Mechanisms to build research capacity in the rural health workplace: a realist synthesis.

Introduction: Workplace-based research training contributes to research capability and capacity in rural areas where access to university expertise is limited. Rural health complexities and the diverse approaches previously used to build research capacity have led to a lack of clarity about how to build research capacity within rural health services. Methods: Using a critical realist foundation, we explored distributed workplace-based rural research training and synthesized five studies centered in rural New South Wales, Australia. Critical realism allowed the exploration of the structural supports and barriers for workplace-based research training activities and the ability of individuals to pursue research activities within rural health workplaces. Results: The component studies showed that distributed rural research training programs improve individual research capability by developing research skill, increasing research experience and facilitating research networks across sectors. Rural research activities are characterized by individual agency and partnering or relationships to access support and expertise. Structural barriers including a lack of operational planning for research and few ongoing research opportunities limit translation of capability into research capacity. Discussion: Individual workplace-based research training is effective, but not sufficient to build and maintain research capacity. Structural supports such as organizational commitment and careful training design can maximize cooperative partnerships with education partners. Addressing both structural and individual factors is needed to build rural health research capacity and generate real-world health research to drive meaningful improvements in rural health.