The NIHR was established by the Department of Health and Social Care to improve the health and wealth of the nation through research. The Clinical Research Network (CRN) provides the infrastructure for local researchers to make research happen in health and social care settings. One of the key harmonised objectives relates to promoting and improving early career researcher involvement in NIHR research, which includes appropriate role models and mentors.
Athena SWAN is a charter established and managed by the UK Equality Challenge Unit in 2005 that recognises and celebrates good practices in higher education and research institutions towards the advancement of gender equality: representation, progression and success for all. It is now a requirement for NIHR infrastructure funding, for example the Biomedical Research Centres, that applying institutions are in possession of an Athena SWAN Silver award.
Stroke is one of 30 specialties within the NIHR CRN, and participates in two international collaborations, the Global Alliance of Independent Networks in Stroke (GAINS) and the European Stroke Organisation Trial Alliance (ESOTA), which are committed to promoting the international funding and delivery of stroke research, and the development and mentorship of stroke researchers. In addition, ESOTA has also prioritised the promotion of women in academic stroke medicine. This therefore provides an opportunity for the NIHR CRN to reflect on its own support of female leadership of multidisciplinary stroke research.
From 1st April 2015 to 31st March 2019, the stroke specialty has recruited over 100,000 participants to NIHR CRN portfolio studies. Overall, these participants were recruited to 202 studies, of which there were 136 unique Chief Investigators listed. Chief Investigators were from a wide range of professional backgrounds, reflecting the multidisciplinary nature of stroke research and care, including medical, therapy, nursing, psychology, assistive technology and biomechanics. Overall, 66 of the 136 unique CIs were female (49%) and 15 of the 66 were Early Career Researchers (Table 1).
Table 1: NIHR CRN Stroke Portfolio Trials by Professional Background and Sex of Chief Investigator
| Profession | Total | Female | Male |
|---|---|---|---|
| Medical | 56 | 9 (16%) | 47 |
| Nursing | 5 | 4 (80%) | 1 |
| Physiotherapy | 18 | 17 (94%) | 1 |
| Occupational therapy | 4 | 4 (100%) | 0 |
| Speech and Language therapy | 8 | 7 (88%) | 1 |
| Other therapy | 0 | 0 | 0 |
| Psychology | 21 | 14 (67%) | 7 |
| Other | 24 | 11 (46%) | 13 |
Finally, with respect to Randomised Controlled Trials (RCTs), 66 of the 202 studies (33%) were RCTs, with 56 unique Chief Investigators. Twenty-nine (44%) of the RCTs were led by a female Chief Investigator, again from the broad range of stroke professional backgrounds (Table 2).
Table 2: Unique Chief Investigators of NIHR CRN Stroke Portfolio Randomised Controlled Trials by Professional Background and Sex of Chief Investigator
| Profession | Total | Female | Male |
|---|---|---|---|
| Medical | 24 | 3 | 21 |
| Nursing | 1 | 1 | 0 |
| Physiotherapy | 11 | 11 | 0 |
| Occupational therapy | 3 | 3 | 0 |
| Speech and Language therapy | 3 | 3 | 0 |
| Other therapy | 0 | 0 | 0 |
| Psychology | 9 | 6 | 3 |
| Other | 5 | 2 | 3 |
In summary, this snapshot of the NIHR CRN stroke portfolio shows a commitment to promoting Chief Investigators from a range of professional backgrounds, including a high percentage of female staff. This is important in providing role models for future trial leadership, and reflects the commitment of NIHR to promoting gender equality in research leadership.
Authors
- Des Johnston, Director, Specialty Cluster A Co-ordinating Centre
- Sine Littlewood, Head of Business and Marketing (Non-Commercial), CRN Co-ordinating Centre
- Emanuela Mariani, General Manager, Specialty Cluster A Co-ordinating Centre
- Tom Robinson, NIHR CRN National Specialty Lead for Stroke
Quotes:
Professor Tom Robinson, Professor of Stroke Medicine, University of Leicester, and NIHR CRN National Specialty Lead for Stroke, said:
"NIHR recognises and promotes the importance of excellence in its research leaders in all disciplines, and stroke is proud to have highly successful and internationally leading female chief investigators that are truely inspirational to our future research leaders."
Professor Helen Rodgers, Professor of Stroke Care, University of Newcastle-Upon-Tyne, and former Associate Director for Patient, Carer and Public Involvement, NIHR Stroke Research Network, said:
"Since NIHR research networks were established in 2005 I have led four multicentre randomised controlled trials to evaluate stroke rehabilitation services. It has been a pleasure to work with clinicians and researchers from a range of backgrounds and institutions, and patient and carer groups, to design, deliver and evaluate new stroke rehabilitation services. It is exciting and rewarding to contribute to the evidence base which supports stroke service development."
Professor Anne Forster, Head of the Academic Unit of Elderly Care and Rehabilitation, University of Leeds, and former Clinical Lead for the Yorkshire Local Stroke Research Network, said:
"I have always thought it was huge credit to the stroke network that when it was first formed (as a Topic Specific Network) I was appointed Clinical Lead of a Local Network (female: non-medic), I believe the SRN was a trail blazer in this regard. Whilst it is clear some professions have some progress to make it is great to see that neither gender nor profession is a barrier to leading large scale research projects that will contribute to enhancing care for all after stroke."
Professor Pam Enderby, Emeritus Professor, University of Sheffield, and former Chair of the Royal College of Speech and Language Therapists said:
"We are fortunate in the world of Stroke that we have had many leaders who have stressed the importance of interdisciplinary research and care which has by necessity provided opportunities for diversity in careers.
Professor Marion Walker, Professor in Stroke Rehabilitation, University of Nottingham, and former Associate Director for Rehabilitation, NIHR Stroke Research Network said:
"Understanding the value of diversity and inclusion in the area of stroke research leadership is absolutely crucial if we are to ensure we are delivering optimal world class research. By being inclusive we are using all the talent accessible to us and spearheading the delivery of evidence for best care of our stroke patients and their families."
"I am a great advocate that data drives change; I am therefore delighted that CRN are systematically analysing data on the gender diversity of trial leadership and conduct. The fact that 49% of study unique CIs were female is wonderful news and illustrates the gender balance that exists across the stroke portfolio. However when we distil these figures down by profession we note that the bulk of the female leadership is in the female dominated nursing and allied health professions. Only 16% of females are CI’s in medically led studies in a profession where women represent approximately half of students entering medical schools. We need to better understand the supportive co-applicant roles women play in stroke trials and fully understand the reasons why women are not in key leadership positions."
Professor Dame Caroline Watkins, Professor of Stroke and Older People’s Care, University of Central Lancashire, and UK Stroke Forum Chair said:
"It is fantastic that there are a large number of women healthcare professionals leading stroke research. However, there is clearly a need to promote research leadership in nursing, and in AHPs to add to those in physiotherapy. Funders need to think how they could actively engage more nurses, and AHPs in gaining both doctoral and postdoctoral fellowships to start them along the path towards being a chief investigator.
"Nursing studies present a number of challenges not just in terms of there being complex interventions, which require additional care time and excess treatment costs, but in gaining support for such trials in the face of huge nursing staff shortages."