This qualitative study describes the motivation of family physicians to join, contribute and stay active within PBRNs. Although our study is limited by being comprised of self-identified participants in a convenience sample, we believe that these (and other) clinician stories provide an important medium to understand the intersection of research with professional practice and life and give voice to this unique method of participatory research.(17
) Greenhalgh and Wengraf note “The aim of narrative research is not necessarily to determine a `true' picture of events, but rather to explore such things as how the individual has made sense of these events, their attitude toward them, what meanings the events hold for them, and how these feelings came to be.”(19
Narrative research such as our PBRN Clinician Stories Project provides useful information for academic researchers, including those linked with practice-based research networks and with community-based participatory research. PBRNs expend considerable time and effort in the recruitment, engagement, and retention of network clinicians and practices, so these narratives also provide useful information to the PBRN community, as well as a template for individual PBRNs to pursue their own stories projects.
These stories from 38 clinician members of practice-based research networks provide important insights regarding the motivations and values they associate with participation. These motivations and values relate to three levels of influence:
- Meaning and belonging to the primary care profession and culture
The stories reflect the unique path taken by these clinicians and include issues of overcoming practice isolation, straddling academia while not losing the integrity of `outside' practice, developing and maintaining critical thinking skills, staying connected to colleagues and to the salient health topics that need addressed to improve primary care outcomes, and membership in a stimulating learning community. Frequently mentioned was the value of mentorship. It is important that PBRNs encourage clinician commitments, and additional commitments will be required from those who can provide mentorship outside of academia, where there are more established avenues. Recurrent themes that relate specifically to meaning and belonging within this group of clinicians include the family physician as a scientist; being validated, recognized, connected and belonging; and, being stimulated and energized. The family physicians sharing stories were not always able to find enough stimulation from like-minded colleagues in their local practice and community. Several physicians (Beasley, Friedler, Beaufait, and Bujold) with a long history of practice-based research noted that connecting with a PBRN provided a means to connect with other “unique” family physicians and some clinicians identified the link to academia through the PBRN as providing an important relationship that offered balance to the daily challenges of clinical practice.
- Generating an evidence base for primary care
These clinicians placed a high value on improving the quality of care to their patients and improving systems of care, including enhanced IT.
- Ensuring that the primary care evidence base is locally relevant and contributes to policy and population health
Clinicians valued community oriented outcomes that focus on public health, such as increase in flu vaccination rates for the entire community, and on developing research that was responsive to the needs and concerns of the clinician's entire community and communities within communities. Story clinicians noted value in collaboration, including establishing active partnerships with major health plans and a community health foundation. One clinician noted that Centers for Medicare & Medicaid Services (CMS) is interested in their disease management strategy.
Personal satisfaction motivations to participation in PBRNs, particularly those aligned with meaning and belonging to the primary care profession and culture, correspond with Deci's and Ryan's Self-Determination Theory (SDT) to explain how human beings become proactive and engaged.(11
) The three innate psychological needs of competence, autonomy
, and relatedness
describe the forces behind intrinsic motivation and mental health. Social contexts such as PBRNs facilitate satisfaction of these three needs and correlate with optimal motivation. The stories we describe include:
- Competence — intellectual stimulation, “the physician as the critical scientist”, creating and applying a primary care evidence-base, and staying up to date
- Autonomy — enjoyment of research without the hassle of academic work-life
- Relatedness — the importance and influence of mentors, belonging to a group of like-minded individuals, and social gatherings (convocations). The PBRN provides an antidote to the intellectual isolation and loneliness associated with day-to-day primary care practice.
The clinicians represented in these stories participate in PBRNs because it is interesting and satisfying and they are in control of their choices. Although there is little published work regarding motivations to participate in practice-based research, the factors described are similar to earlier reports. In a study of ASPN practices, Green and Niebauer (1991), found a desire to be a part of a group doing relevant practice-based research and recruitment by an esteemed individual to be the most important reasons for joining a PBRN.(20
) These interviews of 11 ASPN members emphasize the personal and professional rewards of participation.(8
) They describe the value of being part of the bigger picture, enhanced academic credibility and critical thinking, and contributing answers to relevant research questions. Whereas the majority of studies done in ASPN were descriptive and disease and symptom oriented, PBRNs today are most often involved in dissemination and implementation of studies designed to enhance the delivery of preventive health services and chronic illness care. With too much work and too little time, the interest and relevance in changing systems of care is high among family physicians. Our stories describe PBRNs as facilitators of change and show the high value these family physicians place on their relationship with the PBRN. One PBRN study identified membership in a practice-based research network as a determinate of staying in rural practice longer. (21
We were able to recruit family physicians from only 12 networks and these physicians likely reflect a high degree of engagement. There was considerable variation in the effort to recruit stories among the PBRN directors. There is considerable consistency among the stories we analyzed and the themes described reflect the broader community of family physicians participating in practice-based research.
It is likely that these stories reflect the values of a group of individuals who have found common ground in participating in practice-based research. Although these stories describe unique paths, clinicians participating in PBRNs share a number of motivational factors. It is our intention that the voices of these family physicians will influence others to participate in practice-based research.