer for both research fellows and clinicians (e.g., they got a certificate, a degree, etc.)? Data collection: You stated "They participated in three longitudinal interviews of approximately 60 minutes duration, over a 12-month period (once every four months)", however, I prefer to rephrase this into "They participated in three longitudinal interviews of approximately 60 minutes duration each, over a 12-month period (once every four months)" More clarifications are needed about the interview guide: • Was it a structured or semi-structured interview? • How this interview guide was pilot-tested/ validated? what are the development and the validation process of the interview guide? • Would it be more useful if you can share the interview guide as supplementary materials for other researchers?
Data analysis: You have used the Key knowledge brokering activities mapped to theoretical domains for analyzing the data. I would suggest using the Role Domains of Knowledge Brokering: A Model for the Health Care Setting (https://pubmed.ncbi.nlm.nih.gov/26937654/) for future publication. This model is more recent and more comprehensive as it compasses all possible roles of knowledge brokering.

Results:
For the section of "Shared explanation of how research fellows supported clinicians' engagement in research", I would suggest organizing the data in relation to the three knowledge brokering roles "knowledge managers, linkage agents and capacity builders" instead of listing data narratively. I think this will help readers to better follow the results.
I have difficulty understanding table 2, I would suggest re-arrange it to be more clear to the readers.
Practical application: I would better summarize the essential tips/ tasks that research fellows performed throughout the process; this would be useful for researchers to consider in order to expand the knowledge brokering activities among research fellows.
Limitation: You didn't mention what were the limitations of this study? I imagine that you surely face many challenges that would be useful for future researchers to consider, in addition to the limitations of the study (i.e., can this study be replicated in primary care settings? or chronic diseases management?)

REVIEWER
Abey, Sally University of Plymouth REVIEW RETURNED 15-Jan-2022

GENERAL COMMENTS
I would like to commend the team on a very interesting and well presented paper. I would like to draw you attention to two areas: 1) Sentence 45-46 (page 4) difficult to interpret meaning and therefore clarity of purpose is not as clear as it could be. This would resolve my objection to the study objection not be entirely clear.
2) Not clear how the research fellows were 'matched' to clinicians (see line 60 page 5)

VERSION 1 -AUTHOR RESPONSE
Reviewer: 1 This paper is very well-written. I think it added an innovative method to provide an in-depth understanding of the knowledge brokering activities. However, I have a number of minor concerns to be considered by the authors. RESPONSE: Thank you for your time and consideration in peer reviewing this paper Title: The title is reflective of the content within the paper, however, it could suggest more reflective title such as "Using Research Fellows as knowledge brokers to promote allied health clinicians' engagement in research: A qualitative exploration" RESPONSE: I am reluctant to directly ascribe research fellows as knowledge brokers given the contested debates about what knowledge brokers are. Instead, this research was focused more pragmatically on describing how research fellows used knowledge brokering activities specifically to facilitate clinicians to participate in and lead research. This has been made clearer to the reader in the final paragraph of the introduction. "While most research has investigated the organisational impact of knowledge brokering, this study will investigate how embedded researchers use knowledge brokering activities, in addition to traditional mentoring and facilitation activities, to engage individual clinicians in research. Most research to date has focussed on encouraging clinicians to engage with and to use research [3]. Therefore, this study was designed to explore how research fellows used knowledge brokering activities to support clinicians' engagement in, that is participating in and leading research." Background: The background is well done and adequately provides information relevant to the study. Objectives: You describe the objectives of the study as "to explore how embedded researchers utilised knowledge brokering activities to engage research interested clinicians in research", while I would describe this study as "to explore how embedded researchers can act as knowledge brokers to engage research interested clinicians in research" RESPONSE: see comment above Material and Methods: Study design: You stated "This longitudinal, qualitative interview-based study", while I would state it as "A longitudinal qualitative study using structured/ semi-structured interviews". You may need to clarify if your interview is structured or semi-structured. RESPONSE: Change in wording made as suggested. Clarified that semi-structured interviews were used in the paragraph describing data collection. Setting: You stated that "experienced embedded allied health researchers (referred to as research fellows) were matched with research interested allied health clinicians (referred to as clinicians) who volunteered to participate in and/or lead a local clinically relevant research project" However, it is better to clarify how the matching process was done (based on what?). Was it based on the area of clinical expertise, area of research interest, time availability, etc..? Please, clarify the matching process to guide future researchers who may need to replicate the study at their clinical settings. RESPONSE: The following sentence was added to clarify the matching process. "The matching process incorporated complimentary content expertise, methodological skills, time and availability."

Participants:
You have mentioned that three research fellows were invited to participate in this study and matched with 21 clinicians. I would ask you to provide more explanation on how the clinicians were invited (based on which criteria? Based on their willingness to participate only?) Also, what kind of incentive you have offered to clinicians to encourage them to participate, given that clinicians have limited time and a heavy clinical caseload that usually act as barriers for clinicians to participate in research projects! The same question goes to the research fellows as well, how do you convince them to participate in this study during which they performed many tasks (which is much time-consuming for researchers) rather than research activities. Please, clarify what kind of incentive or motive do you offer for both research fellows and clinicians (e.g., they got a certificate, a degree, etc.)? RESPONSE: The research fellows were invited to co-design the studythis has been added. We described in the setting that "research interested allied health clinicians (referred to as clinicians) … volunteered to participate in and/or lead a local clinically relevant research project" We have added in the phrase that they also "had their manager's support to participate". This is consistent with what was published in our protocol.
Data collection: You stated "They participated in three longitudinal interviews of approximately 60 minutes duration, over a 12-month period (once every four months)", however, I prefer to rephrase this into "They participated in three longitudinal interviews of approximately 60 minutes duration each, over a 12month period (once every four months)" RESPONSE: The word 'each' has been added More clarifications are needed about the interview guide: • Was it a structured or semi-structured interview? RESPONSE: The interviews have been described as face-to-face semi-structured interviews….. • How this interview guide was pilot-tested/ validated? what are the development and the validation process of the interview guide? RESPONSE: The interview guide was co-developed between researchers and research fellows, to the extent that research fellows did not require any additional questions (beyond what we included) in the second and third rounds of interviewing. We have added the sentence "This semi-structured interview guide was pilot tested in the initial interviews and validated, with-out change through the remaining second and third interviews" to clarify this.
• Would it be more useful if you can share the interview guide as supplementary materials for other researchers? RESPONSE: It can be made available, however, it is likely that future research studies will tailor their own interview template to meet their own research questions. Data analysis: You have used the Key knowledge brokering activities mapped to theoretical domains for analyzing the data. I would suggest using the Role Domains of Knowledge Brokering: A Model for the Health Care Setting (https://pubmed.ncbi.nlm.nih.gov/26937654/) for future publication. This model is more recent and more comprehensive as it compasses all possible roles of knowledge brokering. RESPONSE: We have chosen to utilise Bornbaum's paper to guide our analysis as the thematic analysis in this paper was derived from a systematic review. Although more recent, the Role Domains model is predominantly theoretical, and more likely to be open to reporting biases from both authors. We have made reference to this informative paper in our discussion. "In addition, the facilitative and evaluation functions of knowledge brokers were also evidence in this study. Research fellows described evaluating clinicians' capability and motivation to do research, and their workplace demands, in order to facilitate their learning about and engagement with research [23]." Results: For the section of "Shared explanation of how research fellows supported clinicians' engagement in research", I would suggest organizing the data in relation to the three knowledge brokering roles "knowledge managers, linkage agents and capacity builders" instead of listing data narratively. I think this will help readers to better follow the results. RESPONSE: The focus of this section has been refined to explain how research fellows facilitated a unique learning journey for every clinician. The first 2 key steps have been identified ('Clarify clinicians' capability and motivation to do research', and 'Match demands of the workplace context with clinicians' research project'). The final step of 'Building individualised learning curriculums has been identified as influencing the selection of knowledge brokering activities. The pattern of use of the 3 knowledge brokering roles was overlaid across this sequence. The initial paragraph of this section has been reworded as: "In addition to utilising all ten knowledge brokering activities, research fellows described facilitating an overarching and unique learning journey for each clinician. This journey was defined by the clinician's capability and motivation to do research. Research fellows also had to match the demands of each clinicians' local workplace context with those of their research project. This influenced the way in which research fellows selected knowledge brokering activities for each clinician. A corresponding pattern emerged in the way research fellows initiated linkage and exchange functions early and then facilitated knowledge management and capacity building functions to co-create individualised learning journeys for clinicians around their own research project." Headings have been inserted to match the phases of creating the learning journey, rather than the knowledge brokering roles. I have difficulty understanding table 2, I would suggest re-arrange it to be more clear to the readers. RESPONSE: Table 2 has been deleted. Practical application: I would better summarize the essential tips/ tasks that research fellows performed throughout the process; this would be useful for researchers to consider in order to expand the knowledge brokering activities among research fellows. RESPONSE: Active activities have been highlighted in a separate paragraph. "Initial identification of clinicians' motivation and capability for engaging in research, together with matching the demands of the work environment with the tasks of local research project can set the scene. Embedded researchers may need to initiate linkage and exchange activities to identify, communicate and collaborate with a local network of researchers around each clinician. They may also need to create research projects using local project management tools and strategies. With facilitative relationships that support clinicians' learning about research, embedded researchers can gradually hand over specific research tasks, support just-in-time learning and provide ongoing feedback. Limitation: You didn't mention what were the limitations of this study? I imagine that you surely face many challenges that would be useful for future researchers to consider, in addition to the limitations of the study (i.e., can this study be replicated in primary care settings? or chronic diseases management?) RESPONSE: Thank you for the suggestion. A paragraph has been added to address this omission. "A key limitation of this study is the focus on allied health clinicians within one health service at a point in time when there was management support for professorial and senior research fellow positions. This study is also focused on the individualised relationships. It does not refer to specific individual and/or organisational behavioural strategies that can also facilitate clinicians' motivation and maximise social influences [7]." Reviewer: 2 I would like to commend the team on a very interesting and well presented paper. I would like to draw you attention to two areas: 1) Sentence 45-46 (page 4) difficult to interpret meaning and therefore clarity of purpose is not as clear as it could be. This would resolve my objection to the study objection not be entirely clear. RESPONSE: This sentence has been reworded to read "Therefore, this study was designed to explore whether research fellows could include knowledge brokering activities to support clinicians' participation in and leadership of research" 2) Not clear how the research fellows were 'matched' to clinicians (see line 60 page 5) RESPONSE: The following sentence was added to clarify the matching process. "The matching process incorporated complimentary content expertise, methodological skills and practical time and geographical availability." GENERAL COMMENTS I am still unable to understand the following sentence: Therefore, this study was designed to explore how research fellows used knowledge brokering activities to support clinicians' engagement in, that is participating in and leading research [3,9,22].
It is the last section that I cannot make understand and therefore the objective is not clear. I am sure this can be easily resolved.