Principles Of Participatory Action Research Research Articles

Participatory action research in critical data studies: Interrogating AI from a South–North approach

In this article, we draw inspiration from participatory action research (PAR) and the work of Latin American thinkers such as Freire and Fals Borda to interrogate artificial intelligence (AI). We propose a South-North flow by utilising PAR approaches that stem from Latin America, challenging how the North's centrality is taken for granted regarding AI epistemologies, experiences, and understandings. Conducting workshops in London with a diverse group of students, tech workers and activists, we argue that PAR can not only empower marginalised communities in the Global South; we can also learn more from its application in the Global North, in contexts where people deal with different struggles. Our analysis delves into three specific concepts around AI and data (in)justice: autonomy, empathy and dialogue. First, inspired by PAR principles, participants started to problematise what they called an empty interpretation of empathy, establishing parallels with transnational dynamics of data capitalism, which disadvantage marginalised communities in the Global South. Second, PAR offered a critical lens to analyse issues of AI and autonomy in ways that are less individualistic and more collective and politically engaged. Third, PAR's dialogical spirit enabled participants to locate various intersections between AI and dialogue. Critiquing the idea of a superior AI, participants were reminded of the possibilities offered by human intelligence and the combination of thinking, making and feeling or what Fals Borda (2003. Ante la crisis del país: I deas acción para el cambio, 1st. Ed. Bogotá: Panamericana) calls our sentipensante nature.

Exploring barriers to accessing mental health services within minoritised communities in Nottingham City, UK - a creative participatory approach to service improvement

ObjectivesWe use an art-based approach to engage and involve members of African, African Caribbean and Muslim communities’ in exploring barriers to accessing and using mental health services in the co creation and co-production of mental health communication material. Study designA creative practice approach underpinned by the principles of participatory action research was used. MethodsSeven community-based interactive workshops were held between February and June 2022 at three community centres in Nottingham, UK Attendees were invited to take part in open discussions around the conceptualisations of mental health, well-being and emotional health and to draw or describe their experiences of accessing mental health services. ResultsAttendance was higher than anticipated, with 72 individuals from African, African Caribbean and Pakistan communities taking part in the workshops. What emerged was the low level of understanding of the services available in addressing mental health. In addition, it was felt that health professionals in the National Health Service (NHS) do not sufficiently acknowledge or consider the ethnic, social, cultural and economic factors influencing the mental health and emotional well-being of minoritised communities. Attendees critiqued and provided feedback on service providers’ posters and leaflets. They commented on the lack of key information provided, the inclusion of what was viewed as irrelevant content and the use of unfamiliar terminology. Some attendees created mock-ups of what they believed a good poster should look like. ConclusionA creative practice approach that follows the principles of participatory action research can play an important role in engaging members of minoritised communities in the co-production and co-design of services. This approach highlighted the need to establish trust and shared ownership among marginalized communities affected by inequities of mental health service provision.

Enhancing the care experiences of Black women along the breast cancer journey: Meaningfully engaging breast cancer survivors to co-create a targeted, culturally relevant resource hub

There is very little tailored and culturally relevant information available for Black women in Canada around breast cancer. For those who are diagnosed, and who undergo their own breast cancer journey, many feel isolated while navigating care programs that centre around whiteness and perpetuate medical and anti-Black racism. Although it is well-documented that Black women in the United States are often diagnosed with more aggressive forms of cancer and at a younger age, the lack of race-based data in the Canadian context makes it difficult to know for certain how women in Canada are affected. In order to provide trusted, reliable and tailored information, The Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital, in partnership with the Olive Branch of Hope, developed a resource hub that was the first of its kind in Canada, and launched during Black Liberation Month in 2022. Presented in the form of a website and disseminated to over 50 cancer centres and hospitals across the country, components of this resource included, a.) a synthesis of all available evidence on breast cancer disparities for Black women in Canada, mapped to actionable steps b.) representative images and videos of Black clinicians explaining concepts in plain language (from risk factors to reconstruction), c.) community resources compiled from the Olive Branch of Hope and d.) a list of relevant research studies and clinical trials. Guided by principles of Black Feminism and Participatory Action Research, this resource was co-created in partnership with four Black women who were breast cancer survivors (‘co-creators’) who channeled their lived experiences into the project direction. This paper aims to highlight our process with co-creators, discuss key reflections to guide future work and highlight the need for ongoing work in this area.

Evaluating the effect of a 12-month youth advisory group on adolescent’s leadership skills and perceptions related to chronic disease prevention research: a mixed-methods study

BackgroundYouth Advisory Groups (YAGs) represent a promising method to engage adolescents in research of relevance to them and their peers. However, YAGs are rarely implemented or evaluated in chronic disease prevention research. The aims of this study were firstly, to evaluate the effect of participation in a 12-month YAG on adolescents’ leadership skills and perceptions related to chronic disease prevention research and secondly, to evaluate the process of establishing and facilitating a 12-month YAG and identify barriers and enablers to establishment and facilitation.MethodsThis study was a 12-month pre-post study. Eligible participants were adolescents (13-18-years) and current members of an established YAG. Data collection involved online surveys and semi-structured interviews at baseline, six-months and 12-months follow-up. Participatory outcomes such as self-efficacy, leadership skills, and collective participation were derived from Youth Participatory Action Research Principles (YPAR), and the Lansdown-UNICEF conceptual framework for measuring outcomes of adolescent participation. Process evaluation data were captured via meeting minutes, Slack metrics and researcher logs. Quantitative data was analysed using descriptive statistics and qualitative data was thematically analysed using a reflexive thematic analysis approach.ResultsThirteen (13/16) YAG youth advisors consented to participate in the evaluation study (mean age 16.0 years, SD 1.3; 62% (8/13) identified as female). Survey data assessing participatory outcomes found an increase in leadership and life skills scores over 12-months (+ 8.90 points). Semi-structured interview data collected over the 12-month term revealed three key themes namely: influence, empowerment, and contribution. Comparison of pre-post themes determined a positive trend at follow-ups, demonstrating improved participatory outcomes. Process indicators revealed that at 12-month follow-up the YAG was implemented as planned. Semi-structured interview data determined barriers to YAG facilitation included time and limited face-to-face components, while enablers to YAG facilitation included flexibility, accessible delivery methods, and a supportive adult facilitator.ConclusionThis study found that a YAG fostered positive participatory outcomes and unique opportunities for youth participants. A successful YAG based on YPAR principles requires researchers to ensure YAG establishment and facilitation is an iterative process. Taking into consideration important barriers and enablers to YAG facilitation ensures adolescent engagement in a YAG is both meaningful and impactful.

A participatory approach to increase HPV vaccination in marginalized Roma communities in Slovakia

Abstract Background Roma living in marginalized communities are among underserved groups facing limited access to vaccination services. The RIVER-EU in Slovakia aims to identify and tailor the intervention to address health system barriers to HPV vaccination faced by people from marginalized Roma communities. Methods Following principles of participatory action research, a wide spectrum of stakeholders was engaged to discuss the transferability of promising evidence-based interventions. Interviews and focus groups aimed to assess the suitability of interventions and identify barriers and facilitators for the transfer and implementation taking contextual characteristics into account. Results Key stakeholders included community members (parents and daughters), Roma health mediators, healthcare providers, policymakers, and representatives of the municipality, school, and public health authority. The most challenging was to engage community members as they had almost no information about the HPV vaccination. Building relationships and trust with communities require intensive cooperation with field services, time and energy. Engaging primary care providers was difficult due to their restricted capacities and work overload causing their motivation to engage in time-consuming collaborative processes to be low. Successful engagement of all stakeholders required concentrated efforts and specific strategies of the research team. Conclusions Active participation of all those who will be affected by the intervention and those whose cooperation will be necessary for successful implementation requires to engage keep on board a number of stakeholders holding different opinions. Facilitating consensus about the design of tailored intervention requires intense communication and revisiting the ongoing integration of emerging ideas until the consensus is reached. It is a responsibility of a researcher to ensure that at the end of the process, all voices are heard and all needs are met.

Working from the ground up: Women's safety in a community of sub-divided flats in Hong Kong

This study adopted the participatory action research (PAR) approach to co-create knowledge about the community from the perspectives and experiences of women in low-income communities in Hong Kong. Specifically, a ‘Working from the Ground Up’ approach to community development was implemented by social workers. Its effectiveness was evidenced in its capacity for facilitating women's voicing of their primary concerns about gender-specific safety threats. Guided by the PAR principles, the research process involved the community workers and residents. The findings reveal that fear not only affects women's use of public spaces such as streets and parks, but their use of the staircases and inter-building alleys leading to their housing units where they live. Women's housing units are also vulnerable to robbery and thefts due to their poor physical structures. Consequently, women have modified their behaviors to avoid falling prey to general crimes such as physical assault and, in particular, sexual violence.

Abstract 28: Design Workshops: Participatory Co-Design and Iterative Adaptation of Cervical Cancer Screening Implementation Plans in Peru

Abstract Purpose: In many countries, implementation planning for delivery of cancer screening services functions as a ‘top-down’ process, often resulting in fragmentation and bottlenecks at points of service delivery. Participatory engagement of health system planners and actors from across cancer screening and treatment continuum involved with implementation, planning, and adaptation is hypothesized to lead to plans that have a higher likelihood of adoption and sustainability. We tested the feasibility of conducting a 4-day series of participatory ‘design workshops’ for implementation of the recently initiated HPV screening program in the DIRIS Lima Norte (DLN) region of Peru. Methods: The workshop agendas were co-designed by the Peruvian Ministry of Health (MINSA) and the National Cancer Institute (NCI) using principles of participatory action research, implementation science, and systems thinking. The workshop objectives were to clarify the goals and processes of the HPV cervical screening program and reflect on the initial implementation experience. Workshop design was attentive to a) building trust among the health system planners and actors, b) surfacing misconceptions and process bottlenecks, c) equitable representation of perspectives on the process from all levels of the screening system, and d) shared decision-making in actions to improve the system. Results: Through real-time participatory reflection and process mapping of the screening program, context-specific challenges were rapidly identified. The process maps helped participants gain a shared understanding of the complexity of the screening system and quickly identified how one part of the system can create barriers for proximal and distal parts of the system. Participants mentioned feeling detached from the distal barriers before the workshops but now understood their role in the decision-making and problem-solving processes and demonstrated a willingness to work with the regional director to implement process improvements in the system, specifically to ensure women testing positive received the appropriate follow-up care. Conclusion: Rapid embedded implementation research using facilitated workshops with broad health system representation to reflect on the processes and procedures was an acceptable quality improvement activity. MINSA plans to replicate this experience in other regions and to continue to create a culture of trust and establishment of learning health systems. Citation Format: Fatou Jallow, Andrea Matos Orbegozo, Maria Del Carmen Caruhapoma, Víctor A. Palacios, Milagros Montes, Carlos Santos, Margarita Correa-Mendez, Aubrey Villalobos, Alejandro Salicrup, Jose Jeronimo, Laura Nervi, Patti Gravitt, Julia Gage. Design Workshops: Participatory Co-Design and Iterative Adaptation of Cervical Cancer Screening Implementation Plans in Peru [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 28.

Towards a Dignified Death: A New Approach to Care for People Using Substances Who Are at, or Near, the End of Their Lives.

There are no effective intervention studies for people using substances who are at, or near, the end of their lives. The needs of this group of people have been consistently overlooked even within the literature that identifies marginalised groups of people in need of greater recognition in palliative and end-of-life care. The aims of the project were to: (i) determine what a new, co-produced, model of care should look like for people using substances needing palliative and end-of-life care, and (ii) establish whether the new model had the potential to improve people's access to, and experience of, end-of-life care. This paper presents the development of the new approach to care. It was developed using participatory action research principles over a course of online workshops during the COVID-19 pandemic lockdown period in the UK. A theory of change that aims to inform future policy and practice development is presented. While the ambition of the research was stunted by the pandemic, the process of its development and dissemination of the model and its resources has continued. Response from participants highlighted the importance of this work, however, in this new field of policy and practice, preparatory work that engages a wide range of stakeholders is crucial to its success. This relationship building and topic engagement are major parts of implementation before more substantial and sustainable development goals can be met.

Nurse-led shared decision-making on complementary therapy use by patients with diabetes: An participatory action research.

The aim of this study was to develop, implement and evaluate a nurse-led shared decision-making model of care for discussing the use of complementary and alternative medicine with diabetic patients and to explore to what extent the risk-benefit assessment of using complementary and alternative medicine can provide a framework for facilitating nurse-patient dialogue and strengthening patient involvement in their disease management. Participatory action research with pre-post intervention. A two-run cycle of action and spirals from participatory action research was undertaken using a purposive sampling method to involve healthcare professionals and diabetic patients from September 2021 to June 2022. The nurse-led shared decision-making model of care was designed and implemented congruent with participatory action research principles. Quantitative measures were collected about patients' perceived involvement in shared decision-making and their understanding of the risks and benefits of using complementary and alternative medicine. Patients' outcomes of disease control (fasting plasma glucose and HbA1c) were also collected. Data were analysed using IBM SPSS software (version 28). Interviews were summarized using thematic analysis. An EQUATOR Network guideline for participatory action research supported the preparation of this paper. Comparison of pre-post intervention outcomes showed that patients' scale scores on shared decision-making involvement and understanding of the risk-benefit of using complementary and alternative medicine improved significantly after implementing the model. Fasting plasma glucose improved only slightly after a 3-month follow-up. The care model strengthens patient involvement in their disease management and makes appropriate decisions about CAM use that should reduce potentially harmful side effects or interactions between CAM and conventional medicine. The shared decision-making model of care incorporates evidence-based CAM research into practice, facilitates the standardization of CAM management in diabetes, improves care options for patients and educates nurses about CAM use in managing diabetes. No Patient or Public Contribution.

The Ethics of Participatory Action Research with People Living in Poverty

This article is based on the webinar “The Ethics of Research on Poverty” held in April 2018. Coauthored by the four presenters of the webinar, it brings together perspectives on poverty from lived experience in the United States, academia, the District Six Museum in South Africa, and the Joseph Wresinski Centre for Archives and Research in France. The article argues that the ethical principles of participatory action research (PAR) are too generic to address the specific characteristics of research projects conducted with people living in poverty. PAR projects on poverty require, in addition to the relevant general ethical principles of PAR (i.e., leading transformational PAR, treating all participants as co-researchers, nurturing respect for the individual and the group, and raising awareness on the level of literacy of each participant), specific ethical guidelines. For PAR to address the needs of people living in poverty, the choice of words on poverty should be aimed at reducing symbolic and epistemic violence, questions should be framed so as to encourage knowledge to be shared, research should yield direct benefits to participants and outweigh risks, and researchers should aim at eradicating extreme poverty. Researchers failing to apply these principles may find themselves guilty of committing unintended symbolic or epistemic violence to the thinking of people in poverty or fall for the soft bigotry of low expectations that inevitably triggers underperformance. To bridge the divide between narratives of people in poverty and interpretations of these narratives , researchers should be aware of their own biases and remain open to being challenged.

Implementing a participatory model of place-based stewardship for inclusive wetland management: A community case study

The inclusion of local values and an appreciation for different ways of knowing are increasingly considered core principles in wetland management but can be difficult to achieve in practice. This Community Case Study describes the development and impacts of a participatory action research (PAR) project focused on the creation of a community-led stewardship and knowledge sharing in a rural coastal community in Victoria, Australia. The project, Living Bung Yarnda, was designed around four dimensions: vision, knowledge, narrative, and capacity—that align with key principles of PAR and guided the process of knowledge building and exchange. Working with a range of stakeholders, including environmentally-focussed community members, government agencies and Traditional Owners groups, we aimed to discover pathways for the inclusion of local knowledge, lived experience, and acts of care by community members in governance processes. The case description illustrates how embedded knowledge in this community is currently undervalued by management agencies but, if harnessed, can contribute to more holistic and equitable forms of wetland management. We conclude with reflections on the development of the project, emphasizing the role of academic researchers in fostering relationships between community and management authorities that is built on trust, humility and a willingness to find a common language.

Use of participatory action research to support Syrian refugee mothers in the resettlement period in Canada: A longitudinal study.

Research has shown that refugees in a foreign country often experience physical and mental health challenges upon resettlement (Ahmad et al., 2021; Salam et al., 2022). In Canada, refugee women experience a range of physical and mental barriers, including poor access to interpreter services and transportation, and a lack of accessible childcare, all of which can negatively affect their successful integration (Stirling Cameron et al., 2022). Social factors that support Syrian refugees to settle successfully in Canada have been unexplored systematically. This study examines these factors from the perspectives of Syrian refugee mothers living in the province of British Columbia (BC). Framed by principles of intersectionality and community-based participatory action research (PAR), the study draws on Syrian mothers' perspectives of social support in early, middle, and later phases of resettlement. A qualitative longitudinal design consisting of a sociodemographic survey, personal diaries, and in-depth interviews was used to gather information. Descriptive data were coded, and theme categories were assigned. Six themes emerged from data analysis: (1) Steps in the Migration Journey; (2) Pathways to Integrated Care; (3) Social Determinants of Refugee Health; (4) COVID-19 Pandemic Impacts and Ongoing Resettlement; (5) Strength-Based Capabilities of Syrian mothers; (6) Peer Research Assistant's Research (PRAs) Experience. Results from themes 5 and 6 are published separately. Data obtained in this study contribute to the development of support services that are culturally appropriate and accessible to refugee women living in BC. Our objectives are to promote the mental health and improve the quality of life of this female population, and to enable it to access healthcare services and resources in a timely manner.

Recruiting and engaging adolescents in creating overweight and obesity prevention policies: The CO-CREATE project.

The CO-CREATE project aims to collaborate with adolescents across Europe in developing policy ideas that contribute to overweight and obesity prevention. In this paper, we present the theoretical basis and methodological approach to recruitment and engagement in the project. The principles of youth-led participatory action research were employed to design Youth Alliances in which adolescents and adults could collaborate. These Alliances should serve to promote and support adolescent participation and to develop policy ideas that would contribute to obesity prevention. Alliance members were recruited in two local geographical areas per country with a focus on reaching out to underrepresented youth. We started with fieldwork to assess locally relevant forms of inclusion and exclusion. The methodology entailed a handbook combining existing tools which could be used flexibly, a collaborative organization, and budgets for the alliances. Engagement started in local organizations, that is, schools and scouts, and with peers. Health- and overweight-related challenges were addressed in their immediate surroundings and supported the inclusion of experiential knowledge. Adolescents were then supported to address the wider obesogenic system when designing policy ideas. The CO-CREATE Alliances provide a concrete example of how to engage youth in public health, in a manner that strives to be participatory, transformative, and inquiry based.

Enhancing management education: How do experiences outside the classroom matter?

We use principles of participatory action research (PAR) to investigate differences in learning by business students resulting from an experiential course in their curriculum. Our research is framed by Fink's (2013) learning framework classifying student learning into cognitive and behavioural dimensions. As part of PAR, the students participated in this type of action learning through engaging with a community, reflecting on their experiences and participating in the research process. Through a content analysis that explores student learning reflections through the lens of Fink's taxonomy, we explore learning that is linked to the development of humanistic management. We compare how course delivery methods impact the learning of the students and how this difference is manifested along the human dimension. We find that a field-based experiential learning course provides a different learning experience, richer in the humanistic perspective than a traditional on-campus lecture. As part of the PAR, students reflected on their significant learning experiences a year after their initial experiences and demonstrated learning along the human dimension that had lasted and influenced their career decisions. We contribute to the literature on experiential learning in the context of a business curriculum by expanding the importance of place-based learning as a way of learning humanistic principles. We find that over time, students reflect more on behavioural rather than cognitive experiences.

Combining Intergroup Dialogue and Sociotechnical Infrastructure Design: Addressing Social and Technical Determinants of Health Information Disparities with the Latinx Community

This transdisciplinary research project employed a multi-method approach to address health information inequities in Kentucky’s Fayette County during the COVID-19 pandemic. We drew from the study of Sociotechnical Infrastructures, Health Inequities, and Community-Based and Intergroup Dialogue (IGD) to co-create an Alternative Sociotechnical Infrastructure to facilitate information sharing among three stakeholder groups: (1) Latinx community members, (2) civil society organizations, and (3) government officials. Our research design included a combination of methodologies that addressed the technical and, more importantly, the underlying social causes of information access disparities. Focus groups helped identify Information Communication Technology (ICT) use, preferences, barriers, and information-sharing strategies. Community dialogues highlighted information barriers, existing resources, and proposed community-based solutions. The findings informed development of a web-based platform prototype that will facilitate information sharing during a crisis among all stakeholders. The methodology used also allowed the emergence of community champions among Latinx people who need to be invited to the table for these initiatives. We found that combining participatory action research (PAR) principles with critical dialogic methods fosters an environment of trust that enhances collaboration among stakeholders and consequently makes the design of information infrastructures more equitable and sustainable. As Information Communication Technologies embody social relations, we recommend emphasizing dialogic competencies and knowledge around racism/difference while valuing differences, collaboration, equality, and inclusions.

Rethinking social work supervision: is a ‘radical supervision’ model possible?

Professional supervision is considered a key aspect of effective social work practice. In much of the world, front-line social work practitioners prioritise social work supervision as essential to ensuring a supportive working environment. This is crucially the case while working in ethically and politically contentious environments (such as working with refugees). Despite its centrality to effective practice, access to professionally meaningful supervision is nowadays seen by employers as a ‘luxury’, rather than as an integral part of front-line practice. On many occasions, the responsibility for accessing and paying for supervision is delegated to practitioners. Different models of supervision have been proposed over the years. This article provides a unique reflection on the creation and function of a ‘radical supervision’ approach, developed by practitioners and academics in Greece to deal with the complex professional and emotional dilemmas that emerged in the context of working with refugees. By ‘radical supervision’, the participants and authors refer to a non-hierarchical, peer-support supervision model that also prioritises collective action and mobilisation as regards structural challenges, thus departing from than the traditional individualistic approach to supervision. The group consisted of seven front-line practitioners and two academics. All practitioners worked in the field of refugee services. The supervisory group met regularly over a period of eight months from December 2020 to July 2021. The group followed the principles of participatory action research to analyse and report findings and reflections, while the analysis, as well the procedure of the supervision per se, were based on the liberation health model.

Collaborative Learning: A Veritable Tool for Promoting Classroom Participation Among Pre-Service Teachers in Rural Universities in South Africa

The benefits of collaborative learning (CL) in teaching-learning have been well-documented. According to existing literature, it will help students and teachers learn from one another, develop good communication skills, foster a sense of community, trust and respect, and retain and apply the information in their future studies. Unfortunately, observation coupled with research shows that pre-service teachers’ participation in South Africa's rural universities is at its lowest ebb – a potential source of concern to education stakeholders given its futuristic implications in the light of CL benefits. Less pre-service teachers’ participation has been linked to cultural influence, environmental factors and students’ backgrounds and have negatively impacted students’ academic achievement. This paper seeks to typify CL as a panacea to pre-service teachers' apathy toward learning. In doing this, social constructivism theory (SCT) was adopted to underpin the study. Drawing from the principles of participatory action research, fifteen undergraduate students were randomly selected, and data was gathered with the instrumentation of semi-structured interviews and focus groups. The study revealed the think-peer-share strategy, group work strategy, micro-teaching strategy, positive feedback and encouragement, learner-centred method, and inquiry method as strategies for improving participation among pre-service teachers in rural universities. Recommendations were made in line with the findings of the study.

Handling Communication Skills: The Holistic Approach

The three-year study interrogated classroom attitudes toward English and communication skills, using English language learners (ELL), teachers of communication skills and teachers of other subjects. Generally, the study, which highlighted the dominant role of English Language in global relations, was also a teacher’s avenue to improve upon her classroom practice. The specific objective was to help learners develop critical perspectives to strive for effective communication skills, in and out of college, for excellence. The study was guided by two research questions: How could a communications skills instructor explore the most effective classroom approaches to address her students’ needs? How does she balance teaching principles and gentle motivation of students hampered by severe communication handicaps? The study explored the principles of participatory action research to investigate the reasons behind poor communication skills of the participants. It emerged that students’ English grasp was too low, thus, obstructing advanced learning. Participants were persuaded to revisit their position on the subject. It was recommended, among others, that the institution should admit into professional programmes learners who possess the required language proficiency. Additionally, communication skills should be taught throughout a professional programme to help consolidate the communicative skills of speaking, writing, reading, and listening among learners. Keywords: Communication Skills, Language learning/teaching, TVET DOI: 10.7176/JEP/13-30-05 Publication date: October 31 st 2022

‘Applied Social Prescribing Practice: A Focused Arts Based Participatory Action Research Study of Military Veteran Transition Into Civilian Life’

Experiences of transition into civilian life after active service differs widely for military personnel. For those who experience issues in this process of transition, life can often be characterized by perceptions of loneliness, social isolation, poor mental well-being, and a functional dependency on alcohol, alongside other negative behaviors, for coping with post-traumatic stress disorder. This research employed action research methodology and the implementation of participatory action research methods. Both facilitated a systematic and pragmatic process of revealing new understandings about how social prescribing could act as a driver of transformation for veterans and their families (51 participants engaged across 18 individual workshops). This iterative exploratory process enabled a guided understanding of complex individual and collectively-shared experiences of veterans transitioning from military back to civilian lives. The facilitated collective arts experiences for veterans and their families were undertaken by specialist artists to foster a sense of active citizenship. The study revealed that participants transitioning from military to civilian life reported an increased sense of well-being because of engaging in collective creative practice. Participants attributed this to the opportunity of learning new skills, gaining a sense of creative expression, and engaging in reflection on their military heritage and contribution to service alongside peers. Knowledge gained from this research enables consideration of how principles of participatory action research may have potential transferability to other similar contexts which serve to support veterans in their transition from military to civilian life.

New approach to assessing and addressing moral distress in intensive care unit personnel: a case study

PurposeTo test a new approach to address moral distress in intensive care unit (ICU) personnel.MethodsUsing principles of participatory action research, we developed an eight-step moral conflict assessment (MCA) that guides participants in describing the behaviour that they have to implement, the effects this has on them, their current coping strategies, their values in conflict, any other concerns related to the situation, what helps and hinders the situation, new coping strategies, and the effect of the preceding steps on participants. This assessment was tested with eight ICU providers in an 11-bed community ICU.ResultsDuring three one-hour sessions, participants described their moral distress that was caused by the use of ongoing life-support for a patient who the team believed did not prefer this course of care, but whose family was requesting it. Participants experienced frustration and discouragement and coping strategies included speaking to colleagues and exercising. They felt that they were unable to take meaningful action to resolve this conflict. Values that were in conflict in the situation included beneficence and patient autonomy. Based on ranking of helping and hindering factors, the team proposed new strategies including improving consistency of care plans and educating patients’ family members and ICU personnel about advance care planning and end-of-life care. After completing this assessment, participants reported less stress and a greater ability to take meaningful action, including some of the proposed new strategies.ConclusionsWe found this new approach to address moral distress in ICU personnel to be feasible and a useful tool for facilitating plans for reducing moral distress.