RESEARCH Open Access
Doc o al le el esea ch and aining
capaci y in he social de e minan s o
heal h a uni e si ies and highe educa ion
ins i u ions in India, China, Oman and
Vie nam: a su ey o needs
Fa had Ali
1
, A un She
2
, Wei ong Yan
3
, Abdullah Al-Mani i
4
, Salla A kins
3,6*
, Hen y Lucas
5
and o he ARCADE
conso ium
Abs ac
Backg ound: Resea ch capaci y is sca ce in low- and middle-income coun y (LMIC) se ings. Social de e minan s o
heal h esea ch (SDH) is an a ea in which esea ch capaci y is lacking, pa icula ly in Asian coun ies. SDH esea ch
can suppo heal h decision-make s, in o m policy and he eby imp o e he o e all heal h and wellbeing o he
popula ion. In o de o con inue building his capaci y, we need o know o wha ex en aining exis s and how
challenges could be add essed om he pe spec i e o s uden s and s a . This pape aims o desc ibe he
challenges in ol ed in aining schola s o unde ake esea ch on he SDH in ou Asian coun ies –China, India,
Oman and Vie nam.
Me hods: In-dep h in e iews we e conduc ed wi h esea ch schola s, esea ch supe iso s and p incipal
in es iga o s (n = 13) a ARCADE pa ne ins i u ions, which included eigh uni e si ies and esea ch ins i u es. In
addi ion, s uc u ed ques ionnai es (n = 70) we e used o collec quan i a i e da a ela ing o he cou ses a ailable,
eaching and supe iso y capaci y, and ela ed issues o s uden s being ained in esea ch on SDH. Simple
desc ip i e s a is ics we e calcula ed om he quan i a i e da a and hema ic analysis applied o he quali a i e
da a.
Resul s: We iden i ied a gene al lack o aining cou ses ocusing on SDH. Added o his, PhD s uden s s udying
ela ed a eas epo ed inadequa e supe ision, wi h limi ed ime alloca ed o mee ings and poo in e pe sonal
communica ion. Supe iso s ci ed in e pe sonal communica ion p oblems and s uden lack o skills o pe o m high
quali y esea ch as challenges o esea ch aining. Fu he challenges epo ed included a lack o esea ch unding
o include SDH- ela ed opics. Finally, i was sugges ed ha he e was a need o ins i u ions o de ine clea and
app op ia e s anda ds ega ding admission and supe ision o s uden s o highe educa ion p og ams awa ding
doc o al deg ees.
(Con inued on nex page)
* Co espondence: [email p o ec ed]
3
Depa men o Public Heal h Sciences, Ka olinska Ins i u e ,
Tom eboda ägen 18A, 17177 S ockholm, Sweden
6
Facul y o Medicine and Li e Sciences, Uni e si y o Tampe e, PO Box 100,
Tampe e, Finland
Full lis o au ho in o ma ion is a ailable a he end o he a icle
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Ali e al. Heal h Resea ch Policy and Sys ems (2017) 15:76
DOI 10.1186/s12961-017-0225-5
(Con inued om p e ious page)
Conclusions: The e a e gaps in aining o esea ch on he SDH a he su eyed uni e si ies and esea ch ins i u es,
which a e likely o also be p esen in o he Asian coun ies and hei highe educa ion ins i u ions. Some o he
ba ie s o high quali y esea ch and esea ch aining can be add essed by imp o ed aining o supe iso s, clea ly
de ined s anda ds o supe ision, inances o s uden s ipends, and inc eased use o in o ma ion and
communica ion echnology o inc ease access o eaching ma e ials. Inc eased oppo uni ies o online lea ning
could be p o ided.
Keywo ds: Social de e minan s o heal h, Pos g adua e educa ion, Public heal h, ARCADE, Resea ch capaci y
building, Asia
Backg ound
Social de e minan s o heal h (SDH) a e he condi ions
in which people a e bo n, g ow, wo k, li e and age, and
he wide se o o ces and sys ems shaping he condi-
ions o daily li e [1, 2]. High quali y esea ch on SDH
and he mechanisms unde lying heal h inequi y is essen-
ial o imp o ing heal h, especially o hose who a e ul-
ne able and unde se ed. I can also con ibu e owa ds
e idence-based heal h policy [3] o imp o e heal hca e
[4]. Howe e , SDH, by hei e y de ini ion, a e complex
and esea ching hei e ec s equi es skills ha a e no
eadily a ailable in low- and middle-income coun y
(LMIC) con ex s [5, 6]. Resea che s ha e indica ed ha ,
in LMIC se ings, he quan i y and quali y o esea ch
indings is poo [7] and o limi ed public heal h ele-
ance [8]. The ocus o esea ch is also no on SDH is-
sues; in China, inequi able heal h ou comes a e common
[9], bu esea ch ends o ocus on access o heal hca e.
Imp o ing he na ional capaci y o conduc esea ch on
SDH in China is inc easingly being ecognised as a el
need [3]. The need o de elop na ional esea ch capaci y
is sha ed by o he Asian coun ies such as Pakis an [10]
and Bangladesh [11].
Gi en he abo e challenges, esea ch capaci y building
is needed in Asia. High quali y SDH esea ch encom-
passes in es iga ion in o he mechanisms by which social
condi ionings cause ill-heal h and s uc u es o p ima y
ca e whe e medicines con e ge wi h public heal h [12].
This esea ch capaci y building [13] should include de-
eloping skills and con idence, suppo ing linkages and
pa ne ships, ensu ing ha esea ch is close o p ac ice,
de elop app op ia e dissemina ion, in es in in as uc-
u e, and build elemen s o sus ainabili y and con inui y.
These skills a e cen al o ad ancing he well-being o
popula ions and imp o ing heal h [4], including eco-
nomic bene i s [14].
Howe e , capaci y building e o s need o be s uc-
u ed and well planned. They need o be s uc u ed
a ound he iden i ica ion o ele an esea ch p oblems,
he dissemina ion o esea ch indings o a la ge and di-
e se audience, especially hough leade s and key pol-
icymake s, and ha e a clea ocus on he applica ion o
hose indings [15]. This equi es sus ained in es men
om uni e si ies in LMICs [16]. Se e al ini ia i es ha e
al eady been unde aken o enhance he quali y o e-
sea ch aining in he a ea o SDH and heal h equi y in
Asian coun ies, including he ‘INDEPTH T aining and
Resea ch Cen es o Excellence’(INTREC) p ojec [17],
which add essed capaci y building o SDH. This pape
desc ibes he needs assessmen o ano he capaci y
building p ojec , he ARCADE RSDH (A ican/Asian Re-
gional Capaci y De elopmen –Resea ch in Social De-
e minan s o Heal h) conso ium [18].
The needs assessmen conduc ed was conside ed he
i s s ep o capaci y building, namely iden i ying he e-
sou ces and aining al eady a ailable a pa ne ins i-
u es on SDH esea ch and po en ial gaps ha needed
add essing. This pape epo s on a c oss-sec ional s udy
conduc ed a pa ne uni e si ies o su ey exis ing
SDH- ela ed aining, supe ision and in as uc u e.
We desc ibe he esul s o his su ey and iden i y on-
going challenges a pa ne ins i u ions.
Me hods
This was a mixed me hods s udy, u ilising bo h quali a-
i e and quan i a i e me hods. The esea ch was de-
signed as a needs assessmen wi hin he ARCADE
conso ium and conduc ed om Feb ua y 2012 o Sep-
embe 2012. The needs assessmen was pe o med in
he a eas o cou ses a ailable pe aining o SDH, e-
sea ch p ojec s in SDH, esea ch unding o PhD
Schola s in he a ea, access o esea ch publica ions and
online cou ses, and supe iso s’capaci y o suppo e-
sea ch schola s in esea ch me hodology and esea ch
managemen capaci y.
Pa icipan s
Key indi iduals in pa ne ins i u es in ARCADE RSDH
o med he pa icipan s o hese s udies. The esea ch
was conduc ed in he Asian pa ne coun ies o AR-
CADE RSDH, namely China, India, Vie nam and Oman.
The uni e si ies o esea ch ins i u ions (hence o h e-
e ed o as esea ch ins i u ions) composing his con-
so ium we e in i ed o pa icipa e in he s udy and
Ali e al. Heal h Resea ch Policy and Sys ems (2017) 15:76 Page 2 o 11
hese ins i u ions ha e been conduc ing esea ch on
opics ele an o SDH. The pa icipan s we e adminis-
a i e o ice s in adminis a i e o ices a he pa ne in-
s i u ions, s a om dean’s o ices, PhD supe iso s,
PhD s uden s and p incipal in es iga o s o he p ojec .
Table 1 below de ails he coun ies, ins i u ions, ins i u-
ion ypes and he depa men in which da a collec ion
was conduc ed.
Da a collec ion and sampling
The eam de eloped an elec onic ques ionnai e in-
o med by an exis ing ques ionnai e implemen ed in AR-
CADE Heal h Sys ems and Se ices Resea ch [19] o
collec da a om eigh pa ne ins i u ions in ol ed in
he esea ch aining in SDH. The su ey ins umen
consis ed o closed- and open-ended ques ions aimed o
iden i y he cou ses a ailable on SDH, eaching and
supe iso y capaci y on he SDH and associa ed esea ch
me hods, and o he issues ha could con ibu e owa ds
capaci y building in SDH. Table 2 delinea es he a eas o
enqui y. I is based on a amewo k ha suppo s a sys-
emic app oach whe e ocus emains on he en i e causal
chain and in e ela ions a he han he disc e e na u e
and unc ion o each componen in he SDH esea ch
and aining [12]. The ques ionnai es we e sen ia email
o he p incipal in es iga o s o each ins i u ion, who
we e asked o iden i y he pe sons mos app op ia e o
comple e hem. Reminde s we e sen o ins i u es ha
had no esponded in he allo ed ime. Table 2 de ails
he numbe o esponden s o he ques ionnai e and he
opics ha hey in o med. Responses we e ecei ed om
six Adminis a i e O ices and se en Deans’o ices. The
esponses o he ques ionnai es we e colla ed on o Excel
when ecei ed by he s udy eam.
Key in o man s we e deans and p incipal in es iga o s,
mos o whom had had supe ision expe ience bu also
a b oade iew o capaci y building a hei ins i u ions.
They we e in i ed o pa icipa e by elephone o email.
The in e iews conduc ed we e semi-s uc u ed, using a
guide de eloped by he eam. The guide used wi h su-
pe iso s ocused on challenges and po en ial solu ions
ela ing o esea ch and eaching capaci y on SDH, e-
sea ch unding and, o he s uden s, hei mo i a ion o
pu sue PhD aining. We con inued collec ing da a un il
we conside ed ha da a sa u a ion was achie ed. In
o al, 35 PhD s uden s, 31 PhD Supe iso s and 5 p inci-
pal in es iga o s o ARCADE P ojec we e in e iewed.
All in e iews we e conduc ed in English ia Skype o in
pe son. A esea ch associa e in he p ojec ansc ibed
he in e iews.
Da a analysis
Thema ic analysis was used o assess he quali a i e da a,
ocusing on he mani es le el o analysis [20]. The e-
sea ch associa e ead and e- ead he ansc ip s, iden i-
ying codes eely. Following his, ansc ip s we e
coded, and codes gene a ed in o ca ego ies and hemes.
Table 3 depic s an example o he analysis p ocess. The
ca ego ies and hemes we e discussed wi hin he e-
sea ch eam and amended by e e al back o he da a.
No quali a i e da a analysis p og amme was used.
Gi en he limi ed sample size and he in en ion o
using he indings om he quan i a i e da a o suppo
he in e p e a ion o he in e iews and FGDs, analysis
o he ques ionnai es was limi ed o calcula ing simple
equency dis ibu ions using Excel. The esul s below
p esen a combina ion o bo h he quali a i e and quan-
i a i e da a.
E hics
E hical clea ance o he esea ch was p o ided by Ins i u-
ional e hics Commi ee, S . Johns Na ional Academy o
Heal h Sciences. The e hical app o al e e ence numbe
o his s udy was ‘IEC S udy Re No: 64/2012’. The s udy
was explained o he pa icipan s, and he con iden iali y
Table 1 Coun y, ins i u ion ype and da a collec ion depa men o pa ne ins i u es
Coun y Ins i u ion Ins i u ion ype Depa men da a collec ion was
conduc ed
China Tongji Medical College Uni e si y Communi y medicine
China Beijing No mal Uni e si y Uni e si y Medical college
China Zhejiang Uni e si y Uni e si y Medical college
Vie nam Hanoi Medical Uni e si y Uni e si y Social and p e en i e medicine
Oman Sul an Qaboos Uni e si y Uni e si y Medical college
India
a
Indian Ins i u e o Heal h Managemen
Resea ch
Independen esea ch and aining ins i u ion Ins i u ion
India
a
Ruxmaniben Deepchand Ga di Medical
College
Independen medical college Communi y medicine
India
a
Sain John’s Na ional Academy o Heal h
Sciences
Ca holic Bishop Chu ch o India Socie y o Medical
Educa ion
Medical college
a
None o he Indian ins i u ions we e pa o a uni e si y
Ali e al. Heal h Resea ch Policy and Sys ems (2017) 15:76 Page 3 o 11
and anonymi y o he esponses was emphasised. All in e -
iew pa icipan s p o ided w i en in o med consen .
Resul s
A ailable in as uc u e and con en o aining in SDH
The i s pa o ou su ey ocused on he a ailable sup-
po in as uc u e o conduc ing esea ch and on he
SDH-speci ic con en ha was a ailable in cou ses.
Cou ses a ailable suppo ing SDH esea ch
A lis o cou ses ele an o SDH ha we e a ailable a
pa ne ins i u es was compiled using online o ms. The
cou ses we e mainly in he a eas o heal h economics,
epidemiology, bios a is ics and public heal h, he las
emphasising communi y heal h, heal h managemen and
heal h p omo ion. The e we e ew cou ses on aspec s o
me hodology ha may be pa icula ly ele an o SDH
esea ch, such as quali a i e me hods, mixed me hods
and li e a u e e iews. The only ins i u ion om he AR-
CADE collabo a ion ha o e ed cou ses on social sci-
ences and social medicine was Beijing No mal
Uni e si y (BNU) in China, while only he Indian Ins i-
u e o Heal h Managemen Resea ch (IIHMR) in India
an a cou se on in e na ional heal h. O e all, Chinese in-
s i u ions had a wide a ie y o cou ses ele an o SDH
when compa ed o hose in he o he coun ies. Though
SDH- ela ed cou ses we e some imes a ailable o s u-
den s, many o hem no ed (21 o 35) ha he modules
did no su icien ly ake in o accoun he geog aphic and
cul u al aspec s o hei egion.
Almos 50% o doc o al s uden s (16 o 35), el ha
he lea ning modules a ailable a hei uni e si ies we e
adequa e and o su icien quali y (co e ing ange o so-
cioeconomic, cul u al and poli ical issues pe aining o
heal h), while ano he 12 decla ed hem inadequa e and
7 we e undecided (Fig. 1).
I seemed ha he e was a need o aining on he
p ac ical aspec s o conduc ing esea ch, and in pa icu-
la on w i ing up indings o publica ion. A male s u-
den commen ed:
“In gene al he e should be mo e guidance and
emphasis on esea ch pape w i ing, w i ing abs ac s
and pos e s o wo kshops, accessing a ious online
jou nals and submission o pape s and a icles o
a ious jou nals. On hese opics, ainings should be
encou aged.”
Re lec ing his s uden ’s commen , aining on dis-
semina ing esea ch indings o policymake s was
a ailable only a BNU, Hanoi Medical Uni e si y
(HMU), IIHMR and Sul an Qaboos Uni e si y (SQU).
A IIHMR, his opic is one o hose add essed in he
annual cou se on esea ch me hods. Howe e , se e al
o he ins i u ions epo ed ha s uden s ecei ed in-
s uc ion in his a ea despi e he lack o a o mal
aining module.
As pa o su eying he cou ses a ailable, s uden s
we e also asked how hey would p e e o ecei e ain-
ing. S uden s had mixed opinions ega ding he mode o
deli e y o he cou se modules ha hey ook. Some
a ou ed o mal class oom-based eaching while o he s
Table 2 Numbe o esponden s o he su eys and in e iews
wi h opics add essed
Numbe Topics add essed
P incipal In es iga o o
ARCADE P ojec
5 Cou ses a ailable in social
de e minan s o heal h (SDH)
Adminis a i e O ice 6 Depa men wo king on
SDH issues
Facul y posi ions
S uden s pu suing PhD
Dean’s O ice 7 Resea ch g an and p ojec s
Ins i u ional e iew boa d
Supe ision aining o
esea ch supe iso s
PhD S uden s 35 Issues and challenges in
comple ing PhD wo k
Lea ning acili ies
Sugges ions o imp o e
he lea ning en i onmen
PhD Supe iso s 31 Challenges in comple ion
o esea ch
Ways o add ess he challenges
Table 3 Example o analysis
Theme Ca ego y Code Quo e
Financial
conce ns
Suppo du ing s udy Con lic be ween needing o
secu e a li ing and doing a
PhD
I ha e seen many people no being able o do PhD because hey ha e no
go simul aneously unding o s ay in he ins i u e and wo k
Lack o esea ch unding
impac ing on s udies
Challenge o insecu e esea ch
unding
Ensu ing unding o esea ch and you ha e suppo o li e. The e a e ce ain
unce ain ies and hese a e eal challenges
Quali y o
supe ision
Time cons ain s o do
esea ch
Supe iso demands in e e ing
wi h s udies
…my supe iso wan s o see me e e y single day …e e y ime we mee
he e will be changes …[ o example] look a he physical ac i i y [ hen]
cancel i …when a lo o wo k will ha e been done …
Quali y o supe ision Good supe iso is impo an
o s udy
Some imes one is unlucky and does no ge a good supe iso s. So ge ing a
good supe iso is e y impo an
Ali e al. Heal h Resea ch Policy and Sys ems (2017) 15:76 Page 4 o 11
hough ha mo e lexible app oaches including
compu e -based sel -s udy we e p e e able. The e was
conside able suppo (21 ou o 35) o he use o ee
online cou se modules o e he In e ne . Making such
cou ses mo e eadily a ailable was seen by in e iewees
as one way o encou age po en ial candida es o pu sue
doc o al s udies.
Resea ch g an managemen and ins i u ional e iew
boa ds (IRB)
Resea ch g an managemen sys ems and ins i u ional
e iew boa ds can con ibu e owa d ob aining esea ch
unding g an s and main aining esea ch quali y. This
was pa icula ly challenging as i equi ed conside able
in e depa men al coo dina ion and coope a ion. This
u he became challenging due o compe ing p io i ies,
imelines and esou ces a ailable wi h di e en depa -
men due una ailabili y o s uc u es ha pull hese de-
pa men oge he . The ins i u ions su eyed had
di e en app oaches o managing g an s, om
supe iso -managed o cen alised managemen sys ems
(Table 4). No ably, only Ruxmaniben Deepchand Ga di
Medical College (UCTH) in India epo ed ha ing a cen-
al g an s managemen sys em. As can be seen om he
able, he e is g ea a ie y ac oss ins i u ions in e ms o
he numbe o esea ch g an s awa ded o s uden s,
om 0 o 150 pe ins i u ion. Some o he ins i u ions,
o example IIHMR in Jaipu in India, epo ed ha hey
did no awa d g an s o s uden s, who we e ins ead
unded by ex e nal o ganisa ions. All o he ins i u ions
Fig. 1 S uden assessmen o he quali y o a ailable lea ning modules
Table 4 G an managemen sys ems and g an s ecei ed by s uden s
ZJU, China TJMC, China BNU, China HMU,
Vie nam
IIHMR, India UCTH, India SQU, Oman SJNAHS, India
G an
Managemen
Sys em
Supe iso
applies o
and manages
g an s
Resea che s
ele an o
he unds
No ixed sys em and
unding mainly in he
a eas o po e y, heal h
and social
de elopmen
No
speci ic
sys em
S uden s
in ol ed in
ex e nally
unded
p ojec s
G an s
managed
cen ally and
mos unding
is ex e nal
Con ac be ween
esea che and
uni e si y; mainly
in e nal unds and
dona ions
No cen alised
Resea che
applies o
unds and
de ines budge
S uden
Resea ch
G an s 2007–
2012
No speci ic
PhD g an s;
s uden s join
ongoing
p ojec s
24 150 4 0 6 2 3
IRB exis ence Yes Yes Yes Yes Yes Yes Yes Yes
F equency o
IRB mee ing
Once a yea Needs
based
Needs based Once a
mon h
Needs
based
No ixed E e y 2 weeks Once a mon h
BNU Beijing No mal Uni e si y, HMU Hanoi Medical Uni e si y, IIHMR Indian Ins i u e o Heal h Managemen Resea ch, IRB Ins i u ional e iew boa d, UCTH
Ruxmaniben Deepchand Ga di Medical College, SJNAHS Sain John’s Na ional Academy o Heal h Sciences, SQU Sul an Qaboos Uni e si y, TJMC Tongji Medical
College, ZJU Zhejiang Uni e si y
Ali e al. Heal h Resea ch Policy and Sys ems (2017) 15:76 Page 5 o 11

had ins i u ional e iew boa ds ha me wi h a ying
equency, om e e y wo weeks o once a yea .
Cu en p ac ice o SDH aining a pa ne uni e si ies
The second majo ocus o he su ey was on he p ac-
ice o SDH aining o esea ch aining a he pa ne
ins i u es. We ocused on he a ailable aining o su-
pe iso s, and supe iso and s uden pe cep ions o
p ac ices.
T aining o supe iso s and men o s
Fo mal aining o s a o unde ake he supe ision and
men o ing o doc o al s uden s was unde aken a ou
o he s udied ins i u ions: Tongji Medical College
(TJMC) and BNU in China, HMU in Vie nam and SQU
in Oman. The leng h o his aining a ied widely om
a ew hou s o 1 week and i was o e ed a leas once in
each academic yea . None o he h ee Indian ins i u-
ions (IIHMR in Jaipu , UCTH in Ujjain, and Sain John’s
Na ional Academy o Heal h Sciences (SJNAHS in
Bangalo e) p o ided such aining. Spo adic aining as
pa o in e na ional wo kshops has been gi en a some
o he ins i u es (SJNAHS). The supe ision and men o -
ing aining lacked managemen aspec s, which we e
conside ed essen ial by pa icipan s o e ec i e in e dis-
ciplina y esea ch wo k when wo king wi h mul iple
s akeholde s ha ing compe ing p io i ies and in e es s.
PhD supe iso pe spec i es
Pe haps e lec ing di e en le els o aining o supe i-
so s, as would be expec ed in a collec i e o ins i u es
om 4 di e en coun ies, he p ac ices o supe iso s
a ied widely ac oss ins i u es. Gene ally, doc o al s u-
den supe iso s men o ed 1 o 5 s uden s, wi h 9 o 31
supe ising 1 o 3 s uden s. Howe e , some supe iso s
(4 o 31) supe ised 9 o mo e s uden s concu en ly.
Mos supe iso s engaged wi h s uden s on a mon hly
basis (17 o 31), while only six me wi h hei s uden s
weekly. In one case, s uden s and supe iso s in e ac ed
once e e y 3 mon hs o less o en. The numbe o mee -
ings appea s o be en i ely a he disc e ion o he supe -
iso s. One s uden ound ha he demands o he
supe iso , whom she held in high ega d, o e y e-
quen mee ings made i e y di icul o make p og ess:
“…my supe iso wan s o see me e e y single day …
e e y ime we mee he e will be changes …[ o
example] look a he physical ac i i y [ hen] cancel i
…when a lo o wo k will ha e been done …”
Supe iso s epo ed a numbe o challenges in supe -
ision, including s uden s displaying limi ed knowledge
o hei opic, inadequa e esea ch skills, ca elessness
and a lack o ini ia i e. In e es ingly, a s uden om
Oman, who came om a non-medical backg ound, ein-
o ced he conce n wi h ele an skills:
“…basically I don’ ha e he backg ound ha is
needed o he College o Medicine …I wish he e we e
aining in skills …when I en e ed he e …based on
he in e iews hey hough ha I don’ need any
aining …in PhD we don’ ha e cou ses … he e a e
so many hings you a e no awa e unless you a e in
he ield …”
This s uden also poin ed ou ha PhD s uden s had
o en spen many yea s in employmen since lea ing uni-
e si y. While he knowledge o he wide wo ld may be
a aluable asse in e ms o esea ch on he SDH, i is o
be expec ed ha hey will need help in mee ing he e y
di e en challenges encoun e ed in academic esea ch a
he highes le el. Supe iso s also el ha in e pe sonal
communica ion be ween supe iso s and s uden s could
be imp o ed upon. Some o he supe iso s indica ed
ha s uden s su e ed om a lack o inancial and o he
esou ces, ag eed ha supe ision was no always o
good quali y and sugges ed ha s uden s could bene i
om o ganised o ums in which hey could discuss is-
sues o mu ual in e es . A male p o esso said:
“Du ing he PhD aining hey may no ha e adequa e
esou ces… unding o pe o m esea ch… hey may no
ha e adequa e guidance…. hey may no ha e
adequa e men o ship. They may no ha e a o um in
which hey a e able o discuss wi h each o he and y
esol e some issues o discuss p oblems.”
PhD supe iso s seemed o hink ha la ge unde -
lying issues, speci ically inadequa e esea ch unds and
una ailabili y o s uden s ipends, posed se ious chal-
lenges o some s uden s. These we e seen as majo de-
mo i a ing ac o s, and we e linked by supe iso s o he
ailu e by many s uden s o ocus su icien ly on hei
doc o al p og am, gi en ha hey we e dis ac ed by en-
gagemen in o he income gene a ing ac i i ies. O he
ac o s men ioned in he in e iews included he di icul-
ies o accessing esea ch ma e ials (such as ull ex e-
sea ch a icles), he limi ed abili y o many new s uden s
o p oduce cohe en and eadable w i en ou pu s and
ime-consuming amily esponsibili ies.
Doc o al s uden s’pe spec i es o esea ch aining
The i s issue su eyed was he easons o s uden s o
join a PhD p og amme. The mos equen ly men ioned
mo i a ion was o ob ain a highly paid job a e g adua ion
(16 o 35). Ele en s uden s men ioned wan ing o pu sue a
ca ee in e ia y educa ion and esea ch, and saw he
PhD as a necessa y i s s ep. A simila numbe we e
Ali e al. Heal h Resea ch Policy and Sys ems (2017) 15:76 Page 6 o 11
inspi ed by he p es ige associa ed wi h a PhD deg ee. The
oppo uni y o s udy ou side he home coun y was im-
po an o six s uden s and he a ailabili y o a s ipend
du ing s udy was men ioned by 11 s uden s (Fig. 2).
The s uden s sugges ed ha mo i a ion o apply o
doc o al p og ams would be inc eased i esea ch g an s
we e a ailable (22 o 35) and schola s we e p o ided
wi h an adequa e mon hly s ipend (20 o 35). A male
s uden om India emphasised he impo ance o inan-
cial ac o s:
“I was lucky o ge he unding o my p ojec as well as o
mysel , h ough he E asmus p og am. Bu no e e ybody
is lucky like ha . I ha e seen many people no being able
o do a PhD because hey ha e no go unding.”
Mos s uden s (22 o 35) epo ed ha becoming a
doc o al s uden had no been easy. Though only wo
s uden s epo ed mul iple applica ions, many indi-
ca ed ha hey had delayed he s a o hei doc o al
aining; 11 said ha his was due o exis ing wo k
commi men s, and 5 ha hey could no ind a sui -
able aining p og am. O he challenges included lack
o awa eness o aining oppo uni ies and amily
commi men s.
Mos (21 o 35) s uden s conside ed ha he mos im-
po an ac o ha would con ibu e o a success ul PhD
was he le el o commi men by supe iso s. In e es -
ingly, while hey exp essed a gene al conce n wi h he
quali y o supe ision, only a ew s uden s epo ed
p oblems wi h hei own supe iso s. The quali a i e
da a sugges ed ha s uden s conside ed supe iso s’
commi men as he mos impo an issue in e ms o
pu suing hei doc o a e.
Re lec ing his, a emale s uden om India said:
“…some imes one is unlucky and does no ge a good
supe iso . So ge ing a good supe iso is e y
impo an …”
S uden s sugges ed ha mo e ime om supe iso s
and a mo e sys ema ic app oach o esea ch wo k would
conside ably imp o e he PhD aining expe ience. One
s uden om Oman, o example, epo ed ha :
“I is e y di icul o mee wi h ou supe iso s
because hey a e e y busy wi h hei eaching and
wi h hei clinics.”
One conce n aised by some was ha hey did no
ha e su icien oice in he selec ion o he PhD opic,
which ended o be imposed by hei supe iso s. In
many cases, he s uden s would ecei e mul iple in i a-
ions o wo k on a pa icula opic and i was di icul
o hem o make a se ious assessmen as o which was
mos app op ia e. As one epo ed:
“… hey should gi e a chance o he s uden o decide
which lec u e she wan s o wo k wi h, a he han he
lec u e app oaching him o he …[saying] OK, you
wo k wi h me we will do his o inish his …”
The sala y enhancemen o e ed o s a o aking on
PhD s uden s was seen as p oblema ic by his s uden ,
hey saw i as encou aging a bidding p ocess which
could be e y con using. Besides he impo ance o PhD
supe iso s, o he ac o s ci ed by he s uden s as con-
ibu ing o a success ul PhD included an abili y o ocus
on he doc o a e, access o aining ma e ials and
mon hly s ipends ha alle ia ed dis ac ing inancial
conce ns. Many o he s uden s also epo ed ha
Fig. 2 Issues in luencing s uden decisions o apply o a PhD cou se
Ali e al. Heal h Resea ch Policy and Sys ems (2017) 15:76 Page 7 o 11
engaging in a doc o al p og amme was challenging.
Some (8 o 35) had expe ienced se ious delays in com-
ple ing hei doc o a e; 14 s uden s said ha hey aced
p essu e o seek employmen ins ead. O he s uden s e-
po ed challenges ha included inadequa e eading ma-
e ial (10 o 35) and inadequa e in e ne acili ies (9 o
35) cons aining lea ning and knowledge building o he
s uden s on he opics ela ed o SDH. Some o he chal-
lenges ha s uden s aced comp ised inancial con-
s ain s (8 s uden s) and amily esponsibili ies (10 o
35). This las i em was seen as a majo conce n, espe-
cially o emale s uden s, a iew ein o ced by one p in-
cipal in es iga o , who epo ed ha , in his pe sonal
expe ience:
“…pa en s …don’ espec ha hei child en ha e o
s udy …when he child en come home and need o
s udy … he pa en s …say don’ do ha , you ha e o
ca e o you mo he you ha e o ca e o you
g andmo he , you ha e o help you a he , you ha e o
help you b o he …”
Finally, s uden s we e asked o sugges how PhD aining
could be imp o ed. Thei sugges ions included he need o
inc eased suppo on how o w i e esea ch pape s, hough
some a gued ha oo much weigh was placed on he abil-
i y o p oduce well-c a ed publica ions and ha his should
no be a manda o y equi emen . O he issues aised we e
ela ed o p o iding g ea e access o cou se modules a ail-
able on he in e ne , inc easing he le el o cou sewo k in
doc o al p og ams and he alloca ion o c edi s o online
cou sewo k. One commen ed:
“I hink i new cou ses a e a ailable online ha will
bene i and help s uden s o comple e hei PhD imely
and mee he equi emen s o he esea ch deg ee.
Such cou ses a e e y much needed. The con en is
mos impo an . People will pa icipa e only i he
con en is good.”
Some s uden s (mainly om China) also eques ed
mo e English p epa a ion cou ses o imp o e hei lan-
guage skills, and exchanges o s a and s uden s ac oss
coun ies we e conside ed po en ially help ul.
Discussion
Nume ous cons ain s ha inhibi esea ch on he SDH
among he pa icipa ing ARCADE RSDH ins i u ions a e
desc ibed abo e. Such cons ain s p obably apply o
many simila ins i u ions o esea ch and highe educa-
ion in Asia and elsewhe e [19], limi ing he impac o
esea ch in SDH. While a numbe o No h–Sou h col-
labo a ions ha e a emp ed o add ess his si ua ion (e.g.
[6, 16]), p e ious a emp s a esea ch capaci y building
ha e adop ed a ela i ely na ow ocus, ypically imple-
men ing aining on speci ic a eas o me hods o se-
lec ed ainees linked o pa icula esea ch p ojec s
[21], o es ablishing join deg ees be ween ins i u es
[22]. Howe e , om a s a egic iewpoin , ac i i ies
in ended o enhancing esea ch capaci y in gene al and
pa icula ly in social de e minan s o heal h should ocus
on wide goals, adop a sys ems pe spec i e and adap o
speci ic na ional o egional con ex s [21].
In he di e en Asian coun y se ings conside ed he e,
mul iple ba ie s o he p oduc ion o high quali y e-
sea ch ou pu s ha e been iden i ied ha need bo h ech-
nical and inancial suppo speci ically in SDH esea ch
gi en he in e disciplina y na u e o his wo k [17].
These include a lack o app op ia e and con ex -speci ic
cou ses ha may ha e long- e m e ec s wi h ega ds o
lack o con idence and esea ch skills as wo king p o es-
sionals, limi ed unding o s uden main enance, limi ed
unding o esea ch ac i i ies, a ying quali y o supe i-
sion, g an managemen p ac ices ha ail o incen i ise
s uden s and challenges o in e depa men al coo din-
a ion. All o hese ac o s a e impo an o capaci y
building, as mul iple ing edien s, no only dependen
on s uden s and supe iso s, in luence he comple ion
o esea ch deg ees [23]. Ou ecommenda ions o
imp o ing esea ch aining in SDH in Asian ins i u-
ions a e summa ised in Box 1 and discussed in
g ea e de ail below.
Box 1: Key ecommenda ions
Supe ision o PhD s uden s is cen al o s uden
aining [24], and is an an aspec ha we ound
highligh ed by bo h s uden s and hei supe iso s. As
migh be expec ed, s uden s sugges ed ha supe i-
so s alloca ed insu icien ime and ailed o add ess
hei p oblems adequa ely, while supe iso s ci ed s u-
den lack o basic academic abili ies and disinclina ion
•T aining o supe iso s o meaning ul engagemen wi h hei
s uden s
•S anda ds o supe ision should be o mally de ined in line wi h he
coun y con ex
•Ins i u ions should y o ensu e accessible aining ma e ials in
social de e minan s o heal h and public heal h, possibly in
pa ne ship wi h o he na ional o in e na ional o ganisa ions
•Conside using and c edi ing blended lea ning app oaches o
imp o e cou se access
•Doc o al esea ch should be p o essionally managed wi h clea oles
and esponsibili ies and de ined miles ones
•Use o in o ma ion and communica ions echnology should be
p omo ed o imp o e he access o aining ma e ial
•Ins i u ions should y o secu e sus ainable inances o und
esea ch wo k and p o ide s ipends o s uden s in o de o a ac
and e ain he mos capable
Ali e al. Heal h Resea ch Policy and Sys ems (2017) 15:76 Page 8 o 11
o ocus on hei wo k p og am. In e es ingly, a num-
be o s uden s also el insu icien ly p epa ed o he
challenges o he PhD and el ha a mo e s uc u ed
aining p og amme a he s a o hei doc o al
s udies would allow hem o gain he equi ed expe -
ise on speci ic a eas which had no been co e ed in
hei ini ial deg ee cou ses. These indings do no di -
e om gene al li e a u e on supe ision p oblems,
as insecu i y among doc o al s uden s is common in
many se ings, including Sweden [25]. Howe e , an
app oach in ol ing s uc u ed aining a he s a
would seem pa icula ly ele an in e ms o SDH e-
sea ch, gi en he need o a ac s uden s om a
wide ange o disciplines and expe iences, pa icula ly
i he b oade ocus discussed abo e is o be ealised.
Bo h supe iso s and s uden s epo ed ha poo
communica ion was a se ious ba ie o p og ess. One
po en ial eason o hese obse a ions could be a
lack o unde s anding o he essen ial equi emen s
o e ec i e supe ision [26] by bo h s uden s and su-
pe iso s, he la e compounded by he ela i e ab-
sence in pa ne ins i u ions o o mal aining on he
supe ision and men o ship p ocess. In ou s udy, we
ound ha only ou ou o he eigh ins i u es e-
po ed ha ing supe iso o men o aining p o-
g ams. As he quali y o supe ision has a di ec
bea ing on he ou come o pos g adua e aining [26],
p o iding o mal aining o hose supe ising doc-
o al s uden s could g ea ly bene i pa ne ins i u-
ions. This aining could ocus on he de elopmen
o he ange o posi i e supe iso y cha ac e is ics,
impo an ly ela ionship skills [27]. These skills could
include being a guide, eache , iend, ad iso , di ec o
and manage who di ec s s udy, moni o s p og ess,
gi es sys ema ic eedback and plans u u e wo k [15].
Supe iso s also ha e an impo an posi ion in enab-
ling he s uden o become pa o he scien i ic commu-
ni y [24], which is imp obable when s uden s a e me
only e e y 3 mon hs, as some we e in ou s udy. Again,
in he case o SDH doc o a es, his aining should aim
o enable supe iso s o app ecia e he speci ic needs o
s uden s om a ange o academic backg ounds and
ha e ewe expec a ions as o hei amilia i y wi h opics
such as heal h sys ems, epidemiology o s a is ical
analysis.
Gi en he challenges iden i ied in ou s udy, he e is a
need o g ea e a en ion on a ange o p ocedu es o
capaci y-building, including se ing s anda ds o he ad-
mission o s uden s o doc o al s udies, d a ing guide-
lines o hei supe ision o e en supe ising
supe iso s [28], de ining he equi ed minimum e-
quency o s uden /supe iso con ac and limi ing he
numbe o s uden s guided by each supe iso . Acknow-
ledging he inpu o he supe iso and he impac o
s uden s on hei wo kload is also impo an [29]. In
Eu ope, he Eu opean Commission has emphasised he
impo ance o ha monising he s anda ds o academic
deg ees and o ensu ing he quali y o cou ses [30], in-
cluding a angemen s o s uden supe ision.
Inadequa e s uden unding, ano he majo issue aised
by his s udy, was pe cei ed by bo h s uden s and supe -
iso s as nega i ely impac ing on mul iple aspec s o
doc o al s udies in SDH esea ch opics. This issue could
e lec he impo ance placed on SDH opics by coun y
and in e na ional unde s. Many s uden s pos poned he
s a o hei aining because o a eluc ance o abandon
paid employmen , and engagemen in o he income gen-
e a ing ac i i ies du ing aining was common. O he au-
ho s ha e also ound ha as e comple ion o deg ees
is ela ed o highe le els o inancial suppo [31]. The
low le els o ins i u ional g an s gi en o s uden s sug-
ges ha s uden s a e dependen on ex e nal suppo ,
which is di icul o ob ain. Supe iso s also sugges ed
ha s uden s’e ec i eness in s udying is comp omised
by hei need o sou ce unding. Gi en hese challenges,
in o de o build he nex gene a ion o compe en local
scien is s, he e is a need o ad ocacy and unding a ound
ins i u ion-based g an s o doc o al s uden s o mo i a e
bo h en olmen o highly quali ied candida es and ensu e
hei ull engagemen wi h hei s udies. One ecen ad o-
cacy e o made o he go e ning body o he Wellcome
T us /DBT India Alliance, a ounda ioninIndia, esul edin
app o al o unding suppo o esea ch aining ellowships
o clinicians and public heal h esea che s [32]. Fu he -
mo e, ha ing cen alised g an s managemen sys ems and
adminis a o s who a e amilia wi h SDH esea ch opics
and he speci ic issues a ound ob aining esea ch unding in
his a ea, has he po en ial o con ibu e o ob aining g an s
o s uden suppo .
Finally, we ound ha he e was a limi ed a ailabili y
o cou ses ha add ess he needs o SDH esea ch a
pa ne ins i u ions. This was no wholly su p ising,
gi en p e ious esea ch [6] and ha he impo ance o
his opic has only come o he o e o e ecen yea s.
Howe e , i does indica e an u gen need o imp o e he
aining o young esea ch s uden s in his a ea, so ha
hey can become he designe s and implemen e s o ele-
an cou ses in he u u e. Join p og ams inco po a ing
blended lea ning cou ses be ween no he n and sou he n
ins i u ions could be one a enue o add ess hese p ob-
lems. These p og ammes could be i ual [33] o la ge-
scale capaci y building conso ia such as ARCADE RSDH
[34]. The po en ial ad an age o he la e is he emphasis
on blended lea ning and men o ed semina s.
Conclusions
Theabo e indingshighligh clea gaps in esea ch aining
capaci ies a all he eigh ins i u es o esea ch and highe
Ali e al. Heal h Resea ch Policy and Sys ems (2017) 15:76 Page 9 o 11