Participatory Action Research Intervention Research Articles

From Our Cell to Your Block: Hip Hop and Podcasting as a Youth Participatory Action Research Intervention

This narrative inquiry explores the experiences of youth in a school within a juvenile detention facility, who participated in a hip hop and podcasting small-group counseling intervention. Specifically, youth wrote and recorded a podcast consisting of a hip hop song, interviews with their peers, and staff reflections on the youth’s experience. Salient results from this study offered that the hip hop podcasting group supported youth in emotionally processing their experience of being incarcerated.

IMPLEMENTING SYSTEM DYNAMICS AND PARTICIPATORY ACTION RESEARCH AT THE NEXUS OF PATIENT CARE FACTORS

Ponte Academic JournalFeb 2023, Volume 79, Issue 2 IMPLEMENTING SYSTEM DYNAMICS AND PARTICIPATORY ACTION RESEARCH AT THE NEXUS OF PATIENT CARE FACTORSAuthor(s): Maseeha Mahomed Farouk Ansermeah ,Cecile Gerwel ProchesJ. Ponte - Feb 2023 - Volume 79 - Issue 2 doi: 10.21506/j.ponte.2023.2.7 Abstract:Purpose: Factors influencing patient care were analyzed in a public health setting in a bid to enhance patient experience and identify areas of health care delivery which could be improved upon. Methods: Patients and members of health care staff were interviewed by means of purposeful sampling. Causal loop diagrams and stock flow diagrams were merged with the use of Systems archetypes under the broad purview of System Dynamics and Participatory Action Research. Results and Conclusion: System Dynamics heuristics unmasked flaws in the system which were then acted upon utilizing Participatory Action Research interventions. Overall there has been a homogenous improvement in understanding the factors which contribute to patient care. Download full text:Check if you have access through your login credentials or your institution Username Password

Participatory Action Research for Tackling Distress and Burnout in Young Medical Researchers: Normative Beliefs before and during the Greek Financial Crisis.

(1) Background: We aimed to explore Young medical researchers (YMR) normative beliefs and perceived causes of distress and burnout, prior and during the financial crisis in Greece, and to assess their views on Participatory Action Research (PAR) interventions towards tackling these disorders. (2) Methods: A Participatory Learning and Action (PLA) methodology was performed in two time periods (prior crisis: December 2008; during crisis: February–March 2017). In both time periods, three different groups (Group 1: females, Group 2: males, Group 3: mixed) of 5–7 participants and two sessions (≈1 h/session) per group took place in each site. Overall, 204 sessions with 1036 YMR were include in the study. (3) Results: Several socio-demographic characteristics of YMR altered during the crisis (lower income, higher smoking/alcohol consumption, etc.). The majority of YMR conceived distress and burnout as serious syndromes requiring professional support. Feeling very susceptible and the necessity for establishing PAR interventions were frequently reported during the crisis. Numerous (a) barriers and (b) cues to action were mentioned: (a) lack of time, money and support from friends/family/colleagues (b) being extensively informed about the intervention, participation of their collaborators, and raising awareness events. (4) Conclusions: The changing pattern of Greek YMR’s beliefs and needs during the crisis stresses the necessity of interventions to tackle distress and burnout. Effectiveness of these interventions could be enhanced by the suggested cues to action that emerged from this study.

‘This made me feel honoured’: a participatory action research on using process drama in English language education with ethics of care

ABSTRACT This study investigates English as a foreign language learners' emotions and questions the authenticity of the communication in language classrooms in Turkey. To become more aware of learners' emotions and to make a speaking module more engaging, the teacher-researcher decided to utilise process drama as a participatory action research intervention. The data were collected over a three-week process drama. Drawing on ‘ethics of care' and ‘social and emotional learning', the findings demonstrated that authentic communication empowered learners when the content was relevant to their emotion labour. When learners’ emotions are scrutinised explicitly through drama-in-education, they feel respected and more engaged.

Participatory action research intervention for improving sleep in inpatients with cancer.

To design and implement a plan to improve oncohaematological patients' sleep. The hospital environment can compromise inpatients' sleep, negatively impacting on health outcomes and patient satisfaction. The improvement plan was designed in collaboration with 18 professionals, 3 patients and 3 accompanying relatives. The study designed followed the SQUIRE 2.0guidelines. Outcome variables were self-reported patient satisfaction regarding sleep, measured using a 30-item, ad hoc questionnaire and a 10-point visual analogue scale, completed by 318 oncohaematological inpatients (pre-intervention n=120, post-intervention, n=198) in a comprehensive cancer centre in Spain from 2017 to 2019. Overall, 61.5% (n=190) of the inpatients reported sleep alterations, and 92.6% reported interruptions in their nightly sleep. Half slept less than 6h/night, but 58.0% said they felt rested upon waking, despite the interruptions. These outcomes were similar before and after the intervention. The improvement plan identified four domains for work (professionals, care procedures, instruments/environment and patients/relatives), 10 areas for improvement and 35 actions for implementation. However, overall sleep worsened significantly, from 6.73 to 6.06 on the 10-point scale. The intervention significantly improved variables related to professionals' behaviour, including noise during the shift change, conversations at the control desk and the use of corridor lights. Sleep disturbances were mainly caused by pain/discomfort and infuser alarms, and collectively they decreased significantly after the intervention (p=.008). However, overall sleep worsened significantly, from 6.73 to 6.06 on the 10-point scale. Pain, clinical devices and noise made by professionals are the main causes of sleep disturbances. Involving professionals in decision-making to improve patients' sleep have a positive impact on noise levels. This study proposes new strategies for improving sleep by increasing staff awareness and changing attitudes towards patients' sleep. Nurses should be involved in addressing sleep disturbances during hospitalization.

Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries

Although fragmentation in the provision of services is considered an obstacle to effective health care, there is scant evidence on the impact of interventions to improve care coordination between primary care and secondary care in terms of continuity of care—i.e. from the patient perspective—particularly in Latin America (LA). Within the framework of the Equity-LA II project, interventions to improve coordination across care levels were implemented in five Latin American countries (Brazil, Chile, Colombia, Mexico and Uruguay) through a participatory action research (PAR) process. This paper analyses the impact of these PAR interventions on the cross-level continuity of care of chronic patients in public healthcare networks. A quasi-experimental study was performed with measurements based on two surveys of a sample of patients with chronic conditions (392 per network; 800 per country). Both the baseline (2015) and evaluation (2017) surveys were conducted using the CCAENA questionnaire. In each country, two comparable public healthcare networks were selected, one intervention and one control. Outcomes were cross-level continuity of information and clinical management continuity. Descriptive analyses were conducted, and Poisson regression models with robust variance were fitted to estimate changes. With differences between countries, the results showed improvements in cross-level continuity of clinical information (transfer of clinical information) and clinical management continuity (care coherence). These results are consistent with those of previous studies on the effectiveness of the interventions implemented in each country in improving care coordination in Brazil, Chile and Colombia. Differences between countries are probably related to particular contextual factors and events that occurred during the implementation process. This supports the notion that certain context and process factors are needed to improve continuity of care. The results provide evidence that, although the interventions were designed to enhance care coordination and aimed at health professionals, patients report improvements in continuity of care.

Effects of the Participatory Action Research on Reducing the Risk of Metabolic Syndrome in Adult Women.

This study aimed to evaluate the effects of a participatory action research (PAR) on reducing the metabolic syndrome risk factors among the Koran adult women. The effectiveness of the PAR intervention was examined using a one-group pretest-post-test design. The data were collected from 58 adult women living in a community health center in Ulsan, Korea, between May and November 2016. The psychosocial factors (empowerment, social support, and quality of life), metabolic-related indices, and health behaviors were collected to measure the intervention’s efficiency. After applying it, the participants’ empowerment, social support, and health-related quality of life increased significantly, as compared to the pre-test. Furthermore, their metabolic-related indices improved significantly in the post-test, as compared to the pre-test. Therefore, the PAR intervention was found to be effective in enhancing the psychosocial factors, metabolic-related indices, and health behaviors in the aforementioned population and could be applied to other community health centers.

Using participatory action research to improve immunization utilization in areas with pockets of unimmunized children in Nigeria

BackgroundIn 2005, Nigeria adopted the Reaching Every Ward strategy to improve vaccination coverage for children 0–23 months of age. By 2015, Ogun state had full coverage (100%) in 12 of its 20 local government areas, but eight had pockets of unimmunized children, with the highest burden (37%) in Remo North. A participatory action research (PAR) approach was used to facilitate implementation of local solutions to contextual barriers to immunization in Remo North. This article assesses and seeks to explain the outcomes of the PAR implemented in Remo North to understand whether and possibly how it improved immunization utilization.MethodsThe PAR intervention took place from 2016 to 2017. It involved two (4-month) cycles of dialogue and action between community members, frontline health workers and local government officials in two wards of Remo North, facilitated by the research team. The PAR was assessed using a pre/post-intervention-only design with mixed methods. These included household surveys of caregivers of 215 and 213 children, respectively, 25 semi-structured interviews with stakeholders involved in immunization service delivery and 16 focus group discussions with community members. Data were analysed using the Strategic Advisory Group of Experts (SAGE) vaccine hesitancy framework.ResultsCollaboration among the three stakeholder groups enabled the development and implementation of solutions to identified problems related to access to and use of immunization services. At endline, assessment by card for children older than 9 months revealed a significant increase in those fully immunized, from 60.7% at baseline to 90.9% (p < .05). A significantly greater number of caregivers visited fixed government health facilities for routine immunization at endline (83.2%) than at baseline (54.2%) (p < .05). The reasons reported by caregivers for improved utilization of routine immunization services were increased community mobilization activities and improved responsiveness of the health workers. Spillover effects into maternal health services enhanced the use of immunization services by caregivers. Spontaneous scale-up of actions occurred across Remo North due to the involvement of local government officials.ConclusionThe PAR approach achieved contextual solutions to problems identified by communities. Collection and integration of evidence into discussions/dialogues with stakeholders can lead to change. Leveraging existing structures and resources enhanced effectiveness.

Interventions to increase adherence to micronutrient supplementation during pregnancy: a systematic review.

Prenatal micronutrient supplements are cost‐effective in reducing nutritional deficiencies and adverse pregnancy and birth outcomes. However, poor adherence remains a potential barrier to the successful implementation of these supplementation programs. This systematic review assessed the effectiveness of interventions designed to increase adherence to prenatal micronutrient supplementation. Following the Cochrane Collaboration Methodology, literature searches were conducted in six electronic databases and gray literature (on July 24, 2020), and abstract screening, data extraction, and risk of bias assessment were conducted independently by two reviewers. We included 22 studies. Interventions that resulted in increased adherence were most of the education‐based strategies, consumption monitoring by volunteer health workers or family members, SMS reminders, free provision of supplements, a multicomponent intervention with community mobilization, and a participatory action research intervention. In several studies, increased adherence was accompanied by beneficial effects on pregnancy and birth outcomes. Given the heterogeneity of study designs and methods used to define and measure adherence, a meta‐analysis was not appropriate. We identified several potentially effective strategies to improve supplementation adherence, which may need to be adapted to specific contexts when considered for program implementation. However, additional high‐quality studies are critically needed to effectively guide policies and programs.

Participatory Action Research on School Culture and Student Mental Health: A Study Protocol

Background: Young people spend a large proportion of their time in school, which presents both risk and protective factors for their mental health. A supportive school culture can promote and protect good mental health by creating experiences of safety and belonging amongst staff and students. In this qualitative study, we seek to explore whether a participatory action research (PAR) approach is an effective way to promote and improve student mental health. Methods: Participatory action research is an approach in which people collaboratively research their own experience: the researched communities become co-researchers of their own experiences in a specific context. We will work with four secondary schools in the UK to develop PAR projects. In each school, a group of 2–4 staff and 6–8 students will work together to develop a shared understanding of their school culture and to introduce activities or changes to make the culture more supportive of student mental health. We will evaluate the effectiveness of the PAR approach through i) a review of school documents pertaining to mental health (e.g., policies and Ofsted reports), ii) interviews with staff members ( n = 40), parents ( n = 8) and students ( n = 24–40) before and after the PAR intervention, iii) observations and reports of the PAR group meetings and iv) interviews with members of the PAR groups after the PAR intervention. Discussion: We anticipate that our research findings will advance knowledge on effective methods to develop a positive school culture that will contribute to the improvement of young people’s mental health and well-being. We will seek to identify the mechanisms through which school culture can have a positive impact on mental health and develop a logic model and a school culture toolkit that can be utilised as a resource to inform public health interventions to promote mental health in a range of educational settings.

Can participatory action research foster social learning in communities struggling for land tenure?

In developing countries, especially in Latin America, unequal land distribution and access remain a significant problem. In this paper, we explore the potential of participatory action research (PAR) in promoting the social learning needed to mobilize actions that improve the situation for disadvantaged actors in the context of land tenure conflicts. Our case study was composed by four socio-ecological systems in the north of Misiones province, Argentina, where we combined focus groups, participant observation, semi-structured interviews, and social network analysis (SNA) to obtain empirical evidence of social learning at different levels (individual and small group, collective, and system). We evaluated early social learning (e.g. the consolidation of a coordination network of collective actions, the emergence of cooperatives, changes in productive practices) triggered by PAR, according to changes in the actors’ network, both at actors’ nodal metrics and nodal structure levels. Changes in nodal metrics indicated improvements in the connections between actors and in their cohesion level, as well as the empowerment of the most disadvantaged, resulting in more effective interactions for problem-solving and exchange of information. Changes in network structure metrics also indicated favorable conditions for social learning. We argue that our PAR intervention has contributed to these aspects. In addition, we compare the usefulness of different network metrics as indicators of social learning. Future evaluations are needed to analyze which initiatives are consolidated within communities and to better understand the potential and limitations of this approach.

Leaving no one behind: using action research to promote male involvement in maternal and child health in Iringa region, Tanzania

IntroductionMale involvement has been reported to improve maternal and child health (MCH) outcomes. However, most studies in low-income and middle-income countries have reported low participation of men in MCH-related programmes....

Immediate influences of hygiene education sessions on handwashing behaviors of selected Nepali students

Abstract Appropriate handwashing can prevent 50–70% of water and foodborne infections. However, schoolchildren who are in the formative stage of life, particularly in low-income countries like Nepal, are deprived of such a lifesaving skill. This study investigates the effectiveness of a school-based participatory action research intervention to promote handwashing with soap among basic level community school students in Nepal. Teachers, the school management committee, the participatory action research committee, and child-club members actively participated in designing and implementing the intervention. This study employed a semi-structured interview with the headteacher, five focus group discussions, and spot observations during 50 handwashing with soap events involving students, to collect the data. This study assesses the handwashing situation of students before and after the intervention. As part of the intervention, participatory teaching methods such as singing, drawing, showing a video, games, and demonstrations were used. Findings from basic level students who actively participated in hygiene sessions and increased their handwashing with soap before meals and after toilet use were used as a comparison to baseline. Participants reported that the intervention was perceived positively, pragmatic, and cost-effective. This intervention study concluded that handwashing behaviors improved because of the influence of sensitization sessions and demonstrations about handwashing. However, some predominant issues in the teaching of handwashing practices include limited hygiene contents in the curriculum and the practical use of teaching and learning activities. The lack of availability of soap at handwashing stations is the main barrier in sustaining handwashing behaviors in schoolchildren.

Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries

BackgroundFinding new strategies for care integration has become a policy priority for many fragmented health systems in Latin America. Although the implementation of interventions through a participatory action research (PAR) approach is considered to be more effective in achieving organizational change, its application is scarce.This study, part of the research project Equity-LA II, aims to analyze the impact of PAR interventions on care coordination across levels, and key aspects for their sustainability and transferability, from the stakeholder viewpoint in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. Different interventions were designed and implemented through a PAR process to improve communication and clinical agreement between primary care and secondary care doctors: joint meetings to discuss clinical cases and/or training; shared care guidelines; offline virtual consultations; a referral and reply letter; and an induction program.MethodsA qualitative, descriptive-interpretative study was conducted in the healthcare network of each country. Focus groups and semi-structured individual interviews were conducted with a criterion sample of participants: local steering committee (29) and professional platform members (28), other health professionals (49) and managers (28). Thematic content analysis was conducted, segmented by country and type of intervention.ResultsInformants highlighted that joint meetings based on reflexive methods contributed substantially to improving contextually relevant elements of clinical management coordination – communication in patient follow-up, clinical agreement, appropriateness of referrals – and also administrative coordination. The meetings, alongside the PAR process, also helped to improve interaction between professionals – knowing each other personally and mutual trust – thus fostering willingness to collaborate. The PAR approach, moreover, served to spread awareness of the coordination problems and need for intervention, encouraging greater commitment and interest in participating. No noteworthy contributions were identified in remaining interventions due to low uptake. A necessary condition for the sustainability and replicability was that PAR process had to be used appropriately in a favourable context.ConclusionsEvidence is provided on the substantial contribution of interventions to improving locally relevant clinical coordination elements and professional interaction when implemented through an adequate PAR process (in terms of time, method and participation levels), a necessary condition for their sustainability and replicability.

Outcomes and conditions for sustaining changes of Participatory Action Research interventions

Abstract Background Finding new strategies for care integration has become a priority for many health systems in Latin America. Although the implementation of interventions through a participatory action research (PAR) approach is considered effective, its application in health services is scarce. Aim to analyse impact of PAR interventions on care coordination, and aspects for sustainability and transferability in public healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. Methods A qualitative, descriptive-interpretative study was conducted in each healthcare network. Focus groups and individual semi-structured interviews were conducted to a criteria sample of Local Steering Committee (29), Platform of professionals (28), professionals (49) y managers (28). A thematic content analysis was conducted, segmented by country and themes. Different interventions were designed and implemented through a PAR process: joint meetings to discuss clinical cases and/or training; shared care guidelines; offline virtual consultations; a (back) referral form; and an induction program. Results Informants highlighted that joint meetings based on reflexive methods contributed substantially to improving contextually relevant elements of clinical coordination - communication in patient follow-up, clinical agreement, appropriateness of referrals - and administrative coordination. The meetings, alongside the PAR process, helped to improve interaction between professionals, fostering willingness to collaborate. No significant contributions were identified in the remaining interventions due to the low uptake. A necessary condition for the sustainability and replicability of the interventions was that the PAR process had to be used appropriately in a favorable context. Conclusions Evidence is provided on the significant contribution of interventions to improving locally relevant clinical coordination elements and professional interaction when implemented through an adequate PAR process. Key messages It contributes to fill the gap regarding the impact of PAR interventions on care coordination. A key aspect for impact and sustainability is an adequate use of PAR approach in a favourable context.

Understanding the factors influencing the implementation of participatory interventions to improve care coordination. An analytical framework based on an evaluation in Latin America.

Healthcare coordination is considered key to improving care quality. Although participatory action research (PAR) has been used effectively to bridge the gap between evidence and practice in other areas, little is known about the key success factors of its use in healthcare organizations. This article analyses the factors influencing the implementation of PAR interventions to improve clinical coordination from the perspective of actors in public healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. A qualitative, descriptive-interpretative study was conducted in each country’s healthcare network. Focus groups and semi-structured individual interviews were conducted to a criterion sample of: local steering committee (LSC) (29), professional platform (PP) (28), health professionals (49) and managers (28). Thematic content analysis was conducted, segmented by country and themes. The PAR process led by the LSC covered the return of baseline results, selection of problems and interventions and design, implementation and adjustment of the intervention, with PP. Interventions were implemented to improve communication and clinical agreement between primary and secondary care. Results reveal that contextual factors, the PAR process and the intervention’s content influenced their implementation, interacting across time. First, institutional support providing necessary resources, and professionals’ and managers’ willingness to participate, emerge as contextual pivotal factors, influenced by other factors related to: the system (alignment with policy and political cycle), networks (lack of time due to work overload and inadequate working conditions) and individuals (not knowing each other and mutual mistrust). Second, different characteristics of the PAR process have a bearing, in turn, on institutional support and professionals’ motivation: participation, flexibility, consensual decision-making, the LSC’s leadership and the facilitating role of researchers. Evidence is provided that implementation through an adequate PAR process can become a factor of motivation and cohesion that is crucial to the adoption of care coordination interventions, leading to better results when certain contextual factors converge.

Water Scarcity and Water Quality: Identifying Potential Unintended Harms and Mitigation Strategies in the Implementation of the Biosand Filter in Rural Tanzania.

Bottom-up public health interventions are needed which are built on an understanding of community perspectives. Project SHINE is a community-based participatory action research intervention focused on developing sustainable water, sanitation, and hygiene strategies with Maasai pastoralists in Tanzania. The aim of the study is to understand perceptions related to water quality and scarcity as well as to assess the potential of the Biosand Filter as a low-cost, low-tech water treatment option. To avoid unintended harms, the community was engaged in identifying potential harms and mitigation strategies prior to the implementation of the filter.Two in-depth interviews and two group discussions were analyzed using thematic content analysis, while three think tanks were analyzed using directed content analysis. The findings highlight a range of concerns regarding water scarcity and quality. The think tank approach was an effective means of engaging the community in identifying potential unintended harms across four dimensions: the physical, psychosocial, economic, and cultural contexts. In addition, two external themes emerged as salient: political harm and harm by omission.

Can it be done? An evaluation of staff perceptions and affordability of a school-based multi-component integrated intervention for improving the resilience of Aboriginal and Torres Strait Islander boarding students

Internationally, schools have recognised the need for supporting and improving the resilience of students, particularly those facing a multiplicity of challenges. However, social and emotional learning programmes, including those aimed at enhancing resilience, are often not evaluated thoroughly nor detail process and economic evaluations. This paper evaluates a multi-component integrated intervention designed to strengthen the resilience of remote-living Aboriginal and Torres Strait Islander students attending boarding schools. This evaluation is largely process-based, focussing on the acceptability, feasibility, preliminary outcomes and affordability of implementation of the intervention. Fourteen boarding or teaching staff members, eight female and six who identified as Aboriginal, were interviewed. The interviews were conducted with staff members at eight Queensland boarding sites where the intervention was delivered. Qualitative inductive thematic analysis was used to evaluate feasibility and acceptability and outcomes described by staff. A descriptive analysis of the costs (AU$ 2018) was performed in Microsoft Excel 2013. This evaluation identified multiple major themes around feasibility and acceptability, including sharing experience across sites, staff knowledge, attitudes and behaviours, and perceived student achievement, leadership and relationships. Implementation of the resilience intervention was considered feasible and affordable, and embraced by boarding providers. School-based participatory action research interventions aimed at improving culturally appropriate support structures for Indigenous boarding students are achievable with the appropriate resourcing and time to implement and embed change.

Cultural studies and intersectionality in English language education: exploring students’ engagement in issues of celebrity, identity, gender and sexuality

ABSTRACT The increasing orientation towards interculturality in language education calls for research to investigate teacher and student perceptions and practices of interculturality. Most research already conducted in this area primarily concerns teacher perceptions and practices, but this study contributes to an exploration of how lower secondary school students (15-year-olds) engaged in broader issues of interculturality, which include issues of celebrity, identity, gender and sexuality. The participatory action research intervention analysed in this paper explored the pedagogical potential of Cultural studies and the case of celebrity Miley Cyrus' toying with intersecting identities. The study's findings show that many of the participating students had sufficient linguistic and analytical resources to engage in a discourse analysis of an open letter to Miley Cyrus on Facebook from Sinead O'Connor. From the study's explorative intervention, it emerged that knowledge about Cultural studies with focus on three key concepts, intersectionality and othering (Dervin, F. 2016. Interculturality in Education: A Theoretical and Methodological Toolbox. London: Palgrave Macmillan) and subtextuality (Svarstad, L.K. 2016. Teaching interculturality: developing and engaging in pluralistic discourses in English Language Teaching, Århus University Press) supported the analysis of classroom dialogues and helped to conceptualise and develop a metalanguage of broader issues of interculturality.

Can clinical coordination be improved through Participatory Action Research (PAR) interventions?

Abstract Background Despite the effectiveness of Participatory Action Research (PAR) in reducing the gap between evidence and practice, its use to improve care integration is rare. The aim is to analyze the factors influencing the implementation of PAR interventions to improve clinical coordination in public health services networks of Brazil, Chile, Colombia, Mexico and Uruguay. Methods A qualitative, descriptive-interpretative study was conducted in participating healthcare networks of each country. Focus groups and individual semi-structured interviews were conducted to a criteria sample of participants: members of Local Steering Committee (LSC)(29), professionals’ platform (PP)(28), other professionals (49) and managers(28). Thematic content analysis was performed, segmented by country and themes. Results Findings reveal that contextual factors, the PAR process and interventions’ content were determinants in the implementation, interacting over time, and differing among experiences. On the one hand, institutional support (providing the necessary resources) together with the interest of professionals and managers in participating, emerged as influencing factors influenced by other factors related to: the system (alignment with policies; electoral cycle), networks (lack of time due to work overload; precarious employment conditions) and individuals (limited mutual knowledge and mistrust). On the other, some characteristics of the PAR process facilitated institutional support and motivation: professionals’ participation in all activities, design flexibility and shared decision-making - also present when interventions were based on mutual adjustment - the LSC’s leadership and the facilitating role of the research team. Conclusions Evidence is provided that when some contextual elements converge the implementation of interventions through PAR processes can turn into a factor of motivation and cohesion, determinant for the adoption of clinical coordination interventions. Key messages Contributes to fill the knowledge gap in factors influencing the implementation of PAR interventions in healthcare. Provides a framework for analysis and recommendations for their implementation.