Open Access Open Badges Research article

Do health care institutions value research? A mixed methods study of barriers and facilitators to methodological rigor in pediatric randomized trials

Michele P Hamm16*, Shannon D Scott23, Terry P Klassen4, David Moher5 and Lisa Hartling1

Author Affiliations

1 Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

2 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada

3 Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

4 Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada

5 Ottawa Hospital Research Institute, Ottawa, ON, Canada

6 Department of Pediatrics, University of Alberta, ECHA 4-482B, 11405-87 Avenue, Edmonton, AB, T5G 1C9, Canada

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BMC Medical Research Methodology 2012, 12:158  doi:10.1186/1471-2288-12-158

Published: 18 October 2012



Pediatric randomized controlled trials (RCTs) are susceptible to a high risk of bias. We examined the barriers and facilitators that pediatric trialists face in the design and conduct of unbiased trials.


We used a mixed methods design, with semi-structured interviews building upon the results of a quantitative survey. We surveyed Canadian (n=253) and international (n=600) pediatric trialists regarding their knowledge and awareness of bias and their perceived barriers and facilitators in conducting clinical trials. We then interviewed 13 participants from different subspecialties and geographic locations to gain a more detailed description of how their experiences and attitudes towards research interacted with trial design and conduct.


The survey response rate was 23.0% (186/807). 68.1% of respondents agreed that bias is a problem in pediatric RCTs and 72.0% felt that there is sufficient evidence to support changing some aspects of how trials are conducted. Knowledge related to bias was variable, with inconsistent awareness of study design features that may introduce bias into a study. Interview participants highlighted a lack of formal training in research methods, a negative research culture, and the pragmatics of trial conduct as barriers. Facilitators included contact with knowledgeable and supportive colleagues and infrastructure for research.


A lack of awareness of bias and negative attitudes towards research present significant barriers in terms of conducting methodologically rigorous pediatric RCTs. Knowledge translation efforts must focus on these issues to ensure the relevance and validity of trial results.

Clinical trials as topic; Risk of bias; Pediatrics; Mixed methods