Characterising socially accountable research: a scoping review protocol paper

Abstract

Introduction

Social accountability is a key value and aspirational goal of many medical institutions. While much has been studied on social accountability in the context of medical education and institutions, less research has examined how social accountability influences research. In light of this absence, the objective of our scoping review is to research the following questions: (1) What characterises socially accountable research (SAR), and how is it expressed and experienced? (2) How do language, positionality, and worldview influence SAR?, and (3) What structures and considerations are necessary to support successful SAR in local and global contexts?

Methods and analysis

To answer the above research questions, the Arksey and O’Malley, Levac et al, Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and Joanna Briggs Institute (JBI) guidelines will be followed. The search strategy was adapted and applied to MEDLINE, Embase, ERIC, and CINAHL databases. A total of n=5289 eligible articles were identified. Articles were excluded if they were published before 1995, were in a language other than English, or were duplicates, leaving n=2840 articles for title/abstract screening.

Ethics and dissemination

Ethical approval is not required to complete this study. We will take an integrated knowledge translation approach. Throughout the project, results will be disseminated to knowledge users (ie, consultations, following Arksey and O’Malley). Our findings will be presented to the larger academic community, policymakers, and healthcare practitioners through presentations, reports, newsletters, and an online repository.

Trial registration number

Open Science Framework 16 July 2024. osf.io/mvhnu.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• Our study is a scoping review, the gold standard method for gathering information on a subject when little is known about it.

• Four guidelines for scoping reviews (Arksey and O’Malley, Levac et al, Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and Joanna Briggs Institutes (JBI) were followed in order to maximise rigour and reproducibility.

• Only articles printed in English were included due to translation barriers.

Introduction

Social accountability has been described as a key value, aspirational goal, and equity-oriented policy strategy in medical and health professions education and healthcare service delivery.¹ It reorients and invites healthcare institutions and organisations to ‘direct their education, research and service activities towards addressing the priority health concerns of the community, region and/or nation they have the mandate to serve’.² Moreover, the priority health concerns are to be identified jointly by governments, healthcare organisations, health professionals, and the public. Since the original definition was outlined in 1995, social accountability has grown considerably, and it is now an accreditation standard in medical education in Canada, and is being considered elsewhere.^{3 4} The burgeoning literature on the topic has also addressed the importance of educating individuals and transforming institutions while cultivating professional competencies that help health professionals better serve their communities and societies.⁵ This literature has framed social accountability in terms of individual professionalism and service⁶ and large-scale institutional transformation.⁷ Scholarship on social accountability has further emphasised its contribution to health equity⁸ and health policy strategy,¹ and more recently, it has been compared and contrasted with the principles of social justice, equity, diversity, inclusion, decolonisation, and anti-racism, in ways that demonstrate both continuities and discontinuities between the two sets of concepts.⁹

Amidst this growing conversation, however, the place of research within the definition and goals of social accountability has yet to be examined in detail.¹⁰ Social accountability has been a significant part of conversations on professionalism and service, and it is an emerging conversation on what it means to do socially accountable research in medical education.¹¹ However, it risks being rejected because of the tensions between accountability to communities and society, as well as the norms and values of academic freedom and self-determined research programmes. What makes research itself—from the selection of a research question, through the development of a methodology and employment of a method, to project execution, all in the context of knowledge translation and the provision of actual health outcomes in the community—socially accountable? How can physician researchers, for example, respond to the unique and community-identified research needs of the societies they serve? Moreover, what specific conditions allow researchers to call a project or programme socially accountable?

The Community-engaged Research in Education, Advocacy and system Transformation for advancing health Equity (CREATE) project is a 7-year (2023–2030) Social Sciences and Humanities Research Council Partnership Project. The CREATE project aims to reinforce a Canadian-led local and global research institute that seeks educational, institutional and systemic changes to realise the transformative potentials of the socially accountable practice of medicine.¹² The CREATE project has four phases: Phases 1 and 2 - deepening our understanding, Phase 3 - adapting and applying and Phase 4 - supporting and evaluating. The current scoping review protocol paper responds to questions in Phases 1 and 2 of the project.

Rationale

The rationale of this review is that research on and about social accountability has hitherto focused on its role in education and healthcare service delivery, while the place of research in its conceptual framework and values has been understudied. This scoping review and the protocol developed below respond to that absence. So far, there is no systematic or scoping review of what characterises socially accountable research (abbreviated below as SAR). As such, we will address a critical gap in knowledge and practice by synthesising the existing literature on SAR to determine what it is, how to perform it, and what structures are required to support it. We have chosen to undertake a scoping review rather than a systematic review. A systematic review attempts to collate empirical knowledge based on a few studies to answer a specific research question by making definitive statements. Our review is better characterised as a scoping review because it has broad research questions and aims to provide clarity, definitions and an overview of the SAR literature. This will enable us to determine precisely how SAR is conducted and identify knowledge gaps for future research.

Purpose

This scoping review will examine the current body of literature on SAR, help to identify common dimensions and conceptions of SAR and identify major strengths and gaps in the literature.

Objective

In its basic form, our objective is to answer the question: What characterises SAR? Using the PCC framework, where our Population is unlimited, our Concepts are social accountability and research and the Context is health, the research question is: When health-related research uses the term social accountability to describe itself, what self-identified characteristics does it have?

Research questions

Our scoping review will examine definitions, theories and values associated with SAR literature to answer the following questions:

1. What characterises SAR, and how is it expressed and experienced?

2. How do language, positionality and worldview influence SAR?

3. Locally and globally, what structures and considerations are necessary to support successful SAR?

Methods

Methodological frameworks

We will follow the method of Arksey and O’Malley¹³ and Levac et al,¹⁴ which includes consultations with communities and knowledge users. To abide by current standards, we will also follow the guidelines set out by ¹⁵Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).¹⁶ A completed Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist adapted for a scoping review¹⁶ can be found in the appendix. Our protocol was registered on the Open Science Framework on 16 July 2024. osf.io/mvhnu. Our study commenced in July 2024 and will conclude in August 2025.

Eligibility criteria

Eligibility criteria are based on the PCC framework¹⁷ and are detailed in table 1.

Table 1. Inclusion and exclusion criteria.

	Include	Exclude
Year published (bibliometric)	≥1995	≤1994
Language (bibliometric)	English	All others
Type of study (bibliometric)	Empirical and non-empirical studies (including intervention, observational, qualitative and meta-analyses).	Conference abstracts, protocol papers
Population	There is no specific population. Social accountability applies to any human population (including human-animal relationships across the species barrier).	N/A
Concept: social accountability	Social accountability, as it is defined within health professional education programmes. Also referred to as social responsibility or social responsiveness.	Social accountability, as the term is used in the context of governance outside health and social policy, voting, anti-corruption (eg, by the World Bank) and corporate social responsibility.
Concept: research	Research conducted by academics in the context of universities, hospitals, research centres and other community-engaged institutions. Research that was undertaken using the methodologies of the natural sciences; medical, health and life sciences; social sciences; humanities and the arts, including programme evaluation and QI (each as defined by the Canadian government in CRDC/FOR document).22	All research that is not concerned with human questions about individuals, communities and the public good.
Context	The context of this review is health-related research about individual professional competencies (health professions education), community-engaged and community-based research and action and institutions focused on the public good (colleges, universities, community organisations).	Articles that only mention ‘Social Accountability’ but do not focus on it. If the article only contains a line in the conclusion or in the introduction, as an afterthought or buzzword.

QI, Quality Improvement .

Population: This review is not bound by specific population restrictions because social accountability concerns social bonds and connections and, therefore, applies to any human and human-related population (including relationships across the species barrier and with the natural and ecological environment).

Concept: The first concept under examination in this review is social accountability, as it is specifically defined within health professional education programmes and health systems (often in response to the 1995 definition published by the WHO). Social responsibility is a Medical Subject Heading (MeSH) term in PubMed, encompassing social accountability; therefore, social responsibility appears first in our search strategy, with the following abbreviations to social responsibility. This concept of social accountability that we are using comes from the discourse on medical education and does not encompass social accountability as the term is used in governance, voting, anti-corruption,¹⁸ or corporate social responsibility.¹⁹ Our second concept is research, which pertains to all academic research endeavours in universities, hospitals, research centres, and other community-engaged institutions. This concept does not include research that is not concerned with human questions about individuals, communities, and the public good.

Context: The context of this review is health-related research that considers health professional competencies, actions, and institutions focused on the public good. It does not pertain to articles that only mention social accountability but do not focus on or define it.

Bibliometric criteria: This review will only include articles published during or after 1995, as Charles Boelen officially defined the term ‘social accountability’ in a 1995 report for the WHO.²⁰ Due to the limitations of our research team, we will only screen articles printed in English; all other languages will be excluded.

Types of evidence sources

Our analysis will include both empirical and non-empirical studies, including study designs that are quantitative, qualitative and mixed methods. We will also include all types of data synthesis in the form of scoping reviews, systematic reviews and meta-analyses. This wide breadth of article types is necessary to attempt to encapsulate the ambiguous nature of socially accountable research. Grey literature will not be included in our analysis because our focus is on socially accountable research, which is predominantly published in white literature. We will, however, include the founding documents on social accountability by the WHO in the framing of our review. The exclusion of grey literature will be a potential limitation in our review.

Search strategy

Our search strategy was developed through close consultation with a librarian with subject matter expertise. Briefly, general literature searches were conducted to determine keywords and phrases associated with our concepts of ‘social accountability’ and ‘research’. Using the identified terms, six test searches were established and conducted. The results of these searches were then examined for feasibility and to ensure they contained articles deemed seminal by the research team. Based on these criteria, the search strategy presented in table 2 was determined to be most effective. Our search strategy was adapted and applied to the following databases: MEDLINE, Embase, ERIC, and CINAHL. See the appendix for details.

Table 2. Search strategy.

Ovid MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions <1946 to May 02, 2024>
Number	Term/phrase	Result
1	exp Social Responsibility/	25 643
2	(social* adj3 account*).ab,kf,ti.	3790
3	exp Research/	711 761
4	1 or 2	29 062
5	3 and 4	3519

Study selection

The same protocol detailed below will be used for the title, abstract, and full-text screening. Reviewers will be trained by participating in conversations on SAR during CREATE team meetings and reading suggested articles. Because we will use two reviewers, we will perform a calibration exercise to ensure accuracy when implementing our inclusion and exclusion criteria. Calibration will occur with each reviewer following inclusion and exclusion criteria for the same random 5% of initial articles. If abstracts are not available, full texts will be screened. Reviewers will compare the results of the screening calibration and discuss discrepancies. The calibration exercise will be complete once a 90% consensus is obtained. Reviewers will screen the remaining articles individually, meeting regularly to discuss disagreements. If an agreement cannot be made between the two reviewers, a third reviewer will be consulted. The third reviewer will be EC, the project’s Principle Investigator. Our final article will record and report the reason for excluding full-text articles. The reference sections of the papers that met our search and inclusion/exclusion criteria will also be hand-searched for additional relevant articles. Screening results will be presented in a flow diagram following PRISMA-ScR guidelines.

Data extraction

The research team will use Atlas.ti as an extraction tool. Our predefined codes are described in table 3. Two independent reviewers will pilot our code book on 5% of the full-text articles included in the review (n=7). The reviewers will compare extracted data and adjust the extraction table as necessary. Our full-text scoping review article will present the final extraction tool used. During the extraction process, two reviewers will independently extract data. They will meet every ten articles to cross-check their extractions. If reviewers cannot agree on what data should be included, our third reviewer will be consulted.

Table 3. Code book.

Code	Definition
SAR definition	Extract the exact definition of SAR given in the article. Or the definition of what is being referred to as SAR in the article.
SAR characteristics	Extract the specific characteristics and key descriptors (eg, community-driven, participatory, inclusive, collaborative, equity-based).
SAR in practice	Extract real-world applications or examples where SAR was implemented in the study. Look for any case studies, experiments or community engagement described in the article.
Objective
Language	Extract the specific terminology used to describe SAR in the article. Look for terms like ‘community-driven,’ ‘equity-based’ or ‘social justice’.
Positionally	Extract details about the researcher’s presentation of themselves (eg, professional role, personal background) and how it influences the research process, including power dynamics.
Worldview	The research paradigm
Author details
Journal
Methods	How to do SAR
Population	The population or context of the paper
Institutional support	Extract the names and roles of institutions or organisations (eg, universities, NGOs, hospitals) that supported SAR in the study. Look for details on their involvement (eg, funding, research assistance).
Local structures	Extract local structures (eg, community organisations, grassroots movements) involved in SAR. Look for how local communities contributed to the research or supported its implementation.
Successful SAR	Extract key factors (eg, strong community partnerships, institutional support) that contributed to the success of SAR in the study. Note any challenges or barriers mentioned.
Global structures	Extract global structures (eg, international collaborations, global funding bodies) mentioned in the article. Look for how these global structures influenced SAR.
Country
SAR resources	Extract specific resources (eg, funding, human resources, infrastructure) and identify who provided them (eg, community organisations, universities, governments).
Title
Authors
Published in

NGO, Nongovernmental Organizations; SAR, socially accountable research.

Data analysis and presentation

A descriptive analysis of bibliometric data will be conducted to aid in determining the structures that support SAR. Country and cultural differences in the definition and implementation of social accountability will be measured. Bibliometric data will also indicate the frequency at which socially accountable research is published in various countries. The material within the articles will be examined through a qualitative content analysis. Specifically, thematic and discourse analysis will be used to identify patterns and themes within the material, allowing researchers to make inferences about the characteristics of SAR, how SAR is influenced and additional structures that support SAR. Data will be presented in thematic maps, tables and charts.

Consultations

Following the guidelines of Arksey and O’Malley and Levac and colleagues,^{13 14} we will include consultations with members of several local sites participating in the CREATE project²¹ to inform the results of our review. Social accountability is focused on and specific to the community it intends to serve. The reviewers hypothesise that the appearance of socially accountable research will differ significantly between communities and reflect different approaches to what constitutes a community. Therefore, results from consultations will capture nuanced differences in the definition and implementation of SAR between these local sites. Consultations will be used to provide supplementary perspectives to the review’s findings and discuss knowledge translation strategies and future directions. Reviewers will schedule consultations to occur with n=50 individuals, approximately n=10 individuals/community in five communities. For our review, a community will be defined as a group of like-minded individuals not necessarily bound by physical location.

Patient and public involvement

Knowledge users (socially accountable researchers) will shape the scoping review results through consultations following data extraction and initial conceptualisation. See the Knowledge Translation section below for the scoping review’s translation and dissemination plan.

Ethics and dissemination

Ethics

Ethical approval is not required as the current study reviews published literature and does not involve the participation of humans or animals.

Knowledge translation

Our scoping review will undertake an integrated knowledge translation approach (iKT) as this framework follows the values of social accountability. Consultations will occur with members of the CREATE project, an international network of socially accountable researchers throughout the research process, to identify our research questions, establish our selection and extraction criteria and contextualise our results. Our KT efforts will aim to increase the global capacity for socially accountable research. Throughout our scoping review, we will communicate with members of the CREATE project with presentations, reports and newsletters. The completed scoping review will be shared with the larger academic community, policymakers and healthcare practitioners to increase the prevalence of SAR. Publications, presentations at academic conferences, reports and an online repository will be used to share our findings with these individuals. The authors acknowledge that knowledge translation plans may change and expand throughout the project. Any deviations from the above plan will be detailed in our final manuscript.

Deviations from the protocol

To maintain transparency, if any deviations from this scoping review protocol occur during the sorting, data extraction or data synthesis phases, they will be reported thoroughly in the final review.