Benefits of PAR: Part two!

I started this blog with a post on the benefits of participatory action research...now seems like a good time for review.

• Participatory action research is a good fit with client-centred practice and can further develop occupational therapists understanding and competence in working in partnership with individuals and communities. These are essential skills to embrace in our bicultural context. 

• The provision of occupational therapy services and the health and social issues that are faced by clients and communities are complex. The cyclical and open-ended process of participatory action research is ideally suited to investigate and address these issues. With a focus on empowerment participatory action research is a useful approach in community development and health promotion initiatives.

• Participatory approaches link theory development to practice and ensure research is based in the genuine concerns of communities and groups. Learning takes place for all parties involved and different types of knowledge should be valued equally. PAR has contributed to the development of theory and changes to practice within occupational therapy.

I have found the process of producing this blog a really useful method for organising my learning around this topic....The format of a blog...with the ability to connect diverse pieces of information (links, pdfs, images, video) has been a great tool to tease out complex concepts and develop my point of view on the benefits of participatory action research for occupational therapy.

Research - Practice - PAR

The outcomes of two occupational therapy projects which utilised participatory action research.
 
Project One: 
Mary Law describes a PAR project she undertook which aimed to...”identify factors within the environment, family and/or child that affect the daily activity patterns of children with physical disabilities” (Law, 2004, p. 43).

The outcomes of the research...

“Contrary to expectations, participants did not identify child-related factors such as diagnosis or functional severity as the most important in determining their child’s ability to participate in daily activities...participants identified environmental situations, particularly social and institutional factors (e.g. social attitudes about disability, institutional policies, choice, information, programme support) as the most significant barriers (Law, 2004, p. 48).                           

                   

Achievements of this PAR project

• Informed the development of theory (influential in the development of the environment aspect of the PEO model). 
• Informed the direction of further large scale research projects and addtional projects with participants as research partners
• Action in the local community. Parents formed an ongoing parent support and advocacy group which advocated for change at a local government level. 

Project Two: 
Creation of a new assesment... Model of Human Occupation Screening Tool (MOHOST)

• Practitioners saw that many standardised assessments did not work in the fast-paced environment of acute mental health. They developed an initial version of a screening tool appropriate to this environment
• Practitioners asked for input from researchers to further develop this assessment
• Researchers and practitioners worked together in a PAR process for five years to refine MOHOST
• Final assessment “satisfied both research and practice concerns” (Kielhofner et al, 2006, p. 653).              

References:

Kielhofner, G., Castle, L., Dubouloz, C., Egan, M., Forsyth, K., Melton, J., Parkinson, S., Robson, M., Summerfield-Mann, L., Taylor, R. R., & Willis, S. (2006). Participatory research for the development and evaluation of occupational therapy: Researcher-practitioner collaboration. In G. Kielhofner (Ed.) Research in occupational therapy: Methods of inquiry for enhancing practice (pp. 643-655). Philadelphia: F A Davis.

Law, M. (2004). Building knowledge through participatory research. In K. W. Hammell, & C. Carpenter (Eds.) Qualitative research in evidence-based rehabilitation (pp. 40-50). Edinburgh: Elsevier.

Letts, L. (2003). Occupational therapy and participatory research: A partnership worth pursuing. American Journal of Occupational Therapy, 57(1), 77-87.

"Nothing is so practical as a good theory" Kurt Lewin

I really like this quote by Kurt Lewin....I believe theories are very practical tools and that theory and practice build on one another in a way that is mutually beneficial for ongoing learning...

Theory has given me a range of ways of interpreting my experiences/observations/actions when working with clients and fieldwork placements have been an opportunity to test theories to see if they are actually useful or relevant...

Evidence-based practice and the Research-practice gap. 

The evidence-based practice movement within health care means there is an increasing pressure for occupational therapy practice to be based on research findings. However, practitioners report having difficulty with applying research to practice (Law, Pollock, & Stewart, 2004). Kielhofner et al., (2006) discuss possible reasons for this research-practice gap.They suggest practitioners may......

• “Question the relevance of the questions addressed and findings generated by the research”
• “Express concern that research reflects occupational therapy conducted under ideal conditions or with resources not readily available in practice”
• “...research evidence does not fit with their perception of the practical situation or a particular client’s needs” 

To be most effective “research should be grounded in practice....with investigators and practitioners working together to advance practice knowledge” (Kielhofner et al., 2006, p. 643).

The benefit of participatory action research as outlined by Taylor et al., (2006) is that it has the potential to function as a  knowledge-creating system in which there is “no artificial division between creating and assessing knowledge on the one hand and applying it on the other” (p. 626). PAR approaches advance both scholarship and practice with a “...cycle of knowledge generation in which theory shapes practice and practice shapes theory” (ibid, p. 625).

Click on the article title for a very interesting article that is tangentially relevant.....in terms of a split between theory/practice...thinking/doing  Mind-body Dualism: A critique from a Health Perspective. Neeta Mehta, PhD.

References:

Kielhofner, G., Castle, L., Dubouloz, C., Egan, M., Forsyth, K., Melton, J., Parkinson, S., Robson, M., Summerfield-Mann, L., Taylor, R. R., & Willis, S. (2006). Participatory research for the development and evaluation of occupational therapy: Researcher-practitioner collaboration. In G. Kielhofner (Ed.) Research in occupational therapy: Methods of inquiry for enhancing practice (pp. 643-655). Philadelphia: F A Davis. 

Law, M., Pollock, N., & Stewart, D. (2004). Evidence-based occupational therapy: Concepts and strategies. New Zealand Journal of Occupational Therapy 51, 14-22.

Taylor, R. R., Suarez-Balcazar, Y., Forsyth, K., G. Kielhofner. (2006). Participatory research in occupational therapy. In G. Kielhofner (Ed.) Research in occupational therapy: Methods of inquiry for enhancing practice (pp. 620-631). Philadelphia: F A Davis.

Power

Closely intertwined with concepts of client-centred practice and partnership are ideas about power. Power should not be seen as something the researcher 'has' and is 'giving' to the participants. Participatory research involves acknowledging the equal value of the different types of expertise that participants and researchers bring to the project. 

In saying that, it is essential that the power differences between participants and researchers are acknowledged and addressed as the “scientific knowledge of researchers is typically considered to be a more privileged and prestigious form of knowledge” (Kielhofner et al., 2006, p. 645). In order to work effectively in a participatory approach Corring (2001) states that the researcher must "actively work to redistribute power and create both dialogue and equality in decision making” (p. 21).

“The role of the researcher has traditionally been to determine the research agenda, and to design and implement the study....It is often acknowledged that PAR projects would not be initiated, gain funding, or be implemented without the attention of an ‘outside’ researcher (Letts, 2003), but there are challenges associated with this leadership or facilitation role. In PAR, the researcher acts more like a consultant who brings a particular skill set to integrate with those skills brought to the project by other participants” (Carpenter & Suto, 2008, p. 72).

There must be recognition that all parties are involved in a process of mutual learning and exploration of the issues under consideration. The participants should be given access to the tools and training they require in order to fully participate in the research process and the researchers need to be open to learning about the experiences and local contexts of the participants. 

The following suggestions for power sharing are taken from:

(Taylor, Suarez-Balcazar, Forsyth, & Kielhofner,2006, pp. 624)

• Shared responsibility, voice, and decision-making about all aspects of the investigation
• Respect and acknowledgement of the unique expertise and insights of all those involved
• Willingness to step outside their usual roles and responsibilities
• Identification and remediation of sources of power imbalance such as money and access to technology
• Sharing resources (e.g., paying for staff time to devote to the project, providing participants with stipends)

References:

Carpenter, C., Suto, M. (2008). Qualitative research for occupational and physical therapists: A practical guide. Oxford: Blackwell. 

Corring, D. (2001). Participant action research. In J. V. Cook (Ed.) Qualitative research in occupational therapy: Strategies and experiences (pp. 13-23). Canada: Delmar.

Kielhofner, G., Castle, L., Dubouloz, C., Egan, M., Forsyth, K., Melton, J., Parkinson, S., Robson, M., Summerfield-Mann, L., Taylor, R. R., & Willis, S. (2006). Participatory research for the development and evaluation of occupational therapy: Researcher-practitioner collaboration. In G. Kielhofner (Ed.) Research in occupational therapy: Methods of inquiry for enhancing practice (pp. 643-655). Philadelphia: F A Davis.

Taylor, R. R., Suarez-Balcazar, Y., Forsyth, K., G. Kielhofner. (2006). Participatory research in occupational therapy. In G. Kielhofner (Ed.) Research in occupational therapy: Methods of inquiry for enhancing practice (pp. 620-631). Philadelphia: F A Davis.

Client-centred practice and occupational therapy

Over the past 30-40 years people who receive health services have advocated for increased input and control into the services they receive. This has led to policy requirements for increased consideration of client perspectives in health care. Occupational therapy responded to these trends by developing client-centred guidelines for practice and concepts of client-centred practice have been elaborated extensively in the occupational therapy literature (Taylor, Suarez-Balcazar, Forsyth, & Kielhofner, 2006). 

Corring (2001) states that a participatory action research approach “fits well with a profession such as occupational therapy that seeks to empower clients, give them a voice, and understand their lived experience of illness and disability” (p. 15). Law (2004) notes that client-centred practice within occupational therapy and participatory action research share similar overarching values in that “each approach is flexible and centred on the development of a positive collaborative partnership” (p. 42). 

It would seem that participatory approaches to research have particular relevance to therapists working within the bicultural context of Aotearoa. Click HERE to read a brief and engaging discussion of the principles of the Treaty of Waitangi (partnership, participation and protection) in the context of health promotion.  Click HERE to read an article by Te Kani Kingi; 'The Treaty of Waitangi: A framework for Maori health development'. 

In the traditional medical model of health care the client role was to be a passive recipient of services. With a move towards a health promotion/prevention focus in health care clients/communities must see themselves as active agents capable of producing change. With a solid grounding in client-centred practice occupational therapists have the opportunity to further develop our understanding of partnership and collaboration by utilising participatory action research approaches.

References:

Corring, D. (2001). Participant action research. In J. V. Cook (Ed.) Qualitative research in occupational therapy: Strategies and experiences (pp. 13-23). Canada: Delmar. 

Kingi, T. R. (2007). The Treaty of Waitangi: A framework for Māori health development. New Zealand Journal of
Occupational Therapy, 54(1), 4-10.
Law, M. (2004). Building knowledge through participatory research. In K. W. Hammell, & C. Carpenter (Eds.) Qualitative research in evidence-based rehabilitation (pp. 40-50). Edinburgh: Elsevier. 

Taylor, R. R., Suarez-Balcazar, Y., Forsyth, K., G. Kielhofner. (2006). Participatory research in occupational therapy. In G. Kielhofner (Ed.) Research in occupational therapy: Methods of inquiry for enhancing practice (pp. 620-631). Philadelphia: F A Davis. 

Waa, A., Holibar, F., & Spinola, C. (1998). Programme Evaluation: An Introductory Guide for Health Promotion. Auckland: Alcohol and Public Health Research Unit, University of Auckland. Retrieved on September 3, 2011 from http://www.hauora.co.nz/resources/ToWandHP.pdf

Aotearoa - projects and perspectives

Explored the internet today to find info relevant to participatory action research in the context of Aotearoa....found a range of inspiring projects and processes....

How Rangatahi Lead Positive Social Change in Identifying their Hauora Issues.
Authors:  Justina Webster, Te Rina Warren, Wheturangi Walsh-Tapiata, Dylan Kiriona with Rangatahi Researchers. Whäia te Hauora o ngä Rangatahi Research Unit, Te Rünanga o Raukawa Inc.      

 

“This paper examines how rangatahi have contributed towards positive social change within a research project that considers their hauora.  Hapü and Mäori providers nominated rangatahi who they believed had leadership potential to be trained and to lead participatory action research into the health and wellbeing of Mäori rangatahi. The rangatahi played an integral role in developing the research including the methodologies utilised and in the process have become role models for the rangatahi that are the participants in the research. A noticeable change of attitude is now apparent from these young people as they realise the positive potential of research as means of ensuring their voices are being heard around social issues that are important to them”  Downloaded from: http://www.firstfound.org/webster%20paper.htm 

Katoa Ltd is a kaupapa Maori research organisation....their website has a great overview of action research with interesting links....Katoa Action Research page

CCS disability action (community participation project, 2003)

“The aim of the project was to develop some shared understandings of community participation and ways to support people with disabilities to take part in community life. The project was to actively involve CCS Disability Action service users and staff to explore:

 ·  The actual experiences of service users and their support staff compared to current     government and CCS Disability Action definitions of community participation;
 ·  The negative and positive experiences of people with disabilities;
 ·  The implications for people who use, staff and fund disability support services”

Sourced from: http://www.ccsdisabilityaction.org.nz/Support/Publications/CommunityParticipation/tabid/1010/Default.aspx

 Rangahau
A website resource related to Kaupapa Maori research

•  Click HERE to view a short video clip of Aroha Mead discussing the importance of ethics in Kaupapa maori research...she notes the importance of relationship as the foundation for good research practice with communities.....
• Click HERE to see a video clip of Joe Te Rito discusses the value of disseminating research knowledge...outside of academic circles...

Action, reflection and occupational therapy

The action research cycle described in a previous post will look familiar to occupational therapy students and therapists. Cycles of reflection and action are embedded in occupational therapy education and in demonstrating our ongoing compentence for practice through the occupational therapy board 'Continuing Competence Framework for Recertification  CCFR process.

 Bannigan and Moores (2009) describe reflection as a "deliberate, structured process involving the processing of information to assist with learning from complex situations" (p. 343). 

Image source:

http://serc.carleton.edu/introgeo/enviroprojects/what.html

The occupational therapy programme places a high value on experiential learning with 1000 hours of fieldwork completed over three years.

We have been encouraged to use Kolb's cycle of experiential learning to bring together our practical experiences, our critical reflection on those experiences, links to theory and further practical experiences informed by theory and our reflection. 

In the development of their model David Kolb and Roger Fry  were influenced by Kurt Lewin who first developed action research.

Another central figure linked to concepts of action and reflection and social change is Paulo Freire. His concepts of conscientization and praxis developed in his 1970 book "Pedagogy of the oppressed" have been influential in the development of participatory action research internationally.

I really like the definition of praxis from the Paulo Freire Institute so I have reproduced it here.......

"It is not enough for people to come together in dialogue in order to gain knowledge of their social reality.  They must act together upon their environment in order critically to reflect upon their reality and so transform it through further action and critical reflection" Freire Institute (2011). Concepts used by Paulo Freire. Retrieved from http://www.freire.org/paulo-freire/concepts-used-by-paulo-freire/

References: 
Bannigan, K., & Moores, A. (2009). A model of professional thinking: Integrating reflective practice and evidence based practice. Canadian Journal of Occupational Therapy, 76(5), 342-349.  

Freire Institute (2011). Concepts used by Paulo Freire. Retrieved September 3, 2011, from htp://www.freire.org/paulo-freire/concepts-used-by-paulo-freire/

Smith, M. K. (2001). 'David A. Kolb on experiential learning', the encyclopedia of informal education. Retrieved August 29 2011,  from http://www.infed.org/b-explrn.htm

Smith, M. K. (2001) 'Kurt Lewin, groups, experiential learning and action research', the encyclopedia of informal education. Retrieved August 29, 2011, from http://www.infed.org/thinkers/et-lewin.htm