Doctoral level research and training capacity in the social determinants of health at universities and higher education institutions in India, China, Oman and Vietnam: a survey of needs

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 © The Au ho (s). 2017 Open Access This a icle is dis ibu ed unde he e ms o he C ea i e Commons A ibu ion 4.0 In e na ional License (h p://c ea i ecommons.o g/licenses/by/4.0/), which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided you gi e app op ia e c edi o he o iginal au ho (s) and he sou ce, p o ide a link o he C ea i e Commons license, and indica e i changes we e made. The C ea i e Commons Public Domain Dedica ion wai e (h p://c ea i ecommons.o g/publicdomain/ze o/1.0/) applies o he da a made a ailable in his a icle, unless o he wise s a ed. 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