Appreciative Inquiry Approach Research Articles

Appreciative Inquiry and Boot Camp Translation: Combining Methods for Community Health Improvement

Communities are dealing with persistent health problems, despite the enormous investment in health research, service delivery, and program development to address those health concerns. While there may be an evidence base for addressing some community health concerns, too often there is incomplete or no medical evidence for addressing many concerns. The High Plains Research Network and Colorado Research Network have used an appreciative inquiry approach to their work for several years, identifying positive aspects of care and developing programs to replicate what is working. Based on five years of informal appreciative-inquiry research and five formal appreciative inquiry projects, we have developed a standard process and method for conducting appreciative-inquiry guided Boot Camp Translations. The purpose of this methodology manuscript is to describe the general approach of using appreciative inquiry as a research tool and the standard process for conducting appreciative inquiry as a patient engagement tool to identify local evidence and develop local solutions.

Overcoming Insecurity in Competing for Jobs in the Pandemic Era

Limited job opportunities amidst high competition in job-seeking during the pandemic can create a sense of insecurity in competing for jobs. This study aimed to help individual overcome feelings of insecurity and increase confidence in competing for jobs in the pandemic era. The study used a psychoeducation program to improve Optimism and Confidence with Appreciative Inquiry approach. The intervention was held in virtual space, through a webinar that was attended by 33 participants. The data collection technique used a sampling technique. Data analysis was carried out using paired sample t-test. The result showed that there was a significant difference in the Optimistic dimension (t=2.528; p=0.020) and there was a significant trend in the Confidence variable (t=1.930; p=0.068). Psychoeducation with the application of the online learning model and Appreciative Inquiry approach can increase individual confidence, especially in the aspect of optimism.

Impact of the Enhanced Universal Support Offer to Care Homes during COVID-19 in the UK: Evaluation using appreciative inquiry.

There are over 2,300 care homes in the North East and Yorkshire Region, with rising rates of COVID‐19 infection in April 2020. The Enhanced Universal Support Offer (EUSO) planned to improve support to care homes, working collaboratively with local integrated community services. Implementation was organised at ‘place’, through clinical commissioning and it was focused on leadership, prevention, additional clinical support, and workforce planning. The aim of the evaluation research was to understand the impact of the EUSO. The evaluation was co‐produced by a group of senior leaders with additional academic involvement. An appreciative inquiry approach informed the interviews and focus groups with representative stakeholders. A thematic analysis using NVivo enabled a validation process and the data were charted into a systems framework. Data analysis resulted in five high level themes: Communication, Working Relationships, Systemic Perceptions, COVID‐19 Implementation, and Organisational Support. Best practices were associated with joint working between health, local authority and care homes including medication optimisation and technology use. Care homes valued access to a named General Practitioner and community nursing working as a part of a wider multidisciplinary team. Conversely an overly reactive response to care homes combined with ‘command and control’ limited the benefits that were achieved. The EUSO was delivered at pace and resulted in an increased appreciation of the policy and principles of care home residents and workforce. The evaluation reflected a need to appreciate the care homes' knowledge and experience of resident wellbeing, and more fully involve them in the design of the support.

A Protocol for a Comprehensive Monitoring and Evaluation Framework With a Compendium of Tools to Assess Quality of Project ECHO (Extension for Community Healthcare Outcomes) Implementation Using Mixed Methods, Developmental Evaluation Design.

Introduction: The United States Centers for Disease Control and Prevention (CDC), through U.S. President's Emergency Plan for AIDS Relief (PEPFAR), supports a third of all people receiving HIV care globally. CDC works with local partners to improve methods to find, treat, and prevent HIV and tuberculosis. However, a shortage of trained medical professionals has impeded efforts to control the HIV epidemic in Sub-Saharan Africa and Asia. The Project Extension for Community Healthcare Outcomes (ECHOTM) model expands capacity to manage complex diseases, share knowledge, disseminate best practices, and build communities of practice. This manuscript describes a practical protocol for an evaluation framework and toolkit to assess ECHO implementation.Methods and Analysis: This mixed methods, developmental evaluation design uses an appreciative inquiry approach, and includes a survey, focus group discussion, semi-structured key informant interviews, and readiness assessments. In addition, ECHO session content will be objectively reviewed for accuracy, content validity, delivery, appropriateness, and consistency with current guidelines. Finally, we offer a mechanism to triangulate data sources to assess acceptability and feasibility of the evaluation framework and compendium of monitoring and evaluation tools.Expected impact of the study on public health: This protocol offers a unique approach to engage diverse group of stakeholders using an appreciative inquiry process to co-create a comprehensive evaluation framework and a compendium of assessment tools. This evaluation framework utilizes mixed methods (quantitative and qualitative data collection tools), was pilot tested in Tanzania, and has the potential for contextualized use in other countries who plan to evaluate their Project ECHO implementation.

Using Appreciative Inquiry to Explore Effective Medical Interviews

The objective of this study was to uncover the elements of successful medical interviews so that they can be easily shared with health educators, learners, and practitioners. The medical interview is still considered the most effective diagnostic tool available to physicians today, despite decades of rapid advancements in medical technology. When the physician-patient interaction is successful, outcomes are improved. Semi-structured interviews were conducted using an Appreciative Inquiry approach, which seeks to uncover strengths from positive experiences. The inquiry sought to identify the elements that comprise the participating physicians’ most successful patient interviews. Subsequent qualitative analysis revealed eight themes: social support, mutual respect, trust, active listening, relationships, nonverbal cues, empathy, and confidentiality. These themes do not each exist separately or in a vacuum from one another; they are in fact strongly interconnected and equally important. For instance, if a physician and a patient cannot at least maintain mutual respect, then building a relationship, or even trust, is impossible. Given the qualitative nature of this study, future quantitative research should seek to validate the results. As patients assume a more participatory role in modern medical encounters, communication and other soft skills will be key in satisfying patients and improving their medical outcomes.

The Way School Leaders Develop Tourism as a Viable Major in Vocational Education in West Papua

This project examines the West Papuan community’s assumptions regarding the vocational high school major in Tourism, specifically the high school in Manokwari that was established in 2007. Unfortunately, the expectations of the policy makers in the field of vocational education and tourism are not met by the low number of young people who are interested in the school and finally decide to enroll in the school. The Causal Layered Analysis (CLA) used in this study looks at the issues through each of four layers, namely the Litany, Systemic/Social Causes, Discourse/Worldview, and Myth/Metaphor. The analysis moves from the current scenario through the layers to the construction of a new alternative scenario. It is recognized that the school needs innovation in the paradigm of the relational type of leadership model. The recommendations propose four main areas of cooperation through the Appreciative Inquiry approach: 1) within the school, 2) with the community, 3) with the tourism business sector, and 4) with the local Department of Tourism and the Department of Education. The project fills the gap in the literature, which lacks research on tourism vocational high schools in West Papua.

Giving midwives a voice - Qualitative perspectives of an 'empowering decision-making workshop'.

To establish midwives' perceptions of the value of workshops designed to empower their decision-making and leadership skills using validated midwifery clinical reasoning frameworks and appreciative inquiry methods. The medical lens of childbirth can disempower women and midwives. Midwives often face challenges navigating their role as autonomous practitioners and advocates for shared decision-making, particularly when there is tension between women's wishes, governance frameworks and organisational requirements. This can lead to 'Midwifery Abdication' and/or the midwifery voice being silenced. Appreciative inquiry, involving qualitative analysis of 31midwives' personal reflections during 'Empowering Midwives' Decision-Making' workshops. Standards for reporting qualitative research (SRQR criteria) guided the preparation of this manuscript. Decision-making tools and 'appreciative' strategies can strengthen leadership attributes, enhance feelings of empowerment and deepen understanding. Reflecting on 'Midwifery Abdication' was perceived as confronting. Workshop activities offered understanding the reasons why 'Midwifery Abdication' may or may not occur. One overarching, key theme was identified: 'Finding my midwifery voice'. This theme encompassed three sub-themes: 'I am not alone', 'Using leadership to promote collaboration to effect change' and 'An onward journey of enlightenment and empowerment'. Midwives need to find their voice and develop skills in both clinical reasoning and transformative reflection. Workshops, using Appreciative Inquiry approaches, that focused on reflection, clinical decision-making and 'Midwifery Abdication', facilitate this and may create feelings of reunification in midwives and rejuvenate inherent passion for the profession. Sharing feelings around providing care in the often-contested space that is advocating for women using midwifery philosophy may provide relief from moral distress and a sense of shared identity desperately sought after by midwives struggling to navigate the increasingly complex terrain of maternity care. Findings encourage the need for further discussions around strengthening midwifery leadership which may be achievable using Appreciative Inquiry frameworks and approaches.

Using Appreciative Inquiry to explore approaches towards mental health in a Scottish secondary school

Rationale:In Scotland, two-thirds of children have faced at least one adverse childhood experience. Research demonstrates a graded relationship between adversity and mental health outcomes. As adolescents spend a large amount of time in school, it is no surprise that schools are vital when supporting and delivering mental health interventions.Aim:The research aims were two-fold: to gather a clear understanding of mental health and wellbeing supports within a secondary school in Scotland; and to explore the use of Appreciative Inquiry as an approach for organisational change.Method:Semi-structured interviews were conducted, using an Appreciative Inquiry approach. A purposive sampling method was employed to select 55 secondary school stakeholders.Findings:Results highlighted several targeted supports in place within the secondary school, with the adoption of more consistent and visible universal systems needed. Key themes identified included: the importance of relationships, ensuring mental health literacy is core to the curriculum and encouraging an open conversation about mental health. The use of Appreciate Inquiry led to a clear action plan for the secondary school, building upon strengths already identified within the organisation.Limitations:One secondary school took part in this research, therefore, results cannot be generalised. Participants were school-based, future research should consider the role of external agencies.Conclusions:This research provides an insight into the current mechanisms in place within a secondary school in Scotland to support mental health and wellbeing. The use of Appreciative Inquiry was an effective approach for creating a plan intended to impact organisational change.

Strong and Deadly Futures: Co-Development of a Web-Based Wellbeing and Substance Use Prevention Program for Aboriginal and Torres Strait Islander and Non-Aboriginal Adolescents.

School-based programs can effectively prevent substance use; however, systematic reviews and consultation with stakeholders identified a need for effective, culturally inclusive programs for Aboriginal and/or Torres Strait Islander (hereafter Aboriginal) youth. This paper describes the development of Strong & Deadly Futures, a six-lesson, curriculum-aligned wellbeing and substance use prevention program that was designed for, and with, the Aboriginal youth. Formative reviews and consultation recommended that the program (i) combine effective components of mainstream prevention with cultural elements, highlighting Aboriginal cultural strengths; (ii) avoid stigma and celebrates the cultural diversity by catering to both Aboriginal and non-Aboriginal students; and (iii) use digital technology to enhance engagement, implementation and scalability. Guided by an Appreciative Inquiry approach, the program was developed in partnership with an Indigenous Creative Design Agency, and four schools in New South Wales and Queensland, Australia. Aboriginal (n = 41) and non-Aboriginal students (n = 36) described their role models, positive aspects of their community and reasons to avoid substance use; these formed the basis of an illustrated story which conveyed the key learning outcomes. Feedback from teachers, students and content experts supported the acceptability of the program, which will be evaluated in a subsequent randomised controlled trial.

Examining Post traumatic Growth After a Natural Disaster: An Appreciative Inquiry

With the frequency and intensity of natural disasters expected to increase as climate change persists, it is crucial for agricultural educators and extension agents around the world to develop the capacity to assist individuals in the wake of traumatic natural disasters. Data were collected in January 2019 and surveyed Georgia residents who they themselves, or someone they cared about, were affected by Hurricane Michael which occurred in October 2018. Data were measured using a modified version of Tedeschi and Calhoun’s (1996) 21-item posttraumatic growth inventory. Highest mean posttraumatic growth score was associated with the Relate to Others scale, while the lowest mean score was associated with the Appreciation of Life scale. Approximately 48% of respondents reported a large or very large change in their compassion for others and their appreciation of each day as a result of their traumatic experience. Female respondents scored higher than male respondents on all the posttraumatic growth factors. Significant differences at the .05 level between male and female mean posttraumatic growth scores were identified for five scale factors; personal strength; spiritual change; appreciation of life; and overall posttraumatic growth. These findings suggest females may be more adaptive to traumatic events and more likely to be receptive to the potential to perceive positive benefits resulting from traumatic experiences. An associated recommendation would be for agricultural educators and extension personnel to utilize the appreciative inquiry approach when assisting individuals recovering from natural disasters and other traumatic events. Keywords: posttraumatic growth; Hurricane Michael; natural disasters; appreciative inquiry

Successful Psychological Strategies of Experienced Chronic Fatigue Patients: A Qualitative Study.

Trying to care for patients with medically unexplained symptoms (MUS) can lead to frustration and disappointment for both patients and health care professionals alike. Learning positive ways to assist patients avoids professionals collapsing into therapeutic nihilism. We sought to understand how people with such symptoms can live well despite (or even because of) their condition. Chronic fatigue was chosen as the exemplar symptom. Participants were invited to join the research if they, themselves, considered they were living well with this symptom. One-on-one interviews using an appreciative enquiry approach were performed and thematic analysis undertaken. Twelve participants were interviewed before data saturation occurred. The emotional stance or relationship a participant had with, and towards, their illness was the primary determinant underlying their interpretation of “living well.” Five major themes of this meta-theme were identified: (1) engaging with elusiveness, (2) befriending uncertainty, (3) reflecting on self, (4) living creatively, and (5) moving in stillness. Encouraging patients who are struggling with MUS to consider how they emotionally engage with their illness via these 5 positive dynamics may lead to better health outcomes for patients and happier, more fulfilled health care professionals.

Creating a Pathway for Psychosocial Support in Siblings of Youth with a Chronic Illness: Findings from an International Summit.

Serious childhood illnesses such as cancer affect all family members. Siblings experience strong emotions and disruptions to their routines as families reorganize to confront the disease and manage treatment. Addressing siblings' psychosocial needs is a standard of care in pediatric oncology, but siblings' needs are rarely met because of systematic barriers in our health care system. Thus, we aimed to re-envision sibling care. We used an appreciative inquiry approach to inform systematic screening of siblings' psychosocial risk and unmet needs as a first step toward providing appropriate support. Sibling-focused researchers, clinicians, policymakers, advocates, and families of youth with cancer (N = 29) convened for a 2-day community stakeholder-centered international summit to create a vision for standardizing and optimizing sibling-focused psychosocial screening and assessment as a pathway to care, including crafting a research agenda and articulating best clinical practices. Summit attendees created a detailed framework for best practices in universal sibling psychosocial screening and pathways to support. The framework emphasizes links between hospital- and community-based care. It highlights the need to prepare systems to feasibly and effectively attend to siblings' needs and recommends incorporating siblings into family-based psychosocial screening at cancer diagnosis, systematically conducting sibling-focused psychosocial screening during and after cancer treatment, and connecting siblings with community-based resources. A systematic approach to sibling psychosocial services expands the idea of family-centered care to include siblings and ensures that siblings' needs are adequately recognized and met. This framework was created in the context of cancer but is applicable across illness groups.

Sustaining quality education and practice learning in a pandemic and beyond: ‘I have never learnt as much in my life, as quickly, ever’

The context of healthcare and of healthcare education has radically changed as a result of the Covid-19 pandemic. To identify positive strategies for midwifery education in this context, five case studies from the UK and beyond were conducted using an appreciative enquiry approach, from the perspectives of students, the maternity services, cross-university collaboration, and digital learning. A health system analysis was used to identify strategies to cope, adapt, and transform for the future, at the levels of individuals, teams, and the whole system.Findings showed that the implementation of effective responses was possible. Responding effectively and rapidly to a shock as profound as this pandemic requires courageous, respectful, evidence-based, innovative, collaborative, cross-sectoral working and leadership across education institutions, practice settings, the regulator, government, and with students themselves. Pre-existing trusting relationships and collaborative systems supported rapid responses. Effective digital learning requires a pro-active, student-centred approach, and addressing the problems of inequitable access to equipment and space. Joint problem-solving and focussing on the key outcomes that matter contribute to developing successful strategies and robust processes. The pandemic provides an opportunity for student midwives to be re-imagined as essential members of midwifery teams and not ‘just students’. Transformative actions identified include whole-system working, tackling longstanding problems including racism, poverty, prejudice, and systemic discrimination, and keeping students at the heart of the education system.

Professional dialogue in researcher-teacher collaborations: exploring practices for effective student learning

ABSTRACT The role of educational research, and schools’ and teachers’ engagement in and with research, changes when it is viewed as a form of professional development. The study presented in this paper intended to explore teachers’ practices for designing learning, instructing students and managing classrooms in the context of the primary–secondary school transition years, from Years 5–9 in Australia. Qualitative data were collected through semi-structured interviews with eight teacher participants who were asked to reflect on their everyday practices. This research contributes to the understanding of the multiple teaching roles of teachers for supporting students’ learning, and it highlights the potential for professional learning associated with researcher-teacher collaborations. The Appreciative Inquiry approach adopted for the research established a professional learning culture within a safe and authentic environment that respected the teachers’ knowledge and experience. Professional dialogue through productive and respectful collaborations generated new insights for transformative practice.

Rural Aboriginal high school students' views of their future tertiary education

Abstract In the context of a stark discrepancy in the educational outcomes of Aboriginal Australians compared to non-Aboriginal Australians, this article aims to contribute the voices of rural Aboriginal high school students to the discourse. This article utilises an appreciative enquiry approach to analyse the opinions and aspirations of 12 Aboriginal high school students in a South Australian regional centre. Drawing on student perspectives from semi-structured interviews, this article contributes to and contextualises the growing body of literature regarding educational aspirations. It demonstrates how rurality influences a complex system of intrinsic attributes, relationship networks and contextual factors. It offers an important counterpoint to discourses surrounding academic disadvantage and highlights the lived experience of rural Aboriginal Australians.

Applying information for national adaptation planning and decision making: present and future practice in the Pacific Islands

Climate change adaptation decision-making frameworks have evolved over the past three decades, with the management of information and knowledge now a key element of these processes. This paper examines the use of climate change-related information for national adaptation planning and decision-making in the Pacific Islands region to better understand the use of, and demand for, such information. Using an appreciative inquiry approach, a situation analysis was undertaken to examine the information praxis of national governments in Papua New Guinea, Tonga and Tuvalu, as well as the Secretariat of the Pacific Regional Environment Programme. The study revealed that adaptation decisions are (i) driven by national strategies and priorities which are innately community-centred, (ii) largely made through collaborative structures involving multiple stakeholders within a specific governance or project setting, and (iii) informed by a range of climatic and nonclimatic information from domestic, regional and international sources. The study also affirmed the importance of information and knowledge management to national adaptation planning and decision-making, evidence of collaborative and multistakeholder decision-making processes, and the trend towards country-driven and user-centred information and knowledge production. The study recommends dedicated commitment to and investment in information and knowledge management for Pacific Islands, and the need for a holistic understanding of the complex environment in which climate change adaptation takes place.

Factors influencing nurse retention within children's palliative care.

Retention of staff presents major challenges within children's palliative care; this has substantial implications for children, families and the nursing workforce. To address this, a programme was undertaken that provided pathways of professional development for senior nurses working in this field. This study reports the views of nurses completing this programme, the overall project manager (PM) and the day-to-day programme lead (PL) as well as factors that influence nurse retention within children's palliative care nursing. The study drew on an Appreciative Inquiry approach that comprised of interviews with the PM and PL as well as focus groups and questionnaires with senior nurses from the children's palliative care sector, who participated in the training programme. Thematic analysis of data from interviews and focus groups revealed factors influencing nurse retention: speciality, positivity and making a difference, support, provision of adequate resources, tailored education/professional development and resilience. These themes were supported by the questionnaire findings. The programme was perceived as having a positive influence on nurse retention within the children's palliative care workforce. In addition, it was felt to be very beneficial in terms of shared learning and development. Participants highlighted the need for similar opportunities in the future.

Key drivers of social accountability in nine Canadian medical schools*

A social accountability mandate for Canadian medical schools formally emerged in Canada with changes to accreditation standards in 2015. However, how social accountability is defined and operationalized within medical schools has transpired independently. Key enablers of social accountability in Canadian medical schools have been largely unexplored. This paper is the first of a two part series that seeks to explore drivers of social accountability in a sample of Canadian medical schools. Nine key drivers of social accountability emerged from the data including a unified vision, committed leadership, accreditation standards, champions of social accountability, authentic community engagement, community-based learning opportunities, a supportive organizational and governance structure, diversity within medical schools, and measurement of progress and outcomes. This is the first study of its kind to examine what is driving social accountability across Canadian medical schools. An appreciative inquiry approach highlights areas of progress for future work to focus and build upon. This paper presents the findings from part one of the study – exploring the themes emerging from key informant interviews with senior leaders. A second paper will dive into the broader perspectives of faculty, staff and students, to explore more fully the varying perspectives of social accountability within colleges.

Advancing quality culture in health professions education: experiences and perspectives of educational leaders

The concept of quality culture has gained increased attention in health professions education, drawing on insights that quality management processes and positive work-related attitudes of staff in synergy lead to continuous improvement. However, the directions that guide institutions from quality culture theory to educational practice have been missing so far. A prospective qualitative case study of three health professions education programmes was conducted to explore how a quality culture can be enhanced according to the experiences and perspectives of educational leaders. The data collection was structured by an appreciative inquiry approach, supported with vignette-based interviews. A total of 25 participants (a selection of course coordinators, bachelor coordinators and directors of education) reflected on quality culture themes to learn about the best of what is (Discover), envision positive future developments (Dream), identify actions to reach the desired future (Design), and determine how to support and sustain improvement actions (Destiny) within their own educational setting. The results are presented as themes subsumed under these four phases. The experiences and perspectives of educational leaders reveal that peer learning in teams and communities, attention to professional development, and embedding support- and innovation networks, are at the heart of quality culture enhancement. An emphasis on human resources, (inter)relations and contextual awareness of leaders stood out as quality culture catalysts. Educational leaders are therefore encouraged to especially fuel their networking, communication, coalition building, and reflection competencies.

Adopting an Appreciative Inquiry approach to propose change within a national talent development system

ABSTRACT The subject of talent in sport continues to fascinate and intrigue as organisations seek to identify and deliver an effective talent development programme in an effort to ensure systemic success. In the quest to deliver an optimal national governing body talent development programme, this paper investigates the role that Appreciative Inquiry can play in addressing change within a complex landscape. The coaches (12 talent coaches) and researcher (Head of Performance) utilised an Appreciative Inquiry framework to identify a ‘routemap’ for change within the programme. Results highlighted the challenges and benefits of adopting a strength-based approach to programme development within sport, particularly the generative capacity of Appreciative Inquiry amongst coaches. Results also indicate some complexities of strength-based collaborative change, namely the need for time to break through semantics and coaching rhetoric. Through the design and delivery of an Appreciative Inquiry summit, key themes for an optimal development environment were identified. Namely, coaches felt that when at its best the programme adopts a mastery focus. Findings indicate that to achieve this, participants felt that for the programme to become optimal, the themes of leadership, coach–athlete relationships and player autonomy were integral elements to build on going forward.