Participatory action research (PAR) aims to empower individuals and communities to achieve social change.

This blog will explore the relevance of this research approach to occupational therapy.


Monday, September 5, 2011

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.

Sunday, September 4, 2011

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

Saturday, September 3, 2011

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


“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:
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 


Friday, September 2, 2011

Viva Live Oak


The Community Psychology Research & Action Team at the University of California at Santa Cruz has an ongoing relationship with the local community and has engaged in a number of really creative participatory action research projects under the direction of Regina Day Langhout. 

The Viva Live Oak project utilised photovoice  (photography is used as a tool for empowering communities to reflect on their situation and work towards social change).

"Through our lenses, these images and narratives will give you our perspective of life in Live Oak. Our laughter and tears create unity as we strive for social justice, historical and ecological preservation, and community pride." (Retrieved from: http://vivaliveoak.com/home.html)

Click here to view a slideshow of the images and text created by the participants. 

The participants went on to hold exhibitions of their images and held events to foster community dialogue around themes raised in the images.  They also created a website to showcase the project.

Community Net Aotearoa

Community Net Aotearoa is a comprehensive online resource for community groups.
They have assembled a large number of resources (publications, website links, email lists).

Well worth a browse are their........

Tuesday, August 30, 2011

Experiential learning.....

Participatory action research has an emphasis on experiential learning....
Last week I got to do some of my own learning through 'doing' when I 
attended a meeting of a group involved in an action research project.

Action research is traditionally conceptualised as a series of cycles...
Image sourced from


Sitting in on the meeting it was not as clear cut as this cycle would suggest. It appeared to me that many of the stages were intertwined and would continue to be so for the duration of the project. This made for a more open-ended process that was responsive to change and new data/directions emerging in the research.

During the meeting participants....
  • Reflected on what have the group had done so far 
  • Discussed where they wanted to go (with the initial identified problem and data they had compiled so far)
  • Planned action to be taken in the coming weeks and months
  • Reflected and discussed other issues they may want to address in the future
  • Discussed pragmatic concerns such as budgets and distribution of information 

Several things seemed to make this meeting successful including:
  • Power-sharing.....Encouraging group members to take up roles of responsibility
  • The acknowledgement of different skills and expertise within the group...
  • Group facilitation...the use of open questions and reflecting back to the group....
  • Range of levels of participation within the group... 
  • High level of participant interest, involvement and commitment to the issues/problems

A Ladder of Citizen Participation

Lori Letts discussed using frameworks to analyse the level of involvement participants had in projects. One of these was Sherry Arnstein's Ladder of Citizen Participation.

The ladder moves from non-participation to citizen power...... interesting concepts to consider when aiming for client participation in research or occupational therapy.


Reference:
 Arnstein, S. (1969). A Ladder of Citizen Participation. Journal of the American Planning Association, 35(4), 216-224.

Monday, August 29, 2011

Levels of participation and power relationships.....

I have been reading and re-reading a 2003 journal article by Lori Letts: Occupational therapy and participatory action research: A partnership worth pursuing.  

Letts discusses the key principles of participatory action research and outlines examples of PAR projects undertaken by herself and other occupational therapists. These include PAR projects working with a range of groups (occupational therapists, parents of children with disabilities, people with physical disabilities, older adults and adults with mental health issues).
Letts notes that PAR is a good fit with occupational therapists commitment to client-centred and occupation-focused practice.

Whilst on one level Letts' article functions as an endorsement of the relationship of participatory action research to occupational therapy she also raises a number of challenging questions regarding levels of participation within  the PAR projects she discusses. As outlined earlier in this blog the ideal within PAR is that participants be involved in all stages of the research...in reality, a number of the projects did not meet this ideal....
  • The research question/problem was generated by the researcher not from the concerns of the community
  • There was variable participation....participants were more involved in some phases of the research than others
  • Participants were more likely to be involved in the action phases of the projects than the analysis of data and the distribution of findings to the wider community
I am left with the following questions.....
How much participation is enough? 
Is some participation is better than none? 
How do you ensure high levels of participant ownership of research?
How do you balance the different types of expertise that community members and external researchers bring to the project? Especially when some forms of knowledge/expertise are valued more than others.

Letts notes that it is essential that there is a transparent process of identifying power differences and that researchers/academics working within a PAR framework are willing to share knowledge and power with participants. 
Reference:
Letts, L. (2003). Occupational therapy and participatory action research: A partnership worth pursuing. American Journal of Occupational Therapy, 57, 1, 77-87.
 

Sunday, August 28, 2011

Recipes for Life

'Recipes for Life' was a participatory action research project completed in 2002-2004 by the Institute for Community Research. The project enabled a group of older adults to share their perspectives on successful aging with each other and the wider community. The older adults "exchanged family food recipes, life stories, and successful aging strategies" which were documented via photographs, text, and portraits of the participants and exhibited to the wider public within their housing building and at a community art gallery. The project encouraged social interaction, creativity and self-expression and celebrated the knowledge and experiences of the older people involved. It also further developed knowledge around the strategies older adults use to age well in the community. 
Click here for detailed info on this project....

References:
Institute for Community Research. (n.d.). Recipes for life. Retrieved from http://www.incommunityresearch.org/research/programsrecipesforlife.htm

Institute for Community Research. (n.d.). Participatory action research training and evaluation. http://www.incommunityresearch.org/research/paresearch.htm

Institute for Community Research


Found an amazing organisation on the internet this weekend...The Institute of Community Research which is based in the United States. Their aim is "research partnerships for healthy communities". They have a detailed website listing detailing past and present projects. Totally inspiring, I would highly recommend a visit.

This year a number of our classes at polytech have included a shift in focus from working with individuals to working alongside communities and populations. We have looked at the principles and application of health promotion and community development. Participatory action research fits well with this new orientation in occupational therapy. 

Thursday, August 25, 2011

Why do we research......?

Juliet Merrifield a researcher in the field of adult education asks the following questions....

"Why do we do research? Who benefits from it? Who uses the information we gather, and what for? What is worth researching? These are the central questions which Participatory Action Research (PAR) makes us confront" (Merrifield, 1997)
Here is a link to her article: Knowing, Learning, Doing: Participatory Action Research

References
Merrifield, J. (1997). Knowing, Learning, Doing: Participatory Action Research. Focus on  Basics: Connecting Research & Practice, 1(A), downloaded from http://www.ncsall.net/index.php?id=479.

Participatory Action Research defined.....

I have been enthusing to a range of people around the polytech about this research approach.
I have noticed there can be a point when their eyes glaze over. 
This seems to be related to the name. Say it with me (deep breath) 
Participatory Action Research ......

So l'm going to try and break down each word according to my current understanding of PAR...


Participatory.....  
  • Participants play an active role in all aspects of the research process; from establishing the problem or concern to finding possible solutions, implementation and evaluation of the outcomes
  • The research process draws on participants current knowledge and strengths.
  • Participants become empowered as co-researchers and gain skills in research processes and facilitating change.
  • Participants are active subjects vs passive objects of study. Research is carried out in partnership ‘with’ participants......not......... ‘for’ or ‘on’ or ‘about’  participants. 
Action..... 
  • PAR approaches aim to create positive social change in the real world.
  • This approach eliminates the research/practice 'gap' where there is a lag between the research being published and its application to clinical practice.
  • The action that is taken is sustainable because it is generated from the participants genuine concerns and situated within local contexts. 
Research........ 
  • The research process aims to generate both practical outcomes and “knowledge that is useful and meaningful to participants” p. 84 (Ritchie, Bernard, Trede, Hill, & Squires, 2003).
  • Knowledge is created through a cyclical process of experiential learning.....action and reflection on action (Liamputtong, 2009). 
  • PAR projects emphasise learning of all involved the participants and the researcher/s. 

References
Liamputtong, P. (2009 ). Qualitative research methods (3rd ed.). Australia: Oxford. 

Ritchie, J., Bernard, D., Trede, F., Hill, B., & Squires, B. (2003). Using a participatory action  research approach as a process for promoting the health of older people. Health Promotion Journal of Australia, 14, 54-60.  
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Thursday, August 18, 2011

Benefits of Participatory Action Research




VOYCE (Voices of Youth in Chicago Education) 
VOYCE is a youth-led project that allows high school students to use Participatory Action Research in order to address the drop out rate in Chicago Public High Schools. This collaborative project engages 7 different community organizations from around the Chicago area. 

Fantastic example of the benefits of PAR ... key messages include:
  • Problem and need for change defined by the community. 
  • Participants are seen as the experts on their lives. 
  • Social change is led from the 'ground up'. 
  • Being involved in the research project and in making practical positive change to their community leads to individual and group empowerment.
    A longer video by VOYCE available here