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 Journal of http://jrn.sagepub.com/
Research in Nursing

International research collaboration : Issues, benefits and challenges of the global

network
Dawn Freshwater, Gwen Sherwood and Vicki Drury
Journal of Research in Nursing 2006 11: 295
DOI: 10.1177/1744987106066304

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 jrn
FOCUS

International research
collaboration Journal of Research
in Nursing
Issues, benefits and challenges of the global network © 2006
SAGE PUBLICATIONS
London, Thousand Oaks,
New Delhi
VOL 11(4) 295–303
DOI: 10.1177/
1744987106066304
Dawn Freshwater PhD, BA(Hons), RNT, RN, FRCN
Professor Applied Research (Mental Health and Primary Care)
IHCS, Bournemouth University

Gwen Sherwood PhD, RN, FAAN

Professor and Associate Dean
University of North Carolina at Chapel Hill, USA

Vicki Drury MClNsg, BA(Ed), RN, MRCNA

Researcher/Lecturer
Edith Cowan University, Perth, Australia

Abstract It has been argued that whilst globalisation brings with it significant
challenges, it also provides an opportunity for unifying health care activity and that
of related research practices across international boundaries. Internationalisation,
often confused with globalisation, is a process that can lead to a more extensive
pattern of activity and collaboration. International research collaboration in health
care has intensified and is frequently regarded as an indicator of quality and a way in
which to develop and disseminate scientific knowledge to newly developing
countries. There is however little substantive information for researchers new to the
global research network on how best to manage the challenges posed by
international collaboration, nor ways in which to measure the effectiveness of the
same. In this paper we begin by examining the importance of international research
collaboration before outlining some of the challenges of global information
management. Drawing upon our own experience of jointly funded research
initiatives and transnational working, alongside the available literature, we signpost
some of the possible processes, practicalities and problems encountered when
attempting to establish common ground.

Keywords research collaboration, globalisation, international, global networks

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Journal of Research in Nursing 11(4)
No man is an island, entire of itself; every man is a piece of the continent, a part of the main
(Donne, 1624)

Background
Globalisation, a term that is now well and truly embedded in the fabric of our daily
communications, and indeed now enables most of that communication, is a much
debated and highly contentious topic. It can be defined as a set of processes that con-
tribute to an intensified human interaction across spatial, temporal and cognitive
boundaries, and in a wide range of spheres, such as political, economical, social and
environmental (Lee, 2000). Importantly, globalisation impacts thought processes,
the timeframe of human interaction and of course territorialisation. Bettcher and Lee
(2002: 12) argue for a qualitative difference between globalisation and international-
isation, suggesting that internationalisation is a quantitative process that leads ‘to a
more extensive geographical pattern of economic activity’.
For some, globalisation is the spectre of threat to security, policies, law and order
and, indeed, to our very existence; while for others it brings with it the promise of a
new and brighter future (Bettcher and Lee, 2002). On a global scale, the impact of a
world without boundaries (metaphorically speaking) is too huge to comprehend.
Even within our own individual and fairly contained world of health care, the influ-
ence of the global knowledge economy is enormous. For nurses and healthcare pro-
fessionals, globalisation provides a wealth of opportunities for joint learning, both
informally and formally, through conferences, exchange and shared education (see,
for example, Ketefian et al., 2005). What, though, are the practical implications of
globalisation for nurse and healthcare researchers, who now, more than ever before,
have the opportunity to work across a vast horizon of sites and disciplines, and with
access to a wide array of resources and networks?

The importance of international collaboration

International research collaboration, which, it is argued, is characteristic of rapidly
changing research systems, is regarded by many as an indicator of high-quality
research (Kim, 2006). Kim notes that

research collaboration is often regarded as an effective way to get access to the developed
scientific knowledge and technologies for the Developing or Newly Developed countries.
From this perspective, the research collaboration is not an indicator of research quality as
such but a means to reach that quality.
(2005: 231)

International research collaboration presents health researchers with opportunities to

share experiences, data and methods that can provide the basis for new and import-
ant perspectives on existing practices. Rolfe et al. (2004) refer to the power that
international collaboration can bring to the research enterprise; this, they argue, is
directly related to the comparison of experiences and analysis. In their informative
paper on addressing common problems in healthcare, Rolfe et al. (2004) outline a
number of significant stages that comprise the practical process of forming a sustain-
able collaboration: the formation of collaborative structures; the sharing of informa-
tion; the sharing of resources and skills, and multidisciplinary involvement. They
conclude that collaborative research can help to address common healthcare prob-

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 Freshwater et al. International research collaboration
lems through the pooling of resources. In our own experiences we have found great
benefit in sharing methods and protocols, previously unique to one region. This has
forced us to challenge our taken-for-granted assumptions, move towards fresh per-
spectives and, in practical terms, aims to reduce disparities. Moreover, international
partnerships can facilitate the acquisition of new research skills and push the bound-
aries of research methods and techniques.
Clearly, many opportunities emanate from international collaboration, including
those that see researchers travelling to new places, meeting diverse groups of people
from differing cultures and immersing themselves in those cultures. Grathwol (2005)
refers to this as looking at the world through a different window, and asserts that inter-
national collaboration will inevitably broaden a person’s horizons, enrich their lives
and provide them with both professional and personal networks for a lifetime.

The impact of context

Bettcher and Lee (2002) provide a comprehensive glossary of core issues for considera-
tion when debating and discussing globalisation in the public health arena. Such theo-
retical insights and definitions are extremely helpful in pointing would-be collaborators
towards the political, ethical and economical issues affecting the research process.
However, practical examples of such partnerships highlight some of the more complex
‘real-world’ processes that can lead to the success or demise of the study. Hooper et al.
(2005) explain how language differences complicated aspects of their collaborative
study, and how interesting cultural dimensions, such as a large number of participants
having exactly the same name (surname and forename), required creative but sensitive
solutions. They also document the difficulties encountered when travelling is permitted
only under official government orders and with high-level support. Lida et al. (2005)
observe that a collaborative context is highly dependant on a relationship of mutual
consultation and joint decision-making, commenting that

although the intense collaboration demonstrated great potential for facilitating the research
process, it also brought numerous challenges, including increased demands on staff time
and the need to resolve issues inherent to differences in the internal and external environ-
ments of public and private organisations.
(Lida et al., 2005: 221)

Alliances that cut across diverse cultural settings present their own unique challenges,
as Hooper et al. (2005) note in their reflections on a USA–Saudi Arabian partnership.
They report:
As members of a Saudi–US research team, we were keenly aware of the differences between
our 2 nations outside the domain of science. Some of these differences had the potential to
affect our ability to access data, construct and analyzable data set, and interpret our find-
ings.
(2005: 193)

In reality, the international context presents numerous threats to the development

and success of a research project, but it is these threats that often create the potential
for the most learning, as the following reflection suggests.

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Journal of Research in Nursing 11(4)

The context of international research in Western Australia (VD; a

personal view)
Australia is geographically isolated from the continents of North America and Europe.
Perth, the capital of Western Australia (WA), is situated almost 3,000 kilometres from
the nearest capital city and is often described as the most isolated capital city in the
world. The majority of Western Australians live in Perth and, not surprisingly, all
major universities and healthcare facilities are situated in the capital — although
small university campuses, perhaps better described as annexes, are also situated in
major regional centres throughout WA. Getting to Perth, let alone to the regional
centres, is not without difficulty or cost. Having arrived in Perth, the only way to
access all major centres more than 400 kilometres distant is by air. Unlike Europe,
North America and other westernised countries, WA does not have cheap fares
created by ‘fare wars’, so visiting regional centres can be expensive. Indeed, it would
seem that there is little international collaboration outside Perth and the tyranny of
distance is the most obvious reason. This raises a number of major issues for the
researcher engaged in national research activity, which are amplified once the collab-
oration becomes international. Specifically there are difficulties in attracting both
high-calibre healthcare staff and high-calibre researchers, either as visiting scholars or
to work long term on funded projects. Neophyte nurse researchers, as with all disci-
plines, need competent and effective mentors and supervisors, which are also hard to
come by; and those that are around are in high demand!
My experience of international research collaboration has primarily been gained
through attendance at international conferences. It is hard to describe the impact that
this significant life event had on both my personal and professional life. The level of
scholarship I experienced was, at times, daunting. However I was also overwhelmed
by the degree to which everyone was willing to share their knowledge and was
willing to develop the neophytes! I came away refreshed, energised, motivated and
thirsting for the type of research and level of scholarship I had been exposed too. In
practical terms, through attendance at the conference, I now have a network of
people that I can call on from a range of disciplines with a diversity of interests.
Recently I received an email from the USA regarding an international research project
and they were looking for an Australian researcher to collaborate. While this was an
exciting prospect, the area was not my specialty; however, I was able to put them in
touch with the relevant experts in my own country. It is challenging living and
working in regional Australia where research has not had a high academic focus. The
international links I have forged keep me positive and motivated, while also provid-
ing me with support and encouragement. The personal and professional growth
I have gained from these collaborative links cannot easily be measured.

Establishing common ground: maximising potential

Several authors share lessons learnt from collaborative research (Boga et al, 1992;
Sansted et al., 1999; Lida et al., 2005). Sansted et al. (1999) point out the necessity for
investment of sufficient time and money to build and sustain partnerships, emphasising
also the importance of commitment by participants to the research project and, indeed,
to the coalition. Lida et al. (2005), drawing upon the creative work of Reason and
Heron (1995), signify the centrality of effective leadership, which in their own study
‘enabled those with the greatest expertise on particular issues to play a guiding role and
establish ownership of the group process’ (Lida et al., 2005: 223). They further delin-

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 Freshwater et al. International research collaboration
eate the role of diversity and respect and resolving and accommodating differences in
order facilitate a consensus approach to decision-making. Similarly in our experience,
collaborative research that straddles international boundaries requires a lead researcher
who has the skills to acknowledge and transcend cultural differences and create a virtual
environment within which the research team can form a motivated and coherent
whole, albeit with diverse skills and knowledge. Frenk and Gomes-Dantes (2002)
suggest, rather succinctly, that international activities that aim to improve healthcare are
characterised by exchange, evidence and empathy. Outcome, however is also critical,
both to the collaborators and their institutions.

Measuring the effectiveness of collaboration

Kim (2006) points out the problems of using a bibliometric approach to the mea-
surement of research collaboration. This is usually done by counting the number of
co-authored papers, and is based on the assumption that this demonstrates research
collaboration. (For a comprehensive account of the problems of using co-authorship
as an evaluative method, readers are pointed to Kim’s interesting paper.) However,
co-authorship is clearly only one part of collaboration and is not always an outcome
of even long-term investment. Skirton and Williams (2002), outlining the outcomes
of a collaboration between a team of genetic nurses, depict a progressive model of
evolving professional relationships and activities. Again outcomes include peer-
reviewed joint publications, but are not restricted to this. An area that requires
further development within nursing is that of benchmarking the effectiveness of
international research collaboration.

Global information management

Improvements in information technology and communication systems, and the
Internet in particular (an example of transnational activity), have facilitated the rapid
and extensive exchange of information, expertise and ideas across international
communities, resulting in the widespread creation and dissemination of knowledge
(Bettcher and Lee, 2002; Freshwater, 2004). Academics, practitioners and policy-
makers alike have access to networks that can facilitate the ‘coordination of global
campaigns and petitions’, engaging them in dialogue and collective action (McKee et
al., 2005a, b). This latter point, relating to social action, should not be underesti-
mated in the discussion of globalisation, internationalisation, research and healthcare.
For, as Bettcher and Lee (2002: 8) assert: ‘globalisation has made individual human
suffering an irrevocable universal concern. While Governments continue to be
important, global integration of world markets and instant communication have
given a role and a profile to those in business, civil society, NGOs and intergovern-
mental organisations.’ Freshwater (2004) concurs, challenging nurses to consider
their own unique contribution to the global knowledge economy.
Almost all of the literature reviewed for this paper relating to international
research collaboration emphasises the importance of face-to-face meetings (see, for
example, Hooper et al., 2005; Lida et al., 2005). Much work can be accomplished by
email, telephone conference and video-conference. However, as Lida et al. (2005)
argue, investment in face-to-face contact underpins and is central to the development
of collegial relationships that build, maintain and sustain complex and diverse
research studies. Naturally, such meetings have significant implications for resources
and can often lead to substantial challenges for the team.

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Journal of Research in Nursing 11(4)

Barriers and challenges

International partnerships in research inevitably incur additional financial costs,
whether this be related to travel, personnel or provision of translators and
equipment. Budget management practices vary from place to place, and rules may
differ for how monies can be spent, particularly for budget support of staff which
has stringent rules in the USA. Further, there are the sheer logistics of currency
exchange, the organisation and cost of travel for face-to-face meetings among the
team, and also for presentation of the results (most grantors limit travel expenditures
for such reasons).The financial costs of telephone and video-conferencing are not
inconsiderable and determining how these costs are shared across universities and
countries is an added dimension, especially where one university is financially more
secure than another or holds the funds. The financial dilemma is even greater if the
collaboration involves the need to meet outside one’s own country. As an example,
in WA one may gain approval to attend international conferences, but limited finan-
cial assistance is given by the university. Global outreach in research is still gaining
acceptance and suffers at times from lack of understanding of the relevance and
importance of international collaboration by grantors, administrators who must
approve linkages, reviewers and researchers themselves. For example, on return from
an international conference and a week visiting a university overseas, no one in the
faculty of one the authors was interested in reading a report or hearing their col-
league speak about what had been learnt. Unfortunately it was seen to be skiving!
The challenges of international research require creative problem solving and
commitment to the overall purpose and benefit of the project. Language differences
contribute to several barriers. Meanings of words are not always clear and can con-
tribute to misunderstandings, not only among the research team but also with
participants. Grant writing is never easy, and writing across nations using various
electronic means can be problematic even beyond language differences. Keeping
track of the current version of the document, motivating team members to respond
according to project timelines, and resolving differences in viewpoints require diplo-
macy and high-level communication skills. Knowledge of the culture and prospective
costs may be understood by the researchers in the country where a grant is to be sub-
mitted; and they may make an assumption that all members of the research team
understand not only the process for working out the costs but also the rationale
behind the costs. Indeed these costs may differ significantly to those in other coun-
tries and cause concern among some members of the team.
Procedures for subject recruitment vary greatly from nation to nation among dif-
ferent ethnic beliefs and attitudes so that potential participants may not respond to
traditional recruitment procedures. McNeill et al. (2003) describe efforts to recruit
Hispanics to investigate responses to pain management with suggestions on how to
use sensitivity to recruit particular populations. Other challenges involve training data
collectors remotely using virtual communication, even with detailed protocols. Clear
communication of the study’s purpose, study variables and the importance of
control, potential threats to validity, and times to call for help can help to insure
useable data. Differences in philosophies, culture, belief systems, values and attitudes
can also yield varying interpretations of data.
Time zones are a challenge that often go unmentioned, but are of significance in
international collaboration. This is particularly relevant in Australia, where global
time zones, with the exception of some countries in Asia and the Pacific region, are
diametrically opposed to the United Kingdom and many areas of the USA. For

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 Freshwater et al. International research collaboration
example, researchers in Australia were having afternoon tea whilst talking to the
British member of the research team where it was 6 am!
Governance, the ways in which institutions and individuals manage their common
affairs, vary both in fundamental values and views of human life. At times, this can
result in quite different attitudes and procedures related to human subjects review,
differing attitudes about ethical frameworks, especially towards participants, differ-
ing research protocols, methods, and participant availability, and subject recruitment
rules and procedures. Some nations do not have human subject review and may not
understand the stringent rules, for example, in the UK and USA. Negotiation among
team members to reach consensus needs to fit within rules and regulations of all the
parties involved, which can be time-consuming in terms of negotiation of contracts.
These challenges were evident in a project involving researchers from the USA and
Mexico. Even though detailed protocols were developed and exchanged for training
data collectors, the Mexican team inserted changes to accommodate their own needs,
but did not notify their USA counterparts. While the changes did not violate usual
research procedures, because of the differences in data collection, there were limita-
tions in how data could be merged and compared across the two studies. However,
because the two groups had established a solid relationship, discussions led to greater
understanding and cooperation between the two universities.
Intellectual property rights vary around the world, with different attitudes towards
ownership and about plagiarism. In working with Asian doctoral students, issues
have arisen about using passages verbatim in literature reviews. International research
collaboration also encompasses the sharing of information. This is generally done
through conference forums, journal articles and informal professional networking.
To avoid hurt feelings or misunderstanding, again, team members must engage in
clear communication at the start of the collaboration about intellectual property,
authorship of papers and presentations, and a clear understanding about using other
literature. Universities also often have their own policies regarding these policies and
it is important to integrate these with practices associated with intellectual property
and authorship. This is often an opportunity for the older, more-established universi-
ties to provide guidance on what is acceptable best practice globally.
The globalisation of everyday life through the Internet, video-conferencing and
telephone networking makes international collaboration across postgraduate students
a viable and exciting reality. For students in countries where research is in its
infancy, the ability to be supervised by international researchers with proven track
records can only add to their experience and their learning. For the supervisors the
experience can be equally rewarding through mentorship by the more experienced
supervisor. The major difficulty with international collaboration across postgraduate
students relates to ensuring that all communication channels between the supervisors
and student are open and that all three are involved in all discussions that take place.
While this may be difficult, it is not impossible, and does not necessarily mean that
all must be present in some capacity – emailed suggestions from one supervisor to
the other may occur prior to a meeting between supervisor and student for example.

Making a difference
International research is challenging, but there are generous outcomes. Healthcare
can truly be transformed as researchers are able to apply interventions with multiple
populations simultaneously. While so much of the healthcare information we have is
derived from our own populations, we have learned that these findings cannot

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Journal of Research in Nursing 11(4)
simply form the basis for treatment of other groups. International research is a major
factor in helping to reduce disparities among various under-represented populations.
Cardiac intervention provides a prime example, with variances in treatment now
emerging for women, African-Americans, and other groups.
International research has truly transformed treatment for many communicable
diseases, particularly AIDS/HIV, a disease that knows no boundaries. The SARS epi-
demic provides another example of a global health issue approached from a global
perspective. Pain is also a universal phenomenon subject to multicultural considera-
tions. Researchers are working across nations to try to determine genetic differences,
cultural beliefs and attitudes, and personal responses to different treatment regimens.
International collaboration in mental health has seen the development and sustain-
ability of best practice across nations.
Whilst international collaboration is important, research, especially in Third-World
countries, needs to leave people with changes that make a difference and over which the
community can take ownership. Research that is dynamic and leaves communities with
sustainable and improved outcomes will provide more opportunities in the future.
Often, the lessons learned are surprising, and the developed world does not
always have the best answer!

Summary
If, as Donne (1624) asserts, humankind is interrelated, then research is not isolated but
is also interrelated. International collaboration allows researchers to take into considera-
tion the impact of that research in a different culture. It encourages best practice through
the sharing of ideas and facilitates evidence-based practice. International collaboration
also promotes the exchange of information and ideas. The authors of this paper have had
many interesting experiences with graduate students, Post Doctoral fellows and fellow
researchers from other nations. The opportunity to mentor and learn from others
remains a challenge, yet is so rewarding. The unequal distribution of doctoral and
research programmes in nursing has fostered exchange among nations for post-docs in
which learning moves in both directions — which in fact should be the guiding prin-
ciple for all global collaborations in research. Internationalization of research illustrates
humanity’s link in all corners of the world across health and human suffering.

Key points
• Globalisation highlights the fact that healthcare systems face universal
challenges in the management of human suffering
• The dismantling of global and international boundaries provides
opportunities for extensive sharing of research expertise
• International research collaboration presents unique challenges and
opportunities for healthcare practitioners
• International research collaboration requires the sharing of expertise in
problem identification and problem-solving activities
• Attention should be given to geopolitical, religious and social differences
across healthcare systems

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 Freshwater et al. International research collaboration
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IHCS
Bournemouth University
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