Developing a Consolidated Research Career Competency Framework for Allied Health Professionals

Background Allied Health Professionals (AHPs) form a significant part of the healthcare workforce, and have a great potential to improve services through research and research informed practice. However, there is a lack of tradition in undertaking research alongside practice in these professional groups. Barriers include clinical caseload pressures, a lack of training and consequent lack of confidence in practitioners. Practice managers are ill-equipped to monitor and guide staff research development. Uni-professional competency frameworks can act as further barriers to research culture across the healthcare system that is moving toward multi-disciplinary research focussing on the patient. A common framework, acceptable to all AHPs might be helpful in planning and developing clinical career pathways. Methods Aim: to develop a consolidated framework of research competency to help plan and guide research activity throughout AHP clinical-academic careers. The study was conducted in three phases. Phase one identified existing AHP research frameworks (AHPRF) through expert consultations and literature searches. Phase two involved thematic content of the AHPRFs to develop a single consolidated framework. Phase three included a workshop with experts to validate and adapt the framework for practice. Results 19 AHPRFs were identified. A consolidated framework was shaped by content analysis of the AHPRFs resulting in a consolidated framework of eight sections, each containing a series of competencies. Each section relates to an analytic theme within the content analysis, and the competencies were based on analytic sub-categories of themes. The final framework was further shaped by the phase three workshop into a set of ‘stem’ competency statements that can be adapted to reflect different levels of expertise. It also includes a set of guiding principles for use. Conclusion The consolidated framework was entitled ‘Shaping Better Practice Through Research: A Practitioner Framework’ by stakeholders, thus emphasising its ambition to embed research activity into practice. It

performance, and improved organisational efficiency [12,13]. A strong research culture is associated with reduced staff turnover and faster translation of evidence into practice, and individual practitioners report improved job satisfaction and career progression, recognition and professional kudos, increased awareness of research findings and the reward of seeing impact on practice [9,12,13]. The National Institute for Health Research (NIHR) Clinical Research Network's AHPs Strategy 2018-2020 [7] recognises that realising the research potential of AHPs is core to delivering the NIHR's mission "to provide a health research system in which the NHS supports outstanding individuals, working in world class facilities, conducting leading edge research which is focused on the needs of patients and the public". This reflects global health and social care policies [14][15][16][17].
Research capacity building is defined as "a process of individual and institutional development which leads to higher levels of skills and greater ability to perform useful research" [18, p. 1322]. Building research capacity in frontline health and social care practitioners is essential to the development of a thriving research culture that offers value and meaning to patients and the public [19]. Within the context of allied health, the aim of this process is to "strengthen existing practitioner expertise with complementary research" [19, p. 56] in order to enable high quality practice and advancement of the profession. Much effort has been made in recent decades to build research capacity and embed research cultures within the allied health professions [20][21][22][23][24]. Despite this, several barriers have been identified to establishing an effective research culture within this sector [8,25].
A recent systematic review by Borkowski, et al [8] highlighted a lack of confidence in research skills to be a major barrier to a research culture. Many AHPs perceive their knowledge and skills to be inferior, and opportunities for continued learning and development in research is considered lacking for practising clinicians [8,25]. Lack of time, and sporadic organisational support can be exacerbated by managers ill-equipped to monitor and guide staff research development, participate, and provide appropriate resources and support learning activities [25,26]. The research literacy of individual managers within allied health is varied and access to support from experienced clinical academics is limited [11,27,28]. This suggests further support is needed to enable all individual practitioners to continue to develop research skills, and for allied health leaders to track and support the research competency of others.
Although many allied health disciplines provide frameworks for continuing professional development, the breadth and depth of research knowledge and skills described within these is variable. The field of clinical and applied research is an increasingly multidisciplinary context in which the same standards, regulatory requirements, and responsibilities are applied regardless of professional background [29]. Potential convergence and divergence in guidance by individual professional bodies is likely to act as a further barrier to research activity and engagement, and could create challenges for recruitment of appropriately skilled and competent researchers [8,25,29]. Language used to refer to research within academic institutions can also be perceived as intimidating to AHPs applying research to their own practice [25]. This suggests a common framework, acceptable to AHPs practising in all applied health and social care systems and consolidating key research skills, knowledge and competency across the professions would be helpful in supporting a strong AHP research culture.

Aim
To develop a consolidated framework of research competency that supports allied health professionals practising in all public, private and voluntary sectors of health and social care to help plan and guide research activity throughout their career.

Design and Objectives
A three phase pragmatic approach was applied to develop this consolidated framework.
Each phase aimed to achieve the objectives listed in table 1. Table 1 Phase one: Identifying AHP Research Frameworks This phase aimed to identify the scope and range of existing frameworks designed to support AHPs to develop research skill and competency.
Expert consultation was performed with key leaders within AHP research and professional development across the UK and with the authors and developers of AHPRFs identified through original literature searches and expert consultation [33]. Representatives from organisations listed in Table 2 were consulted in phase one. References of key AHPRFs were tracked and judgement used to determine relevance to the research question [33]. Table 2 Phase two: Thematic content analysis of AHPRFs to develop a consolidated framework In phase two, the AHPRFs identified in the first phase underwent content analysis to JC and KG independently reviewed the data to identify additional patterns, consider outlying codes, and offer multiple perspectives as to relevance and repetition / duplication. JH, JC and KG then met to convert the categorical data into statements of competency organised under theme headings to create a new consolidated framework.
The research team met to review language and terminology to ensure consistency throughout this new consolidated framework, and ensure that themes and competency statements remained true to the original cases (AHPRFs). At the end of phase 2, a draft consolidated framework was produced ready for wider consultation with stakeholders.
Phase three: consultation about content and next steps The relevance and validity of the consolidated framework was established through multi-stakeholder consultation and peer review. A purposive sample of participants were invited to the workshop that included representatives from AHP professional bodies; clinical research capacity-building leads, clinicians and managers from a range of organisations, and CAHPR strategy group members. Authors of some existing AHPRFs including the national NIHR workforce group were also participants.
The workshop also aimed to consider practical application and next steps in development. to include all aspects of career development.
A review of how the themes mapped against the original AHPRF can be seen in Table 4.
It can be seen that the area that is not included in most of the original AHPRFs is that of career development and planning. Gaps in the education and planning were also evident in many. Three [39][40][41] of the original frameworks did include some content within all of the themes of the consolidated framework, but they did not include the full range of subcategories identified through this content analysis of all of the documents. A few addition elements were included from the learning of CLAHRC including developing skills in co-production of research with stakeholders, and supporting outputs from research that are directly useful for practice, which the CLAHRC defines as 'actionable outputs' [42].
Thus the consolidated framework helped to include a full and comprehensive addition to the existing AHPRFs.
The content analysis revealed subcategories within each of the themes listed above. A series of statements were developed to reflect the research competency of these subcategories, thereby generating the detail of the draft-consolidated framework. In doing this we reflected that competencies identified operated at a range of expertise, from research awareness needed for most practitioners to an advanced level for research leaders. Before going out to consultation, the research team tentatively allocated the level of experience for each subcategory statement using four the NIHR CRN Integrated Workforce Framework expertise levels of awareness, core, intermediate and advanced levels [43] to encourage discussion at the phase three workshop. A selected example of the draft framework that went out to consultation is given in table 5. Table 5 Findings from the workshop regarding content and next steps.
Twelve participants attended the workshop, and a further two participants provided written comments on the draft-consolidated framework as they were unable to attend.
Invited participants included people with wide range of experience and expertise including four members of the CAPHR strategy group, three representatives from NIHR Clinical Research Network (CRN), two regional research training providers, and three clinicians who were both research and clinically active. Two national workforce planning policy representatives also attended. Most of the group were AHP trained including three radiographers, an SLT, three physiotherapists and a dietician, an orthoptist and an occupational therapist.
Workshop participants reviewed each theme of the consolidated framework. Statements were adjusted to ensure consistency in language, clarity and suitability across the range of practice settings and AHP roles. It was highlighted that many AHPs work across the health and social care system, and that some work in private practice. The final framework needed to embrace this, and so participants advised that the terminology moved away from clinical research language and be replaced with the term 'applied research' that reflected its application in different contexts.
The title was also changed from 'Clinical Research Skills and Knowledge Framework' to 'Shaping Better Practice through Research: A Practitioner Framework' to reflect a practitioner and practice focus.
A small number of additional statements were incorporated after this consultation, which included an expansion of competencies around public and patient involvement, and a stronger emphasis of working with wider stakeholders. Developing and influencing research capacity was thought to be an important element of research leadership. An increased focus on research-informed teaching in clinical practice was also expanded upon. Some statements were re-categorised. For example, statements related to grant and fellowship were moved from the 'research strategy and planning' section to 'research methodology and methods'. Other skills were incorporated within overarching principles as they were considered pertinent to all research activities across the consolidated framework, for example team-working skills were incorporated into overarching principles (see Figure 2 VII and VIII).
Workshop participants made recommendations regarding presentation of the consolidated framework including techniques to make the framework easier to navigate and increase usability.
Discussions ensued about expertise level and competency. As a result of this, competencies statements were developed to a series of 'stem statements' where the important aspect of the competency was highlighted in bold. The entry level could be considered the start of a spectrum of competencies linked to the stem statement. In practice subsequent levels will build on the entry-level competency. An example of how a stem statement can be developed to reflect increase in expertise is given in table 6. Table 6 There was some debate about the entry level for each competency and changes made. It was agreed that the entry level for some stem statements would start at the higher entry level, for example in those relating to research leadership, applying for research grants and external funding, and co-ordination of research programmes. The final framework includes competency stem statements with a suggested entry level, but these are only tentative and more work is needed here to establish consensus. A section of the resultant consolidated framework if given in Figure 1.
How the consolidated framework should be used: principles for application Participants considered that the consolidated framework should be implemented flexibly to inform conversations about research competency and career development with practitioners, managers and policy-makers. It was advised that the consolidated framework should not be used as a linear model to map performance objectives or pay, but should inform discussions for career planning, and support integrating research activity into everyday practice. It could be incorporated into, or used alongside existing appraisal systems, and in local and national workforce planning, policies and guidance.
The ambition would be to develop a space for discussion and reflection, to help plan a future practice-based workforce that conducts and delivers research alongside practice.
As a result of the phase three workshop guiding principles were developed reflecting the workshop discussions, and these are given in box 2.
A further AHPRF was identified during in the workshop [40], but its content was covered in the consolidated framework, implying a saturation of the data.  [24] and reflect international regulation [46].
A further emergent theme within the consolidated framework was 'own career development'. Over recent decades, allied health roles in high-income countries have developed in response to changing health and social policy to accommodate the needs of an aging population [47,48]. This has included flexibility in role boundaries, extended scope or advanced clinical practice, and emergence of allied health research positions [10,49]. Although individual career progression within allied health is likely to be informed by profession-specific requirements and health and social care policy, engagement in research is considered the most over-looked of the four pillars of advanced practice [50]. Frameworks such as the Vitae Researcher Development Framework [39] have been traditionally used within academic settings in the UK to map research career development but is not commonly implemented in practice-based environments. This was a useful addition to the consolidated framework and may facilitate discussions across sectors enabling joint appointments and other new career pathways.
The consolidated framework ensures knowledge, skills and behaviours associated with individual AHP research practice reflects national and international policy and regulation.
The inclusion of internationally recognised competency frameworks [44,51,52], and to national job profiles [41,43] as well as expertise gained from phase three of this project will facilitate workforce planning across practice settings. This combination of competencies and review by a multi-stakeholder audience can promote a shared research language amongst AHP disciplines including practitioners, managers, academics and policy-makers. Pager, et al [25] found 25% of AHPs reported they were intimidated by research language. More recent systematic reviews have acknowledged the value of effective communication from leaders and recommended a coordinated approach with a shared purpose that can offer collaboration across teams, services organisations including universities and industries [24,26].

Future developments
The current iteration of 'Shaping Better Practice Through Research: A Practitioner Framework', offers stem-statements under eight theme headings that can be used by the range of AHPs. It is acknowledged that the level and rate at which a practitioner will advance through each category or will vary according to the specific AHP role.
In common with international frameworks, future developments of the consolidated framework are likely to benefit from statements that identify both "what to do" and "how to do it" [29]. Although early iterations of the consolidated framework mapped competency levels in line with NIHR / CRN Integrated Workforce Framework (IWF) levels [43], it was not within the scope of this project to gain consensus on levels of progression that reflected all professional roles and practice settings and international qualifications frameworks. This is a limitation of the findings. Additionally, phase three of this project recognised further iterations of the consolidated framework should include case exemplars mapping elements of the framework against research-specific roles.

Future iterations of 'Shaping Better Practice Through Research: A Practitioner Framework'
are likely to require consensus through Delphi study including input from international AHP representatives and further consultation and piloting in practice-based environments.

Limitations
This project was completed with time and resource constraints and, therefore, followed a pragmatic approach that reflected the funding available. The data that informed the consolidated framework reflects the analysis of existing framework with expert opinion and experience. The wider literature was not used and therefore is a limitation. We were also unable to establish consensus on the entry level of each stem statement due to time constraints, and this requires further work. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests
The authors declare that they have no competing interests  Table 1 Study phases and objectives   Table 2 CAHPR member organisations and other multi-professional research organisations consulted within phase one Table 3 Research Frameworks identified in phase one of project Table 4 Content of existing AHPRFs and how they map against consolidated framework categories Table 5 Example of subtheme statements in draft consolidated framework Table 6 How stem statement can be adapted to reflect range of expertise  Tables   Table 1 Study phase Objective Phase one Identify existing AHP research frameworks (AHPRF) or research frameworks for other relevant non-medical health professions that was relevant.
Phase two Thematic analysis of AHPRFs to produce one consolidated framework.
Phase three Workshop of national experts to explore content and face validity of the consolidated framework, and develop next steps.   Table 6 Stem statement: Research, audit and service evaluation

Awareness
Able to differentiate between research, audit and service evaluation Core Able to plan and deliver audit and contribute to service evaluation projects Intermediate Able to plan and deliver audit, service evaluation and re projects Advanced Uses service evaluations to promote service change an prepare for research grant proposals Figures 29 Figure 1 A selected example of the consolidated framework Guiding principles to set the context of using the consolidated framework.