Introduction: According to the multinational point prevalence study Global PARITY, 13.1% of children in resource-limited settings (RLS) have pediatric acute critical illness (PACI) with a 6.3% related mortality rate.Global research is essential for improving healthcare outcomes. Despite extensive recruitment efforts for Global PARITY, only half of the interested sites participated, underscoring the persistent challenges to research participation in RLS. While prior research has revealed systemic barriers to research participation, other challenges and facilitators are unknown. We aimed to investigate barriers and facilitators for global research participation within RLS. Methods: We conducted a qualitative study using the Consolidated Framework for Implementation Research (CFIR) domains to assess the characteristics of the research participation process. Principal investigators were intentionally recruited based on their initial interest and participation in Global PARITY; interviews were performed virtually in English and Spanish via Zoom, video recorded, transcribed, and translated into English as needed. A codebook was created deductively utilizing the CFIR domains enhanced by inductive themes. Using thematic content analysis, barriers and facilitators were identified. Results: We performed 24 semi-structured interviews: 14 from participant sites, 7 from non-participating sites, and 3 from sites that received institutional review board (IRB) approval but did not participate.Identified facilitators for participation included the researcher’s motivation to engage in international research and enhance research skills, the urgency to evaluate the impact of PACI in RLS and the robust organization of the primary study. Identified barriers were the administrative process for obtaining local research approvals and the multi-step IRB process, the absence of protected time for research, and the challenge of balancing clinical and personal responsibilities with data collection. Conclusions: PACI is prevalent in resource-limited settings. This study emphasizes how participation in international research is hampered by administrative obstacles and a lack of protected time. Integrating RLS and researchers into international studies is crucial for enhancing global initiatives aimed at improving outcomes in global PACI.
Baron et al. (Sun,) studied this question.