The first author of this paper was the interviewer with thirty years of experience as a biomedical librarian working in a major national research organisation and three leading Australian research universities. The other authors of this paper provided expertise in designing the study and assisting with the conceptual analysis of the data from the interviews. The research commenced in 2016. Members of an Australasia PMC Working Group (originally set up as an Australia PMC Steering Committee to provide advice and feedback on an Australia PMC investigation) also gave feedback on the draft interview questions. When a member joined the PMC Working Group from the University of Auckland, the name of the group became the Australasia PMC Working Group. A senior librarian pilot tested the interview questions. The Monash University Human Research Ethics Committee approved the study and the associated documentation.

Stakeholder interest in an investigation on the concept, viability and potential for an Australasia open biomedical repository is the proposition expanded upon, as the first cycle of an action research project. Action research is particularly relevant for practitioner research because it involves the people who are experiencing the organizational or social challenges being addressed [ 11 ]. The dual aims of action research are for practical problem solving, and for testing and/or potentially developing a model or theory. The EBHC pyramid and KM models were used as the theoretical lenses for this research. The change intervention, which is a key component of action research, comprises the recommendations made by the Australasia PMC Working Group [ 12 ]. The data collection, research techniques included semi-structured interviews and a focus group.

All participants contacted agreed to partake in the interview and there were no participant dropouts. Interviews were in person or captured using the Zoom video conferencing system. All of the interviews took place in a workplace setting and took approximately one hour each. Twenty-eight health sciences librarians provided input in a focus group setting to the same questions answered by interview participants. Consent authorisation for use of the interview findings was obtained. NVivo software was used by the authors for coding the interview transcripts in the form of a SWOT analysis.

The semi-structured interviews and the focus group occurred between December 2016 and February 2017. Interview questions related to participants’ experience of PubMed, MEDLINE, PMC and their use of information resources for research and clinical practice [S1 interview and focus group questions]. The 45 participants included two Head biomedical researchers, a senior executive from the Australian Research Council (ARC), a senior executive and biomedical researcher from Australia’s National Health and Medical Research Council (NHMRC), executive directors, prominent clinical academics and practitioners, university repository managers, medical library leaders located throughout Australia and a medical journal editor and retired hospital director from New Zealand. According to Creswell, a sample size of 20–30 is adequate to obtain feedback for most or all perceptions and to achieve saturation on the topic. The sample here generated a sufficiently informative range of opinion on the subject matter [ 15 ].

The research used purposive sampling to seek comprehensive and authoritative feedback on the proposal to establish an Australasia PMC. Research participants were either colleagues or known by their professional reputation to the interviewer. As shown in Table 1 , the selection of participants ensured gender diversity and geographic spread across Australia. The research team chose potential stakeholders of an Australasian PMC based on their professional roles as leaders in their field, to participate in the research. Participant representation from fields of biomedical research, clinical practice and healthcare organisations, medical societies, publishing, universities and libraries was required. Participants each received a study explanatory statement, a briefing document and interview questions prior to either an interview or the focus group. All potential 17 stakeholders accepted their interview invitation and the 28 health sciences librarians consented to participating in a focus group session. The 28 health sciences librarians included 20 working in university libraries and 8 working in hospital libraries located throughout Australia. The focus group took place on the last day of a four day, Evidence Based Practice Librarians’ residential workshop.

The Evidence Based Healthcare (EBHC) pyramid, developed by Haynes in 2001, was the theoretical model adopted to explain the use of research output contained in a PMC [ 13 ]. The EBHC has been widely adopted to help determine which resources to consult for answering clinical queries and to provide a perspective on the wide array of health sciences information resources available from library databases and repositories [ 14 ].

Themes identified from the interview transcripts were coded as Strengths or Opportunities towards the establishment of an Australasia PMC or Weaknesses and Threats against the establishment of a potential Australasia PMC. Table 2 is a summary of the major themes identified.

Strengths

For biomedical researchers PubMed, MEDLINE and PMC are the foundation, primary research repositories. As funders, such as the ARC and the NHMRC, have open access policies that require researchers adhere to openly publishing articles, considering an Australasian PMC for reporting on research performance is a means to achieve funding body compliance. Institutional executives and open access leaders view the PMC system, such as the Europe PMC, as a means to manage and review the output of biomedical research linked to grant details and a means to help avoid duplication of research and link related findings.

Health sciences librarians and biomedical researchers commented that an Australasia PMC might be a way of reducing the fragmentation of university repository systems by consolidating biomedical research output. They mentioned that particular areas of research could benefit, such as tropical health, indigenous health and other regional priorities. Heightening opportunities for research collaboration is another benefit raised by the librarians. (Focus group, health sciences librarians, 28 participants, Adelaide).

A key strength of an Australasia PMC for biomedical researchers specifically relates to opening up more full-text manuscripts linked to research data. A Head biomedical researcher for example, indicated that having one site would make the data to be richly annotated and discoverable to allow researchers to download large sets and mine the content. (Interview participant, biomedical researcher, male, Victoria).

A librarian commented that there are groups that do not have access to subscription journals, proprietary bibliographic databases and other collections, such as general practitioners, clinicians outside the state and territory health service, private industry and not-for-profit community groups who would benefit significantly (Interview participant, senior librarian, female, New South Wales). According to the focus group participants, an Australasian PMC would provide ease of access and remove obstacles to full text papers.

All of the biomedical researchers interviewed indicated the importance of using primary research outputs. The clinical academics interviewed did use primary literature though commented that many of their peers did not. A participant commented that lack of access to research resources is a huge problem for some clinicians and pointed out that some do not even know how or where to find the research output (Interview participant, senior executive & biomedical researcher, female, Victoria). A hospital librarian highlighted the importance of searching the primary studies and non-commercial publications for research on redesign of service delivery and health technology applications. She commented that, “health technology applications is another area where we go back to the primary literature usually indexed by MEDLINE.” (Interview participant, senior librarian, female, New South Wales).

According to the librarians “PubMed is at the base of the Evidence Based Healthcare pyramid and without that you cannot build upon the rest of the pyramid to achieve higher quality clinical information resources.” (Interview group, health sciences librarians, 28 participants, South Australia).

Weaknesses. Findings about the opinions on usage of full text research articles was uneven. Clinicians and biomedical researchers interviewed mentioned that the sheer volume of primary research outputs and the work required to synthesize papers is a major reason why clinicians do not read primary papers. A senior executive and biomedical researcher claimed that they discourage clinicians from reading the raw evidence. Based on the vast amount of subscription and other content available from libraries and societies, a PMC maybe of limited value to many Australasian healthcare practitioners. An allied health practitioner claimed, “MEDLINE is exclusive and doesn’t cover enough of the allied health sciences.” (Hospital clinician/allied health practitioner, female, Victoria). A clinician responded that they would not use a PMC, though indicated they did use Google Scholar for answering clinical queries. The first Google Scholar landing page will usually retrieve papers from PMC, so inadvertently many clinicians already rely upon PubMed and PMC. A repository manager explained that in Australia principles and practices of repository interoperability need to occur in order to avoid the duplication of effort taking place throughout institutional repositories. Based on the investment in repositories, according to an institutional repository manager, Australian researchers appear to be ambivalent about open access publishing in gold and green modes; this is demonstrated by researchers’ lack of enthusiasm to submit ‘green’ approved versions of their research manuscripts to institutional repositories in response to funder and institutional open access policies [16]. Opportunistic predatory journals give open access publishing a bad reputation [17]. Most of the interviewees raised the importance of safeguarding the high standards traditional publishers have achieved over hundreds of years. Two of the senior executives interviewed argued that Australia simply lacks the funding for PMC type projects; one executive stated, “We don’t have Wellcome Trust funding in Australia.” (Senior executive, female, Canberra). Biomedical researchers and a clinician raised the point that half of the content in journals is not reproducible and that this is a strong weakness of the published biomedical literature; this weakness only heightens the need to manage knowledge more effectively.

Opportunities. Health sciences librarians supported the notion that an Australasia PMC could mirror and contribute to PMCI and include biomedical content from Australian and New Zealand national libraries. The participants confirmed that the content in an Australasia PMC could include preprints, guidelines, government reports, patents, books, images and research data, such as the world clinical trial registries. An allied health practitioner argued that a PMC presents an opportunity to remove biomedical research out of silos, link to quality sites, and other core resources. The greater accessibility of resources would aid research engagement and provide an avenue for obtaining evidence of impact, which are priorities for research evaluation, such as the Excellence in Research for Australia process. A further possibility is the establishment of a regional network of medical libraries, to collaborate with a PMC; the US National Library of Medicine has achieved this, with membership of over 6,500 libraries in their support network [18]. There is potential to leverage a PMC for hospitals and health care organisations that do not have research repositories or the expertise to set them up. According to a senior hospital library manager: “If there was an Australasia PMC harvesting citations it may even take away the need for every small health service to have their own and this would be excellent.” (Interview participant, senior librarian, female, New South Wales). For researchers not affiliated with a university, an Australasia PMC would provide a suitable outlet to make their research openly available. PMC can help make research more discoverable, for example, PMC contains the largest proportion of articles with open access copies, based on a sample of articles published since 2009 [19]. Systems such as PMC provide infrastructure to discourage authors from signing away their copyright to the publishers, who resell it to agencies that have funded it in the first place. User education on Creative Commons and promotion of the system to upload manuscripts become a possibility. Bringing together suitable authorities to determine system protocol, screen quality resources and processes based on international principles, is a benefit of managing a regional PMC. A Head biomedical researcher proposed that an Australasia PMC could be a trusted site for promulgating significant research developments that are notable for healthcare practice. Researchers interviewed described the opportunity for an Australasia PMC to be a single portal through which to open federated datasets and a means to get beyond restrictive journal subscription paywalls. A leading biomedical researcher explained that richly annotated content would ensure discoverability and provide researchers with datasets for mining content. This effort would complement the work currently underway to develop living systematic reviews and guideline creation [20]. Based on the EBHC pyramid design, researchers work down the levels of this model to seek relevant output to meet their research needs. Some biomedical researchers expressed difficulties with mastering specialised language for searching repositories, such as Boolean logic. Establishment of an Australasia PMC presents an opportunity to develop a repository system with greater search and retrieval precision. It may also be possible to tackle the indexing of studies whereby the research output is unreliable or not reproducible. The National Library of Australia (NLA) has responsibility for making national digital content available, including Australian health and medical journals, books and reports that are of potential relevance to an Australasia PMC [21]. Using the NLA’s sophisticated data aggregation processes records from university repositories could be transferable to a PMC from the NLA’s Trove system. Establishment of an Australasia PMC may be a means to transfer some of the traffic away from the ‘Wild West’ sites, such as Sci-Hub, where the pirating of research papers takes place and ResearchGate where users at times ignore or misunderstand copyright restrictions (Interview participant, senior repository manager, male, Victoria).