Developing a Consolidated Research Career Framework for Allied Health Professionals in the UK

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 knowledge & skills 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. Aim: to develop a consolidated research career framework to help plan and guide research activity throughout AHP clinical-academic careers. The study was conducted in three phases.


Abstract
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 knowledge & skills 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.
Aim: to develop a consolidated research career framework to help plan and guide research activity throughout AHP clinical-academic careers. The study was conducted in three phases.

Methods
Phase one identified existing AHP research frameworks (AHPRF) through expert consultations and literature searches. Phase two involved Framework Analysis 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 analysis of the AHPRFs resulting in a consolidated framework of eight sections, each containing a series of statements. Each section relates to an analytic theme within the thematic analysis, and the statements were based on subcategories of themes. The final framework was further shaped by the phase three workshop into a set of 'stem' statements that can be adapted to reflect different levels of expertise and the inclusion of a set of guiding principles developed through expert consultation.

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 instigates a new perspective within AHP research by offering practitioners and managers a tool that can be applied across public, private and voluntary settings for AHPs in all disciplines. Its ambition is to develop capacity in the AHPs that can undertake research to improve services and the health of service users.

Background
Allied Health Professionals (AHPs) constitute a large proportion of the international healthcare workforce and have great potential to improve services through research [1]. AHPs make up approximately one third of the health and social care workforce in the UK with over 65,500 qualified staff registered with the NHS in 2018 [2]. The term 'Allied Health Professionals' is used within the UK to describe a diverse range of 14 autonomous professionals including physiotherapists, occupational therapists, radiographers, paramedics, speech and language therapists, podiatrists, dietitians, operating department practitioners, orthoptists, osteopaths, prosthetists and orthotists, art therapists, music therapists and dance therapists [3]. Although the scope of each of these professions is unique, they collectively offer holistic care within the domains of prevention, health promotion, diagnosis, treatment, support and enabling independence [4]. The breadth and range of skills and delivery of care within the public, private and voluntary sector offer AHPs unique opportunities to impact lives and transform the health and wellbeing of our changing population [5].
Research informed practice is a core principle across all allied health disciplines and is a key component of pre-registration training [6][7][8]. Many initiatives support engagement, involvement and the delivery of research-informed practice, and skilled AHP researchers add impact and value to all levels of health and social care [9][10][11][12]. Health and social care organisations that engage in high quality and person-centred research activity have demonstrated higher rates of patient satisfaction, reduced mortality, improved quality performance, and improved organisational efficiency [12,13]. At a departmental level, strong research culture is associated with reduced staff turnover and faster translation of evidence into practice with potential to improve patient outcomes, patient satisfaction and resource efficiency [12,13]. However, when asked to consider why they choose to be involved in research, individual practitioners list personal interest in the topic, improved job satisfaction and career progression, recognition and professional kudos, increased awareness of research findings and the reward of seeing impact on practice amongst their reasons [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 building a positive research culture amongst allied health professionals. 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]. Practitioners describe high workload with limited time or resources to focus on research activity and sporadic support from managers [8,25,26]. The research literacy of individual managers within allied health is also varied, leaving many ill-equipped to support staff research development or signpost to experienced clinical academics [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 abilities of others. Although many allied health disciplines provide education and guidance for continuing professional development, the breadth and depth of research knowledge and skills described within these is variable [29]. The field of clinical and applied research is an increasingly multi-disciplinary context in which the same standards, regulatory requirements, and responsibilities are applied regardless of professional background [30]. 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 [8,25,30].

Aim
To develop a consolidated research framework 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.

Objectives
Identify AHP research frameworks (AHPRF) Undertake thematic analysis on the content of the identified AHPRFs to develop one consolidated framework.
Undertake consultation with key stakeholders on the consolidated framework 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.

Study phase Objective
Phase one Identify existing AHP research frameworks (AHPRF) or research frameworks for other relevant non-medical health professions.
Phase two Thematic analysis of AHPRFs to produce one consolidated framework.  Table 2 were consulted in phase one.. JH, JC & KG considered relevance to the research question according to application of research knowledge, skills or behaviour in allied health or social care and non-medical health profession For pragmatic reasons, phase one consultations were limited to those organisations for whom contact could be made within given timescales. However, saturation of statements were considered once significant overlap, duplication or lack of unique concepts was noted. 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. The aims for the workshop were to share the draft framework with key experts from across AHP professional bodies and relevant experts, to explore and validate the content domains within the framework to identify what is missing and items to be excluded as they are not relevant, to check 'entry level' of each of the items from 'awareness' through to 'advanced' levels, to explore how AHPs might use the framework in practice, and to identify next steps for development.
A purposive sample of participants was mapped out to include representatives from AHP professional bodies, clinical research capacity-building leads, clinicians and managers from a range of organisations, and CAHPR strategy group members. Participants were approached via CAHPR strategy group and level of expertise was established via nomination through AHP professional bodies. 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.   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 [42][43][44] 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 the analysis of all of the documents. A few addition elements were included as a result of expert opinion from workshop. This included 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' [45][46][47]. Thus the consolidated framework helped to include a full and comprehensive addition to the existing AHPRFs.
The data analysis revealed subcategories within each of the themes listed above.  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. 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 such as visual icons to represent each theme, use of a glossary, consistency in terminology and use of case examples as appendices.
Discussions ensued about expertise level. As a result of this, statements were developed to a series of 'stem statements' where the important aspect of each statement was highlighted in bold. The entry level could be considered the start of a spectrum of abilities linked to the stem statement. In practice subsequent levels will build on the entry-levelstatement. An example of how a stem statement can be developed to reflect increase in expertise is given in table 6. There was some debate about the entry level for each statement 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 coordination of research programmes. The final framework includes 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 skills and career development with practitioners, managers and policymakers. 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 practicebased workforce that conducts and delivers research alongside practice.
As a result of the phase three workshop, 'Research Practitioner Framework Guiding Principles' were developed reflecting the workshop discussions 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. Although there were many similarities across the AHPRFs analysed within this project, 'delivery of applied research' was a useful emergent theme that offered guidance on specific competencies

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 be expected to advance through each category or will vary according to the specific AHP role, opportunities and service need.
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"

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. Original AHPRFs were predominantly based in a UK setting limiting transferability across geographical and political settings. We were also unable to establish consensus on the entry level of each stem statement due to time constraints, and this requires further work.

Conclusions
'Shaping Better Practice Through Research: A Practitioner Framework' offers a consolidation of existing AHP research frameworks developed through thematic analysis and expert consultation. This consolidated framework has the potential to support AHPs to fulfil their research potential by facilitating research career and activity planning across a variety of practice-settings. By offering a coordinated approach and shared language, this framework provides a unique opportunity to build research capacity in the allied health workforce and work together across health and social care systems to plan clinical academic careers, and to improve services and health of service users. Availability of data and material

Abbreviations
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    Guiding principles to set the context of using the consolidated framework

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