Role of research in occupational therapy clinical practice: Applying action learning and action research in pursuit of evidence‐based practice

Background: In South Africa, as in many other countries, the development of research capacity in students and their early professional career is regarded as of major importance. Within the context of clinical education for occupational therapy students at the University of the Free State, a lecturer and her students embarked on a collaborative journey while fulfilling the requirements of their undergraduate curriculum. The outcome is a model promoting evidence‐based practice (EBP) during service development on a dementia care ward. Methods: The practical use of action learning, action research (ALAR) approach in the clinical context, was used to encourage student engagement in successive small‐scale research projects while simulating EBP. The projects ranged from the development of therapeutic multi‐sensory environments to compiling activity profiles for identified residents. At the same time, students had the opportunity to experience the value of a scientific approach to practice development, which stimulated their awareness of the importance of research. Results: Reflection by the researcher contributed towards more effective ways for compiling project assignments and a formalised approach for assessing projects. Students described personal and professional gains because of participation in projects against the life‐changing experience of rendering a service to elderly persons suffering from dementia. The formalised approach guiding thoughts and actions finally assisted in developing a practical process model that could support EBP. Conclusions: The ALAR model contributed towards a scholarship of practice where the students, clinical educator and residents of a dementia unit all experienced the value of research.     

Participatory action research

This glossary aims to clarify some of the key concepts associated with participatory action research.     

Preparing researchers for patient and public involvement in scientific research: Development of a hands‐on learning approach through action research

Background

Acquiring the theoretical and practical knowhow of conducting patient and public involvement (PPI) in research is not part of the traditional curriculum of researchers. Zuyd University of Applied Sciences and Huis voor de Zorg, a regional umbrella patient organization, therefore started a 1.5‐year coaching programme.

Objective

To establish a community of practice by developing a PPI coaching programme for senior and junior health services researchers of Zuyd University. The context consisted of research projects conducted by the participants.

Methods

A participatory action research methodology. Data were collected from reports of thematic group meetings and individual sessions with participants, field notes and regular reflection meetings with the project team. Data were analysed by reflexive deliberation.

Findings

The programme comprised a kick‐off meeting (52 attendees), followed by 7 group meetings with 11 junior and 9 senior researchers. The project team constructed a serious game based on the concept of the participation ladder. Questions and concerns differed for junior and senior researchers, and separate tailored meetings were organized for both groups. Between group meetings, participants received individual assignments. Group meetings were accompanied by individual coaching sessions to provide tailor‐made feedback. The programme concluded with a combined meeting with all stakeholders.

Conclusion

Building a community of PPI practice through action research facilitates the development of a coaching programme that fosters social learning, empowerment and the development of a shared identity concerning PPI. The role and responsibilities of senior researchers should be distinguished from those of junior researchers.     

Investing in lay researchers for community-based health action research: implications for research,policy and practice

Calls for greater community participation health-related research are increasingly made and, it seems, heeded–albeit to varying degrees. We report here, from the perspective of external evaluators, on practical efforts by the leaders of two community-based health action research projects to enhance such participation still further by employing a small number of local people as lay action researchers within their own community. ‘Action research’ in this context was conceived as an approach by which comparatively small projects, based on partnerships between academics, communities and public sector organisations, could address local issues of health and well-being. The purpose of the paper is to examine project leaders’ initial assumptions and expectations of the lay action research role and to compare these with the actual experience of those researchers. On this basis we consider the value to organisations and communities of the lay action research role for community health development and point out some of the unanticipated risks such individuals may face. We conclude by highlighting implications for future policy and practice in this area.     

Supporting self‐management by Community Matrons through a group intervention; an action research study

The aim of this study was to examine the feasibility and impact of a group intervention by Community Matrons to support those living with multiple long‐terms conditions. Little evidence exists as to how the role of the Community Matron (CM) should be delivered to effectively enhance disease self‐management and levels of self‐efficacy for the service users. This qualitative participatory action research study explored the use of group work as a method of intervention by CMs. A purposive sample of 29 participants was recruited. Each patient group had 8–10 participants, led by a CM working in both the researcher and practitioner role, operating over 12‐month period. Data were collected by participant observation, researcher reflexive account and interviews. Grounded theory method was used to systematically analyse the data. Three main data categories emerged: (i) comparison by patients that leads to re‐motivation of the self; (ii) learning, leading to enhanced self‐management techniques, through storytelling and understanding of each other's experiences; and (iii) ownership that resulted in the self‐awareness, cognisance and insight into the role of the support group they were based in and how it benefited them. The core category of ‘Taking back the self – understanding the whole,’ conveyed the impact that this care delivery method had upon readjusting the balance of power between health professional and service users and its consequence in refreshing and improving their self‐management and the patients’ self‐efficacy. It was concluded that CM intervention using a model of group learning can lead to more effective and efficient support, through improving self‐efficacy and patients’ related self‐management ability.     

Rebuilding people-centred maternal health services in post-Ebola Liberia through participatory action research

During the March 2014–January 2016 Ebola crisis in Liberia, Redemption Hospital lost 12 staff and became a holding facility for suspected cases, prompting violent hostility from the surrounding New Kru Town community, in the capital city Monrovia. Inpatient services were closed for 6 months, leaving the population without maternity care. In January 2015, Redemption reopened, but utilization was low, especially for deliveries. A key barrier was community trust in health workers which worsened during the epidemic. The New Kru Town council, Redemption Hospital, the International Rescue Committee, and Training and Research Support Centre initiated participatory action research (PAR) in July 2015 to build communication between stakeholder groups, and to identify impacts of the epidemic and shared actions to improve the system. The PAR involved pregnant women, community-based trained traditional midwives (TTMs) and traditional birth attendants (TBAs), and community leaders, as well as health workers. Qualitative data and a pre-post survey of PAR participants and community members assessed changes in relationships and maternal health services. The results indicated that Ebola worsened community-hospital relations and pre-existing weaknesses in services, but also provided an opportunity to address these when rebuilding the system through shared action. Findings suggest that PAR generated evidence and improved communication and community and health worker interaction.     

The research potential of practice nurses

Little is known about the research aspirations and experiences of practice nurses. The study discussed in the present paper had three main aims: (1) to assess the level of research interest among practice nurses working in Essex and East London, UK; (2) to identify practice nurses' research priorities; and (3) to explore factors which facilitate and impede the development of practice nursing research. All practice nurses (n = 1,054) in the above areas were sent a questionnaire, and a total of 40% (n = 426) responded after two follow-up letters. Fifty-five respondents who volunteered for further participation were interviewed, either individually or in focus groups. About half (n = 207) of the survey respondents expressed an interest in undertaking research. One-third (n = 145) reported previous participation in research, and 20% (n = 85) had initiated their own research. Logistic regression showed that practice nurses educated to graduate level, and those working in practices with nurse training or participation in external research, were most likely to want to undertake research. Working in a medical training practice was found to be a negative predictor of research interest. Respondents prioritised research into long-term health problems with a high prevalence in the local population; for example, diabetes. Their reasons for wishing to engage in research included improving the service, career development, making work more interesting and reducing isolation. The main barriers identified were lack of time, lack of support from some general practitioners and poor access to higher education resources outside formal courses. The development of practice nurse research would provide a distinctive perspective on health need and service provision. It would contribute to the achievement of the national strategic objective of improving the quality of primary care, enhance the status of the profession, utilise the enthusiasm of individuals, increase job satisfaction and staff retention, and answer real questions.     

Uncovering the benefits of participatory research: implications of a realist review for health research and practice

Context: Participatory research (PR) is the co‐construction of research through partnerships between researchers and people affected by and/or responsible for action on the issues under study. Evaluating the benefits of PR is challenging for a number of reasons: the research topics, methods, and study designs are heterogeneous; the extent of collaborative involvement may vary over the duration of a project and from one project to the next; and partnership activities may generate a complex array of both short‐ and long‐term outcomes. Methods: Our review team consisted of a collaboration among researchers and decision makers in public health, research funding, ethics review, and community‐engaged scholarship. We identified, selected, and appraised a large‐variety sample of primary studies describing PR partnerships, and in each stage, two team members independently reviewed and coded the literature. We used key realist review concepts (middle‐range theory, demi‐regularity, and context‐mechanism‐outcome configurations [CMO]) to analyze and synthesize the data, using the PR partnership as the main unit of analysis. Findings: From 7,167 abstracts and 591 full‐text papers, we distilled for synthesis a final sample of twenty‐three PR partnerships described in 276 publications. The link between process and outcome in these partnerships was best explained using the middle‐range theory of partnership synergy, which demonstrates how PR can (1) ensure culturally and logistically appropriate research, (2) enhance recruitment capacity, (3) generate professional capacity and competence in stakeholder groups, (4) result in productive conflicts followed by useful negotiation, (5) increase the quality of outputs and outcomes over time, (6) increase the sustainability of project goals beyond funded time frames and during gaps in external funding, and (7) create system changes and new unanticipated projects and activities. Negative examples illustrated why these outcomes were not a guaranteed product of PR partnerships but were contingent on key aspects of context. Conclusions: We used a realist approach to embrace the heterogeneity and complexity of the PR literature. This theory‐driven synthesis identified mechanisms by which PR may add value to the research process. Using the middle‐range theory of partnership synergy, our review confirmed findings from previous PR reviews, documented and explained some negative outcomes, and generated new insights into the benefits of PR regarding conflicts and negotiation between stakeholders, program sustainability and advancement, unanticipated project activity, and the generation of systemic change.     

What is participatory research?

Research strategies which emphasize participation are increasingly used in health research. Breaking the linear mould of conventional research, participatory research focuses on a process of sequential reflection and action, carried out with and by local people rather than on them. Local knowledge and perspectives are not only acknowledged but form the basis for research and planning. Many of the methods used in participatory research are drawn from mainstream disciplines and conventional research itself involves varying degrees of participation. The key difference between participatory and conventional methodologies lies in the location of power in the research process. We review some of the participatory methodologies which are currently being popularized in health research, focusing on the issue of control over the research process. Participatory research raises personal, professional and political challenges which go beyond the bounds of the production of information. Problematizing ‘participation’, we explore the challenges and dilemmas of participatory practice.     

实践社团视角下科研管理中的非正式沟通

大科学时代下,科研团队呈现出分布式、虚拟性等特点,科研团队成员定期或不定期开展非正式沟通以实现知识共享的行为广泛而频繁,引起科研管理对非正式沟通管理的重视。本文以实践社团为视角,从关注科研团队中的非正式社交网络、提供非正式沟通的条件、培养沟通协调员,科学衡量非正式沟通价值等四个方面提出了开展有效非正式沟通管理的思考。     

Using phronesis instead of ‘research‐based practice’ as the guiding light for nursing practice

Abstract Phronesis, a popular Aristotelian concept that emphasizes deliberation and moral action, should replace the phrase ‘research‐based practice’ as the guiding light for nursing practice. Knowledge from research is still essential, of course, but is insufficient by itself for practice. In this paper, the author describes assumptions behind the apparent superiority of research‐based knowledge, and offers a critique of this position. One critique is that by automatically accepting the superiority of research‐based knowledge other types of knowledge (e.g. intuitive, ethical, personal) are devalued. A second critique is that undeliberated, indiscriminate use of research findings may lead to inappropriate nursing practice. Phronesis is then described, and its application to nursing. For example, phronesis requires that the context of the situation be considered very carefully before acting. Aristotle stated that the goal of personal phronesis is to reach eudaimonia, or genuine happiness or ‘human flourishing’. Infusing nursing practice with phronesis means that an anthropomorphized discipline's eudaimonia would be the eudaimonia of patients. That is, nursing practice would be guided by a desire for patients' genuine happiness or human flourishing. The final section of the paper offers rebuttals to potential criticisms.     

Sexuality and gender: change through reflection and action

Gender and sexuality inequalities lie at the root of poor sexual and reproductive health (SRH). An India-based non-governmental organization (NGO) implemented a field-based methodology to integrate gender and sexuality into existing SRH projects in two states. Personal and organizational change occurred through critical analysis and experiential exercises which normalized topics on sexuality for program staff and communities. Staff learned how biases prevented them from engaging with communities. Community women came to understand sexual pleasure as an important aspect of strengthening the family and community. Mapping women's mobility revealed the link between sexuality, mobility and family honour. Gender myths, portraying men as oppressors, made explicit the narrow and biased picture of men that perpetuates through social norms maintained by staff and not only by communities in which they work. Methods improved social relations and prompted both behaviour and social changes at the community level.     

Telling stories from everyday practice, an opportunity to see a bigger picture: a participatory action research project about developing discharge planning

In spite of laws, rules and routines, findings from Swedish as well as international research show that discharge planning is not a simple matter. There is considerable knowledge about discharge planning, but the quality of the actual process in practice remains poor. With this in mind, a research and developmental health and social care network decided to use participation action research to explore the discharge planning situation in order to generate new ideas for development. This paper reports on the research process and the findings about our enhanced understanding about the discharge planning situation. Story dialogue method was used. The method is based on stories from everyday practice. The stories are used as 'triggers' to ask probing questions in a dialogical and structured form. Local theory is developed to help the participants to find solutions for action in the practice. Our findings were that the discharge planning situation could be seen as a system including three interconnected areas: patient participation, practitioners' competence and organizational support. To reach good quality in discharge planning, all these three issues need to be developed, but not only as routines and forms. Rather, when developing a discharge planning situation, a system where relational aspects such as confidence and continuity are essential and thus needs to be considered. To achieve a change, the core problem needs to be clarified. When the issue is complex, the solution needs to consider the bigger picture and not just the parts. Telling stories from everyday practice, and to systematically reflect and analyse those in interprofessional groups can create opportunities for enhanced understanding, as well as be a vehicle for future change of practice.