Participatory Action Research Process Research Articles

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.

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.

The Extended Citizens’ Assembly Model for Collaborative Governance:

Based on data from two Citizens’ Assemblies and a year-long participatory action-research process, this article describes on-going attempts to shift the political culture towards collaborative governance in Gipuzkoa (Basque Country), Spain. Quantitative and qualitative evaluation data from a Citizens’ Assembly in 2022 suggest that such representative-deliberative processes might be transformative under some circumstances, increasing action confidence, building capacity and co-creating a shared vision of the future. Could it be that the increase in confidence is a side-result of the co-creation of a shared vision? The growing literature on the impact of standard Citizens' Assembly models is used to explore and refine this hypothesis. Research has uncovered some barriers to such an impact, such as outcome-contingency and difficulties to scale because limited resources. To tackle those problems, and help institutionalize existing Citizens’ Assemblies, a prototype for an Extended Citizens’ Assembly is presented. This model contributes to collaborative governance by facilitating online-onsite deliberation in a frugal way and further extending those transformative and visionary capacities that Citizens’ Assemblies and other experiments in democratic inquiry help to cultivate in cities and regions.

Participatory action research on webs of caring in the digital age across four European countries

PurposeThe digital age requires people of all ages to communicate and organise their lives through digital technologies. The project EQualCare investigates how the growing population of older people living alone is managing this transition, how it shapes their (non-)digital social networks and what changes on a local level need to be brought about. This paper aims to give insight into the process of participatory action research (PAR) with older people in the community across four countries and reflects on experiences made by academic and co-researchers.Design/methodology/approachFollowing the emancipatory underpinnings of PAR, which aims to reduce inequalities through collaboration and co-design, EQualCare involved nine teams of co-researchers across Finland, Germany, Latvia and Sweden making older people the centre of policy development. Co-researchers were involved in formulating research aims, collecting data, reflecting on data, formulating and disseminating recommendations for local policy stakeholders.FindingsCo-researchers’ motivation to invest considerable time and effort was driven by a desire to create a more equal future for older people living alone. Moreover, they were keen to involve marginalised older people and became frustrated when this proved difficult. Power dynamics played a role throughout the process but became productive as roles and responsibilities were renegotiated. Doing PAR with older people can be emotionally challenging for co-researchers when negative feelings around ageing are encountered.Originality/valueThe paper advances understanding on the process of PAR in ageing research by reflecting on the social, cultural and political contexts of doing PAR with diverse sets of older people.

The dementia-inclusive choices in exercise project: Using participatory action research to improve physical activity supports for persons with dementia.

Persons with dementia have the right to equal inclusion in rehabilitation, including physical activity. However, the perspectives of persons with dementia are rarely integrated into decision-making related to physical activity programming, services, and supports. Here, we describe the participatory action research (PAR) approach used to develop the Dementia-Inclusive Choices for Exercise (DICE) toolkit, which aims to increase the quality and number of physical activity opportunities available to persons with dementia. The DICE Research Team included persons with dementia, a family care partner, exercise professionals, community and dementia service providers, health care professionals, and researchers who worked to: 1) Engage/maintain the Research Team; 2) Set/navigate ways of engagement; 3) Understand barriers to physical activity; 4) Prioritize the audience and actions; 5) Develop the toolkit; 6) Conduct usability testing; and 7) Implement and evaluate. Guided by the Behaviour Change Wheel, and informed by interviews, focus groups, and existing research, our PAR Team chose to prioritize training exercise providers; exercise providers can enable exercise for persons with dementia if they understand common changes with dementia and how to support persons with dementia in exercise. The content and format of the toolkit was co-developed: drafted by our Research Team, adapted through a stakeholder workshop, and refined through iterative development and usability testing. The product of our PAR process, the DICE toolkit, includes videos meant to destigmatize dementia, training modules and a training manual for exercise providers, a physical activity handout for persons with dementia, and wallet cards to help persons with dementia communicate their abilities, needs, and preferences. Our usability study indicated that the toolkit could be used by exercise providers and may improve attitudes about dementia. Our vision is that our co-developed DICE toolkit will empower exercise providers to improve physical activity opportunities and support for persons with dementia.

팬데믹 속, 요양시설 거주노인들의 자기결정 지원: 돌봄종사자들과 함께 한 12주 동안의 실행연구 기록

This study focuses on efforts for human rights and self-assertive lives of elderly people struggling with long quarantine under
 the COVID-19 pandemic. This paper aims to explore and analyze what support strategies care workers are carrying out and what barriers
 exist to help the elderly living in nursing homes make 'self-determination' well. Data were collected from 16 workers at two institutions
 through an Participatory Action Research(PAR) process consisting of 17 FGI sessions, and the data were analyzed through directed content
 analysis. This study proposed 7 frameworks of practice. In the last COVID-19 situation, three factors such as ①Internalization of Extrinsic
 Motivation, ② Understanding Preference & Value, ③Close communication based on trust were smoothly implemented, while strategies such
 as ④Areas, ⑤Causal Agent, ⑥Providing information and options, ⑦Providing Enough time were not well utilized. Based on the results
 of the study, we presented the following policy suggestions. First, it is necessary to establish a system that can support the self-determination
 of the elderly living. Second, a friendly culture and environment should be created so that nursing facilities can work more actively. Also
 it is emphasized that there is a need for a place to actively discuss the base-line when there is a value that conflicts with self-determination.

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.

Indigenous Women and Their Nutrition During Pregnancy (the Mums and Bubs Deadly Diets Project): Protocol for a Co-designed mHealth Resource Development Study.

Nutrition in pregnancy is pivotal to optimizing infant growth and maternal well-being. The factors affecting Indigenous people's food and nutrition intake are complex with a history of colonization impacting the disproportionate effect of social determinants to this day. Literature regarding the dietary intake or dietary priorities of Indigenous women in Australia is scarce, with supportive, culturally appropriate resources developed for and with this group rare. Research suggests mobile health (mHealth) tools are effective in supporting health knowledge of Indigenous people and positive health behavior changes when designed and developed with the expertise of Indigenous communities. This study seeks to build the body of knowledge related to nutrition needs and priorities for Indigenous women in Australia during pregnancy. Further, this project team and its participants will co-design an mHealth digital tool to support these nutrition needs. The Mums and Bubs Deadly Diets study recruits Indigenous women and health care professionals who support Indigenous women during pregnancy into 2 phases. Phase 1 (predesign) uses a mixed methods convergent design using a biographical questionnaire and social or focus groups to inform phase 2 (generative). Phase 2 will use a participatory action research process during co-design workshops to iteratively develop the digital tool; the exact actions within a workshop will evolve according to the participant group decisions. To date, this project has undertaken phase 1 focus groups at all Queensland sites, with New South Wales and Western Australia to begin in early to mid-2023. We have recruited 12 participants from Galangoor Duwalami, 18 participants from Carbal in Toowoomba, and 18 participants from Carbal in Warwick. We are expecting similar numbers of recruits in Western Australia and New South Wales. Participants have been both community members and health care professionals. This study is an iterative and adaptive research program that endeavors to develop real-world, impactful resources to support the nutrition needs and priorities of pregnant Indigenous women in Australia. This comprehensive project requires a combination of methods and methodologies to ensure Indigenous voices are heard at each stage and in all aspects of research output. The development of an mHealth resource for this cohort will provide a necessary bridge where there is often a gap in access to nutrition resources for women in pregnancy in Indigenous communities. DERR1-10.2196/45983.

Evaluating Human Papillomavirus eHealth in Hmong Adolescents to Promote Vaccinations: Pilot Feasibility Study.

Human papillomavirus (HPV) is a common sexually transmitted infection, causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished by HPV vaccination. Unfortunately, vaccination rates among Hmong Americans are substantially lower than those among other racial and ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally appropriate educational interventions to improve HPV vaccine rates in Hmong Americans. We aimed to develop and evaluate the effectiveness and usability of an innovative web-based eHealth educational website, the Hmong Promoting Vaccines website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations. Through social cognitive theory and community-based participatory action research process, we created a theory-driven and culturally and linguistically appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website's effectiveness and usability. Overall, 30 Hmong-American parent and adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at preintervention, 1 week after intervention, and at the 5-week follow-up. Participants responded to survey questions about website content and processes at 1 and 5 weeks, and a subset of 20 dyad participants participated in telephone interviews 6 weeks later. We used paired t tests (2-tailed) to measure the change in knowledge, self-efficacy, and decision-making processes, and used template analysis to identify a priori themes for website usability. Participants' HPV and HPV vaccine knowledge improved significantly from pre- to postintervention stage and follow-up. Knowledge scores increased from preintervention to 1 week after intervention for both parents (HPV knowledge, P=.01; vaccine knowledge, P=.01) and children (HPV knowledge, P=.01; vaccine knowledge, P<.001), which were sustained at the 5-week follow-up. Parents' average self-efficacy score increased from 21.6 at baseline to 23.9 (P=.007) at post intervention and 23.5 (P=.054) at follow-up. Similar improvements were observed in the teenagers' self-efficacy scores (from 30.3 at baseline to 35.6, P=.009, at post intervention and 35.9, P=.006, at follow-up). Collaborative decision-making between parents and adolescents improved immediately after using the website (P=.002) and at follow-up (P=.02). The interview data also revealed that the website's content was informative and engaging; in particular, participants enjoyed the web-based quizzes and vaccine reminders. This theory-driven, community-based participatory action research-designed and culturally and linguistically appropriate educational website was well received. It improved Hmong parents' and adolescents' knowledge, self-efficacy, and decision-making processes regarding HPV vaccination. Future studies should examine the website's impact on HPV vaccine uptake and its potential for broader use across various settings (eg, clinics and schools).

Development of a health promotion action with mothers aiming to support a healthy start in life for children using Participatory Action Research

ABSTRACT Health inequalities arise already during the first thousand days of a child’s life. Participatory action research (PAR) is a promising approach, addressing adverse contexts that impact health inequalities. This article describes the experience of mothers involved in a PAR process to develop a health promotion action that supports both children’s and mothers’ health. It also describes the experiences of mothers who attended the developed action and trainers who facilitated it. The PAR process resulted in the development of a sustained action called Mama’s World Exercise Club aimed at promoting the health of mothers and their children. Results showed that the PAR process empowered the mothers and gave them a sense of pride at playing a useful role in their community. The developed action was highly valued by other mothers in the neighbourhood and widely implemented. These positive results can be ascribed to the strong collaboration between the researchers and the mothers, and the willingness of local stakeholders to support the action. Future studies should investigate if the results of this study sustain over a longer period of time and improve health outcomes of children and mothers in the long run.

Developing teachers’ capacity to support students’ assessment experiences: An exploratory participatory action research project in collaboration with high school students

ABSTRACT Involving young people in the co-production of whole-school wellbeing strategies is aligned with the United Nations rights of the child and current UK legislation. This exploratory participatory action research (PAR) project aimed to facilitate teacher-student collaboration in one high school to develop whole-school practice with a focus on assessment. Training videos were co-created focusing on students’ assessment experiences and ways to improve wellbeing and performance. Reflexive thematic analysis of the data identified key facilitators and challenges to the PAR process, alongside insights into students’ assessment experiences. The paper concludes that PAR has the potential to empower young people and open channels of communication between students and teachers. Implications for educational psychology (EP) practice and future research are discussed.

Lessons learnt from the process of designing care coordination interventions through participatory action research in public healthcare networks of six Latin American countries

BackgroundThe participation of health professionals in designing interventions is considered vital to effective implementation, yet in areas such as clinical coordination is rarely promoted and evaluated. This study, part of Equity-LA II, aims to analyse the design process of interventions to improve clinical coordination, taking a participatory-action-research (PAR) approach, in healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. This participatory process was planned in four phases, led by a local steering committee (LSC): (1) dissemination of problem analysis results and creation of professionals’ platform, (2) selection of problems and intervention (3) intervention design and planning (4) adjustments after evaluation of first implementation stage.MethodsA descriptive qualitative study based on documentary analysis, using a topic guide, was conducted in each intervention network. Documents produced regarding the intervention design process were selected. Thematic content analysis was conducted, generating mixed categories taken from the topic guide and identified from data. Main categories were LSC characteristics, type of design process (phases, participants’ roles, methods) and associated difficulties, coordination problems and interventions selected.ResultsLSCs of similar composition (managers, professionals and researchers) were established, with increasing membership in Chile and high turnover in Argentina, Colombia and Mexico. Following results dissemination and selection of problems and interventions (more participatory in Chile and Colombia: 200–479 participants), the interventions were designed and planned, resulting in three different types of processes: (1) short initial design with adjustments after first implementation stage, in Colombia, Brazil and Mexico; (2) longer, more participatory process, with multiple cycles of action/reflection and pilot tests, in Chile; (3) open-ended design for ongoing adaptation, in Argentina and Uruguay. Professionals’ time and the political cycle were the main barriers to participation. The clinical coordination problem selected was limited communication between primary and secondary care doctors. To address it, through discussions guided by context and feasibility criteria, interventions based on mutual feedback were selected.ConclusionsAs expected in a flexible PAR process, its rollout differed across countries in participation and PAR cycles. Results show that PAR can help to design interventions adapted to context and offers lessons that can be applied in other contexts.

Realising radical potential: building community power in primary health care through Participatory Action Research

BackgroundWhile community participation is an established pro-equity approach in Primary Health Care (PHC), it can take many forms, and the central category of power is under-theorised. The objectives were to (a) conduct theory-informed analysis of community power-building in PHC in a setting of structural deprivation and (b) develop practical guidance to support participation as a sustainable PHC component.MethodsStakeholders representing rural communities, government departments and non-governmental organisations engaged through a participatory action research (PAR) process in a rural sub-district in South Africa. Three reiterative cycles of evidence generation, analysis, action, and reflection were progressed. Local health concerns were raised and framed by community stakeholders, who generated new data and evidence with researchers. Dialogue was then initiated between communities and the authorities, with local action plans coproduced, implemented, and monitored. Throughout, efforts were made to shift and share power, and to adapt the process to improve practical, local relevance. We analysed participant and researcher reflections, project documents, and other project data using power-building and power-limiting frameworks.ResultsCo-constructing evidence among community stakeholders in safe spaces for dialogue and cooperative action-learning built collective capabilities. The authorities embraced the platform as a space to safely engage with communities and the process was taken up in the district health system. Responding to COVID-19, the process was collectively re-designed to include a training package for community health workers (CHWs) in rapid PAR. New skills and competencies, new community and facility-based alliances and explicit recognition of CHW roles, value, and contribution at higher levels of the system were reported following the adaptations. The process was subsequently scaled across the sub-district.ConclusionsCommunity power-building in rural PHC was multidimensional, non-linear, and deeply relational. Collective mindsets and capabilities for joint action and learning were built through a pragmatic, cooperative, adaptive process, creating spaces where people could produce and use evidence to make decisions. Impacts were seen in demand for implementation outside the study setting. We offer a practice framework to expand community power in PHC: (1) prioritising community capability-building, (2) navigating social and institutional contexts, and (3) developing and sustaining authentic learning spaces.

Turbulence: Arts-based participatory action research on the experience of creative arts therapists and creatives who identify as Black and people of colour

Following the production of Turbulence, an original play featuring the experiences of creative arts therapists and creatives who identify as Black and people of colour (BPOC), members of the ensemble agreed to engage in an arts-based participatory action research process in which co-researchers drew on dramatic, visual, musical and poetic forms of inquiry to ask themselves about the realities and hopes faced by this community and the environmental conditions that would support their movement, growth and mobility. Findings emphasized the value and necessity of creative affinity groups together with sustainable structural, financial and relational support to encourage the hopes and dreams of BPOC students and professionals.