An emerging TIMER-2C framework for addressing barriers to research culture and productivity among local healthcare providers in the Middle East and sub-Saharan Africa: A qualitative study and modified Delphi approach

Contributions from healthcare professionals in the Middle East and North Africa (MENA) and sub-Saharan Africa (SSA) to global health research remain disproportionately low. We conceptualized the TIMER-2C framework to capture the multi-level barriers and facilitators shaping research productivity among local healthcare professionals in MENA and SSA. We conducted qualitative interviews using a modified Delphi approach comprising two rounds to: 1) identify barriers and facilitators, and 2) establish consensus on the most prominent factors influencing research productivity. We purposively sampled 17 participants from Jordan, Qatar, Egypt, Lebanon, North Sudan, South Sudan, Nigeria, Ghana, Kenya, Uganda, Ethiopia, South Africa and India. Interview guides were grounded in theoretical frameworks. Transcripts were analyzed for barriers, facilitators, and recommendations for increasing research output. Barriers and facilitators to research productivity occurred at individual, institutional, national, and global levels. Key barriers included limited time, funding, mentorship, and research training; institutional prioritization of clinical and teaching duties over research; lack of national investment and supportive policies; and global challenges in funding, publishing, and collaboration. Facilitators included personal motivation, protected time, access to training and mentorship, institutional support for research, national funding strategies, and meaningful global partnerships that value local contributions. We identified six themes and one overarching theme from which we coined the TIMER-2C framework: 1) Time, 2) Instability, Interest & Infrastructure, 3) Money & Resources, 4) Expertise & Experience, 5) Recognition, and 6) constructive Collaboration, together fostering a positive research Culture (2C). Research culture emerged as an overarching influence on research contributions. We unveil an emerging framework, the TIMER-2C, that depicts relationships among multilevel factors shaping research productivity and offers a useful tool to guide and evaluate local capacity-building strategies. We recommend further application of this framework to guide the design, implementation and evaluation of multi-pronged strategies to enhance research contributions from MENA, SSA, and similar contexts.