Science, technology, and innovation in health for the next twenty years: A survey analysis in Colombia

Abstract

Background

Colombia is a Latin American country with a very complex social and political context that has not allowed the allocation of sufficient resources to the fields of science, technology, and innovation (STI). This is particularly worrying for the area of health since not enough resources are allocated for public health, research, or education.

Methods

The so‐called “Great Survey in Health 2019” was administered online through the SurveyMonkey platform to 5298 people in different regions of the country, representing the public, private, and academic sectors. The questionnaire consisted of 46 open and closed questions, including demographic inquiries. Data analysis involved textual analytics and sentiment analysis.

Results

Overall, 56% of those surveyed were women within the adult life cycle. Most respondents had a postgraduate education. Greater participation was observed in the Oriental, Bogotá, and Antioquia regions, which also concentrate the largest number of resources for STI. Among the main recommendations derived from the results, priorities include investing in research, personalised medicine, promoting the social appropriation of knowledge, addressing mental health, regulating research through a statute, promoting undergraduate research, and establishing recertification exams to pursue excellence.

Conclusion

The results of this original study serve as a fundamental input to promote and strengthen the STI processes in life sciences and health. They serve as a guide to generate public policies and actions that guarantee better health and well‐being for the Colombian population, strategically proposing a clear roadmap for the next 20 years.

This study analyzes the opinions and perceptions of 5298 health and life sciences professionals and students regarding the main shortcomings for the correct development of science, technology, and innovation (STI) in the country. Our research is a pioneer in developing a national survey on health research and development issues, for the first time in the country's history. This technical study outlines a roadmap for the next 20 years, providing public policy recommendations for STI in health in a country like Colombia, which with over 50 million inhabitants and is still in the process of economic development.

Abbreviations

GHS

Great Health Survey

LHS

Life and Health Sciences

OST

Colombian Observatory of Science and Technology

STI

Science, technology, and innovation

WHO‐5 WBI

General Welfare Index of the World Health Organisation

1. INTRODUCTION

In 2020, Colombia joined the Organisation for Economic Co‐operation and Development; however, its political and social context has historically been complex, with little interest in significant investment of resources for science, technology, and innovation (STI) being shown by the different governments. Not enough resources are allocated for public health, research, or education. As a result, several hospitals throughout the national territory do not meet the requirements or have sufficient supplies to provide adequate health services [1], whilst higher education academic programs have not seen a significant increase in the budget allocated by the government, which has an impact on the quality of the services provided [2]. All this leads to an environment in which it is difficult to investigate or innovate, and this is reflected in the most recent Colombian Observatory of Science and Technology (OST) indicators, which show that, whilst there has been a significant increase in the number of publications in recent years, their impact has decreased dramatically [3].

Another particularly worrying issue is the brain drain, which is explained by the lack of job opportunities, the lack of infrastructure for the development of highly complex projects, the lack of resources for project development, and the low pay in some cases [4]. The Life and Health Sciences (LHS) Focus of the International Mission of Wise 2019 (a state initiative made up of different national and international experts, including several Nobel Prize winners, which sought to propose and define the strategies that Colombia should build in the long term) therefore considered it pertinent and inclusive to collect information, perceptions, and opinions on these issues, addressing multiple interest groups whose work or activity was related to the field of LHS, to make recommendations and proposals for public policy in this sector. It was judged that the best instrument to fulfil this objective was a survey, which was called the Great Health Survey (GHS) 2019 [5, 6, 7, 8]. This research article summarizes the findings of such work, from a macro approach, highlighting the issues that society considers paramount for the future of LHS in Colombia.

The detailed results of the GHS 2019, analysed with a regional approach (in addition to the national approach, developed here) can be found online at https://tinyurl.com/yeyw8zxz.

2. METHODS

2.1. Survey design

The target population of the study was people directly and indirectly related to the LHS, including students and professionals linked to both the public and private sectors. Given that the information collected was intended to be heterogeneous and from a specific group of the population, the best way to capture information was through an online survey that was sent via email, since it: (i) supports multiple platforms and browsers, (ii) allows multiple deliveries, (iii) allows questions to be presented logically or adaptively, (iv) collects answers to both open and closed questions, and (v) allows rating scale formats to be included, such as Likert, and nominal scales [5, 7, 9, 10, 11, 12].

The survey was constructed with objective and subjective questions. With the objective questions, we sought to obtain information about facts and behaviours, while the subjective questions were concerned with attitudes and opinions [13]. Additionally, the following aspects were considered during the construction of the survey: (i) the text of the question; and (ii) the order of the questions. Understanding the importance of constructing robust questions from a psychometric point of view, the following criteria were considered: (i) using familiar words; (ii) avoiding ambiguous questions; (iii) keeping the text of the question short; (iv) not including recall questions unless necessary; (v) not asking questions inductively; (vi) avoiding sensitive questions; (vii) not asking double questions; (viii) not elaborating negative questions; and (ix) avoiding hypothetical questions [5, 9].

Once all the questions were defined, the sequence in which they would be formulated was considered, since the order of the questions can affect the result [7, 14]. This process was carried out in conjunction with four psychometric experts who rigorously reviewed the construction and order of the questionnaire.

2.2. Informed consent process

As a mandatory condition, the application of the virtual survey was preceded by informed consent by the surveyed individuals. The consent obtained was free, prior, express, and informed. Personal data was only accessed by members of the study and its use for academic purposes only, within the survey context, was guaranteed within the informed consent.

2.3. Pretesting

The purpose of this test was to determine if: (i) the questions were formulated correctly; (ii) the wording of the questions allowed the desired results to be obtained; (iii) the order of the questions was the best; (iv) the questions were understood by all types of respondents; (v) additional questions were needed or unnecessary questions should be eliminated; and (vi) whether the instructions for the interviewees were adequate [9].

The pilot test of the survey was carried out with a total of 30 participants, who were selected for convenience, since it was known a priori that their work activities were related to LHS and, having easy access to them, comprehensive feedback was obtained about the survey. As a result of the pilot test, some modifications were made to the survey, with its latest version being found in Supporting Information.

2.4. Recruitment process

Considering that there was no database with the contact data of potential respondents, a database was built with the emails of LHS individuals, composed of people linked to institutions of different types:

• Health care delivery organisations: health service provider institutions, health‐promoting entities, occupational risk administrators, medical associations, and independent professionals, among others.

• Academic: universities, research institutes, scientific centres, among others.

• Private companies: pharmaceutical laboratories, trade associations, and medical device manufacturers, among others.

• Public sector: National Institute of Health, National Institute of Health Surveillance Medicines and Foods, Ministry of Health and Social Protection, Secretaries of Health, and National Superintendence of Health, among others.

Participants were initially contacted by email, in which they were sent a URL and QR codes to access the survey. After this, daily calls were made to the different institutions as a reminder to complete the survey [15, 16].

2.5. Survey administration

The platform chosen to administer the survey was SurveyMonkey. The survey was distributed via email on August 1, 2019, and remained open for completion until September 30, 2019. The questionnaire consisted of 46 questions, including demographic inquiries, and incorporated both open and closed questions. The questions were presented in 21 screen series, allowing respondents to freely navigate forward or backward.

2.6. Statistical analysis

Analysis of the data was performed according to the specific objectives of the questionnaire, namely sociodemographic characteristics, STI, education, social appropriation of knowledge, public health, perception about associations and productive sector, and well‐being according to the General Welfare Index of the World Health Organisation (WHO‐5 WBI) [17].

The results were segmented according to various characteristics of interest, to better define the population studied; for example, according to the life cycles recognised by the Ministry of Health and Social Protection of Colombia [18]: adolescence and youth (15–28 years), adulthood (29–59 years old), and older adults (60 years or older). After segmentation, the results were transversally analysed according to the highest educational level, current occupation, current environment, sector to which the respondent dedicates most of their working time, and nine different regions of the country (according to the segmentation used by the National Administrative Department of Statistics of Colombia in the National Survey of Quality of Life [19]).

In the GHS 2019, Tufte's statistical visualisation techniques [20], descriptive analytics, and textual analytics (word clouds, semantic networks, correlograms, and sentiment analysis) were used [21, 22, 23, 24, 25, 26, 27]. R 3.6, Python 3.8, QGis 3.12, and Gephi 0.9 software were used for the data analysis.

3. RESULTS

After excluding the pilot test surveys and repeated responses (identified through email registration), 5298 completed surveys were obtained. The descriptive analyses of the GHS 2019 at the national level are presented below.

3.1. Demographic characteristics of the population surveyed

Most of the surveyed were female, and the most common highest degree of study corresponded to specialisation, followed by a high school degree. The least represented degree was the technician. Concerning the life cycle, the population was mostly composed of adults, followed by young adults, with the elderly being the least represented (Figure 1).

Figure 1.

Sociodemographic characteristics of the population.

On the other hand, 42.43% of the professionals who answered the GHS had studied medicine, followed by psychology with 11.69%, nursing with 5.26%, and dentistry with 4.95%. Other careers related to health, such as biology, pharmacy, and veterinary medicine, all had less participation, with 2% representation. The most frequent occupations were worker (38.92%), student (35.50%), teacher (29.37%), and researcher (20.44%); the sum of all the possible categories comes to more than 100% since respondents could carry out more than one occupation. Regarding regional participation percentages, we found the highest proportion in Bogotá, followed by Antioquia. The regions with the lowest participation corresponded to Orinoquía‐Amazonía and Foreigner.

3.2. Research, science, and technology

It was found that 51.46% of respondents had previously worked in some line of research in STI, 93.43% considered that specific lines of research should be implemented for different regions in the context of each department, and 95% considered it pertinent to promote research on particular subjects in areas with significant health cost indicators. For example, greater investment in dengue research in departments with a high incidence. The best strategies to link primary health care to advances in technology were considered to be: (i) promote the social appropriation of knowledge, (ii) direct research objectives to the analysis and approach of the main public health problems, (iii) perform clinical trials directly in primary care centres (Figure 2).

Figure 2.

Better ways to relate primary health care with advances in science, technology, and innovation in health.

Of those surveyed, 89% considered it necessary to implement a statute to properly regulate researchers' activities, and 96% believed it beneficial to link research centres with clinical care centres. Using the Borda rule as an orderly voting system [28, 29, 30], the GHS 2019 showed that the respondents believed the country should prioritize investigating the following topics in the next 20 years: (1) personalised medicine, (2) big data, (3) blockchain, (4) clinical trials, and (5) artificial intelligence and the Internet of Things. Regarding entities responsible for financing health research, the observed order was: (1) state, (2) hospitals, (3) pharmaceutical industry, (4) nongovernmental organisations, and (5) universities.

3.3. Public health

According to the survey respondents, the primary public health problem was the lack of coverage in promotion and prevention programs, followed by limitations in access to health services, and equity in health (Figure 3).

Figure 3.

Main public health problems in Colombia.

Respondents who selected “other” referred to corruption and its negative effects, such as theft and fraud of social security resources, resulting in reduced spending on vital social policies. These policies are essential for many users who rely on government support. To address these issues, it was considered necessary to strengthen relations between the public and private sectors. This collaboration is expected to introduce technology and innovation that improves the supply of public services, as well as to bolster the capacity of the public sector to meet the demand for development and infrastructure.

3.4. Regulation

Of those who answered the survey, 89% supported the creation of an international oversight to supervise various public institutions related to STI, in particular, the new “Ministry of Science Technology and Innovation”. This oversight aims to ensure the transparency of the grants, resource allocation, and project execution. Regarding the regulation of professionals and students, 73% implementing a recertification exam for professionals to guarantee minimum competencies, particularly in clinical practice. Nearly half (49.6%) believed this should occur every 5 years. Likewise, 42% of respondents proposed establishing the approval of the current SABER PRO exam (the standardised evaluation instrument carried out for all students in Colombia who are about to graduate from a professional program) as a grade requirement, to ensure a minimum standard of competency and knowledge in higher education institutions nationwide.

When segmented by groups, the idea of establishing the approval of the SABER PRO exam as a grade requirement was more accepted by workers, followed by teachers and researchers. By profession, greater approval was found among those in medicine, bacteriology, nursing, physiotherapy, dentistry, and psychology. Another aspect questioned was the relationship between professional associations and their participation in research and education regulation. More than 50% considered there could be greater participation in these areas. For these entities to play a leading role, the following strategies were proposed: first, to work closely with universities in the education of students, especially in the field of research, since 83% believed that research should be compulsory in higher education; second, providing continuous training courses for professionals; third, establishing quality guidelines and, to a lesser extent, developing clinical practice guidelines.

3.5. Social appropriation of knowledge

In regards to the proposal to promote the social appropriation of knowledge through the implementation of parks, or educational, and interactive health centres, it was found that more than 50% totally agreed, 22.82% moderately agreed, 9.6% slightly agreed, and less than 5% were found in the categories “disagree” or “don't know”. On the other hand, 96% of respondents felt that it would be useful for patients to be grouped into specialised organisations where they could be informed of their disease and provided with basic tools and knowledge to promote a healthy lifestyle according to each pathology, as well as the tools and knowledge to promote self‐care and prevent the complications of each disease. In addition to this, when questioned about strategic proposals to promote health in communities, respondents highlighted the need to support the promotion and empowerment of community members through education. Moreover, they emphasized the importance of providing special attention to caregivers.

3.6. Well‐being of the respondents

The general welfare of respondents was investigated through the application of the General WHO‐5 WBI [17]. One in four people surveyed found themselves uneasy, tired, and with little interest in general, particularly those related to careers in medicine, physiotherapy, biomedical engineering, and psychology, as well as those who were unemployed, entrepreneurs, and students. Regarding the WHO‐5 WBI score, when segmented by region, a national average of 9.7 points was found. The regions that were above this average were Foreign, Orinoquía‐Amazonía, and Valle del Cauca, while only the Bogotá region was found to be below this average (Figure 4).

Figure 4.

WHO‐5 WBI averages, by region and life cycle.

The last question on the GHS allowed participants to discuss any topic that had not been covered before. A sentiment analysis exercise was carried out on the answers to this question (additional topics not addressed in the GHS), to identify the positive or negative connotation in the language expressed by the respondents. The results are consistent with those obtained through the WHO‐5 WBI, showing that the old age life cycle presents a higher score concerning the youth life cycle (the higher the number, plus the use of positive language) in almost all regions, except the Caribe and Oriente regions (Figure 5).

Figure 5.

Sentiment analytics to responses regarding considerations of additional or relevant topics that were not addressed in the Great Health Survey. In the case of the life cycles of youth and old age, no data appears in Orinoquía‐Amazonía, since the answers in these segments could not be assigned a score.

4. DISCUSSION

Based on the results, it was identified that the majority of survey respondents were adults and young people, with medicine being the most common profession. Notably, while participation was observed from other professions, it remained low; with the percentage of doctors exceeding that of all other less representative professions combined. This reflects the strong commitment in this profession about the problems related to STI in health. However, there were demographic biases in participation, with under‐representation from poorer regions of the country due to limited internet and electricity access.

Concerning participation by regions, results were related to the departmental classification given by the OST and National Planning Department for the production of knowledge and technology for the year 2020, where Bogotá and Antioquia were classified as medium‐high production, respectively, while regions such as the Orinoquía‐Amazonía and Pacífica were classified as low. Greater representation was found in the areas of Bogotá, Oriental, and Antioquia. There was low participation in regions with lower resources and development in STI, which were Orinoquía‐Amazonía and the Pacífica, regions with the lowest percentage of undergraduates and specialisation was seen.

The main problems mentioned in the questionnaire addressed the relationship between the development of STI in health and attention in clinical practice, the regulation of research, and the regulation of medical education. In the first place, it was considered that the relationship between innovation and clinical practice needed to strengthen and that efforts should be directed toward promoting the social appropriation of knowledge, given that greater knowledge and participation by patients could improve primary care and increase the participation rate in clinical studies.

The possibility of implementing parks or educational centres where people could learn and relate directly to science was raised as the main strategy to involve the general population and draw their attention to science and technology. Spaces like these could be implemented in different regions of the country, particularly in those where the interest and general development are low, encouraging young people and children in scientific thinking and explaining the importance of STI.

As for the lack of participation in research and the regulation of health education, it was mostly considered that professional associations did not intervene sufficiently. Close work with universities was proposed as one of the alternatives to solve this problem. Improving this aspect through the provision of continuing education will significantly improve both problems, guaranteeing the adequate training of professionals in LHS, orienting their development towards the necessary skills in professional practice, providing practical tools, and supporting the creation of research projects with universities.

The need to implement a probationary exam for the professional degree and a reaccreditation exam were proposed, ideas that were accepted by most respondents. Through the implementation of these measures, minimum requirements and capabilities of health professionals could be established, which would improve the quality of care and allow professionals to be periodically updated in their field. Similar models have been implemented in other countries, such as Austria, Cyprus, and Italy (where the recertification exam is compulsory every 3 years), Croatia (every 6 years), Slovenia (every 7 years), and the United States (every 10 years).

Another problem raised in the questionnaire concerned the lack of collaboration between the academic and productive sectors, a relationship that could be mutually beneficial in terms of resources for both parties, particularly for the private sector through the generation of patents. Finally, regarding the well‐being of those surveyed, the high percentage of people (1 in 4) who did not feel in a good mood, calm, energetic, or well‐rested and who had little general interest in the previous 2 weeks is worrying. However, this is to be expected, given the long working hours and poor working conditions of the country's health personnel, particularly doctors, which is reflected in the increase in cases of burnout syndrome and suicide, especially among students [31, 32, 33, 34, 35, 36, 37].

The results of the GHS 2019 serve as fundamental inputs for STI policy in health. They provide a basis for establishing action plans to foster collaboration between academia, unions, industry, and society to improve the research on relevant topics in Colombia, ultimately impacting the health of its population positively.

5. CONCLUSIONS

Colombia is a very diverse country with numerous problems, both at the health system level and within health education. According to the opinions collected in this survey, the following recommendations are provided: (i) the research priority for the coming years should be personalised medicine; (ii) the creation of a researcher statute should be considered; (iii) to increase the social appropriation of knowledge, interactive parks or educational centres in health should be created, especially in those regions with limited participation and development; and (iv) the dissemination and importance of the sustainable development objectives should be promoted.

In terms of public health, the priorities are: (i) mental health, both in the general population and in health professionals (especially after the severe acute respiratory syndrome coronavirus 2 pandemic); (ii) programs and campaigns for disease prevention and integral health promotion; (iii) equity; and (iv) access to formulated medications. In addition, the empowerment of patient associations regarding shared decision making should be regulated and encouraged.

Finally, we would like to emphasize once again the importance of taking care of the mental health of the human talent in health care. Maintaining adequate mental well‐being strengthens work performance in any healthcare institution. It is essential that the Ministry of Health and Social Protection and the Ministry of National Education of Colombia study, analyse, and make decisions based on evidence in favour of mitigating the risk of poor mental well‐being in the population, even more so in post‐pandemic periods such as the current one [38, 39, 40].

AUTHOR CONTRIBUTIONS

Oscar Espinosa: Conceptualization (lead); data curation (supporting); formal analysis (lead); investigation (equal); methodology (lead); project administration (lead); resources (lead); software (supporting); supervision (lead); validation (lead); visualization (supporting); writing−original draft (lead); writing−review and editing (equal). Gabriela Puentes: Conceptualization (supporting); data curation (supporting); formal analysis (lead); investigation (equal); methodology (supporting); software (supporting); validation (supporting); visualization (supporting); writing−original draft (lead); writing−review and editing (equal). Jhonathan Rodríguez: conceptualization (supporting); data curation (lead); formal analysis (supporting); investigation (equal); methodology (supporting); software (lead); validation (supporting); visualization (lead); writing−original draft (supporting); writing−review and editing (equal). Adriana Robayo: Conceptualization (supporting); formal analysis (supporting); funding acquisition (lead); visualization (supporting); writing−review and editing (equal). Juan‐Manual Anaya: Conceptualization (lead); formal analysis (supporting); investigation (equal); methodology (supporting); validation (supporting); writing−original draft (supporting); writing−review and editing (equal).

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

ETHICS STATEMENT

All data were anonymized before use and the results shown present a high level of aggregation; thus, the approval of an ethics committee was not required.

INFORMED CONSENT

Not applicable.

Supporting information

Supporting information.

Espinosa O, Puentes G, Rodríguez J, Robayo A, Anaya J‐M. Science, technology, and innovation in health for the next twenty years: a survey analysis in Colombia. Health Care Sci. 2024;3:78–87. 10.1002/hcs2.87

DATA AVAILABILITY STATEMENT

The data sets analyzed during the present study are not publicly available due to the confidentiality of personal data.