The following interview was conducted by Editor-in-Chief Dorothy Pringle (DP) in February 2007, with the three co-directors of two research units based in the School of Nursing at the University of British Columbia (UBC). The research units are the Nursing and Health Behaviour Research Unit (NAHBR, pronounced "neighbour") and NEXUS: Researching the Social Contexts of Health Behaviour.
The directors are:
Dr. Joan Bottoroff (JB), Professor and Dean, Faculty of Health and Social Development, UBC - Okanagan; affiliate scientist, BC Cancer Agency; UBC Distinguished University Scholar. Research: primarily in health promotion throughout the cancer trajectory, with a focus on the influence of social context on cancer prevention, particularly tobacco use, as well as cancer screening and how genetic information can be used to improve health.
Dr. Pamela Ratner (PR), Professor, School of Nursing, UBC; co-coordinator of the doctoral program; Michael Smith Foundation for Health Research Senior Scholar; affiliate member, Department of Health Care and Epidemiology. Research: heart health, with particular interest currently in gender and ethnic differences that influence people's symptoms of acute coronary syndromes and the social context that influences help- or treatment-seeking; and a passionate interest in latent variable modelling and measurement.
Dr. Joy Johnson (JJ), Professor, School of Nursing, UBC; Associate Director for Graduate Programs and Research; CIHR Investigator. Research: primarily in health behaviour change; increasingly focused on issues related to addiction, the social context of substance use and factors that facilitate recovery or reduction of substance use.
DP: Can you describe the two research units that you collectively lead?
PR: The best way might be to talk about our historical development. The three of us have collaborated since we were graduate students at the University of Alberta during the late 1980s and early '90s. Later, we were appointed to UBC sequentially, which allowed us to continue our collaboration. We recognized early on that there were many benefits to "branding" our collaboration, and so we named ourselves the Nursing and Health Behaviour Research Unit (NAHBR). We continued to develop the unit, and shortly after, the Michael Smith Foundation for Health Research developed a competition for infrastructure support for research units. We submitted a letter of intent, thinking that we could get some infrastructure support.
The Michael Smith Foundation review panel came back to us and said, "You are doing great work; however, single-disciplinary research units are a thing of the past, and you need to broaden your focus." This was the best advice that anyone ever gave us, so we came back to them with a proposal for a multidisciplinary unit and were successful in getting research funding. We were then faced with the problem of determining whether we would become a new unit and leave the old behind, or whether there were advantages to keeping both alive. We thought that there was something to be gained by maintaining the identity of the Nursing Research Unit as well as a multidisciplinary unit, so they overlap in many respects.
DP: Are they physically separated?
JB: No. NEXUS is a virtual unit with infrastructure provided in the same physical space as NAHBR.
JJ: In addition to that, NAHBR is a much more focused research unit. It involves six nursing investigators - the three of us and Drs. Linda Balneaves, John Oliffe and Paul Galdas. All of us are doing different work yet share a common interest related to health behaviour. The unit has created an opportunity for us to have cohesion across projects, to share staff and to consolidate our work in a way we wouldn't be able to if we were working independently. The School of Nursing provides a lot of the infrastructure. The space we're in is Nursing's space; it's very important to recognize who's putting the roof over your head. So it has been very important for us to maintain our nursing identity and to ensure that our work remains relevant to nursing.
JB: The other important thing that NAHBR has done is to provide us with an opportunity to mentor new investigators. It originally started with Joy, Pam and myself, but then we realized we had an opportunity to bring in new assistant professors who were doing work that overlapped with, or was relevant to, health promotion. We felt we could mentor them and help them jump-start their research programs. Paul Galdas is the newest to come on board, and I see that already beginning to happen for him.
DP: Would researchers who are not nurses but are interested in the same focus as NAHBR be welcome in the research unit?
JJ: We would encourage them to be part of NEXUS, which is the multidisci-plinary unit.
DP: Let's talk a bit about NEXUS, then. How does NEXUS complement NAHBR?
JJ: Joan, Pam and I were already doing a great deal of interdisciplinary, multidisci-plinary collaboration. It didn't take much to expand our vision just by looking at the people we were already collaborating with. We have collaborators in sociology, healthcare and epidemiology, pharmacology, education, etc. NEXUS provided us a way to solidify those relationships. NEXUS is focused on health behaviour issues, but widens the focus to include a broad array of considerations of social contexts; in particular, we focus on how gender, diversity and place affect health behaviour, with a view to determining how we can move forward with policy intervention. It has allowed us to bring different disciplines to the table to consider issues related to health promotion, illness prevention and access to healthcare from a variety of different perspectives. It helped us expand our theoretical vision and increase the tools that we can use in our research.
I want to be clear that NAHBR existed with no infrastructure money. It was just us putting a sign on our door one day. That's a really important lesson for people: it focused us to put a sign up in the hall, to declare ourselves and to think about what we would stand for as a group. That planted the seed for us to move forward and to develop NEXUS as well. So we see the units as very much interrelated. NAHBR acknowledges our home department; NEXUS acknowledges our interest in multidisciplinarity.
DP: What about trainees and the role they play in the development of research programs?
PR: This is also relevant to the difference between NAHBR and NEXUS because, rightly or wrongly, it's a fact that nurses pursue doctoral education typically at a later stage in their career development than in other disciplines. Often, they are not seeking employment or a full-time experience as graduate students. This limits their opportunity to engage in research programs or their need to work for a faculty member; so we have had a challenge in attracting doctoral students to our unit on a full-time basis.
PR: NEXUS, because it was a multidisciplinary program, very quickly had access to top-notch graduate students who were in need of, and thirsty for, the apprenticeship experience. I think it's suitable and appropriate for graduate training, and so NEXUS has flourished in large part because of the doctoral students and post-doctoral fellows that it was able to attract.
DP: Does NAHBR, then, continue to support and mentor more young faculty as opposed to as many graduate students?
JJ: Yes, that's a fair claim. I wouldn't want to suggest that there are no nursing doctoral students because they certainly are here, but not in the numbers that we could support.
DP: How do you manage the leadership of these two units? There are the three of you, and you have important stakes in both. What's the leadership like?
JB: The leadership is very collaborative, partly because of - and perhaps facilitated by - the fact that we all went to the same graduate school and we've worked together for so long. There are rarely things that we disagree on or that we need to hash out, as so often we are all thinking the same thing at the same time.
PR: I think it's more than that. I agree with you, Joan, because I've started to observe what's happening in other units that are trying to get off the ground and emulate what we're doing. I don't think we ever were competitive with one another. We recognized very early that to collaborate was going to be far more successful in the long term, and that we would all benefit if one of us was successful. I think we supported each other in that, and so it's about trust and generosity.
JB: There were a few challenges - not among our group, but in profiling ourselves for things like career award competitions. We heard through the grapevine that people were having difficulty figuring out who was actually taking the lead on what. So we realized that besides working closely together, we also needed to define particular areas of expertise and take the lead in those perhaps more consistently, but still not in a competitive way.
DP: So you have a non-competitive, collaborative style that allows the three of you to work closely together. How does that translate in terms of the other members of the unit?
JJ: First of all, with NAHBR, we've been very clear that for a research unit to function, everybody has to show up every day. Obviously, we travel and do other things. The other reason it's worked is that none of us works at home to a great degree. We're present in the unit, we're overseeing our staff and we're engaging our staff and graduate students in the work of the unit. We have a very egalitarian management style in terms of bringing people on board in decision-making. We've had the idea that we can shoulder the load for awhile as the new investigators get themselves established, but we meet on a weekly basis, we talk about the unit, we talk about issues that are coming up and things we need to be concerned about. It's not as if any decision is being made in the unit without all the investigators involved. We are very keen for them to be the next generation of NAHBR, in the next several years - to take it on themselves and help take it in a new direction. These are the things that are on the table for us in terms of moving forward.
With NEXUS, we are coming to the end of our five-year term in a year's time, and so are just entering strategic planning. The leadership of NEXUS needs to go back onto the table. We want to keep it housed in Nursing, but we need to continue to work on the leadership model for NEXUS as well, because the pool of investigators has increased over the past several years.
PR: I want to add that we're very sensitive to notions of leadership succession and sustainability. All three of us have worked in research units that were created by very charismatic individuals whose units failed when they left. They were able to bring people together to create and develop something, but they were not able to ensure sustainability beyond their tenure. That concerns us, so we have put in place opportunities that will ensure that these units exist without us.
DP: Would you describe your leadership of NEXUS any differently than your leadership of NAHBR?
JJ: Joan, Pam and I have some concerns about the fact that the three co-leads of NEXUS are all from nursing. We realize that we must be very inclusive of the other investigators in all essential decisions. We basically manage the administration of NEXUS, but we feel strongly that we need to continue to bring on board the other investigators around any key decisions, because of that optic and because we want to be multidisciplinary.
DP: How does a research agenda get set for both NAHBR and NEXUS?
PR: Well, for NEXUS we actually set out a research agenda in our proposal, and it was discussed and negotiated by the lead investigators. We set out a framework of three thematic areas that our research was going to focus on, and that was negotiated. With the strategic planning we're going to again bring people together to envision the next five years for NEXUS, and that'll be part of our proposal.
DP: Do you set annual research goals or objectives in either of the units, or is the process more informal than that?
PR: It is formal for NEXUS. It's a reporting requirement. I curse the process, but it's good for us because it's far more informal when it's not required.
DP: And are there advantages to one or the other?
JJ: I think you need to do both, in a way. Our experience is that we have to have a research agenda, especially for NEXUS, but also be flexible enough that when opportunities arise we can put some resources behind them and pursue them. So we know, for example, that there are strategic calls from the Canadian Institutes of Health Research that fit into the mandate of NEXUS. We need to be looking at those opportunities on a regular basis. While they might not have been on our initial agenda, we need to be flexible enough to bring people together.
It's the same for NAHBR, as well. NAHBR functions a bit more like a collective of investigators - we have work-in-progress sessions. We talk about our research on a regular basis. There's a lot of cross-pollination across the projects because we're committed to working together and to sharing ideas. We are on one another's grants. We review one another's papers. It's actually a much more organic process in terms of our research agenda moving forward. We're aware of the projects, what proposals we're trying to develop and what areas people are trying to branch into. We look for opportunities for one another, so I think it's a bit more organic with NAHBR than it is with NEXUS.
PR: In some ways, I think it's clearer to establish a research agenda in the basic sciences or medical sciences, where the next logical question is not all that debatable. In the social and behavioural sciences, it's not always apparent what the next logical question is. There are a fairly wide range of research projects and activities within the group. The agenda follows the people. It's a team that came together because we like one another and we like the people we work with. We work well together, and we actually try to identify things that would cross our particular areas of expertise and interests.
DP: Tell me what having infrastructure funding brings; what's the advantage?
JB: An operating grant doesn't fund proposal development. In the past, it hasn't funded dissemination very strongly - for instance, developing websites, profiling the group, etc. Nor is an operating grant intended to carry you through when the actual funding hasn't been sufficient to complete the project entirely. Those funds don't carry us through some of those dry points to allow us to do pilot work that we've needed to do, and ethics applications.
In many ways, having this infrastructure has been helpful in getting grants out the door, in supporting some of our dissemination activities and meetings, in moving research programs forward and in supporting some of the collaborations and training activities in the research unit. So, for example, in the NEXUS research unit, we've been able to support some of the students' research that's being done as part of their master's and doctoral dissertation work and to give them some travel funds to disseminate that work.
JJ: Infrastructure money is like glue. It's the extra stuff that helps hold it all together. We have a regular spring institute where we bring our researchers and trainees together, and that's funded through our infrastructure money. There's no grant that would allow us to do that, but it is so important in terms of creating a research community. We have a fabulous manager at NEXUS right now who is working very hard to make sure our work is not just disseminated into scholarly journals but that we're getting the word out into other community groups and different media so that we can transfer some of the knowledge we're developing to relevant communities. Those are the extra bits that help solidify a research program and make it stronger.
DP: Does the fact that you've got funding and resources play a role in your ability to attract investigators to NEXUS?
JB: I would say, absolutely. The way NEXUS works is that we, on a regular basis, ask if there are new people around or additional people that we're working with that we should invite to be part of NEXUS. The fact that you have a research unit that has resources that can be offered to people has a magnetizing effect. People are way too busy, and there is a sense of competition out there. So, to bring people together and to encourage cooperation - you need to be able to offer something.
DP: What's the added value of the infrastructure funding?
PR: This unit wouldn't exist without it, and that's the added value for us. Also, having a relationship with a funder like the Michael Smith Foundation puts some accountability into the process that is more formal. We have to keep an eye on some goals that we might not otherwise pay attention to. We have to be able to quantify our impact.
DP: What would be the advantages to a new investigator in formalizing a membership in NEXUS, as opposed to continuing to collaborate with you?
JJ: First of all, when you're putting in a CIHR grant, it's very advantageous to indicate that you are part of this larger research network or unit, that you have this background and this grounding in multidisciplinary research. I think another advantage is what I would call methodological and theoretical capital that is gained through access to other investigators in the unit. We have monthly rounds or seminars, our spring institute; we have social activities, ways to start to connect and get new ideas. This creates a network by which you can gain access, perhaps, to new populations or new communities.
JB: If co-investigators have trainees, it also provides their trainees with links to NEXUS and all the activities of NEXUS; so it offers an enriched training opportunity for their trainees, as well.
JJ: One of our co-investigators last year wanted to put in an interdisciplinary capacity enhancement grant; it involved a number of NEXUS investigators. We thought that was a good initiative, and so we put resources into developing that grant and it ended up getting funded. So, the fact that you can ask for a resource - that is, some staff time and some assistance in putting together a very complex research proposal - is definitely an advantage. We're doing more of this at NEXUS.
DP: Is becoming a member of NEXUS by invitation only?
JJ: Yes. The investigators get together, suggestions are made, CVs are reviewed. For example, recently I was working with a psychopharmacologist. I found him very helpful on the grant - we are already collaborating. I have a sense of what he can offer, so therefore I suggested him as a NEXUS co-investigator. Some investigators, like the individual I mentioned, are fairly isolated and actually are looking for these opportunities, and for like-minded people or others who are working in slightly different areas, to feed their work. We expect people to already have some history together, because that helps ensure you're not bringing in people who won't know how to collaborate or what their role might be. So it's known investigators that we bring in - those CVs get vetted and then invitations get offered.
We have two types of investigators: lead investigators or people who are in the core group, which numbers about 13; then we have a number of collaborators, or what the Michael Smith Foundation refers to as affiliated health researchers. These are more community members, clinicians, those types of people. We probably have about a dozen of those individuals.
DP: What would the Michael Smith Foundation for Health Research say it was getting for the money that it's investing in NEXUS?
JB: I think it's fair to say it's increased the productivity of this group of researchers and brought more money into BC. I mean, it is hard, because we have nothing to compare it to, but that ICE grant is a perfect example - by putting a few resources into that, we were able to bring back CIHR money into BC. So, I think in terms of money brought in, we can certainly show a substantial increase in our trajectory of success in terms of bringing dollars to BC.
JJ: I think the Michael Smith Foundation is very interested in this return-on-investment issue and to demonstrate ways in which research is making a difference. They contacted us because they see that NEXUS is moving into changing practice, giving back to communities, translating our knowledge into workable solutions. I am thinking about Joan's project on tobacco use in couples, which is moving towards interventions with community. I've got a project on tobacco use in the context of severe and persistent mental illness, and we've been able to create some policy documents and are engaging with mental health teams in Vancouver about what can be done on this issue. So I think that they also see that NEXUS's initiatives are making a difference in terms of the health of British Columbians - that's really important.
DP: What would UBC and the School of Nursing say was their return on investment?
JB: The benefit to UBC has been that it's attracted new faculty, particularly in nursing, because they've been able to see that this is a place where successful research can happen. Also, it's useful in attracting graduate students, particularly doctoral students, and most recently I think it's been extremely important in attracting post-doctoral fellows.
PR: I want to speak about human resources, because BC has struggled. We have had challenges in attracting people from across the country and from other nations. NEXUS can very demonstrably show that we've been able to attract people internationally. In the long term, that's good for the economy and good for the intellectual capital of the province.
DP: Is there anything else I should ask you about your leadership of the units that would be useful to our readership?
JB: One thing that was really helpful initially, especially at the NAHBR level, was that we committed one day a week to work together. Then it became half a day a week a year or two later because of our other demands. Committing that time on our schedules protected the work. This was always a first priority; at the beginning, it really made a difference in terms of consolidating our work together.
PR: When we started, we would run our research on a project-by-project basis, and we would hire people, good people, that got trained. The project would wind down and they would leave, and we'd be out searching for new people. We've gone well beyond that, where we've got people who've worked with us for years now, and we've been committed to finding ways to keep them. What gives me the greatest joy is coming into this unit and seeing young and not-so-young people who enjoy working together and developing expertise.
We just went through an exercise where the unit outlined its values about what kind of work environment we wanted to create: one that was sensitive to the environment, where people were respected, that didn't have hierarchical structures in place, where people were encouraged to grow. Our proudest achievement is that we've taken undergraduates from various disciplines, and they've decided to pursue careers in health sciences because of their experience here. We're committed to creating a climate where people have fun. I sure like coming in every day, and I have a hunch they'd say the same. I can't tell you how important that is.
DP: Does that extend to the other investigators? I hear you talking about staff, but do you assume responsibility for enhancing the careers of the investigators who are part of NEXUS?
JB: We're all very interested in making sure that we create opportunities for all the investigators. So, for example, from time to time with NEXUS, we'll know an investigator that isn't as linked in as they need to be and maybe we need to reach out to them and find out what they're working on and figure out how we can develop some work that could include them more. There really is a consciousness, and that's the other reason we've had an invitational process. We genuinely want to have a cohesive group of people who feel committed and who want to support one another - that's been a very important part of the process.
PR: Our research manager, on an annual basis, has met privately with each investigator and asked what's going well, what isn't, what do they need, and we've been responsive to that feedback. One of the concerns this year was that people just didn't have an opportunity to get to know one another, so we placed greater emphasis on having social affairs where people can informally share their ideas.
DP: It's a culture you've created?
JJ: That's very key. I look at other research units; there are some that are shells - they look good on paper but it's hard to get a sense of what they're really about. This is a very committed culture and an environment where people really do want to work together and value one another. That makes a big difference.
JB: And so our next challenge is that I'm in Kelowna at UBC Okanagan and one of our other lead investigators for NEXUS is now situated at the University of Victoria. We're trying to figure out the next phase and how we can use technology to link. We're setting up videoconferencing equipment so that we can extend the culture via long distance.
DP: Thank you for this. It has been a pleasure talking with all three of you. It will be fun to watch the next phase of NEXUS as it evolves beyond UBC Vancouver.
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