An emerging TIMER-2C framework for addressing barriers to research culture and productivity among local healthcare providers in the Middle East and sub-Saharan Africa: A qualitative study and modified Delphi approach

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ABSTRACT Background Contributions from healthcare professionals in the Middle East and North Africa (MENA) and sub-Saharan Africa (SSA) to global health research remain disproportionately low. we conceptualized the TIMER-2C framework as emerging approach to capture the multilevel barriers and facilitators shaping research productivity among local healthcare professionals in MENA and SSA. Methods We conducted qualitative interviews with a modified Delphi approach comprising two rounds of interviewing to: 1) identify barriers and facilitators, and 2) establish consensus on the most prominent factors influencing research productivity. We purposively sampled 17 established and early career health researchers from Jordan, Qatar, Egypt, Lebanon, North Sudan, South Sudan, Nigeria, Ghana, Kenya, Uganda, Ethiopia, South Africa and India. Interview guides were grounded in the “Capacity Strengthening of Health Research in Conflict” and the “Health Equity Implementation” frameworks. We explored barriers, facilitators, and recommendations for increasing research output. Transcripts were managed in ATLAS.ti and thematically analyzed to identify emerging themes. Results Barriers and facilitators to research productivity occurred at individual, institutional, national, and global levels. Key barriers included limited time, funding, mentorship, and research training; institutional emphasis on clinical and teaching duties over research; lack of national investment and supportive policies; and global inequities in funding, publishing, and collaboration. Facilitators included personal motivation, protected time, access to training and mentorship, institutional support for research, national funding strategies, and equitable global partnerships that value research contributions from local healthcare professionals. We identified six interlinked core themes and one overarching theme from which we coined the TIMER-2C conceptual framework to represent: 1) T ime, 2) I nstability, Interest & Infrastructure, 3) M oney & Resources, 4) E xpertise & Experience, 5) R ecognition, and 6) constructive C ollaboration, which are elements that promote a positive research C ulture (2C stands for Collaboration and Culture) that builds research capacity and creates a sustainable pipeline of researchers. Conclusion We identified research culture as an overarching influence on research contributions from MENA and SSA. We unveil an emerging conceptual framework, the TIMER-2C framework , that depicts and explains the relationship between factors associated with research productivity. This framework with its seven constructs can be a useful tool for guiding and/or evaluating local and global strategies to increase research output. We recommend further use of this framework to guide the design, implementation and evaluation of multi-pronged strategies to enhance research contributions from healthcare professionals in MENA, SSA, and other similar contexts.

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