Title: Clinical Nursing and Midwifery Research in Southern and Eastern African Countries
Description: Background: Although nurses provide the majority of healthcare, Africa also has the fewest healthcare workers in the world, including the least number of nurses and midwives in any WHO region. Concurrently, the majority of healthcare research is generated within the United States and Europe, creating evidence for practice that is potentially not applicable in African countries with limited resources and vastly different healthcare problems. Limited information is available regarding what determines which topics are studied in nursing, and even less is known regarding what predicts research trends in African countries. To maximize the use of the limited supply of nurse scientists available, it is important to understand what influences trends in nursing and midwifery research and whether these trends are correlated with what experts consider to be research priorities in a given geographical location and healthcare field. Objective: To address these gaps in the literature and to assist nurse scientists in southern and eastern African countries in directing their research toward those topics with the most critical needs, the aims of this study were to identify 1) what research is currently being conducted, 2) which topics local experts consider to be priorities and furthermore, 3) what influences trends in nursing research.

The background and theoretical framework as well as an overview of the dissertation are presented in Chapter 1. Methods: This was accomplished through 1) an environmental scan (including a scoping and a grey literature review in Chapter 2) 2) a Delphi survey of clinical nurse research experts in southeastern African countries (Chapter 3), and 3) a statistical analysis of factors associated with current research topics (Chapter 4). Results: The results of the environmental scan suggest that overall, there is limited clinical nursing and midwifery research and it is less likely to be published in indexed literature. The Delphi survey suggested that critical research priorities in southern and eastern African countries include midwifery and maternal mortality and infectious disease and infection control. Although clinical nurse and midwifery research experts in the region are sensitive to the needs of the region, topics that they rank as critical priorities (such as midwifery and infectious disease) are under-researched.

Publication in the grey literature (rather than an indexed source) appears to be associated with whether a topic has major funding, affiliations of the first author (such as international affiliations, or affiliation with a nursing school with a global research focus), and the education level of the first author. Conclusions (Chapter 5): Clinical nursing and midwifery researchers in southern and eastern African countries are generating research that is critical for developing and supporting evidence-based practice but may have difficulty publishing in indexed sources reducing the dissemination and impact of this research. Strategies to assist junior nurse scientists with broader dissemination of their work could include establishing a network of clinical nursing and midwifery researchers in the area for mentoring and resource sharing. Moreover, policy makers and funders from outside the region should consider expert opinion when developing health care policy and funding mechanisms for research to assist with the dissemination of research, reduce waste in research, and to ensure improvement of patient outcomes through relevant, translational research.