Action-oriented Research Approach Research Articles

Qualitative study of states' capacity to support alcohol prevention policies during the COVID-19 pandemic in the USA.

The onset of the COVID-19 pandemic accelerated rates of alcohol purchasing and related harms in the USA. The increases followed governors' emergency orders that increased alcohol availability, including the allowance of alcohol home delivery, alcohol to-go from restaurants and bars, and curbside pickup from retailers. Semi-structured interviews were conducted with 53 participants involved in state-level alcohol prevention policy across 48 states. Interviewees' perspectives on changes to alcohol prevention policies during the COVID-19 pandemic, including capacity to respond to alcohol-focused executive and legislative changes to alcohol availability, were explored. Initial codes were developed collectively and refined through successive readings of transcripts using a phenomenological, action-oriented research approach. Themes were identified semantically after all transcripts were coded and reviewed. Four themes were developed including: (i) alcohol prevention policies and capacity during COVID-19; (ii) industry-related challenges during COVID-19; (iii) limited pre-COVID-19 alcohol prevention capacity; and (iv) needs to strengthen alcohol prevention capacity. The pandemic exacerbated states' capacity limitations for alcohol prevention efforts and created additional impediments to public health messaging about alcohol health risks related to greater alcohol availability. Participants offered a myriad of strategies to improve alcohol prevention and to reduce alcohol-related harms. Recommendations included dedicated federal and state prioritisation, more funding for community organisations, greater coordination, consistent high-quality trainings, stronger surveillance and widespread prevention messaging. States' alcohol prevention efforts require dedicated leadership, additional funding and support to strengthen population-based strategies to reduce sustained alcohol-related harms associated with increases in alcohol availability.

Context matters-the phased development of an adaptable food literacy intervention: Up for Cooking.

Adapting interventions to the context increases the impact and sustainability of interventions. Literature acknowledges the need to adapt existing interventions and that these adaptations should be clearly reported. However, little is known about how to incorporate adaptation from the beginning. This paper argues that interventions should be developed and adaptations should be made using an ongoing non-linear approach. An action-oriented research approach with feedback loops is proposed. We illustrate this with the development of a food literacy intervention 'Up for Cooking' (Dutch: Zin in Koken) and present lessons learned in developing, implementing and studying such adaptable interventions. Interventions should clearly define and differentiate the intervention function and form. Implementers, in turn, should be encouraged to tailor interventions within a form that fits with a specific context. Sufficient time, continuous adaptation based on co-creation, feedback loops and interdisciplinary collaboration are important prerequisites for the development of adaptable interventions.

Exploring the implementation dynamics of the Health Promoting School approach in Europe: a qualitative study among school health representatives

PurposeAdapting the Health Promotion School (HPS) approach to context specifics is acknowledged as being essential for implementation and achieving optimal effectiveness. This study aims to explore implementation variations on seven HPS spectra (such as top-down to bottom-up involvement of stakeholders) on which implementation of the HPS approach can vary, and the factors that relate to navigation on these spectra.Design/methodology/approachIn 2020, fourteen HPS researchers and professionals from ten European countries participated in semi-structured interviews.FindingsNavigation variations on the HPS spectra occurred throughout most spectra. Further, a tendency was found towards spectrum extremes of addressing multiple core-components, implementing non-disruptive Health Promotion (HP) programmes, and evaluating the HPS approach through an action-oriented research approach. Important general factors were resources, staff capacity and time available to staff members for implementing the HPS approach. Some spectra required more specific factors like organisational skills, leadership or a certain level of democracy.Practical implicationsThe implementation of the HPS approach should be supported by implementation strategies addressing the spectrum-specific factors, but more generic factors such as staff capacity, resources and the level of democracy should also be considered.Originality/valueThis study explores navigation variations throughout HPS spectra rather than the HPS approach in general. It also nuances implementation diversity across and within different European contexts.

Challenging the binary of home vs. host state governance: Canadian transnational mining behavior and local communities in the Philippines extractive industry

As the world's dominant actor, the Canadian mining industry has historically been scrutinized for its socio-environmentally egregious operations in the Global South, particularly in mineral-rich nations, such as the Philippines. Canadian multi-national corporations are known for causing extensive ecological devastation; contaminating critical watersheds; and exhausting areas of its culturally valuable resources. With over 60 percent of large-scale mines operating in ancestral territories in the Philippines, clashing worldviews on land ownership have driven violent confrontations between Indigenous and local communities, national governments, and corporations. This exploratory study examines Canadian corporate mining behaviors in the Philippines. This study employs an action-oriented research approach applied to a single qualitative macro-level case study. Utilizing document review and semi-structured key informant interview methodologies, the research results indicate that international and domestic actors have used the legal system favoring corporate interests to suppress mining resistance and advance neoliberal modes of extraction.

Resilience for Whom? A Case Study of Taiwan Indigenous People’s Struggle in the Pursuit of Social-Ecological Resilience

While the notion of social-ecological system resilience is widely accepted and applied, the issue of “resilience for whom” is clearly ignored. This phenomenon has also occurred in Taiwan. This article explores the roots of, and a possible solution to, this issue through a case study in the context of Taiwan’s indigenous peoples. The Danungdafu area, the focal social-ecological system, was studied. Qualitative research methods and an action-oriented research approach were employed. For a long period, the central government shaped the political, economic, social, institutional, and ecological contexts; dominated resilience discourses and determined the problem-framing and problem-solving agenda; defined the scale and levels at which social-ecological system governance issues were addressed; and determined the knowledge system used to define and solve problems. After 2011, a new participatory governance regime emerged. Multiple stakeholders, including indigenous communities, began to contribute to resilience discourses and influenced governance and trade-offs among differing governance goals. However, under the established structures dominated by Han people, indigenous views, rights, and well-being continue to be ignored. Affirmative action is required to recognize and safeguard indigenous rights. A practical institutional pathway is available to facilitate the transformation from “resilience for mainstream society” to “resilience for indigenous people” in indigenous territories.

The importance of relationships in the encounter between NAV staff and young, vulnerable users. An action research study

ABSTRACT Vulnerable young people not engaged in work, education or training constitute a user group regarded with increasing concern in Europe. Set in a Norwegian context, this article investigates what the users themselves considered to be the most important help towards employment. The article is based on an action research approach and comprises data from a variety of sources, such as research circle method. A key finding is that relationships are the most crucial factor for the users. Long-term contact and persistent and inquisitive helpers are especially important. The meaningful relationship is not limited to the one with the professional helpers; it also includes the relationship between the users. Based on an action-oriented research approach, the article calls for more research that listens to the users’ voices.

Overcoming language barriers in paramedic care: a study protocol of the interventional trial \u2018DICTUM rescue\u2019 evaluating an app designed to improve communication between paramedics and foreign-language patients

BackgroundIt is essential for medical treatment that patients and medical staff can communicate about acute complaints, pre-existing conditions, and the treatment procedure. Misunderstandings can have far-reaching consequences, particularly in time-critical emergencies, which require rapid assessments and decision-making and in which interpreters are rarely available.In this study, we aim to develop a digital communication tool that is to help paramedics communicate with patients who speak hardly any or no German, to monitor its implementation, and to investigate its effect on communication between foreign-language patients and staff. Furthermore, a large amount of data on patients that are cared for in emergency medical services in Germany are collected for the first time.MethodsTo consider the complex situations of paramedic care and to meet paramedics’ demands, we use an action-oriented research approach to develop the tool. We include the staff of the participating emergency medical service stations and software designers in our approach. The tool is then used and evaluated within an open interventional, non-randomised study with two control groups. Control group 1 (German-speaking patients) and control group 2 (non-German-speaking patients treated without the tool) are recruited starting from the first study phase. In the second study phase, an intervention group is additionally recruited, i.e. non-German-speaking patients with whom the tool is used.The primary outcome of the clinical trial is improved communication with non-German-speaking patients in emergencies by means of the communication tool. The secondary outcome is an improved quality and quantity of the collected information. We exploratively observe on-scene times, demands for emergency physicians, and the usage of the intervention. By recording patients’ clinical parameters, we consider the severity of the health restrictions.DiscussionOur study is an innovative research project in paramedic healthcare comprising the development of a digital communication tool to overcome language barriers in emergency medical services and investigating its usability, acceptance, and effect on communication, in short, its usefulness and value for paramedic care. Additonally, we expect to gain comprehensive information on rescue operations.Trial registrationGerman Clinical Trials Register, DRKS00016719, registered 08 February 2019, World Health Organization Trial Registration Data Set, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00016719

Process evaluation of the Healthy Primary School of the Future: the key learning points

BackgroundWhile schools have potential to contribute to children’s health and healthy behaviour, embedding health promotion within complex school systems is challenging. The ‘Healthy Primary School of the Future’ (HPSF) is an initiative that aims to integrate health and well-being into school systems. Central to HPSF are two top-down changes that are hypothesized as being positively disruptive to the Dutch school system: daily free healthy lunches and structured physical activity sessions. These changes are expected to create momentum for bottom-up processes leading to additional health-promoting changes. Using a programme theory, this paper explores the processes through which HPSF and the school context adapt to one another. The aim is to generate and share knowledge and experiences on how to implement changes in the complex school system to integrate school health promotion.MethodsThe current study involved a mixed methods process evaluation with a contextual action-oriented research approach. The processes of change were investigated in four Dutch primary schools during the development year (2014–2015) and the first two years of implementation (2015–2017) of HPSF. The schools (each with 15–26 teachers and 233–389 children) were in low socio-economic status areas. Measurements included interviews, questionnaires, observations, and analysis of minutes of meetings.ResultsTop-down advice, combined with bottom-up involvement and external practical support were key facilitators in embedding HPSF within the schools’ contexts. Sufficient coordination and communication at the school level, team cohesion, and feedback loops enhanced implementation of the changes. Implementation of the healthy lunch appeared to be disruptive and create momentum for additional health-promoting changes.ConclusionsInitiating highly visible positive disruptions to improve school health can act as a catalyst for wider school health promotion efforts. Conditions to create a positive disruption are enough time, and sufficient bottom-up involvement, external support, team cohesion and coordination. The focus should be on each specific school, as each school has their own starting point and process of change.Trial registrationThe study was retrospectively registered in the ClinicalTrials.gov database on 14 June 2016 (NCT02800616).

Eat, play, learn well-a novel approach to co-production and analysis grid for environments linked to obesity to engage local communities in a child healthy weight action plan.

To describe the process of combining Analysis Grid for Environments Linked to Obesity (ANGELO) with community engagement, qualitative and co-production methods to promote local strategies around child healthy weight (CHW) and to highlight steps taken to engage local people in developing a community CHW action plan around two school communities in Dundee, Scotland. The Eat, Play, Learn Well (Learn Well) approach applied an action-oriented research approach, using qualitative methods. Focus group discussions (FGDs), a co-production approach, and ANGELO were linked by applying a novel three-step process. FGDs were recorded by scribe and following face-to-face interview's key themes were identified using a novel, predefined five-step process, and ANGELO grids were populated. Prioritization events allowed local people to rank most important health statements, with community conversations offering further insights to help create a local CHW action plan. Three FGDs were conducted with parents (n=24) and two with workers (n=15). Eighty-seven attended a prioritization event at school B (41 adults), 59 attended at school A (35 adults), where each school community chose its top four priorities from 11 health statements developed. Two further community conversations then took place and led to the creation of a CHW action plan with five overarching themes. The Learn Well test approach helped gain important insights into local environments linked to obesity and production of a pragmatic, step-by-step process suitable for real-life public health practice that can enable local people to identify key early intervention and prevention priorities, in a tangible way.

The Healthy Primary School of the Future: A Contextual Action-Oriented Research Approach.

Background: Schools can play an important role in promoting children’s health behaviours. A Dutch initiative, ‘The Healthy Primary School of the Future’, aims to integrate health and well-being into the school system. We use a contextual action-oriented research approach (CARA) to study the implementation process. Properties of CARA are its focus on contextual differences and the use of monitoring and feedback to support and evaluate the process of change. The aim of this article is to describe the use of the approach. Methods: Four schools (each with 200–300 children, aged 4–12 years) were included; all located in low socio-economic status areas in the south of the Netherlands. Data collection methods include interviews, observations, questionnaires, and health and behavioural measurements. Research contributions include giving feedback and providing schools with a range of possibilities for additional changes. The contextual data we examine include schools’ health promoting elements, practices of teachers and parents, dominating organisational issues, and characteristics of the student population; process data include the presence of potential barriers to changes. Discussion: CARA is an adaptive research approach that generates knowledge and experiences on how to deal with health promotion in complex systems. We think this approach can set an example for research efforts in comparable initiatives.

A Green Lean approach to global competition and climate change in the agricultural sector – A Swedish case study

Increased global competition in the agricultural sector is rapidly changing the structure of farms and farming. As the number of small and diversified farms (often family-owned) decreases, the number of large and specialized farms (often corporate-owned) is increasing. In this transformation, the agricultural sector is more and more concerned with strategy, innovation, and competition in the effort to be more productive and more profitable. At the same time, the sector faces demands that it become more environmentally responsible in its policies and practices. This paper proposes a Lean Implementation Framework that small and mid-size farms can use as they aim to increase production and profit and yet support environmental sustainability. This case study takes an action-oriented research approach that focuses on the implementation of a Green Lean approach at 34 Swedish farms using various Lean tools. The paper describes how training sessions, farm visits, workshops, and counseling were used to introduce the farmers to the benefits and risks of the implementation of a new business model that added Green elements to the traditional business model design. The paper concludes with recommendations for adaptations to the Framework and suggestions for future research.

Strengthening acute inpatient mental health care for Indigenous clients

Indigenous people are over-represented in inpatient mental health care in Australia. Evidence suggests client-orientated care planning increase client engagement, reduce substance dependence and improve self-management among Indigenous people. The successful uptake and implementation of interventions, however, which promote access and cultural security in primary care practice, remains challenging. The Aboriginal and Islander Mental Health initiative introduced a multi-faceted approach to client-oriented care planning, as part of routine care to the Royal Darwin Hospital inpatient psychiatric unit, to determine whether there was change in the quality of care to Indigenous clients over time.The study used a mixed methods design. It was underpinned by an action-oriented research approach and incorporated stakeholder engagement, interactive training in strengths based recovery approach and psycho-education and a quantitative audit of inpatient files. The results suggest some improvements in quality of care for clients in the inpatient unit with increased attention to social and family history, involvement of translators, and allocation of case managers. Cross-cultural training and tools promoted change in some aspects of clinical practice. Some changes, however, were often not sustained and it did not necessarily promote engagement of AMHWs in routine care. Greater emphases on follow up training and provision of clinician feedback, in conjunction with high-level system change and commitment to introduction of culturally adapted recovery principles, is required for more sustained changes to clinician care and implementation success.

Strengthening acute inpatient mental health care for Indigenous clients

Indigenous people are over-represented in inpatient mental health care in Australia. Evidence suggests client-orientated care planning increase client engagement, reduce substance dependence and improve self-management among Indigenous people. The successful uptake and implementation of interventions, however, which promote access and cultural security in primary care practice, remains challenging. The Aboriginal and Islander Mental Health initiative introduced a multi-faceted approach to client-oriented care planning, as part of routine care to the Royal Darwin Hospital inpatient psychiatric unit, to determine whether there was change in the quality of care to Indigenous clients over time.The study used a mixed methods design. It was underpinned by an action-oriented research approach and incorporated stakeholder engagement, interactive training in strengths based recovery approach and psycho-education and a quantitative audit of inpatient files. The results suggest some improvements in quality of care for clients in the inpatient unit with increased attention to social and family history, involvement of translators, and allocation of case managers. Cross-cultural training and tools promoted change in some aspects of clinical practice. Some changes, however, were often not sustained and it did not necessarily promote engagement of AMHWs in routine care. Greater emphases on follow up training and provision of clinician feedback, in conjunction with high-level system change and commitment to introduction of culturally adapted recovery principles, is required for more sustained changes to clinician care and implementation success.

The implementing process of evidence based intervention to prevent childhood obesity. Participatory Action Research (PAR) used in the “Healthy future” study.

The objective is to describe the design of the developmental project Healthy Future which aims to implement new evidence based program for the prevention of childhood obesity, and the collaboration and sharing of work between specialist and community health care professionals in a county in Norway. Comprehensive Participatory Planning and Evaluation (CPPE) process as an action oriented research approach was chosen, using mixed methods. A bottom-up approach might decrease the barriers when new evidence based childhood prevention interventions are going to be implemented. It is crucial to build partnership, shared understanding, motivation and vision, but also to consider the frames of the organizations, such as competence, and time to carry out the interventions at the right level of health care service and adapting these to the overweight children and the needs of their families. The developmental process of new health care programs is complex, and multi leveled, and requires a framework to guide the process. By CPPE-approach evidence based health care practice can be delivered based on research, user knowledge, provider knowledge in the field of childhood overweight and obesity in a certain context.

Participatory action research in the implementing process of evidence-based intervention to prevent childhood obesity: project design of the "Healthy Future" study.

Objective. To describe the design of the developmental project Healthy Future that aims to implement a new evidence-based program for the prevention of childhood obesity and collaboration and sharing of work between specialist and community health care professionals in parts of a county in western Norway. Methods. Comprehensive participatory planning and evaluation (CPPE) process as an action-oriented research approach was chosen, using mixed data sources, mixed methods, and triangulation. Discussion. A bottom-up approach might decrease the barriers when new evidence-based childhood prevention interventions are going to be implemented. It is crucial not only to build partnership and shared understanding, motivation, and vision, but also to consider the frames of the organizations, such as competencies, and time to carry out the interventions at the right level of health care service and adapt to the overweight children and their families needs. Conclusion. The developmental process of new health care programs is complex and multileveled and requires a framework to guide the process. By CPPE approach evidence-based health care practice can be delivered based on research, user knowledge, and provider knowledge in the field of childhood overweight and obesity in a certain context.

Knowledge and innovation management in the policy debate on biofuel sustainability in Mozambique: what roles for researchers?

This paper contributes to exploring the relationship between Knowledge Management (KM) and Innovation Management (IM) in policy processes. By describing and analyzing the roles of researchers as a knowledge and innovation manager in policy processes authors also contribute to the debate on how researchers can enhance their effective contribution to policy processes. Empirical data for the paper were gathered between December 2008 and November 2010. During that period, two of this paper's authors conducted participatory action research whilst supporting the Mozambican inter-ministerial subgroup sustainability criteria in developing a sustainability framework for biofuel production in Mozambique. Authors conclude that KM and IM are mutually reinforcing and inextricably bound: KM can provide the basis for engaging in more specific IM activities or roles, which may consequently contribute to creating an enabling environment for more effective KM in policy processes. Subsequently, the active embedding of researchers, an action-oriented research approach and systematic reflection can enable researchers to continuously determine what (combination of) KM and IM strategies or roles can enhance the action ability of research in, and the quality of the policy process. To do so successfully, a process-based research approach and strategic management of the boundary between research and policy is a key.

The appropriateness of village level sugar processing technology in Tanzania

This paper is based on research work that was conducted by participatory method using action oriented research approach. The research covered three years from May 1997 to June 2000.

Designing to support Mobile Work with Mobile Devices

This PhD dissertation deals with how to design mobile technology to support mobile work. More specifically, I have worked with the following three connected components: design (as process as well as tool), mobile work (specifically on process plants), and technology (mobile and stationary and the relationship between them). <br /> I define the relationship between these three components based on the action-oriented research approach known as the Scandinavian tradition for systems development, which has grounded and shaped my research method. Cooperation, active user involvement and experimental development of methods and techniques are key elements in this approach, and are elements I develop further in a mobile work environment. Another influencing factor on my approach to the mobile work domain is the current technical development: of the staggering number of microchips produced annually, only a small fraction is being used for Personal Computers the rest are used in mobile and embedded technology. Thus we are dealing with an entirely new range of technology, possibilities and limitations, and consequently new user interface challenges. <br /> Based on this, I see the following key connections to design of technological support of mobile work in a process setting: the design process and the usability methods we use create an understanding of the work practice and the work situations we are trying to support with new technology. The work practise and specific tasks set the boundaries for what we support and how we go about it, and particularly in a mobile work context it is important to understand the heterogeneity in the work: the work tasks and the available resources change in relation to where you are (at the home office, at the site of a client, amongst the machines in the plant) and the users' needs for technological support and access to information changes accordingly. These relationships must be reflected in the technology we design, and it is thus often in a mobile work context more relevant to create a selection of different technological tools for the users to choose between as their needs change, than by replacing one technological approach or device with another. This bears particular importance in relation to mobile technology as the handheld device often supports the mobility but sacrifices the sense of overview because the physically small screens are unable to support it as well as a large PC monitor. <br /> Consequently, the relationship between the three elements is an important aspect of my PhD dissertation. I deal with how mobile work makes new demands on the technological devices we design to support it, thereof mobile technology. I also deal with how the mobile artefacts demand new thinking in relation to the user interface design and functionality because we are dealing with a new type of technology, not just a very small PC with limited screen and next to no peripherals. Finally, I deal with how this new area of research (and the development of HCI and usability in general) sets new demands for the usability methods, how and to what degree we involve users and other professionals in design, how we take advantage of the use environment and utilise the use context actively in the design process. <br /> As a collective concept for the development of mobile technology to support mobile work, I introduce the `web-of-technology' concept that requires we create an understanding of which role the new device should play in relation to the already existing technology in the specific work domain. By placing the new, hand-held technology in the existing `web-of-technology' you are forced to analyse which relations the mobile device should have to the other technological devices in the work context and whether the mobile artefact should be strongly, weakly, or not integrated with the other technology at all. The degree of integration between technologies affects the design of both the functionality and the user interface; strongly integrated devices demand a large degree of visual and functional consistency across devices. It is thus essential that we clarify these questions of the technology that is and the technology that will be early in the design process, just as naturally as we examine how the work practice affects the development and design.

Children enabling change: A multicultural, participatory, community-based rehabilitation research project involving chinese children with disabilities and their families

A participatory, action-oriented research approach was used in developing community-based services for children with disabilities in an urban Chinese community. A review of the literature and discussions with community members revealed that Chinese families who have a child with a disability experience the double barrier of disability and culture. An action research paradigm was developed that would both identify existing barriers for families and provide opportunities for overcoming these obstacles through the research process. A total of 94 persons in the Chinese community were interviewed, including family members caring for a child with a disability and community members with no direct contact with a person with a disability. Results from the interviews revealed negative attitudes towards children with a disability grounded in cultural beliefs regarding a child’s capacity to contribute to the family, a widespread use of traditional healers in conjunction with a family doctor or hospital, and a lack of knowledge on available community support agencies. The findings of the research are discussed with the aim of building on community strengths to reinforce existing family support programs and involve families and children with a disability in such processes in a culturally appropriate manner.