In general, clinical research network capacity building refers to programs aimed at enhancing networks of researchers to conduct clinical research. Although in the literature there is a large body of research on how to develop and build capacity in clinical research networks, the conceptualizations and implementations remain controversial and challenging. Moreover, the experiences learnt from the past accomplishments and failures can assist in the future capacity building efforts to be more practical, effective and efficient. In this paper, we aim to provide an overview of capacity building in clinical research network by (1) identifying the key barriers to clinical research network capacity building, (2) providing insights into how to overcome those obstacles, and (3) sharing our experiences in collaborating with national and international partners to build capacity in clinical research networks. In conclusion, we have provided some insight into how to address the key factors of clinical research network capacity building and shared some empirical experiences. A successful capacity building practice requires a joint endeavor to procure sufficient resources and support from the relevant stakeholders, to ensure its efficiency, cost-effectiveness, and sustainability. Keywords: Capacity building, Clinical research, Network, Collaboration Background mentorship, improvement, empowerment, education, sup- The clinical research network is a joint and structured port, and training, among others. network of individuals, or institutions (such as univer- While capacity refers to the ability or power to finish, sities, hospitals, institutes and other-related centers) change, tackle, develop, or experience some objective that aims to (1) advance research and discovery of or activity, capacity building indicates the interventions, clinical studies, and (2) facilitate collaborations, edu- procedures or activities aiming to produce sustained cations and training, study implementations, data change or improvement to perform activities at levels sharing and other research processes. Figure 1 shows of individuals, organizations, systems, national and/or an example of a research network composed of international entities [1, 2]. Thus, clinical research funders, policy makers, and individual researchers network capacity building refers to programs aimed at from different disciplines aimed at improving cardio- enhancing networks of researchers to conduct clinical vascular outcomes through interventional research, research. In the literature, there have been many exam- evidenced-based practice and policy. Some key attributes ples of local, national and global clinical research of research networks are presented in the word clouds networks with successful capacity development that (Fig. 2). These include collaboration, teamwork, communi- perform and utilize health research resources effi- cation, sharing, capacity building, sustainability, growth, ciently, cost-effectively, and sustainably. Nevertheless, although there is a large body of research on how to develop and build capacity in clinical research net- * Correspondence: email@example.com works, the conceptualizations and implementations Guowei Li and Qianyu Wu contributed equally to this work. 1 remain controversial and challenging [2, 3]. The experi- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada ences learnt from the past accomplishments and Father Sean O’Sullivan Research Centre, St. Joseph’s Healthcare Hamilton, failures can assist in the future capacity building efforts McMaster University, 3rd Floor Martha, Room H325, 50 Charlton Avenue E, to be more practical, effective and efficient. Therefore, Hamilton, ON L8N 4A6, Canada Full list of author information is available at the end of the article the objective of this paper is to provide an overview of © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Li et al. Journal of Venomous Animals and Toxins including Tropical Diseases (2018) 24:15 Page 2 of 7 Fig. 1 Example of a cardiovascular health research network capacity building in clinical research network by (1) Key barriers to clinical research network capacity building identifying the key barriers to clinical research net- A recent systematic review has identified the key work capacity building, (2) providing insights into barriers to health research capacity development in low- how to overcome those obstacles, and (3) sharing our and middle-income countries, which include : experiences in collaborating with national and inter- national partners to build capacity in clinical research fragmented research systems, networks. insufficient funding, Fig. 2 Word clouds of some key attributes of clinical research networks Li et al. Journal of Venomous Animals and Toxins including Tropical Diseases (2018) 24:15 Page 3 of 7 insufficient use of evidence, examples of activities, barriers being addressed and some limited governance and regulatory capacity, key resources for further reading. The first principle is to insufficient networking, understand the local context and accurately assess the inefficient administration and management, existing research capacity. This is a critical step as an initial inadequate material capacity, evaluation of the current background and available baseline limited human capacity with knowledge and skills, resources for the future realistic and feasible capacity limited practical experiences, building . The first endeavor for successful capacity lack of research leaders, building processes generally requires comprehensive as- lack of mentors and role models, sessment of local situations or needs, strong partnership lack of research culture, with local stakeholders to determine agenda, and identifi- low motivation. cation of local champions or leaders. A second principle is to use the most up-to-date An extended literature search reveals similar barriers in research evidence in practice and policy. Building cap- developed countries . In brief, the general critical hin- acity in use of evidence among practitioners and drance to clinical research network capacity building is policy-makers is a critical component of successful cap- the lack of resources and support that include research acity building . In general, use of research evidence system and networking, material support, regulation and needs to work towards integrating evidence into regula- management, evaluation, human resources, and evidence tory, legislative, and policy frameworks, establish plat- and experiences. A successful capacity building process forms to support evidence uptake at all levels, and foster will involve the joint efforts from all stakeholders to en- dialogue and engagement between researchers and users sure sufficient and optimal resources and support. of research evidence. Thirdly, one would secure sufficient collaboration and Some insights on how to overcome the key barriers to networking for effective communication and experience clinical research network capacity building sharing and to establish strong partnership with funders. To addressthe keybarriers, we proposefiveprinciplesfor For example, the CANadian Network and Centre for good practice in clinical research network capacity Trials Internationally (CANNeCTIN) is a national net- strengthening. Table 1 shows the principles, corresponding work for Canadian-led trials in cardiovascular diseases Table 1 Insights on how to overcome the key barriers in building research network capacity Principle Examples of activities Barriers being addressed Key reference Understand the local context and Conduct an initial evaluation of the current Fragmented research systems; [5, 6] accurately assess the existing research background; Insufficient use of evidence; capacity Assess for available baseline resources; Inefficient administration and Evaluate feasibility of capacity building activities management Use research evidence in practice Work towards integrating evidence into Insufficient use of evidence; [4, 5] and policy regulatory, legislative, and policy frameworks; Limited practical experiences; Establish platforms to support evidence Lack of research culture; uptake at all levels; Limited governance and regulatory Foster dialogue and engagement between capacity researchers and users of research evidence Secure sufficient collaboration Build local, national and international Fragmented research systems; [7, 8] and network and establish strong collaborative network by involving Insufficient networking; partnership with funders numerous hospitals and clinical centers; Insufficient funding; Develop collaborative communication; Limited practical experiences Advance experience-sharing processes; Procure long-term and joint funding Increase human resources factors Foster and incentivize collaborations; Fragmented research systems; [9, 10] including the supervision and Establish platforms for exchange of Insufficient networking; mentorship, and the skills and ideas and cross-fertilization; Limited practical experiences; experiences Create strong supervision and mentorship Limited human capacity with systems; knowledge and skills; Expand collaborative network to secure Lack of mentors and role models maximum human resources support; Enhance experience- and skill-sharing activities Identify institutional leadership and Support research infrastructure; Fragmented research systems; [11, 12] environment evaluation Align incentives or rewards with Lack of research leaders; institutional goals and curricula with local Low motivation; and (inter)national needs; Inadequate material capacity Foster co-op or experiential learning Li et al. Journal of Venomous Animals and Toxins including Tropical Diseases (2018) 24:15 Page 4 of 7 and diabetes mellitus and is funded by Canadian Insti- India’s top nine cancer centers as the leadership to tute of Health Research (CIHR) . The CANNeCTIN proactively collaborate with University of Oxford for involves a collaborative Canadian network and an research conductions, fosters experiential learning, and expanded international network of numerous hospitals promotes an interactive platform for communications and clinical centers. The stable funding and networking and sharing. support forms the sound base to conduct nation- and internationally-wide trials via the long-term collaborative Some empirical Canadian-based experiences of clinical communication and experience-sharing processes. A research network capacity building capacity building endeavor pertains to the flexible ap- The African Development AIDS Prevention Trials capacity proach and sustaining progress at multiple levels, among (ADAPT) program which funding is a major issue in many capacity building Led by the Centro de Investigación de Enfermedades cases . How to procure long-term and joint funding Tropicales (CIET) and funded by the International for continued capacity building needs a strategic and Development Research Centre through their HIV Pre- thoughtful plan that will lead to sustainability. Engaging vention Trials Capacity Building Grants program of the funding partners in understanding benefits of research Global Health Research Initiative in Canada, the ADAPT to society, working with funders to determine funding program involved capacity-building in HIV trials in priorities, building capacity to support peer-review ten sub-Saharan countries that included Botswana, process for funding initiatives, and working with media Lesotho, Malawi, Mozambique, Namibia, Swaziland, to mobilize public support for research may be worth- Zambia and Zimbabwe, South Africa, and Tanzania while practices to ensure stable funding in capacity . Theglobalgoalofthe ADAPTprogram wasto building processes. develop state-of-the-art, autonomous, and sustainable A fourth principle is related to the human resource fac- health measurement and planning resources for African tors including the supervision and mentorship, and the countries to better implement and evaluate HIV and AIDS skills and experiences. Such factors have been identified prevention interventions. as a significant role across a range of research network The specific aims of the program included: (1) to capacity building endeavors . A successful capacity increase the capacity of the individual African re- building process will require (1) enhancing research searchers; (2) to increase the capacity of the African productivity, fostering and incentivizing collaborations, institutions; (3) to establish a framework for an and establishing platforms for exchange of ideas and African-led, multi-country AIDS prevention trial; and (4) cross-fertilization; (2) strong supervision and mentorship to facilitate the development of a multi-country AIDS that can facilitate securing more resources, train and prevention trial. The first phase of ADAPT took place in educate students or junior researchers for sustaining 2007–2009 and included an 8 week course for African improvement, and monitor and evaluate the capacity researchers focused on randomized controlled trials building efforts; and (3) sufficient skills and experiences (RCTs) and the use of epidemiology for planning. This that can ensure the effectiveness and efficiency of provided the foundation for the network of researchers capacity development [4, 6, 10]. created across the region who continued to work with A last principle involves identifying institutional lead- CIET, to design and implement an AIDS prevention trial ership and environment evaluation. This step may help through interventions to reduce choice-disablement and with support research infrastructure, align incentives or gender-based violence in three of the countries rewards with institutional goals and curricula with local (Botswana, Namibia, and Swaziland). The second phase and (inter) national needs, and foster co-op or experien- of the ADAPT program took place in 2010–2014. tial learning. For instance, lack of research infrastructure During this phase, the program sponsored two people is a common barrier to capacity building . Exemplary to enroll into Masters programs at the University of good practices include (1) enabling environments for the Witwatersrand and the University of Pretoria in joint appointments between disciplines and research South Africa, and four others to undertake Bachelors centers with the purpose of developing new curricula, programs (at the University of Namibia and University of task groups, research teams, studentships and fellow- South Africa). ships; (2) ensuring credits and promotions of working In Botswana, almost all the members of parliament from clinical research networks, and (3) building an who were contacted considered the training for making interactive context with the combination of oper- healthcare policies as crucial. In October 2011, the ational base, synergistic structure and cumulative ADAPT program collaborated with the government of structure [11, 12]. The INDOX (INDia-Oxford) Cancer Botswana to run a 2-day training session for parliamen- Research Network is an exemplary case of research tarians about evidence-based decision making with a network capacity development . It uses the base of further training session took place over 2 days in Li et al. Journal of Venomous Animals and Toxins including Tropical Diseases (2018) 24:15 Page 5 of 7 November 2012. The training program for parliamentar- mentor, online self-study modules, online discussion ses- ians covered a broad range of evidence-based training in- sions, practical sessions, an Objective Structured Know- cluding how to appraise control group, the influence of ledge Translation Experience (OSKTE), and a book club. bias, significance, the number needed to treat, and With other trainees from other disciplines and the cost-effectiveness, among others. The program secured paired mentor, trainees can build their capacity for ef- sufficient training support successfully including network- fective communication and collaboration skills. It is also ing, funding, local and international supervision, and other expected that trainees should be able to enhance their related resources. After the training, these members of knowledge and appraisal of drug safety and effectiveness parliament had a better understanding of how to allocate information independently. budgets for the specific projects, what population would The DSECT program has been proven a highly appre- benefit from the projects, and what existing evidence ciated training platform and has obtained long-term could be used and what evidence gaps should be ad- funding for its sustainability. Although some challenges dressed. Instead of sitting back and just granting funding, exist including the unavailability of mentors due to their well-educated decision-makers could be proactively in- busy schedules, relatively high work load for trainees, volved in the developing phases of the research. The suc- the short length of the program, and unexpected tech- cess of the ADAPT program in Botswana had interested nology shortcomings, the DSECT program has been the decision-makers and other relevant researchers for significantly improved by procuring more resources and further sustained training sessions . support and by developing more flexible individual education and learning plans . The Canadian trials network (CTN) HIV workshop The CTN for HIV research, funded by CIHR, is commit- The Africa Center for Biostatistical Excellence (ACBE) initiative ted to developing treatments, vaccines and a cure for HIV Well-educated biostatistical methodologists who are disease and AIDS by conducting scientifically sound and sophisticated in study design, implementation, data ana- ethical clinical trials . The HIV workshop provided by lyzing, and results reporting are significantly lacking in the CTN for HIV research is another exemplary case of the sub-Saharan African region. The ACBE, funded by clinical research network capacity building. The CTN, to- the National Institutes of Health (NIH), was therefore gether with the International Conference on AIDS and proposed to reduce such shortage and to enhance the Sexually Transmitted Infections in Africa (ICASA), orga- biostatistics capacity. The ACBE had secured support nized the workshop to share the CTN’s missions and ex- and resources for its foundation, with a collaborative periences with the junior African HIV researchers, effort across academic and research institutions. The address the ethical challenges in conducting the HIV stud- connections between Canadian and local academia en- ies, and help enhance the career development and project sured the human resource support for its sustainability collaborations for the young researchers. The workshop and efficiency. The ACBE will act as a vehicle for pro- attracted substantially more researchers than expected; moting biostatistics capacity building through specialized and the capacity building in ethical and educational strat- academic Master of Science (MSc) programs and regular egies in HIV-related research received highly positive feed- workshops targeting researchers. The ACBE aimed to back at the ICASA conference . sustainably produce qualified biostatistical researchers who can be able to independently tackle the research The Drug Safety and Effectiveness Cross-disciplinary difficulties and challenges in Africa [20, 21]. Training (DSECT) program The one-year DSECT program is supported and orga- Common key elements learnt from the empirical nized by the CIHR, McMaster University, St. Joseph’s Canadian-based experiences Healthcare Hamilton, and other academic entities in The common key elements, learnt from the aforemen- Canada . The program, funded by CIHR, aims to tioned examples, are summarized in Table 2. The key provide fundamental knowledge on drug safety and elements to ensure a successful capacity building process effectiveness, build scientific bridge across different do- Table 2 Common key elements learnt from the empirical mains (trainee and investigator), develop collaborative Canadian-based experiences opportunity for trainees through practical projects, and Program-level-based Individual-level-based incorporate knowledge translation in four different do- Strong local leadership; Passion (commitment); mains of sciences (biosciences, clinical therapeutics, Comprehensive local contextual assessment; Compassion (empathy); population health and epidemiology, and health services Good mentorship; Sharing (unselfishness); and policy research). The curriculum of the DSECT pro- Sufficient collaboration; Openness (transparency); Strong partnership with funders Humility (patience); gram contains an annual symposium, a series of online Friendship (fun) synchronous lectures and tutorials, a one-to-one paired Li et al. Journal of Venomous Animals and Toxins including Tropical Diseases (2018) 24:15 Page 6 of 7 generally include: (1) program-level-based elements that Author details Department of Health Research Methods, Evidence, and Impact, McMaster are composed of leadership, local contextual assessment, University, Hamilton, ON, Canada. Father Sean O’Sullivan Research Centre, St. mentorship, collaboration, and partnership with funders; Joseph’s Healthcare Hamilton, McMaster University, 3rd Floor Martha, Room and (2) individual-level-based components that consist H325, 50 Charlton Avenue E, Hamilton, ON L8N 4A6, Canada. Centre for Evaluation of Medicines, Programs for Assessment of Technology in Health of commitment, compassion, sharing, openness, pa- (PATH) Research Institute, McMaster University, Hamilton, ON, Canada. tience, and friendship. These elements may significantly 4 Department of Clinical Medicine, the First Clinical Medical College, Southern help facilitate the achievement of the clinical research Medical University, Guangzhou, Guangdong Province, China. network capacity building. Received: 1 February 2018 Accepted: 14 May 2018 Conclusions In this paper, we have provided some insight into how to References 1. Sajiwandani J. Capacity building in the new South Africa: contribution of address the key factors of clinical research network cap- nursing research. Nurs Stand. 1998;12(40):34–7. acity building and shared some empirical experiences. A 2. 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Published: May 30, 2018