For a long time most of the developing world relied on research findings, interpretation and application from the western world. This did not always provide the solution to the problems of developing countries. Slow advances however, have been made in medical research in developing countries [3] and more funding, material and logistic support has been provided for conducting research. Nevertheless, the quality of research is affected by lack of expertise in research skills [4]. Problems are also seen in sharing and dissemination of results locally [5] and in incorporation of research findings in policy making [4]; either because a lack of understanding of research findings or its clinical implications by the health policy makers.

Literature shows that clinicians' interest and involvement in research has declined in recent years [6,7]. Several studies have looked at attitudes and interest in research among doctors working in various specialties and subspecialties. In the primary care field, most studies found time, financial constraints [7], busy clinical practices [8] and lack of interest [9] as major deterrents to clinicians' involvement in research. Other similar studies identified financial incentives and infrastructure support as key factors in promoting research [10]. Age and gender differences in research interest were also seen with younger physicians showing more inclination towards research [11] and a comparatively smaller involvement of female physicians [7]. Inadequate mentorship and lack of time have been other major barriers in research [12,13]. Bland and Ruffin [14] and Brocato and Mavis [15] identified accessible resources, appropriate rewards, time allocation, promotion and tenure as stimulators for research and scholarly productivity.

Pakistan is teeming with a multitude of medical, environmental and psychosocial issues which are just waiting to be explored. However, research here like most developing countries is in its infancy. This country faces obstacles in medical research which are similar to other developing countries. With a few exceptions, there is little quality research in Pakistan and a large majority of work is compromised due to flawed methodology and poor research training and background of researchers [5].

A structured questionnaire was designed incorporating important barriers and attitudes in research that were identified through an extensive literature search of the Pub Med database. After consensus of all study investigators, we also included some questions, which were particularly important to our local scenario. Questions about past research involvement and experiences were also included. The time required to complete the questionnaire was about 10 to 12 minutes. In all, 18 questions were included in the study questionnaire. The first five were about study participants' back ground information; the next seven about research training, publications, projects and grant obtained; followed by two questions each about research attitudes, barriers and future plans. The format of all the responses was in categorical design (yes/no and by choosing appropriate responses among already given options). Face and content validity of the questionnaire was obtained through a review process with experts in the field. After incorporating the identified inconsistencies and inaccuracies, the questionnaire was pre-tested on a group of family medicine residents to identify any problems relating to question design, flow and interpretation. This was also done to ensure that the questionnaire was in concordance with the study objectives. Suggestions given were incorporated accordingly.

This study included only those faculty members who were working as Junior faculty (Fellows, Instructors, Senior Instructors and Assistant Professors) at participating universities/hospitals. Senior faculty at associate professor and above were not included and interviewed in this study, as in our setting prior research done during the course of their careers and current seniority made their knowledge, experiences and needs different from junior faculty. We also excluded those faculty members who have reviewed the study questionnaire and protocol previously during its development and finalization phase. Faculty members from the departments of community health sciences and basic health sciences were also not included in this study, as their training and focus in research was more structured and comprehensive compared to other departments making them more productive in research.

In all, 41.5% of study participants were currently involved in research; a significantly higher proportion of men compared to women (men: 50.0% and women: 30.8%; p = 0.01) and those working in public sector versus private sector universities (public: 52.6% and private: 36.1%; p = 0.04). Faculty working in medicine and allied department(s) were currently involved in research at a higher proportion compared to their counterparts in surgery and allied department(s); however the difference was not statistically significant. The most significant factor associated with current involvement in research was research training during postgraduate education (p < 0.001). Those who had research training during their postgraduate years were involved in current research at a significantly higher proportion 55.0% compared to those who had not, 18.5%. Similarly those who were previously involved in research and had research publications and presentations were currently involved in research at significantly higher proportions (table ​(table11).

Attitudes and barriers towards research and differences amongst those currently involved in research versus those who were not, are given in table ​table2.2. Overall, a preponderance of study subjects reported a positive attitude toward research particularly those who were currently involved in research. A large majority (85.2%) of study participants agreed that research was helpful and this proportion was significantly higher among those currently participating in research (94.5%) as compared to those who were not participating in research (78.6%) (OR = 4.69; 95% CI = 1.54-14.26; p = 0.003). Amongst doctors who reported that research as helpful; a higher proportion of those who were presently involved in research reported that research promote critical thinking as compared to those who were not involved in research (AOR = 2.48; 95% 1.22-5.05). Similarly, about half of the study subjects reported that research improve patient care and this positive attitude was higher among those who were involved in current research (AOR = 2.11; 1.05-4.25) (Table ​(Table22).

Overall, majority of physicians sampled, were not involved in research. However, the number of physicians currently involved in research was surprisingly comparable, if not better, to similar studies [7,9,17] conducted in more developed parts of the world.

As expected, the number of male physicians working at a postgraduate level was higher in our institutes compared to females. Among the female faculty, involvement in research was significantly lower compared to males. This finding is similar to some studies done in the US [6,7], one of which [6] cites low self-ability as a major barrier toward involvement in research. No distinct reason was identified in our study to explain this occurrence. However, this difference may be due to different cultural and social expectations and responsibilities faced by females in our setting in contrast to males: like household and marital responsibilities.

Historically staff training, infrastructure, and resources are considered stronger in the private as compared to public or government run hospitals in Pakistan. Thus it was a surprising finding in our study that a higher number of physicians from the public sector were currently involved in research compared doctors in to private universities. This may be explained by a recent influx of funds and support provided to our public sector universities through large grants by Higher Education Commission of Pakistan. The quality of research being done in both the public and private sectors however was not assessed in this study.

Another important finding of this study was an almost lack of undergraduate training in research provided to our medical students. A similar study from India reported that 91% of interns had no research experience in medical schools [18]. Exposing medical trainees at an earlier stage in their careers to the basics of medical research not only improves knowledge and attitudes toward research but also helps to improve their skills in searching and critically appraising medical literature, independent learning and writing [19,20]. This training may translate into an increased interest in research at a post-graduate level and generation of research not only as mandatory projects but also as an additional if not exclusive arm of their careers. Most of the research training of our participants was obtained at a postgraduate level, which in turn was one of the most important factors associated with current involvement in research. Physicians with prior research experience, publications and presentations were more likely to have ongoing research projects. This may be explained by an increased experience and know how in performing literatures searches, data collection, analyses and interpretation. Appropriate rewards like promotions and publications have also been found to be strong motivators and predictors for researcher productivity [10,14,15]. This may very well explain the greater involvement in active research of such participants, also a significant finding of this study.

This study was also able to identify differences in attitudes toward research among study participants very clearly. There were statistically significant differences between faculty actively involved in research, who had a more positive outlook towards research both at a patient care and personal professional level as compared to faculty not involved in ongoing projects.

Another main objective of our study was assessment of barriers of which, a lack of research training was only barrier to have statistically significant difference between those involved in research versus not. This barrier was also cited in another study done earlier in Pakistan [21]. Allocation of time is identified as one of the characteristics of research productivity among faculty at US medical schools [15]. Majority of study participants also pointed out lack of time as one of the barriers for not doing research. This barrier is also reported by other researchers as well [7,9,12]. Even though no statistically significant differences were found between the two groups of physicians involved and not involved in research, other barriers selected by both groups were considerable in number and fairly similar. Of note was that lack of financial incentives was the least selected by both groups.