Appreciative Action Research Articles

First-line managers struggling to lead home care based on the individual’s needs and goals – conflict between ethical principles

PurposeThe purpose of this paper is to describe how first-line managers (FLMs) in home care (HC) reason about the opportunities and obstacles to lead the work according to the individual’s needs and goals.Design/methodology/approachIn this participatory appreciative action reflection project, eight managers within one Swedish municipality were interviewed. The data were analysed using a thematic analysis.FindingsThe results showed a polarization between two different systems that FLMs struggle to balance when attempting to lead HC that adapts to the needs and goals of individuals. One system was represented by the possibilities of a humane system, with human capital in the form of the individual, older persons and the co-workers in HC. The second system was represented by obstacles in the form of the economic needs of the organization in which the individual receiving HC often felt forgotten. In this system, the organization’s needs and goals governed, with FLMs needing to adapt to the cost-effectiveness principle and keep a balanced budget. The managers had to balance an ethical conflict of values between the human value and needs-solidarity principles, with that of the cost-effectiveness principle.Originality/valueThe FLMs lack the opportunity to lead HC according to the needs and goals of the individuals receiving HC. There is a need for consensus and a value-based leadership model based on ethical principles such as the principles of human value and needs-solidarity to lead the HC according to the individual’s needs and goals.

Value Creation in a Coach Developer Social Learning Space: Stories of Openness and Making a Difference

Previous studies concerning coach developer learning have demonstrated notable deficiencies in the provision offered to practitioners, commonly reporting what they experienced was prescriptive instruction on how to deliver coach education courses—a practice starkly in contrast to the espoused theoretical underpinnings of the courses themselves. This Participatory and Appreciative Action and Reflection investigation aimed to better understand the value created for, and through, 10 participants recruited to a 9-month coach developer professional development program that was designed not to prescribe, but to guide, their learning. Data were collected through individual and group interviews, field notes, and professional discussions. Additionally, this study aimed to investigate the extent to which the identification of short and long value flows could provide insight into coach developer learning. Two main themes were constructed, namely (a) openness to finding new ways of developing others and (b) making a difference. Embracing the concepts of value creation, as well as short and long value flows, illuminated the importance of consideringcoach developers’ predispositions, nonprescribed guidance by program facilitators, and the power of value creation stories. These findings illustrate how value creation concepts can potentially help to understand coach developer learning.

Nurse assistants' experiences and knowledge of how they create a meaningful daily life for older persons receiving municipal home healthcare.

To explore nurse assistants' experiences and knowledge of how they create a meaningful daily life for older people receiving municipal home healthcare. A participatory appreciative action reflection approach. Interviews, participant observations and informal conversations with 23 nurse assistants in municipal home healthcare generated the data. A thematic analysis was used. Two main themes were developed. The first main theme, building a reciprocal relationship, was structured by three subthemes: To strengthen the older person's self-esteem, to co-create care and to create equality. The second main theme, creating meaning, was structured by two subthemes: To create closeness and to receive appreciation. The two main themes are each other's prerequisite. Nursing assistants' building reciprocal relationships gives meaning; through the meaning, reciprocal relationships are achieved, and by that, meaningful daily lives for both the older people and the nurse assistants. Nurse assistants built a reciprocal relationship both for the older people and for the nurse assistant. This contributes to create a meaningful daily life for the older people. The older person was the main character, and it seems that the nurse assistants apply person-centred care, which can represent a shared common vision that can be used in the encounter.

We have to turn a transatlantic liner-Leaders' perspectives on creating a meaningful life for older persons receiving municipal care.

To describe leaders' perspectives on what is important to create a meaningful daily life for older persons receiving municipal elderly care. This study combined the Participatory Appreciative Action Reflection approach and qualitative methods. Focus Group Discussions were performed with eighty leaders that was analysed with qualitative content analysis. One overall theme emerged "We have to turn a transatlantic liner". The leaders proposed a need to change from an institutional care to a more person-centered care approach on all levels of the healthcare system. This meant that everyone in the organization needed to think outside the box and find new ways to provide care to older persons. They needed to hire the right persons with the right values and knowledge. The leaders would need to provide for and support staff empowerment. There was also a need to see the older person and their relatives as co-participants. No Patient or Public Contribution.

Individual goal-setting in municipal homecare: A participatory appreciative action and reflection study.

There is a need for structural change in municipal homecare to shift power to older persons and to center the individuals in need. To make this change, the individual older persons should have enough self-determination to formulate their own individual homecare goals. Our aim was to explore how stakeholders reason about individual goal-setting in homecare. We theoretically and methodologically used a participatory appreciative action and reflection (PAAR) design. The stakeholders, that is, the older persons, the older persons' relatives, and the multi-professional team, were seen as co-researchers. Data were collected between 2019 and 2020 through in depth-interviews, focus group discussions, and reference groups. The data were analyzed using thematic analysis. We learned from the stakeholders that it was a struggle to sustain the individual's goal to continue life as usual, that is, being an ordinary human being with an ordinary everyday life and maintaining individual roles. The individual wants to improve health, be active, and enjoying life. The individuals were struggling against the homecare organization, which tended to overshadow the individual's goals. The individual's goals fall under several legal jurisdictions and come to be overshadowed by the professionals' dominant goal. The organization is rigid, with finances and resources creating the framework. We learned that older persons receiving homecare must have the same rights as other citizens in society, which is in line with public health goals.

Preferences for an eHealth tool to support physical activity and exercise training in COPD: a qualitative study from the viewpoint of prospective users

BackgroundDespite well-known positive effects of pulmonary rehabilitation, access is limited. New strategies to improve access are advocated, including the use of eHealth tools.ObjectivesThe aim of this study was to explore prospective users’ preferences for an eHealth tool to support the self-management of physical activity and exercise training in COPD.MethodsA qualitative research design was applied. Data was collected in six, audio recorded, digital co-creation workshops, which were guided by a participatory and appreciative action and reflection approach. A total of 17 prospective users took part in the process, including people with COPD (n = 10), relatives (n = 2), health care givers (n = 4) and a patient organization representative (n = 1). During the workshops, pre-selected relevant topics to exploring end-users’ preferences for eHealth support in self-management in COPD were discussed. The workshops were recorded and transcribed. Data was analysed using inductive qualitative content analysis.ResultsThe overarching theme “fusing with, rather than replacing existing support structures” was uncovered when the two-sided relationship between positive expectations towards digital solutions and the fear of losing access to established rehabilitation systems, emerged in the discussions. Three categories were identified, focused on wishes for an evidence-based support platform of information about COPD, a well-designed eHealth tool including functionalities to motivate in the self-management of physical activity and exercise training, and requirements of various forms of support. Co-creators believed that there were clear benefits in combining the best of digital and existing support systems.ConclusionsCo-creators viewed an eHealth tool including support for physical activity and exercise training as a valuable digital complement to the now existing rehabilitation services. A future eHealth tool needs to focus on user-friendliness and prospective users’s requests.

Participatory methods in a digital setting: experiences from the co-creation of an eHealth tool for people with chronic obstructive pulmonary disease

BackgroundUsing participatory methods to engage end-users in the development and design of eHealth is important to understand and incorporate their needs and context. Within participatory research, recent social distancing practice has forced a transition to digital communication platforms, a setting that warrants deeper understanding. The aim of this study was to describe the experiences of, and evaluate a digital co-creation process for developing an eHealth tool for people with chronic obstructive pulmonary disease (COPD).MethodsThe co-creation was guided by Participatory appreciative action and reflection, where a convenience sample (n = 17), including persons with COPD, health care professionals, relatives and a patient organization representative participated in six digital workshops. User instructions, technical equipment, and skilled support were provided if necessary. Workshops centred around different topics, with pre-recorded films, digital lectures and home assignments to up-skill participants. Process validity, experiences and ownership in the co-creation process were evaluated by repeated respondent validation, member checking, questionnaires and by assessing attendance. Data was analysed quantitatively or qualitatively as appropriate.ResultsThe co-creators were in general satisfied with the digital format of the workshops. Mean attendance and perceived engagement in workshops was high and the experience described as enjoyable. Engagement was facilitated by up-skilling activities and discussions in small groups. Few had used digital communication previously, and feelings ranging from excitement to concern were expressed initially. Technical issues, mainly audio related, were resolved with support. At completion, skills using equipment and digital platform surpassed expectations. Few disadvantages with the digital format were identified, and advantages included reduced travel, time efficiency and reduced infection risk.ConclusionsExperiences of digital co-creation were overwhelmingly positive, despite initial barriers related to computer naivety and use of digital equipment and platforms. The high level of satisfaction, engagement, attendance rates, and agreement between individual and group views suggests that a digital co-creation process is a feasible method. Several important success factors were identified, such as the provision of information and education on discussion topics in advance of workshops, as well as the smaller group discussions during workshops. The knowledge gained herein will be useful for future digital co-creation processes.

Knowing-in-action that centres humanising relationships on stroke units: an appreciative action research study

AbstractBackground:Equal, collaborative and therapeutic relationships centred on the person affected by stroke are important for supporting recovery and adjustment. However, realising these relationships in hospital practice is challenging when there is increasing focus on biomedical needs and organisational pressures. Despite a body of evidence advocating for quality relationships, there remains limited research describing how to achieve this in clinical practice. This appreciative action research (AAR) study aimed to describe the processes involved in co-creating meaningful relationships on stroke units.Design and methods:An AAR approach was used to develop humanising relationship-centred care (RCC) within two hospital stroke units. Participants were staff (n = 65), patients (n = 17) and relatives (n = 7). Data generation comprised of interviews, observations and discussion groups. Data were analysed collaboratively with participants using sense-making as part of the AAR cyclical process. Further in-depth analysis using immersion crystallisation confirmed and broadened the original themes.Findings:All participants valued similar relational experiences around human connections to support existential well-being. The AAR process supported changes in self, and the culture on the stroke units, towards increased value being placed on human relationships. The processes supporting human connections in practice were: (i) sensitising to humanising relational knowing; (ii) valuing, reflecting and sharing relational experiences with others that co-created a relational discourse; and (iii) having the freedom to act, enabling human connections. The outcomes from this study build on existing lifeworld-led care theories through developing orientations for practice that support relational knowing and propose the development of RCC to include humanising values.

‘I felt I’d lost myself – not really knowing who I was’: coach developer learning as negotiating identity through engagement, imagination and alignment

ABSTRACT Across the sporting landscape, there has recently been increased interest in how best to facilitate Coach Developer (CD) learning. The framework of Landscapes of Practice (LoP) encourages us to consider how CD learning can be better understood through consideration of individual negotiated identity as a process of engagement, imagination and alignment. This Participatory and Appreciative Action and Reflection (PAAR) investigation explores the journey of two cohorts of CDs (n = 24) through a bespoke formal learning programme commissioned by a National Governing Body (NGB) of sport in the UK. Over a period of three years, data were captured through reflective materials, focus groups, individual interviews, field notes and professional discussions. Here we discuss three major categories namely, (a) (pre)dispositions to the course; (b) epistemological development, criticality and theoretical congruity; and (c) the learning community. CDs’ identities were highly individualized and there was evidence of deeply meaningful, and negotiated, identity work going on within each individual. We found that consideration of their engagement, imagination and alignment with the course helped to better understand the (re)negotiation of their identities as they deepened their understanding. By specifically addressing the CDs’ (pre)dispositions to the course we were able to offer the learners a more relevant and relatable programme to which they could choose to align – or not. Future research should explore the role and functions of the different forms of social learning leadership in longitudinal courses such as this and seek to better understand how these individuals shape the identities of the learners they support.

Making the invisible more visible: Reflections on practice-based humanising lifeworld-led research - existential opportunities for supporting dignity, compassion and wellbeing.

The need for dignity and compassion in healthcare is enshrined in policy, but is often difficult to enact in practice and what is precisely meant by these concepts is unclear. In this paper, we have explored theoretical underpinnings which form the basis of a lifeworld-led approach which was used in a research study to support the humanity of service providers and users alike. In this article, we share our analysis of what we have learnt after undertaking an innovative appreciative action research project with patients and staff in a stroke ward with the aim of exploring if a novel phenomenologically driven and philosophically derived humanising framework could be applied in health care. Following the research, we wanted to develop a theoretical understanding of the processes occurring during the research in order to provide a framework and language which could be used to support practical lifeworld developments in the future. We analysed the approach through Participatory and Appreciative Action Reflection. As researchers, we found that the approach was underpinned by four key existential principles. The first principle was recognising a mutually arising reality rather than a reality 'out there'. The second was recognising a reality which was constantly changing rather than 'fixed'. The third was recognising that we needed to work from within, as part of a human living system rather than trying to control reality from the 'outside'. Finally, we recognised that this reality could only be accessed through human knowing, including embodied knowing rather than intellectual knowing alone. These principles challenged many of the usual ways of thinking and working within research and healthcare contexts. Understanding the processes and reality in this way gave new perspectives; enhancing our understandings and views of ourselves, what is important and most importantly what is possible in caring systems.

Strength-based Versus Deficit-based Action Learning for Developing Leaders, Teams, and Organizations in Asia: A Field Report of an Appreciative Inquiry and Action Learning Practitioner

Formal learning that equips learners with programmed knowledge extracted from the past is no longer sufficient. Action learning was founded to help managers deal with new unknowns. The author of this article poses the question ‘is it possible to run a deficit-based method positively using an Appreciative Inquiry model?’ using a case study from.

Creating Intergenerational Learning Spaces: A collaboration between UNIVEN Community Engagement Programme and Dzomo la Mupo

This article is a reflection on a collaborative learning process between a university department and a community-based organisation in creating intergenerational learning platforms. The process entailed the coming together of school learners, university students and community elders in a university setup. Participatory Appreciative Action Learning Research was employed. Purposive sampling was used. Data collection methods approach included were semi-structured interviews, one on one individual interviews and focus group discussions. Three generations, namely school learners, university students, and community elders, participated in selecting the learning areas. These included Indigenous Knowledge Systems (IKS), nature conversation topics, peace-building, manners and Ubuntu, social entrepreneurship, and health issues. The purpose of this initiative was to transfer knowledge, skills, norms, wisdom, and values, among generations, through a collaborative effort between an academic institution and a community. It was hoped that this would provide opportunities for lifelong learning and sharing of knowledge and experience among generations. The collaborative intergenerational learning (IGL) process opened with a series of focused discussions about how to bring to mainstream education (both basic and higher education), platforms for learning that should be inclusive of all forms of knowledges, including indigenous knowledge (IK).

The Birth of the Stars: A Participatory and Appreciative Action and Reflection Investigation into the Leadership and Development of a New Superleague Netball Club

This Participatory and Appreciative Action and Reflection (PAAR) investigation illustrates a leader’s first steps in a “values-to-action” journey. Drawing on the interface between transformational leadership and organizational culture, this study focused on the birth of the Severn Stars—a professional netball club in the United Kingdom. In particular, this PAAR investigation explored how the leader’s values were operationalized through the club’s inaugural year. Fourteen operational managers, coaches, and players were individually interviewed in order to gain an appreciative gaze and subsequently reframe their lived experience. Results demonstrated how transformational leadership was manifested through the pragmatic deployment of club values and how the organizational culture was, in part, characterized by individualized consideration, intellectual stimulation, idealized influence, and inspirational motivation. These behaviors and the organizational culture were shown to enhance prosocial relationships and social connections across the club, the influence of the Super Stars, and stakeholders’ perceptions of autonomy.

Core values and local guarantees of dignity in the care of older persons - Application, obstacles and further actions.

Due to reported shortcomings in elderly care in Sweden, the government has introduced national guidelines to establish core values and guarantees of dignity. With a bottom-up perspective, core values and local guarantees of dignity were developed using an participatory and appreciative action and reflection (PAAR) approach and implemented in municipal elderly care. The aim of this study was to evaluate the core values and local guarantees of dignity applied by the municipal healthcare staff caring for older persons. A cross-sectional descriptive design study using a questionnaire was conducted one year after the implementation of core values and local guarantees of dignity in municipal elderly care. In total, 608 caregivers answered the questionnaire. The results show that the caregivers strived to apply the core values and local guarantees of dignity, but experienced obstacles from the organisation. Proposals were given to facilitate further application of the core values.

Trumped: a case study and critical reflections on the threats of unweighted positivity and external context to appreciative inquiry-led participative action research

ABSTRACT Impact-driven participative organizational research can be difficult to undertake and problematic to evaluate, particularly when results are mixed. This article narrates the development of an organizational diversity and inclusion project undertaken using the appreciative inquiry methodology, which can be well-suited when working with vulnerable populations. The five stages of the methodology are examined within the context of the case example, illustrating the strengths and challenges of the method in vivo. As the results of the case example were decidedly mixed, the influences of external and internal context on the abrupt termination of the inquiry are introduced and discussed, including the overlap of the project’s timing with the election of Donald Trump. Three critical theory-based considerations are introduced on how to evaluate and adjust the use of impact-focused participatory action research methods under less than favourable circumstances or when the stakes are high.

Creating conditions for a sense of security during the evenings and nights among older persons receiving home health care in ordinary housing: a participatory appreciative action and reflection study

BackgroundToday many older persons in ordinary housing receive home health care. It is stipulated that the care is to provide security; however, deficiencies in home health care are reported in many countries. It may be difficult to implement a sense of security among older persons receiving home health care in ordinary housing, especially during the evenings and nights, due to a lack of knowledge.MethodsThis study is part of a larger project with a participatory appreciative action and reflection (PAAR) approach. We invited older persons, relatives, nurse assistants, registered nurses, and their managers to co-create knowledge with us on how conditions for a sense of security can be created during evenings and nights among older persons receiving home health care in ordinary housing. We performed thematic analysis of the data.ResultsFive subthemes were developed that gave structure to two main themes. The first main theme, To confirm the self-image, has the following subthemes: To see the home as a reflection of the person’s identity and To maintain self-determination. The second main theme, To create interaction in a sheltered place, has these subthemes: To undress the power, To create control and lifelines, and To create a good sleeping environment. The two themes interact and are each other’s conditions. The person’s self-image must be confirmed in order to create interaction in a sheltered place and through the interaction, the self-image is confirmed.ConclusionConditions necessary for older persons to have a sense of security are living in a familiar environment, having habits and routines maintained, and having self-determination. Other conditions are equality, the prevention of falls, and an individualized sleeping environment. Older people’s self-determination should be honored, and they should not being excluded from decision-making. We need to ask them if the conditions are sufficient and their sense of security is great enough to allow them to continue living in their ordinary housing.

Mentorship for flourishing in schools: an explicit shift toward appreciative action

Purpose Building on findings from research designed to bring to description teachers’ own understandings of what it means to flourish in their work, the purpose of this paper is to show how principals and teacher–leaders in schools are agents capable of building developmental relationships and mentoring cultures that can orient and support teachers toward well-being. Design/methodology/approach This conceptual paper is anchored with findings from a multi-year qualitative research project that was designed using perspectives from positive organizational studies and positive psychology scholarship. The research methods encompassed collaborative and generative use of appreciative inquiry and strength-based research activities in school districts in both British Columbia and Saskatchewan, Canada. Data used to build this conceptual paper are from appreciative focus group conversations with teachers and principals over the course of two years. Conversations were recorded and transcribed. Transcripts were thematically analyzed using the research literature framing the study. Findings This paper offers four domains of inquiry and a model for flourishing schools that encourages principals and teacher–leaders to develop habits of mind and heart to build developmental relationships in ways that help both mentors and mentees to embody and enact positive, appreciative and generative ways of noticing, nurturing and sustaining the work of teaching and learning; all with aspiration to sustain and enhance the well-being of every member of the school community. Practical implications This paper offers conceptual models and storied descriptions that can aid mentors in noticing and nurturing more developmental relationship approaches to mentoring for well-being as opportunities to build mentoring relationships from appreciative and growth-based habits and approaches. As these relationships are built across the school, positive mentoring cultures may foster and grow in ways that promotes a flourishing-for-all approach to teaching and learning. Originality/value This paper contributes a different and complimentary perspective to research and practice on mentoring, offering a positive organizational perspective that highlights and promotes the perceived and evidenced benefits of deliberately focusing on what goes well and what provokes vitality in schools. The conceptual models in this paper offer tools for mentors and mentees to develop and foster in others appreciative and positive capacities for positive mentoring.

Participatory and Appreciative Action Research in Mental Health and Substance Abuse in Norway’s High North

Participatory and Appreciative Action Research in Mental Health and Substance Abuse in Norway’s High North

Gender Perspective on Older People's Exercise Preferences and Motivators in the Context of Falls Prevention: A Qualitative Study.

Background Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises. Aim To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective. Methods Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis. Results Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men. Conclusion Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about women's and men's preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions.

Report on some action research in the implementation of social prescription in Crawley. Paths to greater wellbeing: ‘sometimes you have to be in it to get it’

ABSTRACTThe practice of Social Prescribing as a means of enabling improved quality of life, especially those with long term conditions, is still a ‘work in progress’. Using appreciative action research methods, practitioners involved in commissioning or providing social prescription services can learn important lessons from the experience of citizens/patients who have made successful moves towards greater wellbeing. Most significantly, the rich inquiry conversations that take place between patient and practitioner strengthen the confidence of both parties, deepen practitioners’ connection with their core work, and cement the roles of both patient and professional as joint co-producers in generating improved quality of life. Learning to inquire appreciatively into what has enabled people to overcome challenges and take positive steps towards their wellbeing goals, also has a powerful personal development impact (for both parties). Patients and practitioners can thus contribute to the small but growing body of knowledge on what works in social prescription and can thereby positively influence their respective social and professional networks.