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Challenges and barriers to musculoskeletal injury research in sub-Saharan Africa : a modified Delphi study
Simon Matthew Graham, 1, Robyn Waters1
1Orthopaedic Research Unit, University of Cape Town, Cape Town, South Africa.
Aims:
Musculoskeletal (MSK) injuries are a major cause of morbidity and mortality worldwide. However, research into MSK injuries is hampered by significant challenges and barriers, particularly in low-and middle-income countries (LMICs). Our aim was to identify the most important challenges and barriers to MSK injury care research across Malawi, South Africa, and Tanzania.
Methods:
We conducted a three-stage modified Delphi study. In Stage 1, healthcare professionals and researchers involved in MSK injury care listed challenges and barriers to conducting MSK injury research, which were consolidated in 25 themes. In Stage 2, participants rated each theme on a five-point Likert scale. In Stage 3, to drive consensus, participants re-rated the themes after viewing group and country-specific feedback from the previous stage. Challenges and barriers were ranked by mean score. Consensus was defined as ≥ 75% of respondents rating a theme as 4 or 5 ('important' and 'most important' on the Likert Scale).
Results:
A total of 396 participants completed Stage 1, 424 completed Stage 2, and 434 completed Stage 3. Across all participants, consensus (≥ 75%) was reached on nine key challenges and barriers to MSK injury research, including: lack of funding, high clinical workloads, limited training and mentorship, poor-quality data collection practices, healthcare facility resource constraints, patient loss to follow-up, limited research opportunities outside academic institutions, poverty and financial barriers, and healthcare delays. At the country level, the challenges of lack of funding, high clinical workload, and inconsistent data collection practices consistently achieved consensus in Malawi, South Africa, and Tanzania.
Conclusion:
MSK injuries impose a substantial burden in sub-Saharan Africa, yet research remains limited by funding shortages, high clinical workloads, and inconsistent data collection practices. These challenges, consistently identified across Malawi, South Africa, and Tanzania, highlight the need for targeted investment and regional collaboration to strengthen research capacity and improve patient outcomes.
Insights
Research on musculoskeletal (MSK) injuries in low-income countries faces barriers like funding shortages and high workloads. Addressing these challenges is crucial for improving care and patient outcomes in sub-Saharan Africa.
Area of Science:
- Global Health
- Orthopedics
- Medical Research
Background:
- Musculoskeletal (MSK) injuries represent a significant global health burden, contributing to widespread morbidity and mortality.
- Research in this field, particularly in low- and middle-income countries (LMICs), is significantly hindered by numerous challenges and barriers.
- Understanding these obstacles is critical for advancing MSK injury care and prevention strategies.
Purpose of the Study:
- To identify and rank the most significant challenges and barriers to conducting musculoskeletal (MSK) injury care research.
- To focus on research barriers within Malawi, South Africa, and Tanzania, representing key regions in sub-Saharan Africa.
- To inform targeted interventions and resource allocation aimed at strengthening MSK research capacity in LMICs.
Main Methods:
- A modified Delphi study was employed, involving three distinct stages to achieve consensus.
- Healthcare professionals and researchers involved in MSK injury care participated in theme identification, rating, and consensus-building phases.
- Consensus was defined as at least 75% of participants rating a challenge as important or most important using a five-point Likert scale.
Main Results:
- Nine key challenges and barriers to MSK injury research achieved consensus across all participants.
- Top barriers include lack of funding, high clinical workloads, limited training/mentorship, poor data collection, resource constraints, patient loss to follow-up, limited research opportunities, poverty, and healthcare delays.
- Lack of funding, high clinical workload, and inconsistent data collection practices were consistently identified as major barriers in Malawi, South Africa, and Tanzania.
Conclusions:
- Musculoskeletal (MSK) injuries present a substantial health burden in sub-Saharan Africa, yet research is significantly impeded.
- Persistent challenges such as funding shortages, heavy clinical workloads, and inconsistent data collection practices hinder research progress.
- Addressing these identified barriers through targeted investment and regional collaboration is essential to enhance research capacity and improve patient outcomes for MSK injuries in the region.