651 - The Ones That Got Away: Understanding Site Participation in Global Pediatric Research — Insights from the Global PARITY Study

Publication Number: 3631.651

Alejandra C. Quesada-Stoner, St Jude Childrens Research Hospital, Berkeley, CA, United States; Paula Caporal, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Catalina Ortuzar Lyon, Johns Hopkins Bloomberg School of Public Health, Santiago, Region Metropolitana, Chile; Eliana Lopez-Baron, University of Louisville, Louisville, KY, United States; Benjamin K. Oelkers, St. Jude Children's Research Hospital, Metairie, LA, United States; Teresa B.. Kortz, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Hannah Rees, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Kokou H. Amegan-Aho, University of Health and Allied Sciences, Ho, Volta, Ghana; Sheila AGYEIWAA. Agyeiwaa Owusu, University for Development Studies, TAMALE, Northern, Ghana; Tania Maria. Conde Morelos Zaragoza, St. Jude Children's Research Hospital, Rincón de Monferrato 132, San Luis Potosi, Mexico; Asya Agulnik, St. Jude Children's Research Hospital, Memphis, TN, United States

Background: The Global PARITY study, a multinational point-prevalence study of pediatric acute critical illness, aimed to characterize the disease burden across hospitals in resource-limited settings (RLS). Despite substantial global interest, only half of the hospitals that initially expressed interest engaged in data collection. This underscores persistent barriers to global research participation, particularly within RLS. While prior research has identified structural barriers, few studies have examined the implementation process of global collaborative studies from the perspective of potential collaborators.

Objective: Identify and characterize the factors and processes that facilitate or hinder participation in global pediatric research.

Design/Methods: We conducted a qualitative study guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews were completed with principal investigators from participating and non-participating Global PARITY sites. A codebook was developed deductively using CFIR constructs and inductively refined to capture emerging themes. Thematic analysis identified determinants of participation across all CFIR domains.

Results: We completed 27 interviews with principal investigators from 13 participating and 13 non-participating centers. Investigators described the study's global scope and potential to advance pediatric care as key motivators for participation. However, complex administrative requirements and ethics review processes hindered participation. Hospitals with adequate staffing and electronic data systems were better equipped to contribute, whereas those with paper records and requiring trainee work (without recognition) faced significant barriers. Institutional support for research, combined with investigators' prior experience, facilitated readiness for participation, whereas heavy clinical workloads and competing responsibilities constrained their involvement. Finally, ongoing communication from Global PARITY leadership promoted engagement, while limited follow-up discouraged some sites. Overall, professional growth and the opportunity to represent one's country in global research were cited as powerful incentives.

Conclusion(s): Our findings underscore the need for adaptive, equity-centered implementation strategies for global research studies that enhance institutional capacity, streamline regulatory processes, and ensure the meaningful recognition of local investigators. By investing in infrastructure, mentorship, and sustained global partnerships, future initiatives can transform collaboration into shared leadership and lasting impact.

Figure 1. Global Participation in the Global PARITY Study: Distribution of Participating and Non-Participating Sites
This map illustrates the geographic distribution of hospitals invited to join the Global PARITY study across resource-limited settings. Sites are categorized by participation status: participating (light blue) and non-participating (dark blue). The figure highlights both the global reach of the initiative and the regional disparities in research engagement, emphasizing the structural and contextual challenges that shape participation in multinational pediatric studies.

Figure 2. Barriers and Facilitators to Site Participation in the Global PARITY Study
This figure summarizes key determinants influencing site participation in the Global PARITY study across 91 hospitals invited worldwide. Among these, 46 sites (50.5%) participated, and 45 (49.5%) did not. Facilitators included interest in large-scale international collaboration, clear study coordination, prior research experience, and the opportunity to increase institutional visibility through global representation. Barriers included complex ethics and administrative processes, limited staffing and research time, weak institutional research culture, and inconsistent communication. Collectively, these findings highlight the multifaceted contextual factors that shape engagement in multinational pediatric research within resource-limited settings.

Table 1. Representative Quotes Illustrating Barriers and Facilitators to Site Participation in the Global PARITY Study, Mapped to CFIR Domains
This table presents key barriers and facilitators influencing site participation in the Global PARITY study, accompanied by direct quotes from principal investigators. Themes are organized according to the Consolidated Framework for Implementation Research (CFIR), highlighting how structural, organizational, individual, and process-level factors affected engagement in a multinational pediatric research effort across resource-limited settings.