Between a rock and a hard place: balancing roles of clinician and co-researcher in a primary health care setting - A qualitative study

Background The participation of clinicians in clinical research is necessary, but balancing research and clinical duties can be challenging. We explored chiropractors’ experiences of participating in a clinical trial on spinal manipulation of the neck in primary health care (PHC). Methods A qualitative design was adopted, underpinned by social interactionism. Five virtual focus group interviews were performed between August-November 2023, including 15 chiropractors, who were involved in a clinical trial in PHC. Thematic analysis was applied. Results The interviewees were motivated to participate in the clinical trial to contribute to professional development through investigating the use of spinal manipulation. However, patient recruitment and adherence to the treatment protocol were more difficult than anticipated, especially when patients realised that the treatment would be determined by randomisation and because the chiropractors had to deliver the sham/placebo interventions. The interviewed chiropractors continually negotiated conflicting obligations of clinicians, co-researchers, and breadwinners, shifting loyalties between these roles in response to situational demands. Conclusions The clinicians’ motivations to take part in the trial varied but were in general rooted in a wish to contribute to strengthening the chiropractic profession. The negotiation of multiple roles and shifting loyalties rendered them moral agents. Our findings illustrate the social and relational nature of participating as a co-researcher in a trial conducted in a chiropractic PHC context. Our study also highlights a need for better support systems for research in PHC. This calls for political and organisational will to establish systems that provide necessary support to researchers and clinical co-researchers.