Building resilient health research ecosystems in fragile and conflict-affected situations: Scoping review of challenges and coping strategies

Background Sustaining health research in fragile and conflict-affected situations (FCAS) is a persistent challenge, and evidence is required to understand the unique problems these situations generate, to strengthen health systems, inform policies, and guide interventions. This scoping review aimed to map existing studies on conducting health research in FCAS to identify gaps, challenges, coping strategies and recommendations for building resilient health research ecosystem. Methods This scoping review was guided by Arksey and O’Malley’s framework. We searched major databases (PubMed, PsycINFO, Embase, Cochrane Library, CINAHL, Global Health) and the World Health Organization’s Global Index Medicus. We also identified grey literature from dissertations, conference abstracts, and reports. A broad search strategy was used. Titles, abstracts, and full texts were screened using Rayyan, and two independent reviewers extracted data with a piloted template. Data were narratively synthesized around emerging themes. Results The search yielded a total of 15,601 studies after duplicates were removed. Following title/abstract and full-text screening, 46 studies met the eligibility criteria, with 93.5% published in peer-reviewed journals. Over three-quarters of the included studies were either qualitative or review papers. Key challenges of undertaking health research in FCAS included context-related and safety challenges, resource constraints, limited research productivity and utilization, stewardship issues, methodological limitations, and logistical and infrastructure barriers. Coping mechanisms and potential intervention strategies included community and stakeholder engagement, making research topics and methods locally relevant, methodological adaptations, collaboration and partnership, and the use of digital tools and technology. Conclusions Numerous coping mechanisms that would help to address challenges in conducting health research in FCAS were identified, but further evaluation is needed regarding their feasibility, acceptability, and effectiveness. Emphasis should be given on identifying preventive strategies, in addition to these coping mechanisms. The predominance of qualitative and conceptual review articles underscores the need for more original research, particularly using quantitative and mixed methods. Evidence is scarce on how to alleviate funding constraints; therefore, more embedded implementation research in this area is warranted. Leveraging digital tools and technology is of promise for sustaining health research in crises situations.