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.

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...

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.

 

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. 

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.