Participatory Action Research Process Research Articles

Participatory Action Research and Knowledge Dissemination in Virtual Photovoice: Methodological Insights.

Despite the methodological spread of virtual photovoice, alignments to and potential advances for the participatory action research (PAR) and knowledge dissemination (KD) components of in-person photovoice are poorly understood. Detailing the PAR and KD processes, practices, and products drawn from a virtual photovoice study examining men's experiences of and perspectives about equitable intimate partner relationships, the current article offers three thematic findings. The first theme Processes and pragmatics for selecting representative photographs describes adapting established analytics of preview, review, and cross-photo comparisons to categorize and select images from a large collection of participant-produced photographs (n = 714). Specifically, detailed are the reconciling of researchers deciding which images and accompanying narratives to include guided by PAR principles. Theme 2, Democratizing and disrupting in-person PAR with virtual focus group polls (VFGPs), chronicles participant voting through Zoom to collectively decide and subsequently discuss their favorite photographs. While anonymity for the poll was democratizing in terms of participant equality for voting on the photographs, connecting men virtually from diverse locales could differentiate cultural norms. The third theme KD pledges and pitfalls with online photovoice exhibitions details the potential benefits and challenges for reaching diverse end-users. Evident was the importance of marketing and media for driving traffic to the online exhibition, and the centrality of interactivity for fostering engagement to build and adjust photovoice e-health interventions. With virtual photovoice continuing to grow in popularity post COVID-19, this article offers important methodological lessons for adapting and advancing components of in-person PAR and KD.

Relational knowledge and young people’s cancer care: how community-based participatory research promotes learning and directs action in practice

ABSTRACT This paper reflects on the dynamic of co-developing knowledge within a Community-Based Participatory Research (CBPR) project in the UK that set out to direct teenage and young adult Ambulatory Care. This is a service that offers cancer treatment that would have once required inpatient hospital stays. Working within a Community-of-Inquiry (CoI), young people from this cancer community became co-researchers, participating in every phase of the qualitative research. This contribution is written from the perspective of two members of the CoI, Alison, a cancer researcher-practitioner, and Michela, a young associate researcher with lived experience of cancer. Drawing on the Ambulatory Care research as a case study, they offer a reflective account of involving young people in research that directs both action and participatory action research processes. In doing so, they engage in a critical exploration of their participatory research inquiry, contextualising their discussion with some of the extant literature relevant to their chosen CBPR approach. The researchers found that both Ambulatory Care and their research dynamic foster young people’s agency. Evident too, was that within research that prioritises relationships and knowledge democracy and which associates with a sense of the collective, individuality can also sit comfortably alongside. The authors conclude this that distinctiveness is a strength, which enhances the learning, criticality, and reach of engaged research inquiry.

Neighbourhood-based participatory action research with older adults: Facilitating participation through virtual and remote methods

Participatory action research (PAR) is an effective means of collaborating with older adults to support community change. Limited PAR literature exists in which older adults catalyse social change within neighbourhoods, particularly using virtual methods. In this paper, we discuss a virtual PAR process with older adults that occurred during the COVID-19 pandemic, and the results of inquiry into our application of PAR principles. We conducted PAR in a collective involving university researchers, older adult residents and community partners in an urban core neighbourhood in a mid-sized Canadian city and focused on enhancing daily life for older adults. The PAR project emerged through reflection on previous ethnographic findings regarding older adults’ daily life in neighbourhoods. Our PAR collective collaboratively identified a need among older adults for more accessible information about community resources. To support older adults’ participation and access to community information, the PAR collective created and distributed a free neighbourhood resource booklet, in print and digital formats, to promote equitable access. We evaluated the impact of the booklet through a survey and discussions with community partners. During our PAR process we found challenges and solutions related to using technology, engaging in discussion during virtual meetings, and making collaborative decisions. A combination of in-person, remote and online interactions seemed to facilitate relationship development amongst co-researchers and completion of the project. Future PAR projects would benefit from incorporating in-person, remote and online methods from the outset, as well as ways to support older adults in using and accessing technology. We further noted the value of a local resource booklet, in print and digital formats, in promoting neighbourhood information sharing.

Involving Nurses in Participatory Action Research: Facilitators and Barriers

Involving nurses in research and quality improvement is desirable because nurses are often aware of weaknesses in care or organizational processes. In participatory action research (PAR), practitioners are encouraged to identify problems they encounter and, together with the researcher, develop strategies to solve these problems. This study aimed to evaluate the process of involving nurses in PAR, as well as learn what hampers and facilitates collaboration between the nursing team and the researcher and facilitator. Data collected during a 2.5-year PAR process with a nursing team (15–18 participants) on a geriatric rehabilitation ward was deductively analyzed using seven quality criteria (collaboration, prudent handling of assumptions, accountability, participation, reflection, knowledge sources, and transparency). This study describes how reflection and collective learning as core processes of PAR were facilitated using complementary knowledge sources (theoretical models, knowledge based on practical experiences, and results of empirical research collected during the PAR). The study uncovered that providing the time and setting for reflection and collective learning enables a nursing team to be actively involved in PAR: it helps them diagnose their current practice, plan ahead, and critically experiment with actions. Additionally, a positive learning climate is a prerequisite for this process. However, without a strong link between quality policy and consequent facilitation of participation through earmarked time, these efforts might not lead to sustainable changes. A more permanent link between PAR initiatives and organizational ambitions regarding quality of care is recommended.

The regional development and implementation of home-based stroke rehabilitation using participatory action research

Purpose This study aims to overcome the challenges experienced in the regional development and implementation of home-based stroke rehabilitation (HBSR) and to understand the change process needed. Materials and methods Using participatory action research (PAR), participants and researchers collaboratively produced knowledge and took action to improve the offered HBSR. Different methods for data generation and analysis were used, depending on the aim of the PAR phase and the participants’ stages of change. The Consolidated Framework for Implementation Research (CFIR) was used to select implementation strategies and to evaluate the implementation process. Results Developing and implementing HBSR resulted in multiple products that promoted the implementation of a regional stroke network and affiliated work arrangements. Work arrangements were embodied in a stroke care pathway, follow-up tool, and expertise requirements. Evaluating the PAR process identified participants being able to take the lead, being facilitated by others, and making progress visible, as implementation facilitators. Collaborating within a primary care project can be challenging but is considered essential and has a positive impact on multiple levels. Also, the implementation of HBSR calls for multiple implementation strategies reflecting multiple CFIR constructs. Conclusion This study highlights the complexity and achievements of developing and implementing HBSR using PAR.

Developing a Participatory Action Research Analytic Network to Advance a More Inclusive Process to Housing Research

Community residents have repeatedly organized and identified policy solutions to address rapidly increasing housing pressures within the greater Boston area. However, resident expertise is often dismissed as anecdotal. Since 2015, The Healthy Neighborhoods Research Consortium (HNRC) has used a participatory action research (PAR) approach to articulate research questions, design mixed methods instruments, collect and analyze data, and share findings to meet community-identified research priorities. We argue in favor of research processes that enable resident experiences and expertise to be used in conjunction with quantitative data analysis, and that support real-time action to address the harms of gentrification in their communities. The goals of this brief are to describe the HNRC’s process for developing a “PAR Analytic Network” — a program focused on building community residents’ power to create new academic partnerships for the purpose of answering their broader systems-level questions. Based on our experience we offer four recommendations: 1) Apply a PAR approach to identify research question(s) of mutual interest; 2) Community control over the academic partner selection process; 3) Academic Partners: Trust the PAR process; and 4) Community Residents: Identify the Silver Linings.

Reflections on the opportunities and challenges of applying experience-based co-design (EBCD) to phase 1 clinical trials in oncology.

Experience-Based Co-Design (EBCD) is a multi-stage participatory action research process which was developed originally to increase patient involvement in service improvement initiatives. This viewpoint article serves as a reflection on the researchers' experiences, focusing on the application and feasibility of participatory approaches, particularly co-design, in the specific context of early-phase clinical trials. We reflect on the opportunities and challenges of applying EBCD in a new context of early-phase clinical trials in oncology where experimental treatments are increasingly perceived as a therapeutic option and, in certain instances, their efficacy may lead to accelerated approval facilitating a swifter integration into standard care. We propose that the opportunity of applying EBCD in such trials lies in improving the delivery of person-centered care, care coordination, and support during the transition from experimental to standard care. Three potential challenges when applying EBCD in early-phase clinical trials are discussed related to: the need for standardization in trial processes; planning EBCD in a context of high uncertainty; and vulnerability of patient populations. Integrating EBCD into early-phase oncology trials presents an opportunity to enhance person-centered care and can lead to simultaneous improvements in care processes and therapeutic development. This article has been developed with the collaboration of a patient partner who serves on the advisory board of our ongoing EBCD study in early clinical trials.

"Let's talk about it": Black youths' perceptions on the development of a school-based social media campaign.

The increase in social media mental health (MH) campaigns provides an opportunity to improve awareness and attitudes toward MH. However, racial disparities remain in these social media campaigns. Black youth who participated in MH social media campaigns reported lower levels of improvement in stigma and help-seeking than their White peers. We employed a youth participatory action research (YPAR) process to expand on a previous community-wide MH social media campaign (A. Thompson et al., 2021), focusing on a Central Midwest community. We studied Black adolescents' perceptions of MH stigma and help-seeking to determine essential features of a culturally responsive MH social media campaign for Black youth. With a lead youth-research collaborator, the research team designed the following two-staged study. The first stage consisted of four semistructured focus group interviews (FGIs) (N = 20), analyzed by using a rapid analysis strategy to obtain results for the development of the campaign. In the second stage, using YPAR's iterative and action-based process, five youth researchers collaborated with the research team on the campaign's design. Following the two stages, the researcher's thematic analysis resulted in three themes: (a) broadening horizons for campaign designers and MH professionals; (b) considering mistrust of schools and school personnel; and (c) diverse experiences, sustainability, and accessibility in a campaign. Findings indicated that while culturally responsive social media campaigns to promote MH can be designed, mistrust of adults in schools is likely to hinder the impact of such campaigns. Implications for school psychology practice and research are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluating the process of practice enhancement for exclusive breastfeeding (PEEB): a participatory action research approach for clinical innovation

BackgroundDespite the known benefits of exclusive breastfeeding, global rates remain below recommended targets, with Ireland having one of the lowest rates in the world. This study explores the efficacy of Participatory Action Research (PAR) and Work-Based Learning Groups (WBLGs) to enhance breastfeeding practices within Irish healthcare settings from the perspective of WBLG participants and facilitators.MethodsEmploying a PAR approach, interdisciplinary healthcare professionals across maternity, primary, and community care settings (n = 94) participated in monthly WBLGs facilitated by three research and practice experts. These sessions, conducted over nine months (November 2021 – July 2022), focused on critical reflective and experiential learning to identify and understand existing breastfeeding culture and practices. Data were collected through participant feedback, facilitator notes, and reflective exercises, with analysis centered on participant engagement and the effectiveness of WBLGs. This approach facilitated a comprehensive understanding of breastfeeding support challenges and opportunities, leading to the development of actionable themes and strategies for practice improvement.ResultsData analysis from WBLG participants led to the identification of five key themes: Empowerment, Ethos, Journey, Vision, and Personal Experience. These themes shaped the participants’ meta-narrative, emphasising a journey of knowledge-building and empowerment for breastfeeding women and supporting staff, underlining the importance of teamwork and multidisciplinary approaches. The project team’s evaluation highlighted four additional themes: Building Momentum, Balancing, Space Matters, and Being Present. These themes reflect the dynamics of the PAR process, highlighting the significance of creating a conducive environment for discussion, ensuring diverse engagement, and maintaining energy and focus to foster meaningful practice changes in breastfeeding support.ConclusionThis study highlights the potential of WBLGs and PAR to enhance the understanding and approach of healthcare professionals towards breastfeeding support. By fostering reflective and collaborative learning environments, the study has contributed to a deeper understanding of the challenges in breastfeeding support and identified key areas for improvement. The methodologies and themes identified hold promise to inform future practice and policy development in maternal and child health.

Abandoning a discourse of poverty to develop equitable educational practices through family school partnerships

ABSTRACT A discourse of poverty can influence teachers’ perceptions towards and ways of supporting parents’ engagement in their children’s learning. In 2021, Goodall invited us to examine the discourse surrounding a culture of poverty and seek ways to engage with parents so that we might dismantle systemic inequities. This study explored four primary school teachers’ consideration of how they could adapt their own practices to strengthen families’ engagement in their children’s learning. Data collection incorporated transcripts from reflective practice meetings and semi-structured interviews utilised throughout a two-cycle process of Critical Participatory Action Research. The theory of practice architectures framed analysis of the teachers’ language (sayings), activities (doings) and relationships (relatings) within parent engagement and the specific conditions which support and hinder practice. Within this study the participating teachers perceived that parent engagement is more achievable in a dominant community. Within the nondominant community where the teachers worked, social and cultural factors were perceived to problematise parent engagement. This paper advocates for schools to routinely embed reflexive practices which support teachers to examine and address systemic impediments to parent engagement.

Changing the delivery of continuing professional education: An action research approach

AimA participatory action research project was used to change the design and delivery of continuing professional education in a large Irish academic teaching hospital. BackgroundParticipation in continuing professional education, designed as a short course, is often a method to maintain competence for many nurses. Structured short education courses are often used to orientate and upskill new staff to specialist clinical areas. Traditionally many courses relied on face-to-face delivery over a period of weeks which is challenging for one clinical area to release staff to attend theoretical days in person. DesignA six-stage participatory action research cycle over a 3-year period in a large Irish academic teaching hospital. MethodsMultiple methods were used in the cyclical process of participatory action research. Constructive alignment theory and instructional design principles were used to redesign the educational framework. Data collection included audits of courses, questionnaires and focus groups with key participants. ResultsAnalysis of the focus group themes included 1) underestimated time 2) the process of change 3) teaching and learning styles and 4) acceptance and integration. 20 learners completed the evaluation and reported a positive synergy between e-learning and clinical workshops. E-learning was reported as time-consuming. 75 % of learners reported they were motivated to learn. 90 % of the learners reported they gained new knowledge and skills, 84 % reported the clinical area benefited from the education and 80 % identified a direct improvement in their clinical skills in the specialist area. ConclusionsParticipatory action research supports organisational change in continuing professional education. Constructive alignment theory supports the value of outcomes-based learning. In this context it resulted in successfully blending theory and clinical skills for nurses working in specialist areas. The redesigned continuing professional education framework was positively evaluated across nurses in the organisation.

Centering Community Voice and Knowledge through Participatory Action Research

This paper analyzes a Participatory Action Research (PAR) Project focused on improving public safety and community lighting in one Latinx immigrant community in California as a case example to better understand the possibilities for university-community-government partnerships.  The paper explores residents' motivations for their sustained participation in the project, the relationships and power dynamics that led to a $100,000 commitment from the city government to fund the recommendations of the PAR collective, and the social contexts that allowed community residents to position themselves as political actors as the PAR project progressed over the 2021-2022 academic year.  This case example illustrates how including key stakeholders from powerful community institutions in the PAR process not only created opportunities for dialogue and social change that would not have occurred without this collaboration, but also provided critical spaces for the women to develop their stance as political actors in relationship to people in power.

Adapting and translating the 'Hep B Story' App the right way: A transferable toolkit to develop health resources with, and for, Aboriginal people.

In 2014 the 'Hep B Story App', the first hepatitis B educational app in an Aboriginal language was released. Subsequently, in 2018, it was assessed and adapted before translation into an additional 10 Aboriginal languages. The translation process developed iteratively into a model that may be applied when creating any health resource in Aboriginal languages. The adaptation and translation of the 'Hep B Story' followed a tailored participatory action research (PAR) process involving crucial steps such as extensive community consultation, adaptation of the original material, forward and back translation of the script, content accuracy verification, voiceover recording, and thorough review before the publication of the new version. Iterative PAR cycles shaped the translation process, leading to a refined model applicable to creating health resources in any Aboriginal language. The community-wide consultation yielded widespread chronic hepatitis B education, prompting participants to share the story within their families, advocating for hepatitis B check-ups. The project offered numerous insights and lessons, such as the significance of allocating sufficient time and resources to undertake the process. Additionally, it highlighted the importance of implementing flexible work arrangements and eliminating barriers to work for the translators. Through our extensive work across the Northern Territory, we produced an educational tool for Aboriginal people in their preferred languages and developed a translation model to create resources for different cultural and linguistic groups. SO WHAT?: This translation model provides a rigorous, transferable method for creating accurate health resources for culturally and linguistically diverse populations.

Exploring the relationship between legislative theatre and critical participatory action research

ABSTRACT In this paper, we argue that Legislative Theatre processes, as presented by Boal in his book Legislative Theatre: Using Performance to Make Politics and initially implemented in Rio de Janeiro in 90’, can be considered (Critical Participatory) Action Research processes and conducted as such – depending on the approach of the process leader and their consciousness. We present the scope of Legislative Theatre as part of the techniques of the Theatre of the Oppressed, and we outline the common origins of Legislative Theatre and Action Research in the work of Freire, Boal, Moreno, and Lewin. We explore similarities and differences between their ideas to show where they are convergent and where they are not. In doing so, we aim to highlight the importance of the Action Research perspective for enhancing the work of social activists using Legislative Theatre. We consider the possible benefits and costs of such integration, and we conclude the paper with recommendations for further research.

Developing the Feast for the Future Program through a Community Visioning Process

Abstract: Background: Three tribal communities in the Southwestern United States have a long-standing partnership with the Johns Hopkins Center for Indigenous Health (JHCIH). Objectives: In response to community concerns about obesity, three tribal communities and Johns Hopkins Center for Indigenous Health partnered to develop culturally relevant plans for a new program. Methods: Using a "community visioning" process, a community advisory board (CAB) from each community identified opportunities, challenges, goals, and visions for their communities. The CABs consulted with experts in pediatrics, nutrition, food distribution, agricultural restoration, and community and school gardening. Results: The CABs developed seven components for Feast for the Future: 1) Edible School Gardens; 2) Traditional Food-ways Education Program; 3) Community Gardens, Orchards, and Greenhouses; 4) Farmers Markets; 5) Farmers Workshops; 6) Family Gardens; and 7) a Mobile Grocery Store. Conclusions: A community-based participatory action research (CBPAR) process was critical to developing a culturally appropriate program that built on community strengths.

Opening decision spaces: A case study on the opportunities and constraints in the public health sector of Mpumalanga Province, South Africa.

Decentralised and evidence-informed health systems rely on managers and practitioners at all levels having sufficient 'decision space' to make timely locally informed and relevant decisions. Our objectives were to understand decision spaces in terms of constraints and enablers and outline opportunities through which to expand them in an understudied rural context in South Africa. This study examined decision spaces within Mpumalanga Province, using data and insights generated through a participatory action research process with local communities and health system stakeholders since 2015, which was combined with published documents and research team participant observation to produce findings on three core domains at three levels of the health system. Although capacity for decision making exists in the system, accessing it is frequently made difficult due to a number of intervening factors. While lines of authority are generally well-defined, personal networks take on an important dimension in how stakeholders can act. This is expressed through a range of informal coping strategies built on local relationships. There are constraints in terms of limited formal external accountability to communities, and internal accountability which is weak in places for individuals and focused more on meeting performance targets set at higher levels and less on enabling effective local leadership. More generally, political and personal factors are clearly identified at higher levels of the system, whereas at sub-district and facility levels, the dominant theme was constrained capacity. By examining the balance of authority, accountability and capacity across multiple levels of the provincial health system, we are able to identify emergent decision space and areas for enlargement. Creating spaces to support more constructive relationships and dialogue across system levels emerges as important, as well as reinforcing horizontal networks to problem solve, and developing the capacity of link-agents such as community health workers to increase community accountability.

Supporting delivery of remote pulmonary rehabilitation across different healthcare contexts: A multi-national study.

Purpose: This study aimed to understand factors that health professionals, from a variety of healthcare contexts and countries, believed support remote delivery of pulmonary rehabilitation (PR); and to develop a targeted intervention to support implementation of remote PR. Methods: A 3-phase participatory action-research process was employed, across three study hubs in three countries (NZ, India, USA), representing diverse healthcare delivery contexts. Phase 1 employed focus groups of health professionals working in PR; data were analysed qualitatively with transcripts coded against two implementation frameworks (Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR)). Findings informed development of an online toolbox to support delivery of remote PR (Phase 2), which was evaluated using semi-structured interviews (Phase 3). Results: 20 health professionals participated across all study phases. Factors considered to influence implementation of remote PR were consistent across diverse healthcare contexts and related to staffing availability, skills and confidence, and equipment and technology accessibility. An online toolbox provided support for enhancing knowledge and confidence, but was not able to address all implementation barriers. Discussion: Key factors to support clinicians deliver remote PR are common across different healthcare contexts, suggesting broader telerehabilitation implementation strategies may be applicable across healthcare environments.

Improving goal setting and achieving in geriatric rehabilitation through participatory action research

Introduction/background summary: In geriatric rehabilitation a means to achieve client centered care is to work collaboratively on setting and achieving goals. This might enhance self-efficacy, motivation, adherence to rehabilitation and goal-specific performance. In this participatory action research (PAR) project, a nursing team investigated for itself how to improve goal setting and achieving.
 Who is it for? The actions the nursing team chose and implemented contribute to improved goal setting and achieving and subsequently enhances client centered care.
 Who did you involve and engage with? This research project took place in a Learning and Innovation Network (LIN) on a geriatric rehabilitation ward, in which students and nurses work together on quality improvement projects. The team consisted of fifteen vocational trained nurses and healthcare assistants and eight nursing students, a nurse team leader and a lecturer practitioner spending a day per week on educational activities.
 What did you do? Facilitated by the lecturer practitioner, the nursing team (both staff and students) conducted a participatory action research project: they reflected on the steps they could take to work collaboratively on improving their practice, constantly evaluating their experiences. Data collected during the participatory action research consisted of, amongst others: student’s notes on patient interviews and interviews with nurses of the team, fieldnotes made by the facilitator during the PAR process. During PAR there is a constant need to feedback information and clarify issues. Therefor data analysis in PAR is partly performed concurrently. Data which had been collected by the facilitator or the nurses or students were used as a basis for planning and reflecting in the project group.
 
 Results: The team identified two themes influencing their goal setting and goal achieving with patients. Firstly, continuity of care is sub-optimal; in their opinion all should work on the same goals. Secondly, patients could be better informed about their rehabilitation path. The team chose to work on better preparation of the multidisciplinary care plan meeting with the patient and at the same time updating the patient record to advance continuity of care. A sound evaluation of the rehabilitation process and preparing the multidisciplinary care plan meeting to attain this, is now part of a shared team practice. During their process the team discovered certain barriers to optimally prepare the multidisciplinary care plan meeting, e.g. to optimally evaluate progress on rehabilitation goals the initial plan needs to be complete; certain barriers hamper preparation with the patient, like cognitive abilities or language problems. New actions have been chosen and are being worked on.
 Learning for the international audience: PAR which involves nurses can be seen as advantageous for facilitating change and improving services. Time and setting for reflection and collective learning supports the nursing team to diagnose their current practice and to improve their practice.
 Next steps: The Learning and Innovation Network was a temporary agreement between the nursing home and the nursing college based on research funding. Because of the positive results on team culture of improvement the Learning and Innovation Network might become a permanent facility.

Integrating Irish health care: How can we use the United Nations Convention on the Rights of Persons with Disabilities and Nine Pillars of Integrated Care?

Introduction: Over 1 billion (15%) of the world’s population are estimated to experience some form of disability, of whom up to 190 million people live with significant difficulties in functioning, often requiring health care services.
 Despite a myriad of policies and research, disabled people globally continue to be denied their human rights and face enduring barriers to full participation in society.
 The United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) is an International Treaty setting out legal obligations on States to promote and protect the rights of persons with disabilities. It provides a unique opportunity to improve the quality of life of all disabled people. The convention identifies that disability arises as a result of barriers in society, including negative attitudes, inappropriate or inaccessible services that result in discrimination against persons with disabilities. The convention includes persons who are or will require Integrated Care. A number of the fifty Articles of the Convention are relevant as a framework to guide the implementation of Integrated Care for and with persons with disabilities. The aim of this workshop was to seek to understand how UNCRPD articles and the IFIC 9 pillars might inform priorities for integrated care.
 Methods: Led and co-designed by people with disabilities, a workshop was held to seek to understand from a broad audience how to use the UNCRPD to frame integrated health care in Ireland in parallel with the IFIC 9 pillars of integrated care.
 The workshop used a World Café methodology, a participatory multi-stakeholder action research process that takes place in a cafe style setting and supports the development of collective knowledge among individuals and communities to address shared problems.
 Participants were allocated into four groups to discuss the following four questions under the guidance of facilitators -
 1.In the context of the UNCRPD and the IFIC 9 pillars of integrated care what are the top 3 priorities to be addressed for people with disabilities across Ireland?
 2.What is currently happening in advancing integrated care for people with disabilities in Ireland?
 3.What would a successful, innovative integrated care system for people with disabilities in Ireland look like?
 4.What are the top 3 solutions you would like to see and work to see implemented immediately?
 Feedback and perspectives were captured on post-it notes and flipcharts and subsequently collated by facilitators. Data were reviewed, and a thematic analysis was conducted.
 Results: There were 20 participants from diverse backgrounds, including experts by experience, disabled persons organisations, academia and health services. Four key themes were generated through inductive thematic analysis: 1) the importance of co-production, 2) the need for equity as opposed to equality, 3) the need for data collection, sharing and knowledge mobilisation and 4) the need for a socioecological integrated care system for people with disabilities.
 Conclusions: Having policies and conventions, and models for the rights of persons with disabilities is not sufficient to ensure implementation. Successful implementation of integrated care needs enablers, including co-production of initiatives with persons with disabilities.

Stimulating existential communication - first steps towards enhancing health professionals' reflective skills through blended learning.

Talking about existential issues with patients is often experienced as challenging for healthcare professionals. This paper describes our first steps towards developing existential communication training with particular attention to reflective learning methods. Blended learning was chosen to support reflection and an easier transition to classroom conversations, and through Participatory Action Research (PAR), patients were involved in developing the curriculum. To develop the most valuable and relevant communication training, patients, relatives, healthcare professionals and researchers were involved in a PAR process including 1) three theatre workshops and 2) collaborative meetings to develop the blended learning curriculum and reflection videos. The evaluation of the communication training was based on semi-structured interviews with the healthcare professionals participating in the blended learning communication training. The results indicate that a blended learning format involving a high degree of reflection is valuable for developing skills related to existential communication. Engaging patients in the process may be essential to develop a training curriculum for healthcare professionals that accommodates the patient's needs. Future communication training on existential communication may benefit from adopting a blended learning format, including reflective learning methods and the involvement of patients in curriculum development.