Exploring Paramedicine's Research Infrastructure in Ontario, Canada

Objective: Paramedicine is expanding in scope and diversifying its contributions to healthcare systems and society. To achieve sustainable and meaningful development, paramedicine (like other health professions) must prioritize the generation and use of high-quality evidence to guide practice, policy, and innovation. However, paramedicine's progression has been criticized for lacking a sufficient evidence base, undermining its decision-making. We sought to examine the existing infrastructure within a paramedicine context that supports the community to engage in, produce, and/or use research. Methods: This qualitative study employed semistructured interviews analyzed using reflexive thematic analysis. Purposive and snowball sampling was used to recruit and enroll those engaged in research capacity development and contributions in Ontario, Canada, representing diverse roles within the paramedicine community. The interview guide was informed by Cooke's six-principle research capacity framework: skills, collaboration, infrastructure, ownership, research-practice linkages, and culture. Data were transcribed, coded, and thematically analyzed using Braun and Clarke's six-phase method. Member checking was employed, offering participants the opportunity to review their transcripts for accuracy and to provide revision/elaborations. Results: Twenty-four individuals were interviewed. Two overarching themes emerged: (1) Structural and Cultural Foundations for Research, highlighting infrastructure challenges, fragmented pathways, cultural resistance, and a reliance on informal networks, and (2) Systemic Integration and Strategic Alignment underscoring calls for long-term growth, broader healthcare system integration, solving inequities in access to research infrastructure, better data access and governance, clear leadership on research, and demonstrations of value. Conclusion: Ontario's paramedicine community faces significant challenges to research engagement, capacity building, and contributions, hindering the profession's ability to support the growth and use of a research and evidence ecosystem. Several implications and recommendations are outlined, including attending to internal (e.g., research infrastructure, professional integration) and external (e.g., strengthening collaboration and partnerships) factors and policy goals. International contexts are considered.