Assessing Research Literacy in Complementary and Alternative Health Care Products and Practice: An Invitational Roundtable (Toronto, August 13-14, 2001)

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Table of Contents

• Executive Summary
• Introduction
• Agenda
• Participants
• CAHC and NHP Research Literacy and Capacity Needs
• Key Themes
• Barriers, Facilitators and Strategies
• Prioritization of Strategies To Improve CAHC and NHP Research Literacy and Capacity
• Exploration of Priority Strategies
• Re-Prioritization of Strategies
• Recommendations
• Acknowledgements

Executive Summary

A lack of research literacy and capacity has been identified as a key barrier to complementary and alternative health care (CAHC) and natural health product (NHP) research. The primary objectives of this roundtable were:

• to identify and prioritize CAHC and NHP research infrastructure and training needs to facilitate CAHC and NHP research
• to identify strategies for meeting high priority needs

Four key CAHC and NHP research needs were identified:

1. a need for more awareness and understanding of the value of research
2. a need for mentors, role models and champions for CAHC and NHP research
3. a need for more CAHC and NHP research training
4. a need for more funding for CAHC and NHP research, training and infrastructure

Four strategies to meet these needs were identified as high priorities:

1. the completion of a CAHC and NHP research needs assessment
2. support for a network of CAHC and NHP researchers and clinician investigators
3. the development of CAHC and NHP research learning modules
4. the development of CAHC and NHP research training support programs for faculty

Additional strategies were also discussed. These included:

• the development of a Centre of Excellence for CAHC and NHP research
• the identification of changes necessary within the current research funding and training program structures to allow CAHC and NHP researchers and clinician investigators to access current programs
• the establishment of an advisory group to continue the work started at this meeting
• funding for CAHC and NHP research knowledge transfer

The workshop discussions resulted in the following recommendations:

1. An advisory group should be established to follow up on the strategies and recommendations outlined during this workshop, and to advise Health Canada about future needs with respect to CAHC and NHP research literacy and capacity.
2. A needs assessment or environmental scan is necessary to ensure that future CAHC and NHP research literacy and capacity strategies meet the needs of a broad range of stakeholders. A Health Canada contract for this project may be the most effective way to complete this assessment.
3. Support for a network (or networks) of CAHC and NHP researchers and clinician investigators should be forthcoming to facilitate the development of CAHC and NHP research capacity.
4. Development of research learning modules and training support programs that can be accessed by a variety of CAHC institutions are recommended as ways to address the CAHC and NHP research literacy and capacity needs identified during this workshop. These programs should be designed and implemented following a broader needs assessment.
5. Health Canada should encourage the Canadian Institutes of Health Research to review current funding and training programs to ensure that CAHC clinician investigators, faculty members, and researchers are not unnecessarily excluded from applying for programs that clinician investigators, faculty members and researchers from conventional health care programs can currently access.
6. Support for one or more Centres of Excellence in CAHC and NHP research is recommended as a long-term strategy to enhance CAHC and NHP research capacity.
7. Funding for CAHC and NHP research knowledge transfer is recommended as a long-term strategy to enhance CAHC and NHP research literacy and capacity.

Introduction

A challenge identified by a number of initiatives in the areas of research, natural health products (NHPs) and complementary and alternative health care (CAHC) is a lack of research literacy and capacity. Health Canada planned this collaborative work to identify specific issues related to CAHC and NHP research literacy and capacity and to explore options for addressing them. While the ultimate aim of this project is to be inclusive to all practitioners, consultation at this stage was limited to three CAHC groups: chiropractic, naturopathy and massage, which are more developed in the area of research curricula.

Possible Content Areas

The content areas to be encompassed were expected to include:

• an assessment of CAHC and NHP research literacy curriculum: rationale; audience; range (undergraduate, specialty, continuing education); scope (which disciplines); and approach (distance education, audio and videotapes, case study materials, learning tools)
• the identification of research literacy and capacity needs of clinicians in general practice
• the identification of research literacy and capacity needs of clinicians who wish to undertake post-graduate research training
• an exploration of different delivery methods (e.g., distance education, forming part of residency program)

Primary Objectives of the Workshop

• to identify and prioritize infrastructure and training needs to facilitate CAHC and NHP research
• to identify strategies for meeting high priority needs

Agenda

Monday August 13, 2001

6:00 PM to 7:00 PM

BUFFET DINNER
Participant welcome and introductions

7:00 PM to 9:00 PM

1. Identification of CAHC and NHP research needs
   
2. Prioritization of research needs (Round One)

9:00 PM

ADJOURNMENT

Tuesday August 14, 2001

8:30 AM to 9:00 AM

CONTINENTAL BREAKFAST

9:00 AM to 10:15 AM

1. Exploration and clarification of top five research needs
   
2. Prioritization of research needs (Round Two)
   
3. Small group assignment (top three research needs)

10:15 AM to 10:30 AM

BREAK

10:30 AM to 12:00 PM

Small groups will identify:

1. Strategies for addressing research need
   
2. Barriers and facilitators associated with each strategy
   
3. Top two recommended strategies

12:00 PM to 1:00 PM

LUNCH

1:00 PM to 2:00 PM

Small groups report back

2:00 PM to 2:30 PM

Compilation of potential strategy list

2:30 PM to 2:50 PM

BREAK

2:50 PM to 3:50 PM

Exploration and clarification of strategies
Prioritization of strategies

3:50 PM to 4:30 PM

Development of recommendations for Next Steps

4:30 PM

ADJOURNMENT

Participants¹

Robert Allaby

Canadian Chiropractic Association
Fredericton, New Brunswick

Heather Boon

University of Toronto
Toronto, Ontario

Michelle Dépôt

Axcan Pharma Inc.
Mont Saint-Hilaire, Quebec

Trish Dryden

Centennial College
Scarborough, Ontario

Tannis Jurgens

Dalhousie University
Halifax, Nova Scotia

Silvano Mior

Canadian Memorial Chiropractic College
Toronto, Ontario

Cory Ross

Canadian College of Naturopathic Medicine
Toronto, Ontario

Joan E. Simpson

Health Canada
Ottawa, Ontario

Michael J. Smith

Health Canada
Ottawa, Ontario

Wayne Steinke

Canadian Naturopathic Association
Edmonton, Alberta

Marja Verhoef

University of Calgary
Calgary, Alberta

CAHC and NHP Research Literacy and Capacity Needs

The first group brainstorming session identified a number of CAHC and NHP research literacy and capacity needs. These are summarized below under the following headings: General Needs; Undergraduate Education Needs; Clinician-Investigator Needs; and Researcher Needs

General Needs

• awareness of and need for research (i.e., understanding its value and how it can be applied to clinical practice)
  
• building bridges for collaboration
  
• strategically placed individuals to 'champion' CAHC and NHP research
  
• enhanced funding mechanisms
  
• practice-based research is critical

Undergraduate Education Needs

• CAHC and NHP training institutions need to make research a priority
  
• CAHC and NHP training institutions need to build an institutional memory of research
  
• all programs need a research methods course and the concepts taught in this course need to be integrated into the rest of the training programs
  
• undergraduates need to be taught how to find evidence-based information and how to critically evaluate it
  
• evidence-based practice needs to be demystified and its limits discussed
  
• undergraduates need to be taught about the peer-review process
  
• undergraduates need the opportunity to get involved in research projects
  
• undergraduates need to be taught how research evidence fits into their future practices
  
• teaching about research needs to be encouraging, positive and practical
  
• collaborative education is needed to build interdisciplinary bridges among students that are in training (both within CAHC disciplines and conventional health care disciplines such as medicine, pharmacy and nursing)
  
• mentors and role models are needed

Clinician-Investigator Needs

• research needs to be demystified for clinicians (in terms of research language and in terms of how it can affect their practice)
  
• there is a need for incentives and support for clinicians to participate in research
  
• access to research training is necessary; the training and credentials of CAHC practitioners needs to be recognized to allow them access to research training and higher degrees (i.e., MSc, PhD)
  
• continuing education programs and workshops about research given by researchers are needed; distance education strategies are essential
  
• funding to undertake training and to conduct research is needed
  
• research infrastructure is needed to facilitate research and attract funding for projects
  
• seed grants would be a good idea to give clinician-investigators a chance to start with small projects
  
• sustainability of research efforts is critical
  
• mentors are needed
  
• a critical mass of CAHC and NHP clinician-investigators and researchers is necessary
  
• team building is essential
  
• interdisciplinary links and linking with 'champions;' there is a need to establish networks with potential research collaborators
  
• a CAHC and NHP research newsletter might facilitate networking

Researcher Needs²

• these individuals need to provide mentorship for students coming through graduate programs who are interested in CAHC and NHP research
  
• there is a need to link with CAHC practitioners more and a need to think about how their research findings can be applied and how research knowledge can be shared
  
• there is a need to build networks between researchers, practitioners and organizations interested in CAHC and NHP research
  
• funding competitions that require collaboration between conventional and CAHC and NHP researchers and practitioners might help
  
• protected time to devote to research is needed
  
• seed money to start small (or risky) projects is needed

Key Themes

The ideas arising from this brainstorming session were organized into the following key themes to facilitate continued discussion.

Awareness/Understanding of the Need for or Value of Research

This theme was relevant at an institutional level, practitioner level and undergraduate student level. It encompassed the need to demystify research and make it relevant for practitioners (the application of research). The need to understand the concept of evidence-based health care and its limits was also included in this theme. In addition, the need for knowledge transfer/translation with respect to research results was addressed by this theme.

Mentors, Role Models and Champions

This theme focused on the need for team building and networking among a variety of disciplines and between researchers and practitioners. The need for peer support and a sustainable critical mass of CAHC and NHP researchers (within the CAHC disciplines) was also included in this theme.

Research Training

This theme encompassed the need for research training for undergraduates, graduate students/fellows, clinicians and CAHC faculty members.

Funding

This theme included the difficulties that CAHC and NHP practitioners and researchers have experienced in accessing funding for research projects. Other funding issues such as the need for infrastructure funding, funding for training and funding for networking were also included in this theme.

Barriers, Facilitators and Strategies

The participants self-selected into small groups to identify the barriers, facilitators and strategies associated with the first three themes identified above. It was agreed that funding would be addressed later in the session. Each small group gave a summary of their discussion to the larger group for additional comments. The discussion summaries are provided below.

A. Awareness/Understanding of the Need for or Value of Research

Institutional Level

Short-term Goals: place a greater emphasis on existing research and/or research potential

Mid-term Goals: obtain financial support for research (infrastructure, training and projects)

Long-term Goals: the institution will become known for its research

Barriers: course load; research is not a priority or goal of some institutions; lack of research knowledge of teachers/professors

Facilitators/Strategies: making research a priority; creating post-graduate programs; bring in research 'Champions' for symposia or seminars

Undergraduate Student Level

Goals: graduate students with basic research skills; create interest and passion for research; instil the value and need for research

Barriers: course load/time; misunderstanding of the value of research; fear of the complexity of research; lack of knowledge of research methods; lack of teachers and role models within the institution

Facilitators/Strategies: availability of interdisciplinary researchers; use curriculum revision opportunities to include new courses in research methodology or strengthen existing program; use adult learning principles

Practitioner Level

Goals: practitioners with basic research skills; create interest and passion for research; instil the value and need for research; encourage practitioners to participate in research projects; enable practitioners to apply research results in their everyday practices

Barriers: financial; workload; access to research teams; lack of knowledge

Facilitators/Strategies: professional associations; continuing education opportunities; interest groups and/or networks; the availability of consultation services

Issues Around Evidence-based Health Care

Goals: increased multi-disciplinary collaboration around evidence-based health care and the criteria for assessing 'evidence'

Barriers: lack of common understanding of what evidence is; the individualized treatment philosophy of CAHC; the role of the practitioner in CAHC and NHP treatments; practitioners' fears that evidence-based care may restrict their scope of practice

Facilitators/Strategies: hold more multi-disciplinary events (e.g., seminars); encourage those with research expertise and those with CAHC and NHP knowledge to collaborate

Issues Around Demystifying Research

Goals: make research relevant, exciting and fun

Barriers: lack of knowledge, collaboration and fear of the unknown

Facilitators/Strategies: start small and simple; make training courses available

B. Mentors, Role Models and Champions

Barriers

• level of CAHC institutional commitment
  
• ability of CAHC institutions to provide a 'safe' partnership with researchers/ champions
  
• CAHC institutions do not understand the value of research
  
• reality of the funding base for CAHC institutions makes it very difficult to provide funding for research projects and infrastructure
  
• institutions lack 'political savvy'
  
• lack of CAHC and NHP research infrastructure at institutions confusion about who/what is included in the concept of CAHC

Strategies

• identify university-based researchers at the end of their careers and attract them to CAHC institutions to head research programs
  
• establish a Centre of Excellence for CAHC and NHP research
  
• build on networks that currently exist and create connections between them
  
• develop a 'train the trainer' program
  
• initiate a 'visiting scholar' program (to facilitate guest researchers to spend time at institutions and CAHC faculty to visit other institutions)
  
• develop a peer-mentoring program to take advantage of under-graduate students who have acquired research skills
  
• educate the decision-makers at the institutional level
  
• designate a point person for institutional research so that those wishing to collaborate know who to contact
  
• establish research rounds
  
• advertise the CAHC institutions' research interests
  
• develop a small number of specific research area priorities (these should be practical and build on the institution's areas of strength)
  
• partner with special interest groups/agencies to build research priorities and leverage funding

C. Research Training

Training People to Use Research

Goal: to include undergraduates and practitioners whose current knowledge levels range from novice to experienced researcher

Barriers: money; time; fear of research; access to training

Facilitators: make training practical (applied), easy to access, and practice-enhancing; training programs should be inter-disciplinary and fit the needs of a variety of learners

Strategies: distance education, learning modules and traveling workshops; learners need the opportunity to be part of a research project (e.g., databases, surveys)

Training People to Conduct Research

Barriers: buy-in from CAHC institutions; academic bias; money; time; the current teaching model (i.e., no release time available for faculty)

Facilitators: government recognition of CAHC institutions: funding from private and public sectors; seed money for small projects; new teaching models

Strategies: professional development for CAHC faculty (e.g., workshops, travelling scholars); engaging in affordable, small projects; development of funding for CAHC faculty to return to academia for advanced research training

Prioritization of Strategies to Improve CAHC and NHP Research Literacy and Capacity

The strategies identified by each group were summarized in a single list. From that list, several strategies were identified as important for improving CAHC and NHP research literacy and capacity, but were considered either self-evident enough not to require additional discussion or beyond the scope of this workshop. These included:

• the development of a Centre of Excellence for CAHC and NHP research
  
• the identification of changes within the current research funding and training program structures necessary to allow CAHC and NHP researchers and clinician investigators to access current programs
  
• the establishment of a working group to continue the work started at this meeting
  
• funding for CAHC and NHP research knowledge transfer

The remaining strategies were prioritized by the group to determine which strategies would be discussed in additional detail to allow for the development of specific recommendations. In descending order of priority these strategies were identified as:

1. the development of research learning modules
   
2. the development or facilitation of a network of CAHC and NHP researchers and clinician-investigators
   
3. support for continuing education for CAHC faculty and practitioners (tied with #4)
   
4. the completion of an environmental scan or needs assessment to determine research literacy and capacity needs in the wider community (tied with #3)
   
5. the development of a visiting scholar program (tied with #6)
   
6. the development of opportunities for infrastructure development at CAHC training institutions (tied with #5)
   

Exploration of Priority Strategies

The group decided to break into small groups to brainstorm ways to operationalize the top four strategy priorities. A summary of the ideas from each small group was presented to the large group and is provided below:

An environmental scan/needs assessment to determine research literacy/capacity needs

• This environmental scan/needs assessment should be completed before any other strategies/programs are developed.
  
• This task should probably be contracted out by Health Canada.
  
• Funding required: $15,000 to $20,000
  
• A quick turn-around time is needed to facilitate moving forward with other strategies (e.g., four to six months).
  
• Groups that need to be included in an assessment of research literacy and capacity needs: chiropractic, naturopathic medicine and massage therapy need to be assessed in detail. Other CAHC groups including TCM, acupuncture, homeopathy and herbal medicine should be included as much as possible given their current levels of organization.
  
• The need to investigate the extent to which CAHC is taught in other health care training programs (e.g., medicine, nursing, pharmacy etc.) was discussed; however, it was decided that was really a distinct project (it was noted that some of this information may be obtained from other upcoming initiatives and that opportunities to link the results of the environmental scan proposed here with these other initiatives need to be explored).
  
• Information for each group should be obtained from professional associations and training institutions.
  
• Objectives of the needs assessment: 1) to assess the current level of research training; 2) to identify both short-term and long-term research literacy and capacity needs; 3) to identify opportunities for building bridges across different training programs; and 4) to identify the CAHC and NHP research networks in which each group participates.
  
• The results of this needs assessment need to be available for participants of a meeting planned as a follow-up to this workshop and to the CAHC and NHP research networks identified in the study.

Development of Research Learning Modules

• Health Canada should facilitate (through contracts or other means) the development of basis research methodology courses.
  
• CAHC and NHP research methods courses should be developed with different levels: 1) how to find information; 2) how to interpret and critically assess information; 3) understanding research terminology and basic research methods; and 4) the mechanics of writing research grants, obtaining ethics approval; making links with networks of researchers.
  
• Levels 1 and 2 would be appropriate for consumers and CAHC practitioners.
  
• Topics addressed in the course should include: research process; defining research questions; research design; data collection methods; data analysis; proposal writing; dissemination of research results; knowledge transfer; creating research networks; conducting research projects; and mentoring students.
  
• Objectives/guiding principles throughout all the courses should include inclusiveness, inter-disciplinary teams, adult learning strategies, and accessibility.
  
• The course should be available online, on computer disks, in hardcopy and in workshop format.
  
• Courses should be available to anyone who wants them.
  
• Fees for the courses should be reasonable (but enough to sustain their continued distribution).
  
• Cost of course development, initial advertising and distribution: perhaps $100,000 to $200,000.

Support for Continuing Education for Faculty and Practitioners

• The goal is to support the development and implementation of innovative training and educational programs that will contribute to the sustainability of research programs in CAHC institutions.
  
• The training of CAHC faculty and practitioners should be based on a needs assessment (done by each institution).
  
• Requests for support for the development of formal and informal educational programs need to be considered based upon the strategic planning and needs identified by each institution as required to enhance research productivity.
  
• Pathways for CAHC faculty to pursue Masters and Doctoral level training need to be made available (perhaps funding for two years of training).
  
• Funding should be made available both for the training CAHC faculty and for the CAHC institutions to determine their training needs.
  
• Funding should be provided to a maximum of $50,000 over two years for program development and implementation.
  
• A maximum of $20,000 should be provided for proposals to assess the training needs of practitioners.
  
• Support for graduate training for CAHC faculty members should follow the CIHR funding scale.
  
• Suggestion: fund two post-doctoral fellowships (approx $45,000/person/year) and three PhD students (approx $24,000/person/year).

Development or Facilitation of a Network of CAHC and NHP Researchers

• An environmental scan/needs assessment is a pre-requisite for this initiative.
  
• Complementary and Alternative Health Care and Natural Health Product Network Initiative (CAHC NHP Network Initiative)
  
• Objective: to foster, nurture and support collaborative endeavours in research through network-based initiatives
  
• Method: create new or support existing research-focused networks.
  
• Network areas of interest may include (but are not limited to): biomedical; practice-based; health systems and policy; information and knowledge transfer; and pharmacoeconomics.
  
• Seed money should be given for network infrastructure rather than specific research projects.
  
• Priority should be given to multi-disciplinary proposals.
  
• Each network should be funded to a maximum of $100,000 over two years with a minimum of 2 funded networks.
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Re-prioritization of Strategies

1. the completion of a CAHC and NHP research needs assessment/environmental scan
   
2. support for a network of CAHC and NHP researchers and clinician investigators
   
3. the development of CAHC and NHP research learning modules (tied with #4)
   
4. the development of CAHC and NHP research training support programs for CAHC faculty (tied with #3)

Recommendations

The workshop discussions resulted in the following recommendations:

1. An advisory group should be established to follow-up on the strategies and recommendations outlined during this workshop and to advise Health Canada about future needs with respect to CAHC and NHP research literacy and capacity.
   
2. A needs assessment or environmental scan is needed to ensure that future CAHC and NHP research literacy and capacity strategies meet the needs of a broad range of stakeholders. A Health Canada contract for this project may be the most effective way of completing this assessment.
   
3. Support for a network (or networks) of CAHC and NHP researchers and clinician investigators should be forthcoming to facilitate the development of CAHC and NHP research capacity.
   
4. Development of research learning modules and training support programs that can be accessed by a variety of CAHC institutions is recommended as a way to address the CAHC and NHP research literacy and capacity needs identified during this workshop. These programs should be designed and implemented following a broader needs assessment (see recommendation #2).
   
5. Health Canada should encourage the Canadian Institutes of Health Research (CIHR) to review current funding and training programs to ensure that CAHC clinician investigators, faculty members and researchers are not unnecessarily excluded from applying for programs that clinician investigators, faculty members and researchers from conventional health care programs can currently access.
   
6. Support for one or more Centres of Excellence in CAHC and NHP research are recommended as a long-term strategy to enhance CAHC and NHP research capacity.
   
7. Funding for CAHC and NHP research knowledge transfer is recommended as a long-term strategy to enhance CAHC and NHP research literacy and capacity.

Acknowledgements

This invitational roundtable was made possible by funding from the Health Human Resource Strategies Division, Health Policy and Communications Branch and the Natural Health Products Directorate of Health Canada. Heather Boon (University of Toronto), Marja Verhoef (University of Calgary), Joan Simpson (Health Canada) and Michael Smith (Health Canada) were responsible for determining the agenda for the meeting. Ginette Renaud (Health Canada) and Kathleen Westlake (University of Toronto) provided assistance with the coordination of the meeting.

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