Understanding US-based Clinician Participation in Global Pediatric Hematology-Oncology Work: A Mixed-Methods Study

Background: Collaborative partnerships between institutions in high-income countries (HICs) and institutions in low- and middle-income countries (LMICs) are an effective tool to build global pediatric hematology-oncology (PHO) capacity and reduce survival disparities. However, clinicians at academic centers may face barriers that limit participation in global health work. Understanding these barriers and facilitators is essential to inform targeted interventions that promote sustained and meaningful engagement. Objectives: This mixed-methods study, using an exploratory sequential design, aimed to identify barriers and facilitators to participation in global PHO work among clinicians at a single academic center in order to inform strategies to enhance engagement in global health initiatives. Methods: Participants included faculty, nurses, and trainees from the Dana-Farber/Boston Children's Blood Disorders Center (BC/DF). Qualitative interviews and a REDCap survey were utilized to explore current engagement, barriers, and preferences for global PHO work. Data collection occurred from June 2023 to May 2024, with thematic analysis and descriptive statistics applied to interview transcripts and survey responses, respectively. Results: Thirty-eight clinicians (response rate: 11%) completed the survey, with 16% having prior global PHO experience and 50% expressing interest. Barriers included funding constraints, lack of protected time, and family obligations. Qualitative interviews (n = 15) identified additional barriers at the personal, interpersonal, organizational, community, and policy levels. Organizational barriers, such as academic promotion criteria and institutional support, were most prominent. Conclusions: Despite interest, clinicians face substantial barriers to engaging in global PHO work, predominantly at the organizational level. Solutions proposed include enhanced institutional support, program management, formal educational curricula, and improved funding guidance. These findings underscore the need for tailored strategies to foster effective bidirectional partnerships and enhance global PHO capacity. Future research should explore perspectives from LMIC-based clinicians to optimize partnership effectiveness and sustainability.