Abstract
ABSTRACTBackground: To achieve a sustained improvement in health outcomes, the way health interventions are designed and implemented is critical. A participatory action research approach is applauded for building local capacity such as health management. Thereby increasing the chances of sustaining health interventions.Objective: This study explored stakeholder experiences of using PAR to implement an intervention meant to strengthen the local district capacity.Methods: This was a qualitative study featuring 18 informant interviews and a focus group discussion. Respondents included politicians, administrators, health managers and external researchers in three rural districts of eastern Uganda where PAR was used. Qualitative content analysis was used to explore stakeholders’ experiences.Results: ‘Being awakened’ emerged as an overarching category capturing stakeholder experiences of using PAR. This was described in four interrelated and sequential categories, which included: stakeholder involvement, being invigorated, the risk of wide stakeholder engagement and balancing the risk of wide stakeholder engagement. In terms of involvement, the stakeholders felt engaged, a sense of ownership, felt valued and responsible during the implementation of the project. Being invigorated meant being awakened, inspired and supported. On the other hand, risks such as conflict, stress and uncertainty were reported, and finally these risks were balanced through tolerance, risk-awareness and collaboration.Conclusions: The PAR approach was desirable because it created opportunities for building local capacity and enhancing continuity of interventions. Stakeholders were awakened by the approach, as it made them more responsive to systems challenges and possible local solutions. Nonetheless, the use of PAR should be considered in full knowledge of the undesirable and complex experiences, such as uncertainty, conflict and stress. This will enable adequate preparation and management of stakeholder expectations to maximize the benefits of the approach.
Highlights
To achieve a sustained improvement in health outcomes, the way health interventions are designed and implemented is critical
The approach was reported to have stirred up local stakeholders to create change in a manner that was previously not experienced with other non-participatory approaches
With the wide stakeholder involvement came risks of engagement that had to be managed through the category of balancing risks of wide stakeholder engagement
Summary
To achieve a sustained improvement in health outcomes, the way health interventions are designed and implemented is critical. Participatory action research (PAR) can be defined as a study design that treats the communities of inquiry as part of the generators of knowledge.[1,2] Groups that utilize PAR attempt to redistribute power relations by working as a team to decide what is researched, how it is researched and its benefits across all stakeholders involved In such collaborations, communities in which research is being undertaken take a central role in the decision-making, since the PAR approach involves taking local actions to resolve social injustices.[3] Through iterative processes, participants seek to collaboratively identify social problems, adopt potential solutions and devise strategies to overcome challenges. Such processes are promoted within highly respectful and yet deliberately analytical discussions in order to collectively generate lasting solutions to problems.[1,2,3] By strengthening local capacity and empowering locals, PAR has been lauded as an approach that promotes sustainability of health interventions.[4]
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