Background

Health workforce shortages in remote and rural Australia significantly hinder access to care, leading to poorer health outcomes and increased healthcare costs [1–3]. The latest report from the Australian Institute of Health and Welfare (AIHW) indicates that people living in remote areas have poorer access to health services than those in major cities [4]. In 2022, the full-time equivalent (FTE) rate of clinical health professionals in remote and very remote areas is 1,938 and 1,846 per 100,000 population, respectively, compared with 2,248 per 100,000 in major cities, highlighting a notable maldistribution [4]. This disparity contributes to a higher reliance on patient transfers, contract medical officers, and agency staffing [1]. Delays in care, reduced availability of specialist services, and evidence from other low-resource settings further suggest that inadequate health workforce capacity undermines service provision and compromises the quality and equity of healthcare [1,5,6].

The maldistribution of the health workforce, along with weak coordination between workforce training and employment in remote areas, exacerbates existing shortages [7]. Increased staffing of rural clinics in response to targeted funding is often temporary due to unstable funding, limited job security, and reluctance among clinicians to commit to rural practice [8]. In Western Australia, many remote clinics rely on fly-in fly-out (FIFO) models, with rotating clinicians providing intermittent care [9,10]. While offering short-term relief, this approach undermines continuity, leading to poorer patient outcomes and increased strain on emergency services.

National reports also indicate that rural clinical roles are often perceived as career-limiting, largely due to limited opportunities for specialisation, mentorship, and career progression [11,12]. For example, research has shown that such perceptions can influence medical graduates’ willingness to consider rural practice, particularly among those seeking highly specialised careers or structured career pathways [13,14]. These systemic barriers contribute to ongoing workforce instability, further hindering effective health service delivery in rural and remote communities. This underscores the need to address career development pathways in rural health workforce planning.

Beyond addressing workforce shortages and distribution to improve the quality of rural healthcare, there is growing recognition that building workforce research capability is essential to improving rural health outcomes. One promising approach involves developing practitioner–researcher pathways through research capacity-buildings (RCB).

RCB involves strengthening the skills, systems, resources, and organisational structures that enable individuals and institutions to generate, interpret, and apply research to improve practice and decision-making [15]. These RCBs aim to support rural and remote clinicians to develop research skills, generate locally relevant evidence, and contribute to health service improvement in rural and remote areas. For instance, the Rural Research Capacity Building Program (RRCBP) in New South Wales, initiated in 2006, aims to increase the number of rural and remote health workers equipped with evaluation and research skills [16,17]. Participants report improvements in service delivery, patient outcomes, and professional confidence. Other research capacity-building programs in Australia include the Research Ready Grant Program in Queensland [18] and the Supporting Translation of Research in Rural and Remote health settings (STaRR) program in Victoria [19,20]. These programs contribute to professional development, inform rural health service delivery models, and support evidence-based policymaking.

Despite these gains, rural practitioners continue to face structural and contextual barriers to conducting research. A study by Wong et al. identified macro-level challenges such as limited rural research funding and workforce policy misalignment; meso-level factors including inadequate organisational prioritisation of research; and micro-level issues such as the need for researchers to understand local sociocultural dynamics [21]. These barriers can limit the sustainability and impact of RCB efforts in rural contexts. Thus, to inform remote workforce development strategies in Australia, a scoping review will be undertaken to examine how engagement in research and participation in RCB influences health workforce outcomes such as retention and attraction in rural and remote settings.

Methods

Eligibility criteria

We will include all primary studies and reports published since 2000, including both qualitative and quantitative studies, reports such as governmental/organisational reports and grey literature. We will include studies conducted in both metro and rural areas and extraction for rural results will be done separately. We will exclude systematic reviews (though their references will be used for snowballing) as well as studies conducted exclusively in urban areas and major cities. The detailed inclusion and exclusion criteria are presented in Table 1.

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Table 1. Study inclusion and exclusion criteria.

https://doi.org/10.1371/journal.pone.0340289.t001

Data extraction and analysis

Data from all eligible studies will be extracted using a structured Excel™ spreadsheet developed for this review. Two reviewers (TH and ME) will independently extract data from an initial sample of five studies to pilot and refine the extraction tool. Any discrepancies will be discussed, and the tool will be adapted to ensure it captures all required study characteristics and reporting elements. Following this pilot phase, one co-author (TH) will extract data from the remaining studies, and a second reviewer (ME) will verify the extracted information for accuracy and completeness.

The abstraction sheet is drafted for both qualitative and quantitative evidence. Key information to be collected will include: 1) study characteristics (author, year of publication, country/setting), study design (qualitative, cross sectional, interventional, cohort, case-control), sample size, data collection or methods of analysis); 2) participants characteristics (types of health workforces, speciality, year of experience, and workplace or service context); 3) characteristics of RCB (type of program, area of research, duration or intensity of engagement), and 4) reported outcomes, including workforce retention, recruitment or attraction, sustainability, turnover, intention to leave, and other relevant effects (Table 2). A separate extraction sheet will be used for grey literature sources, capturing document characteristics and key findings.

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Table 2. Data abstraction sheet to describe the study in the final review.

https://doi.org/10.1371/journal.pone.0340289.t002

A descriptive qualitative analysis will be conducted using both deductive and inductive thematic approaches. The deductive analysis will apply the socioecological model to organise the impacts of RCB initiatives across individual, team, organisational, and system levels (Fig 1). In parallel, an inductive analysis will be undertaken, first to identify the key enablers and barriers influencing the implementation and effectiveness of RCB activities, and second to map the pathways through which RCB contributes to workforce outcomes, including its interactions with broader retention and workforce-strengthening strategies. Themes will be generated from the extracted data and refined iteratively, with quantitative findings incorporated to support or extend the qualitative insights. In line with JBI guidance for scoping reviews, we will not appraise study quality or risk of bias, as the purpose of this review is to map and characterise the existing evidence base rather than to synthesise effect estimates.

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Fig 1. Impact of RCB on different levels guided by Socioecological Framework.

A framework which will be used to present the impact of RCB at different levels based on the socioecological model. RCB: Research Capacity Building.

https://doi.org/10.1371/journal.pone.0340289.g001

Discussion

Our scoping review will address gaps in current knowledge by exploring evidence on how health workforce engagement in RCB influences outcomes such as attraction, retention, professional development, job satisfaction, and career progression in rural and remote areas Australia, settings where workforce shortages are persistent and well recognised. By integrating both peer-reviewed and publicly available unpublished literature, and synthesising qualitative and quantitative evidence, the scoping review will map the breadth and depth of available evidence, identify enablers and barriers to implementation, and highlight strategies proposed to strengthen the effectiveness of RCB programs. Ultimately, our scoping review findings will provide insights into how RCB can support professional growth, foster a sense of purpose and connectedness, and ultimately contribute to workforce stability in underserved settings.

The extent to which RCB affects workforce outcomes is likely shaped by contextual factors, including health service type, staff experience, disciplinary background, resource availability, organisational culture, and the systems in place to support research activity. Differences in infrastructure, mentorship, feedback mechanisms, and perceived benefits may all influence engagement. Our scoping review will therefore explore these contextual factors or constrains successful implementation in rural and remote contexts, with the aim of informing future policy and practice.

Our scoping review will also position RCB within the broader suite of interventions designed to strengthen the rural and remote health workforce. We will examine how capability-building initiatives intersect with complementary strategies, such as professional development programs, mentoring and supervision schemes, financial incentives, and organisational retention efforts. By identifying co-interventions, potential synergies, and areas of duplication or missed opportunity, the review will highlight best practices and generate evidence-informed recommendations to enhance attraction, retention, and workforce sustainability at individual, team, organisational, and system levels.

This scoping review will apply a rigorous and transparent methodology, guided by the PRISMA-ScR framework and the JBI approach. Independent, duplicate screening of titles, abstracts, full texts, and data extraction will enhance reliability and minimise reviewer bias. The use of a comprehensive search strategy, covering multiple bibliographic databases, grey literature sources, and organisational repositories, will reduce publication bias and ensure wide capture of relevant evidence. Predefined eligibility criteria and a structured data extraction process will enable systematic mapping of how research RCB initiatives influence health workforce outcomes in rural and remote Australian settings.

Some limitations are anticipated. The inclusion of grey literature may introduce variability in methodological quality, as such works does not undergo peer review; however, this is consistent with the aim of our scoping review, which seeks to map the scope of evidence rather than assess its robustness. Considerable heterogeneity across study designs may limit the comparability of findings, and variability in definitions of ‘rural’ and ‘remote’ may change the synthesis. Challenges in identifying unpublished research and CBP activities may also lead to under-representation of some initiatives.

Despite these anticipated limitations, our scoping review will offer important insights for policymakers, health service leaders, and research administrators. By clarifying how research engagement and RCB operates within rural and remote settings, and the conditions under which they are most effective; this work will support for the design of future programs, inform workforce policy, and guide targeted investment in research capacity as a lever for improving workforce stability.

Supporting information

Acknowledgments

We would like to acknowledge Vanessa Varis (Faculty of Health Sciences librarian) for her assistance with the search strategy, databases, and the use of COVIDENCE.