A scoping review to identify barriers and facilitators of research participation among chiropractic faculty

Designated faculty effort is institution dependent but generally divided among 3 categories: teaching, scholarship, and service. A growing emphasis is being placed on research and publication,¹  creating discrepancies between how faculty spend their time and how they are evaluated during the review, promotion, and tenure process.²  Faculty within chiropractic institutions are particularly impacted, as these programs require heavy teaching loads,³  which may discourage faculty from participating in scholarship.

Creating a culture of scholarship and research requires alignment of institutional values, priorities, policies, and resources to facilitate scholarly activities.⁴  Administrative support, funding, and protected time are necessary to conduct studies, prepare manuscripts, presentations, and grant proposals, and access advanced research-focused training.⁴  Formal mentorship programs are consistently associated with improved scholarly productivity, faculty retention, and successful rank promotion.^4–6  Barriers specific to each of these categories have been identified within chiropractic institutions.^3,7–12 

The lack of training in research methods and inadequate scholarly output within chiropractic institutions is an ongoing topic of discussion in the literature. In a 1983 commentary, DeBour¹³  claimed that research “…has not reached the status of constituting a major part of the fabric of any [chiropractic] institution…” (p. 148). Adams et al⁸  recommended several approaches to improve the status of research capacity within the profession in their 1997 manuscript. A follow-up article¹⁴  published 9 years later evaluated progress on these recommendations and concluded that none was evident. Finally, Hoskins et al⁷  (2006) identified a “confronting paucity” of scholarly productivity among Australian chiropractic faculty members, which was 2–3 times lower than nonchiropractic faculty members.

Our objectives for this scoping review were to describe the scientific literature on chiropractic faculty participation in research, and to identify contributing barriers, facilitators, and other key variables. Scoping review methods were chosen as they are best suited to explore and map evidence on a broad topic, whereas systematic reviews evaluate specific research questions in areas with an established body of evidence.¹⁵  By synthesizing existing knowledge, our study aims to provide a better understanding of the behaviors, circumstances, and experiences that chiropractic faculty face in their endeavors to participate in research.

We followed the 5-step methodological framework for scoping reviews outlined by Arksey and O’Malley.¹⁶  The Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review was used to guide reporting of the manuscript.¹⁷  The study protocol was registered with Open Science Framework on November 16, 2022 (https://doi.org/10.17605/OSF.IO/RGVM3).

Following preliminary reviews of the literature, our scoping review was guided by the following research question: What are the documented barriers and facilitators of chiropractic faculty research participation?

Based upon our research question, 6 articles with likely eligibility served as the validation set (Appendix 1). A comprehensive search strategy, developed with the consulting health services librarian (JS), included National Library of Medicine Medical Subject Headings (MeSH) extracted from the validation set. The literature search was executed on November 8, 2022, utilizing PubMed/MEDLINE, CINAHL (EBSCOhost interface) and Index to Chiropractic Literature databases (Appendix 1). The search was limited to English language publications without date restrictions. Search terms consisted of subject headings specific to each database and free text words related to chiropractic, faculty, and research. The complete search strategies for each database are available in Appendix 1. The presence of the retrieved articles matching our validation set confirmed a successful search strategy. Search results were uploaded to the citation manager Zotero.¹⁸ 

Eligible articles included the search terms chiropractic, faculty, and research in the title or abstract. Reviewers used their judgement on search term synonyms (eg, teachers/professors for faculty). There were no restrictions on publication date or methodology. Ineligible articles did not include 1 or more search terms, were not written in English, or included the above search terms but not in the context of research participation.

The article screening and inclusion consensus process was conducted using Covidence software.¹⁹  All citations were uploaded as an EndNote XML file generated by Zotero,¹⁸  which Covidence automatically de-duplicated. Open access full-text articles were imported automatically, with the remaining full-text articles imported individually by the lead author (BA) and librarian (JS). Covidence logged eligibility decisions and recorded data abstraction across included studies.

Article eligibility determination and data abstraction were conducted by 4 reviewer teams. The process was led by 2 primary reviewers (BA, KS), and involved teams of 2 to 3 secondary reviewers. Eligibility was determined through a 3-stage, sequential review. In the first stage, 3 secondary reviewers (JC, PS, MM) provided the title/abstract screening with eligibility decisions (Yes/No/Maybe) recorded, while primary reviewers (BA, KS) independently performed consensus reviews on half of the articles. Conflicting decisions went to a consensus vote performed by the primary reviewer who did not initially grade the article in question. In the next stage, 3 secondary reviewers (MV, AM, BW) completed preliminary full-text review, with consensus confirmed by the primary reviewers. The final stage included 3 secondary reviewers (AF, KP, KB) evaluating included studies for limitations and quality concerns.

Three members (MV, AM, BW) completed data abstraction using a comprehensive template developed by the lead author (BA) within Covidence to capture desired data. Abstraction fields included: Citation; Location (Country); Aim/purpose; Study methodology; Population; Facilitators of Research Participation; Barriers of Research Participation; Recommendations; and Summary. Additional members (BW, PS, MM, AF, KP, KB) categorized barriers and facilitators, future directions, and limitations using separate spreadsheets.

We collated and summarized the scoping review results descriptively. Descriptive numerical analysis characterized the years of publication, project settings and populations, and study designs. Narrative summaries reported findings with a focus on key results. The qualitative thematic analysis highlighted barriers and facilitators to chiropractic faculty participation in research, as well as identifying future directions and limitations. Interrater reliability statistics provided by Covidence were reported to characterize the level of agreement among reviewers.

Our search yielded 377 publications, with 47 duplicates removed automatically (Fig. 1). Team 1 completed the initial title/abstract screening of 330 records, which excluded 307 records. Exclusions were categorized as epidemiological studies (n = 85) and chiropractic education/students/faculty studies without a focus on research participation (n = 60). Team 2 completed full-text screening of 23 articles, which excluded 9 publications. Fourteen articles were relevant to the research question and included in this review.

Title/abstract screening consisted of 4 reviewer pairs with proportionate agreement values of 0.91, 0.85, 0.91, and 0.89, resulting in Cohen’s kappa values of 0.43, 0.51, 0.49, and 0.29, respectively. The level of proportionate agreement among full-text reviewer pairs was 0.5, 0.78, 0.67, and 0.8. The number of comparisons in full-text review was not adequate to calculate Cohen’s kappa values. Cohen suggests that kappa values <0.20 indicate no-to-slight inter-rater agreement, 0.21–0.40 as fair, 0.41–0.60 as moderate, 0.61–0.80 as substantial, and ≥0.81 as perfect agreement.²⁰  The kappa values calculated in our review correspond to fair to moderate interrater agreement.

Eight publications included cross-sectional or correlational studies, while 6 included editorials, descriptive reports, and narrative reviews. No intervention studies were reported. Article publication dates ranged from 1987 to 2017, with 4 papers published before 1999, 7 between 2000–2009, and 3 published since 2010. Publishers included Journal of Manipulative and Physiological Therapeutics (n = 6), Journal of Chiropractic Education (n = 3), Journal of the Canadian Chiropractic Association (n = 2), Chiropractic & Osteopathy (now Chiropractic & Manual Therapies) (n = 2), and Journal of the Neuromusculoskeletal System (n = 1).

Thirteen articles were completed in the United States (with data collected from Canada in 2 reports) and 1 in Australia. Chiropractic faculty were the principal population studied (n = 12), with faculty publications (n = 2) the other sampling frame. Six studies were conducted in multiple chiropractic educational institutions; 3 studies were completed at 1 chiropractic institution each; and 5 studies covered chiropractic faculty research in general.

Table 1 provides details about the 7 cross-sectional surveys and 1 correlational study included in this review. Three papers by Marchiori and colleagues were associated with a program of research on chiropractic faculty scholarship.^21–23  Three papers described faculty knowledge of informed consent,²⁴  research in chiropractic college clinics,¹⁰  and a needs assessment for an academy of educators to support faculty development.⁹  Three papers explored faculty productivity of peer-reviewed journal publications.^7,11,23 

Table 2 provides details on the 6 additional articles reviewed. Narrative reviews by Adams and Gatterman⁸  and updated by Mrozek et al¹⁴  addressed the current state of research on the chiropractic educational curriculum, noting the vast range of potential topics for scholarly investigation and the limited number of externally funded projects. Both articles strongly recommend faculty embrace patient-centered approaches to research and encourage inter-institutional collaboration to guide chiropractic educational research. Editorials by Keating et al²⁵  and McCoy²⁶  encourage chiropractic institutions to promote a scientist-practitioner model by incorporating advanced training in research design, methodology and ethics,²⁵  along with mandatory student led research projects.²⁶  Ward²⁷  developed a faculty promotion rubric to evaluate evidence of unpublished scholarship among chiropractic faculty. Finally, Lawrence¹²  describes the development of a teaching scholar program based on examples from other institutions.

Table 3 presents the qualitative thematic results among articles, with shared facilitators and barriers to chiropractic faculty research noted. Themes were categorized into 5 domains: demographics and professional roles, personal empowerment, research culture, institutional setting and policies, and research training.

Chiropractic faculty members who engage in research and scholarship share key characteristics including an academic rank of professor and educational backgrounds including research doctorates or combined DC-PhD degrees.^7,23  Faculty clinicians with patient care duties had the lowest levels of research involvement. Age and gender were not predictive of productivity after controlling for rank and faculty position.

Positive values and attitudes toward research are essential.²⁵  A sense of empowerment, job satisfaction, commitment, innovation, self-determination, and productivity were impactful among individuals and their willingness to do research.²¹  Faculty and institutions should shift beliefs that scholarship is a voluntary activity or only for research professionals.^11,22,25  Altering the atmosphere surrounding research, such as increasing scholarly productivity of supervisors, could motivate teaching faculty to conduct and publish research.³¹  Promoting positive research cultures in the chiropractic student body and teaching critical analysis skills early on could help build research capacity and instill the value of research participation.¹⁰  Professional organizations should espouse the benefits of research to the chiropractic profession and public.⁷ 

Institutional support was another facilitator, including such activities as encouraging faculty to pursue higher academic degrees, setting minimum publication levels, and offering advanced standing as incentives.^7,26  Research databases, peer review rubrics, and workshops could communicate standards, monitor research involvement, and evaluate productivity.^7,27  Communal research interests among faculty (and students) should be defined and, when possible, cross-institutional investigations pursued.¹⁴  Embracing patient-centered approaches on student learning and program performance could be meaningful.¹⁴  Lastly, teaching clinics are a potentially impactful environment for clinical research.¹⁰ 

Authors frequently cited inadequate funding as a major barrier to faculty scholarship, organized training,^8,10,14,25  and protected time for research.^8,23  Without external funding, chiropractic institutions are challenged to participate in, or internally support, faculty scholarship through financial incentives and/or seed funding.^8,14  Faculty development is essential. Barriers focused on a lack of research experience, mentorship, role modeling, time, and established training programs. When policies are not in place, faculty mentorship is hindered.^{8,10,12,14,25}  Release time is role and department dependent, and often outside of the faculty members control based on their assigned role.²³  Authors encouraged chiropractic institutions to teach faculty about the research process,^12,14,24,25  which may include developing structured curricula in statistics, research design, grant writing, and research ethics.²⁵  Teaching scholars¹²  and academies of educators⁹  were promoted for their focus on teaching and educational research.

Future research should evaluate and report interventions for faculty empowerment, training, publication support and incentives, and mandated, protected research time from competing job responsibilities.^{8,11,12,23,27}  Faculty empowerment through shared decision making between administration and faculty members based on open communication may drive growth and potentiate productivity among faculty and administrators.²¹  Recommendations to evaluate cross-institutional collaboration among chiropractic educational institutions and between closely aligned academic fields may serve as possible sources of improving publication by drawing resources from other professions.¹⁴ 

Using scoping review methods, we identified 14 articles (8 cross-sectional and correlational studies and 6 narrative reviews or editorials) which allowed us to identify major barriers and key facilitators of chiropractic faculty research participation. No studies examined the effectiveness of interventions to increase chiropractic faculty scholarship. While chiropractic educational institutions are increasingly dispersed on a global scale, most reports (n = 13) were based in the United States, with 2 studies gathering data in Canada, and 1 focused on faculty publications in Australia. Publication dates ranged from 1987 to 2017, with only 2 studies published in the past decade, revealing a continual downward trend over time.

What challenges do chiropractic faculty face when deciding to conduct research? When the philosophy of a chiropractic educational institution towards research remains inconsistent, or even hostile, scholarly productivity is suppressed.²⁵  Institutions may require their faculty to produce scholarship. However, without knowledge, experience, mentorship, or training, faculty will struggle, especially those without advanced academic degrees in research methods.⁷  Without funding, faculty lack resources and incentives to participate in scholarship. The lack of protected time dedicated to research is another important barrier.^8,12  Ward³  documented that teaching workloads among faculty at 1 chiropractic institution were 2.7 times higher than comparable universities, and 3.5 times higher than recommended for graduate level teaching. He concludes “… the high teaching load for chiropractic faculty is related to their low level of scholarly productivity, and it is probable that this does represent a significant impediment to acceptable levels of scholarly activity” (p. 9). As chiropractic training programs are increasingly integrated within university settings, the expectations of and for chiropractic faculty participation in research and scholarship may continue to change to align with those of their institutional peers.

Many facilitators to faculty research participation identified in our scoping review involve research capacity building (RCB) strategies, defined as “a process of individual and institutional development which leads to higher levels of skills and greater ability to perform useful research” (p. 2).²⁸  A systematic review²⁹  of RCB strategies evaluated the impact of various programs on research productivity, including fellowships, masters’ degree programs, teaching scholar programs, writing groups, research awards or grants, and offices of health professions education.

Positive outcomes of RCB interventions were seen in 3 domains; learner satisfaction, increased knowledge, and skills to conduct research, and (most importantly) improved rates of publication and grant writing. RCB among chiropractic educational institutions and their faculties is a cyclical topic of interest within the profession. For example, a recent Chiropractic Educators Research Forum (CERF) conference included over 20 presentations and panel discussions on capacity building for faculty scholarship, suggesting broadening interest worldwide.³⁰  Historically, however, this interest has not translated to improved research productivity, as chiropractic faculty report a lack of time and interest in pursuing publication as the primary reasons for low journal publication rates (30%) following conference presentations.¹¹ 

Organized mentorship programs are another form of RCB with documented positive outcomes, including: a higher likelihood of being awarded research grants, remaining in academia, and career satisfaction; greater confidence in research skills; and developing career plans.⁵  In a survey of 92 junior occupational therapy faculty, those who were actively mentored were more likely to spend at least 5 hours per week on research, serve as principal or co-principal investigators on research projects, and receive grant funding than those without mentors.⁶  One model for developing chiropractic researcher capacity is provided by the Chiropractic Academy for Research Leadership (CARL).^31,32  CARL aims to foster research culture and capacity among a global network of researchers with burgeoning programs of research in chiropractic. The first CARL cohort successfully trained 13 chiropractors using financial and in-kind support from multiple international faculties, research centers, and universities. This model might serve as a template for organizations, such as the Association for Chiropractic Colleges, to develop leadership and research capacity among faculty without extensive research training who teach at chiropractic educational institutions. The RAND Center for Collaborative Research in Complementary and Integrative Health also provides opportunities to strengthen research by facilitating collaboration among faculty at chiropractic colleges.³³ 

Facilitators of faculty productivity among similar doctoral-level academic programs are informative. An academic doctoral credential or associate/professor title, along with institutional Carnegie classification, were significant predictors of research productivity among physical therapy faculty.^33,34,35  A linear decrease in productivity was noted when comparing academic pharmacy faculty at R1 vs R2 vs doctoral/professional institutions.³⁵  Institutions classified as “teaching-oriented” had mean faculty publication rates nearly 50% lower than “balanced” or “research-oriented” institutions. Faculty at public institutions had a 60% higher mean publication rate compared to those at private institutions.³⁶  These findings are relevant to chiropractic faculty, as all US chiropractic institutions are classified as private and doctoral/professional.

Our scoping review had many strengths. We used an established and reproducible step-wise methodology and registered our protocol prior to data extraction. Our team included individuals with experience in scoping reviews, as well as a health science librarian who oversaw the search strategy process and library request procedures. We developed a validation set of articles to assure expected articles on the topic were retrieved with our search strategy. All team members undertook formal training before beginning the review to ensure standardization of methods. Two sets of reviewers (primary and secondary) contributed to the consensus process at every review stage. We also used the innovative Covidence software, which allowed our team to document inclusion decisions, collect data systematically, and generate kappa values about reviewer agreement, a statistic not often reported for scoping reviews within chiropractic.

Our initial search identified over 300 articles potentially related to the topic of chiropractic faculty participation in research and scholarship. Although our search strategy was comprehensive and verified by a health sciences librarian, our study was limited to English language publications and required the inclusion of 3 key words (“research”, “faculty”, “chiropractic” [to capture “chiropractic”, “chiropractor”, etc]) in the article title or abstract. This strategy may have led to a small number of studies being excluded. To maintain rigorous methodology, we included only peer-reviewed articles indexed within 3 databases. We did not include gray literature, such as conference proceedings or graduate theses which may have informed our research question.

One limitation of this scoping review rests on the paucity of current literature on chiropractic faculty involvement in research. Of 14 included articles, 13 are outdated with publication dates before 2010.^{7,10,12,14,21,23–27,31}  Several studies were conducted across multiple institutions, which provides useful, if not dated, information about the state of faculty research participation across the profession.^{7,10,11,21–23}  However, many projects had small samples from single institutions, limiting the generalizability of those findings. Several articles can be classified as editorials, which are not methodologically rigorous and include author opinions. Overall, the included studies have underdeveloped reports of study design. Finally, no publication reported on interventions to increase research productivity or participation among chiropractic faculty.

This scoping review explored the published literature on chiropractic faculty participation in research, including 14 articles published between 1987–2017. Our review offers insights into the key facilitators (research as primary role, institutional culture promoting research, dedicated release time) and barriers (teaching or clinic primary role, lack of incentives and mentorship, excessive teaching load) to faculty scholarship in chiropractic educational institutions. These facilitators and barriers were classified into 5 domains; demographics and professional role; empowerment; research culture; institutional setting and policies; and research training. The need to place a higher value on research participation within chiropractic academic institutions was clearly identified, requiring individual and institutional commitments to faculty training with accompanying funding.