Lack of an established research culture (COM-B: physical and social opportunity)
Some participants described a lack of research culture that constructively supported and developed staff to deliver research in the pre-hospital setting. Many participants indicated that pre-hospital staff, namely paramedics, were focused on service delivery as opposed to the additional work required to conduct trial-related research activities. Some referenced how the lack of dedicated research staff in the pre-hospital setting impacted the training required to deliver interventions in pre-hospital trials, as well as a lack of knowledge and understanding around the research process amongst pre-hospital staff....there’s so few of them [paramedics] that have actually been through the [research] process before…there isn’t that collective understanding that you rely on to a large degree within major specialties in the hospital, so that’s back to culture of not having that background in research as well. Pre-hospital trial researcher 1.However, one participant indicated that the culture was changing, citing examples of an active pre-hospital trainee-operated research network (PHOTON) that provides opportunities for trainees to get involved in pre-hospital research. Another participant also cited positive experiences of conducting pre-hospital trials with paramedics, indicating that paramedics tended to be motivated to participate in clinical research for their professional development.…paramedics were very keen to be involved in research because actually it was something that they could own, they could develop from their own professional perspective and also from their cohort… Pre-hospital trial researcher 2.