Initiating a participatory action research process in the Agincourt health and socio–demographic surveillance site

This paper reports on the process of participatory action research from a three-year project to co-create ideas to reduce educational inequity with young people funded by Erasmus+. The project involved 10 academics and 50 university students from Norway, Denmark and England who co-researched 200 young people’s experiences of educational inequity. The process of participatory action research was challenging but rewarding for its potential for social justice. The participatory process used and the difficulties encountered are identified and discussed in this paper for the benefit of future research. The co-created output from the research, the Wellbeing, Education, Learning and Development Model (WELD) is provided as an example of the potential of action research to inspire multi-level social change.

Since 2001 a team of academic researchers and medical practitioners have been collaborating with Yarrabah Men?s Health Group leaders to implement a participatory action research (PAR) process designed to support the men to (in their own words) ?take their rightful place? in contemporary Australian society. The formative stages of the PAR process and progress over the first 12 months have been documented in previous papers in order to provide much needed direction for others interested in undertaking similar community action-oriented research (Tsey, Patterson, Whiteside, Baird, & Baird, 2002; Tsey et al., 2004). The present paper addresses the need for innovative evaluation methodologies to enable participants in the PAR process to monitor and reinforce the small improvement they are making towards achieving their goals, and to maintain their vision for the future. Participation in men?s group activities resulted in modest but significant change in the men?s personal development and growth and in their response to family responsibilities. Men had the opportunity to dialogue and reflect on their gender responsibilities such as housework, which constitutes a major source of conflict in the family. Several men also gained the confidence and motivation to stand for local government. The study highlights the value of demystifying and making research more relevant to people?s day-to-day living experiences.

Despite increasing recommendations for health professionals to participate in intervention design and implementation to effect changes in clinical practice, little is known about this strategy's effectiveness. This study analyses the effectiveness of interventions designed and implemented through participatory action research (PAR) processes in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay to improve clinical coordination across care levels, and offers recommendations for future research. The study was quasi-experimental. Two comparable networks, one intervention (IN) and one control (CN), were selected in each country. Baseline (2015) and evaluation (2017) surveys of a sample of primary and secondary care doctors (174 doctors/network/year) were conducted using the COORDENA® questionnaire. Most of the interventions chosen were based on joint meetings, promoting cross-level clinical agreement and communication for patient follow-up. Outcome variables were: a) intermediate: interactional and organizational factors; b) distal: experience of cross-level clinical information coordination, of clinical management coordination and general perception of coordination between levels. Poisson regression models were estimated. A statistically significant increase in some of the interactional factors (intermediate outcomes) -knowing each other personally and mutual trust- was observed in Brazil and Chile INs; and in some organizational factors -institutional support- in Colombia and Mexico. Compared to CNs in 2017, INs of Brazil, Chile, Colombia and Mexico showed significant differences in some factors. In distal outcomes, care consistency items improved in Brazil, Colombia and Uruguay INs; and patient follow-up improved in Chile and Mexico. General perception of clinical coordination increased in Brazil, Colombia and Mexico INs. Compared to CNs in 2017, only Brazil showed significant differences. Although more research is needed, results show that PAR-based interventions improved some outcomes regarding clinical coordination at network level, with differences between countries. However, a PAR process is, by definition, slow and gradual, and longer implementation periods are needed to achieve greater penetration and quantifiable changes. The participatory and flexible nature of interventions developed through PAR processes poses methodological challenges (such as defining outcomes or allocating individuals to different groups in advance), and requires a comprehensive mixed-methods approach that simultaneously evaluates effectiveness and the implementation process to better understand its outcomes.

BackgroundDespite increasing recommendations for health professionals to participate in intervention design and implementation to effect changes in clinical practice, little is known about this strategy’s effectiveness. This study analyses the effectiveness of interventions designed and implemented through participatory action research (PAR) processes in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay to improve clinical coordination across care levels, and offers recommendations for future research.MethodsThe study was quasi-experimental. Two comparable networks, one intervention (IN) and one control (CN), were selected in each country. Baseline (2015) and evaluation (2017) surveys of a sample of primary and secondary care doctors (174 doctors/network/year) were conducted using the COORDENA® questionnaire. Most of the interventions chosen were based on joint meetings, promoting cross-level clinical agreement and communication for patient follow-up. Outcome variables were: a) intermediate: interactional and organizational factors; b) distal: experience of cross-level clinical information coordination, of clinical management coordination and general perception of coordination between levels. Poisson regression models were estimated.ResultsA statistically significant increase in some of the interactional factors (intermediate outcomes) -knowing each other personally and mutual trust- was observed in Brazil and Chile INs; and in some organizational factors -institutional support- in Colombia and Mexico. Compared to CNs in 2017, INs of Brazil, Chile, Colombia and Mexico showed significant differences in some factors. In distal outcomes, care consistency items improved in Brazil, Colombia and Uruguay INs; and patient follow-up improved in Chile and Mexico. General perception of clinical coordination increased in Brazil, Colombia and Mexico INs. Compared to CNs in 2017, only Brazil showed significant differences.ConclusionsAlthough more research is needed, results show that PAR-based interventions improved some outcomes regarding clinical coordination at network level, with differences between countries. However, a PAR process is, by definition, slow and gradual, and longer implementation periods are needed to achieve greater penetration and quantifiable changes. The participatory and flexible nature of interventions developed through PAR processes poses methodological challenges (such as defining outcomes or allocating individuals to different groups in advance), and requires a comprehensive mixed-methods approach that simultaneously evaluates effectiveness and the implementation process to better understand its outcomes.

Researchers facilitated a participatory action learning action research process with second year Social Sciences students at a University in the Eastern Cape of South Africa. This paper focusses on the facilitation of a participatory action learning action research process and the contribution of this to the Scholarship of Teaching and Learning of the researchers. A social constructivist theoretical framework was employed. The significance of this research is that it adds to the understanding and implementation of participatory action learning action research, the evolving perception of participation as well as ownership within a participatory action learning action research process within the relatively less studied context of sub-Saharan African and South Africa more specifically. This paper demonstrates how utilising participatory action learning action research contributed to the researchers own “lifelong learning”, particularly with regard to scholarship and collaborations in the process of knowledge production. The researchers’ critical reflections and learning throughout this process could be of assistance to other researchers who are interested in embarking upon similar participatory research projects in higher education.

Following the failure of top-down centralised management approaches to natural resources, attention has shifted in the last two decades to participatory approaches. Unfortunately, participatory resource management projects have produced disappointing results. They have failed to meet the objectives of enhancing sustainable management of resources and of improving the well-being of local people. These efforts have recently been criticized by environmental conservationists, who continue to believe that participation by local people has resulted in increased degradation and loss of biodiversity. Proponents of participation however take the option of reverting back to top-down management approaches as 'reinventing the square wheel' since top-down approaches have an even worse record in resource management. The proponents of participation, therefore, call for alternative approaches that combine improvements of both human well-being and the status of natural resources. It is against this background - a conviction that community participation must be the way forward, despite a number of failed participatory initiatives - that the Center for International Forestry Research (CIFOR) initiated in 1999 a multi-country, multi-site Adaptive Collaborative Management (ACM) project. The starting point of the ACM approach is that sustainable resource management can only be achieved if local people participate in the utilisation and management of those resources. The approach makes use of various theories and concepts from several disciplines including complex systems theory, adaptive management, social learning, cooperation and competition, and theories of human interaction. The ACM project was implemented in Mafungautsi in Zimbabwe forest by a multi-disciplinary team of researchers from 1999 to 2003, and aimed to strengthen an on-going Resource Sharing Project that began in 1994. This thesis documents and critically analyses the interventions facilitated by the ACM team and their outcomes. It also traces these outcomes to check if they were sustained or not, and why. Evidence presented in Chapter 4 shows some of the complexities encountered in implementing the ACM approach. Several activities and processes were initiated simultaneously in the different sites. ACM researchers facilitated stakeholders to go use Participatory Action Research (PAR) processes to deal with their problems and learn from the impacts of their actions, they, too, had to learn by doing. Through context studies the team realised a number of issues had to be addressed at the outset. The context studies revealed a range of issues to be addressed if stakeholders were effectively to participate in the PAR process. These included numerous conflicts among stakeholders at various levels, unequal distribution of power, misunderstandings, passiveness of local community members in issues related to the management of the forest, the fact that not all stakeholders in local communities were interested in all resources in the forest, and finally weak leadership skills among stakeholders. The ACM team therefore developed several interventions to resolve conflicts and build stakeholder capacities before the PAR process could progress. These interventions included empowerment training workshops, conflict resolution workshops, training on leadership skills and finally the formation of the resource user groups. Implementing these interventions took considerable amounts of time. PAR processes were later initiated with various resource user groups. Stakeholders at a range of scales, including resource user groups, resource management committees, and FC officers and researchers, were included in processes to develop visions and implement action plans. The process however was not so neat in all cases and some of the action plans were never implemented. Opportunities were created for stakeholders to share experiences, and learn together. The team also facilitated the development of a collaborative monitoring system to help stakeholders learn about the impact of their actions. The process for doing this was time consuming since several relevant stakeholders had to participate in the process. The CM system was initially not welcomed by all resource users. Follow up studies showed that stakeholders in various RMC areas did not implement all the aspects of the CM system but chose only certain aspects. The development of a plot system in Gababe to monitor the quality of the grass resource as well as resolve problems related to favouritism in allocation of resource harvesting areas was an interesting outcome. The CM system however in some cases (like in the Batanai area) collapsed due to political factors at play. The interventions by the ACM team resulted in some positive outcomes including the empowerment of local communities, some improvement in incomes obtained through value addition and seeking alternative markets, improvement in stakeholders' knowledge about their forest resources through their monitoring activities and the use of sustainable harvesting methods. However, a follow-up study four years after the project ended showed that these positive developments were not sustained. The ACM team also aimed to influence resource management institutions and Chapter 5 traces how the Resource Management Committees (RMC) transformed over time. The chapter shows that the RMCs (especially the one in Gababe) over time, with capacity building on both the RMCs and local communities transformed into downwardly accountable and transparent organisations. The positive change was however short-lived, when the FC officer died. A follow up study four years later showed that, the RMCs were no longer accountable to their communities and several conflicts were now present among stakeholders. These were simply ignored. In trying to understand why things turned out this way, I address one central question – to what extent was failure a result of misconceptualization and misapplication of the participatory approach, as distinct from being a product of the general rapidly declining socio-economic conditions in the country? Although from a superficial analysis one can conclude that wider events in the country finished off a beautiful initiative in its infancy, I argue that the initiative would have failed anyway even if the environment had not changed. I identify key factors that would have led to the failure of the project. First, the overestimation of what the ACM team could do given the limited period and the complexity of the situation in Mafungautsi. Second, the ACM team did not address issues of power and its unequal distribution. Third, the ACM team did not facilitate the development of clear rules and their means of enforcement to support management activities. Fourth, the ACM team paid insufficient attention to the conflicting needs of local resource users, and finally, the team left the future work with an underfunded and understaffed organisation. I conclude that if ACM and other learning-based participatory resource management initiatives are to succeed, they must empower the poor and marginalised and explicitly address issues of power and politics. Joint learning processes should not be taken as a panacea but must integrate elements from other disciplines such as political ecology. Such projects should also ensure that clear rules for management and use of resources are agreed upon as well as their means of enforcement.

This article presents the results of a research on transformation processes for creating more democratic and inclusive schools. Through a multiple case study of four Spanish schools, the authors analyse how the actors involved in participatory action research processes mobilise knowledge on inclusive education. The authors explore the strategies that favour said mobilisation when inclusive, democratic and community curricular practices are implemented. These practices are carried out in schools within the framework of Participatory Action Research (PAR) processes. The results show that collaborative and dialogical practices allow to question the pedagogical practices, and serve for linking contexts (school, territory and university) and mobilising the available knowledge (generate it, apply it, share it and disseminate it).

Men's groups are increasingly being accepted as an important strategy in improving health and well-being, especially in Indigenous communities. However, it is hard to find systematic documentation and evaluation of such initiatives in the literature. This paper analyses the formative stages of a participatory action research (PAR) process which aims to engage and support the members of the Yarrabah Men's Health Group plan, implement and evaluate their activities. Data for the paper are based on a combination of a review of relevant literature, analysis of project documentation, participant observation and discussion and reflection with the participants of the men's group. The paper highlights the importance of (a) using a reflective approach, such as PAR, to engage men's support groups to clearly define the principles and values which both define them and to which they aspire and (b) personal development, education and employment, as a prerequisite for Indigenous men taking greater control and responsibility for their lives. These types of micro-level studies have important implications for the way community development is perceived and approached in Indigenous settings. There are also implications for the roles that academic researchers can play in supporting and adding value to community-driven initiatives to the mutual benefit of both parties.

Participatory action research represents the convergence of two intellectual and practical traditions, that of action research and participatory research. Although participatory action research is by no means uncontentious, it has become a familiar term to social research practitioners. However, in recent years critiques of Western epistemologies by sociologists of knowledge, feminists, post-colonialists and postmodern scholars present challenges for participatory action research in Africa. This article critically examines epistemologies that support and underpin participatory action research. It particularly interrogates the dominance of Western epistemologies in supporting models of participatory action research used in Africa and elsewhere, and explores spaces for indigenous epistemologies and Western epistemologies to be performed together within participatory action research processes.

IntroductionSouth Africa is a country faced with complex health and social inequalities, in which HIV/AIDS has had devastating impacts. The study aimed to gain insights into the perspectives of rural...

Contributions and limitations of diverse qualitative methods to feminist participatory and action research with women in the wake of gross violations of human rights

The main aim of this study was to improve the quality of nursing care for older acutely ill hospitalized medical patients through developing, implementing and evaluating a new model of care using a participatory action research process. One of the challenges of nursing today is to meet the health-care needs of the growing older population. It is important to consider what quality of nursing care means to older patients if nurses are to address gaps between their own perceptions and those of older patients themselves and to consider conceptual models of care appropriate for older patients care in order to improve the quality of care provided. This study is a mixed method triangulated study, involving the use of both quantitative and qualitative methods through participatory action research methodology to establish an evidence-base for an evolving model of care. The model was tested on 60 acutely ill patients aged at least 65 years. The medical ward nurses selected a key reference group including the researcher to facilitate the participatory action research process to develop, implement and evaluate a new model of care based on Orem's self-care model incorporating the Nurses Improving Care to Health System Elders Faculty (Am J Nurs 1994; 94:21) medication protocol to improve the nursing care provided for acutely ill older patients. The participatory action research process resulted in improved heath-care outcomes for the patients, such as significant improvements in activities of daily living capabilities between admission to discharge, significant improvements in knowledge levels regarding their medication regimes, as well as increased satisfaction with nursing care activities as perceived by older patients and nursing staff. The implementation of educational sessions during the model of care improved the older patient's functional activities and knowledge levels of their medication regime prior to discharge. In addition, by repeatedly explaining procedures, nurses became more involved with their individual patient's care, developing a patient-centred care relationship based on Orem's self-care model. This study demonstrates the efficacy of a new model of nursing care in improving the quality of nursing care for older patients in the acute medical ward setting. This study is significant because of its evidence-base and demonstrates how the participatory action research process empowered nurses to make sustainable changes to their practice. The nurses in the study wanted to affect change. The planned change was not dictated by management, but was driven by the clinical nursing staff at the 'grass roots' level. Therefore, being involved in the decision-making process provided an incentive to actively implement change.

Participatory action research is a process in which researchers operate as full collaborators with members of an organization (stakeholders) in linking theory and research to acceptable and effective practice. Schools are being charged to use this approach to address the challenges of developing system-level interventions for many of their current problematic areas, such as family-school partnerships with economically disadvantaged and culturally and linguistically diverse families. Participatory action research is a means for school psychologists, as participatory researchers, to provide leadership for collaborative research within schools for the development of system-level interventions. A case study is described in which a school psychologist served as the participatory researcher in an action research process for the development of a family-school partnership program in a Chapter I, ethnically and linguistically diverse elementary school. The outcomes indicated that the participatory action research process resulted in the design and implementation of a research-based family-school partnership program that was culturally specific, was acceptable to stakeholders (parents and teachers), and had the potential for sustainability. Participatory action research is a viable means for school psychologists to provide leadership in developing research-based, effective and acceptable system-level interventions in their schools.

Participatory action research is a method intended to shift the power of the “researcher” and “researched.” This paper presents the results of a duoethnographic exploration and analysis of experiences working on a participatory action research team. The authors participated in a research team, made up primarily of lesbian, gay, bisexual, transgender, and queer -identified young adults, which studied intra-community bigotry. Duoethnography is a qualitative method that reflects on a shared experience or cultural event from two different viewpoints in order to juxtapose perspectives without attempting to resolve differences or converge into conclusions. Through duoethnography, the authors identified three praxes that offer guidance for qualitative social work researchers. The praxes include negotiating power, engaging in iterative learning and knowledge production, and sharing the burden of vulnerability. These praxes create an opportunity for qualitative researchers to consider the value of participatory action research as a reflective research process that aligns with social work principles of self-awareness and social justice, and to identify participatory and reflexive strategies that can be incorporated into a variety of qualitative methods.

The THErapeutic Optimisation (THEO) project developed by the NICHE Anchor Institute at the University of East Anglia, is a novel and complex intervention research study aimed at optimising the patients’ experience of care. THEO is providing an uplift of two registered nurses working as embedded researchers, combined with a process of participatory action research (PAR) The THEO intervention is partly influenced by evidence that showed that higher nurse staffing levels were associated with better patient outcomes, shorter length of stay and less frequent nurse burnout or job dissatisfaction. The participatory action research (PAR) intervention uses an emancipatory, systematic and rigorous process philosophy; which will involve recruiting core volunteer co-researchers from the existing ward nursing team as bringing expertise in this innovation. In addition, participation will be sought from the wider team and patients/ service users through methods such as observation of care and sharing experiences of care. Wrapped around the implementation of PAR are three other research elements; i) quantitative data (eg Length of Stay), ii) qualitative and iii) process evaluation being led by an external collaborating research partner. Practice development (PD) methods will also be used within the PAR framework, as a facilitated intervention to achieve a participatory approach to inquiry, engaging with staff and patients, within two NHS clinical wards. The co-research team which will comprise of the new embedded researchers and the volunteer co- researchers will have time and space to work in collaboration, to “look” (i.e., gather evidence about a situation or context), “think” (i.e., reflect together to critically analyse the evidence), then “act” (i.e., develop a shared action plan, from which to take informed action). This process will generate both knowledge and agreed action from which to improve the experience and care for both the ward staff and the people who receive care on the ward. The intervention phase of THEO is anticipated to commence in Feb/ March 2025. This paper will be sharing the THEO intervention participatory approach and PD methods that are planned and being implemented. It will also highlight how facilitated practice development offers the chance for health care teams to learn together, hear the voices of patients and shape and innovate their care delivery approach to improve the care experience for all. Participatory approaches to research moves away from the traditional stance of “studying a subject and making a judgement about that subject” and involves a collaborative, participatory and inclusive approach where all involved are partners in both the research and resulting actions and outcomes. This approach is very rewarding and often time consuming in building relationships and partnerships, which is why some avoid this approach in favour of the more traditional approach. However, we will argue that pursuing a participatory approach will result in the ripple effect of ownership and sustainable action for staff and enable patients voices to be heard. This presentation will an opportunity to reflect on the lessons learnt so far in this collaborative and participatory research study between 3 different universities and two NHS sites.