scholarly journals Evaluating the effectiveness of care coordination interventions designed and implemented through a participatory action research process: Lessons learned from a quasi-experimental study in public healthcare networks in Latin America

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261604
Author(s):  
María-Luisa Vázquez ◽  
Andrea Miranda-Mendizabal ◽  
Pamela Eguiguren ◽  
Amparo-Susana Mogollón-Pérez ◽  
Marina Ferreira-de-Medeiros-Mendes ◽  
...  
Keyword(s):  
Action Research ◽  
Participatory Action Research ◽  
Organizational Factors ◽  
Lessons Learned ◽  
Future Research ◽  
Public Healthcare ◽  
Participatory Action ◽  
Intermediate Outcomes ◽  
Quasi Experimental

Background Despite increasing recommendations for health professionals to participate in intervention design and implementation to effect changes in clinical practice, little is known about this strategy’s effectiveness. This study analyses the effectiveness of interventions designed and implemented through participatory action research (PAR) processes in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay to improve clinical coordination across care levels, and offers recommendations for future research. Methods The study was quasi-experimental. Two comparable networks, one intervention (IN) and one control (CN), were selected in each country. Baseline (2015) and evaluation (2017) surveys of a sample of primary and secondary care doctors (174 doctors/network/year) were conducted using the COORDENA® questionnaire. Most of the interventions chosen were based on joint meetings, promoting cross-level clinical agreement and communication for patient follow-up. Outcome variables were: a) intermediate: interactional and organizational factors; b) distal: experience of cross-level clinical information coordination, of clinical management coordination and general perception of coordination between levels. Poisson regression models were estimated. Results A statistically significant increase in some of the interactional factors (intermediate outcomes) -knowing each other personally and mutual trust- was observed in Brazil and Chile INs; and in some organizational factors -institutional support- in Colombia and Mexico. Compared to CNs in 2017, INs of Brazil, Chile, Colombia and Mexico showed significant differences in some factors. In distal outcomes, care consistency items improved in Brazil, Colombia and Uruguay INs; and patient follow-up improved in Chile and Mexico. General perception of clinical coordination increased in Brazil, Colombia and Mexico INs. Compared to CNs in 2017, only Brazil showed significant differences. Conclusions Although more research is needed, results show that PAR-based interventions improved some outcomes regarding clinical coordination at network level, with differences between countries. However, a PAR process is, by definition, slow and gradual, and longer implementation periods are needed to achieve greater penetration and quantifiable changes. The participatory and flexible nature of interventions developed through PAR processes poses methodological challenges (such as defining outcomes or allocating individuals to different groups in advance), and requires a comprehensive mixed-methods approach that simultaneously evaluates effectiveness and the implementation process to better understand its outcomes.

scholarly journals Effectiveness of participatory interventions in improving clinical coordination in Latin America

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Miranda Mendizabal ◽  
I Vargas ◽  
I Samico ◽  
P Eguiguren ◽  
A S Mogollón-Pérez ◽  
...  
Keyword(s):  
Latin America ◽  
Regression Models ◽  
Organizational Factors ◽  
Public Healthcare ◽  
Participatory Action ◽  
Care Level ◽  
Before And After ◽  
Quasi Experimental ◽  
Implementation Time

Abstract Background Evaluation of interventions to improve clinical coordination across care levels is scarce in Latin America. Aim to evaluate the effectiveness of interventions implemented through participatory action research in improving clinical coordination between care levels in public healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. Methods Quasi-experimental study (controlled before and after design). Comparable networks, one intervention (IN) and one control (CN), were selected in each country. Baseline (2015) and evaluation (2017) surveys were conducted applying COORDENA® questionnaire to a sample of primary (PC) and secondary (SC) care doctors (174 doctors/network/year). Designed interventions promoted clinical agreement and communication across levels for patients’ follow-up. Outcome variables: a) intermediate: interactional and organizational factors; b) final: experience of clinical management coordination (care consistency and patients’ follow-up) and general perception of coordination between levels. Poisson regression models were estimated. Results Intermediate: interactional factors -personal knowledge and trust on the other care level-increased significantly in Brazil’ and Chile’ INs; and organizational factors -managers’ support- in the INs of Colombia and Mexico. Comparing to CN in 2017, INs of Brazil, Chile, Colombia and Mexico showed significant differences in some factors. Final: care consistency items -agreement over the treatments- improved in the INs of Brazil, Colombia and Uruguay; and patients’ follow-up in the INs of Chile and Mexico. General perception of clinical coordination increased in the INs of Brazil, Colombia and Mexico. Compared to CN in 2017, only Brazil showed significant differences. Conclusions Improvements in intermediate and final care coordination results, consistent with expected results, were observed in all the INs. Reduced implementation time and some process and context factors may have limited their impact. Key messages First study assessing the effectiveness of participatory interventions in improving clinical coordination between care levels in public healthcare networks of Latin America. Results showed changes in the intermediate and final clinical coordination results in the intervention networks. Longer implementation and evaluation times are expected to achieve greater impact.

On the news today: challenging homelessness through participatory action research

2018 ◽  
Vol 21 (1) ◽  
pp. 13-25
Author(s):  
Bruno De Oliveira
Keyword(s):  
Social Issue ◽  
Action Research ◽  
Participatory Action Research ◽  
Social Issues ◽  
Homeless People ◽  
Media Representations ◽  
Future Research ◽  
Participatory Action ◽  
Content Type ◽  
Local Media

Purpose How can people with lived experience of homelessness actively participate in contesting their marginalisation? The purpose of this paper is to suggest that involving people who are homeless in participatory action research (PAR) is one such strategy. This paper shows that such an approach can have a significant impact on empowering people with direct of experience of homelessness to challenge prevailing social discourses, particularly in terms of the way in which the local media presents homelessness as a social issue. Design/methodology/approach A PAR approach informed the design, development and dissemination of the study on which this paper is based. Analytically, it is underpinned by Foucauldian discourse analysis (FDA). FDA, with its focus on power relations in society, is noted to be particularly useful for analysing local media representations of homeless people. Findings The research reported here found that academic practitioners and homeless people can work together to challenge media discourses, which serve to marginalise people affected by homelessness. Research limitations/implications The research reported here served to challenge some of the ways in homeless people are victimized and stigmatized. Practical implications The research reported here has the potential to inform future research concerned with understanding media presentations of homeless people. It can be seen as a model for how people affected by a particularly pernicious social issue can contribute to research in ways that go beyond researching for the sake of research. Originality/value The research reported here provides evidence of the emancipatory value of research that seeks to bring academic practitioners and homeless people together in a partnership to challenge vital social issues such as the power of the local media to frame understandings of homelessness.

scholarly journals Online-based intervention on LGBTI+ health promotion in Brazil: development and preliminary impacts

2021 ◽  
Vol 31 (Supplement_3) ◽  
Author(s):  
M Signorelli ◽  
M Polidoro ◽  
D Canavese
Keyword(s):  
Health Promotion ◽  
Action Research ◽  
Focus Groups ◽  
Participatory Action Research ◽  
Formal Education ◽  
National Policy ◽  
Course Evaluation ◽  
Public Healthcare ◽  
Participatory Action ◽  
High Interest

Abstract Background Brazil reports public healthcare gaps concerning lesbian, gay, bisexual, transgender, and intersex (LGBTI+) people. Massive Open Online Courses (MOOCs) are online-based teaching interventions, however their use is still scarce in Brazil. We aim to describe the development and to analyze preliminary impacts of the first online-based intervention through MOOCs for LGBTI+ health promotion in Brazil. Methods We adopted mixed qualitative and quantitative approaches, based on participatory-action research: 1) to design the content and format of the MOOC, we conducted 10 focus groups during 2018 and 2019 with key stakeholders in three different Brazilian State capitals, identifying needs and challenges and linking it with guidelines of the National Policy for Comprehensive Health of LGBTI+ people; 2) based on step 1, we developed the MOOC, producing reading content, video-classes and multimedia; 3) we quantitatively analyzed, through a survey, its impact and reach after six months. Results The results showed that: a) focus groups were essentials to inform the priorities to design a tailored MOOC; b) the MOOC had 30 hours of autonomous learning activities divided into two modules, with problem-based evaluation; c) the first ten-month of the course had a total of 5,000 people enrolled with a completion rate of approximately 30%; d) 1,700 successfully completed the course; e) 582 participants joined the survey post-course evaluation and for 370 (63.6%) of them, this was the first training activity on LGBTI+ health. Conclusions Results point to a high interest in LGBTI+ health and high demand for training on this topic among health professionals. The MOOC format was successful and reliable in enabling the teaching-learning process. Key messages Participatory action research was able to inform the content of the first MOOC for LGBTI+ health in Brazil. The MOCC had high interest, and for the majority of concluding participants it was the first activity and formal education about LGBTI+ health.

scholarly journals Collaboration for Improving Social Work Practice: The Promise of Feminist Participatory Action Research

Affilia ◽  
2020 ◽  
pp. 088610992095442
Author(s):  
Holly Johnson ◽  
Catherine Flynn
Keyword(s):  
Action Research ◽  
Participatory Action Research ◽  
Real Life ◽  
Work Practice ◽  
Social Work Practice ◽  
Steering Committee ◽  
Future Research ◽  
Structural Barriers ◽  
Participatory Action ◽  
Institutional Power

Feminist research and participatory action research (PAR) share the belief that research should directly serve social justice aims and work to alleviate suffering of marginalized and oppressed people. This article presents the results of a unique feminist PAR (FPAR) approach to designing and implementing an evaluation of an intervention with women who have used violence. The site of our analysis is the steering committee that oversaw this work and the extent to which members adhered to FPAR principles. Over the two decades since feminist critiques of PAR began to emerge, new discourses of collaboration have appeared. As researchers, we must be alert to FPAR discourses that mask ongoing hierarchies. Our findings suggest that, while reflexivity and genuine commitment to collaboration are fundamental to enacting FPAR principles, social workers nevertheless face real challenges confronting structural barriers that impede anti-oppression goals. This study highlights the challenges of adhering faithfully to feminist participatory principles in real-life settings and the need for future research to examine the effectiveness of FPAR processes in achieving authentic collaboration among committee members who are chosen to represent disparate perspectives and are backed by vastly different levels of social and institutional power.

scholarly journals Development of family‐based follow‐up care system for patients with burn in Iran: Participatory action research

Nursing Open ◽  
2020 ◽  
Vol 7 (4) ◽  
pp. 1101-1109
Author(s):  
Mojgan Lotfi ◽  
Vahid Zamanzadeh ◽  
Ali Ostadi ◽  
Maryam Jalili Fazel ◽  
Afsaneh Nobakht ◽  
...  
Keyword(s):  
Action Research ◽  
Participatory Action Research ◽  
Participatory Action ◽  
Follow Up Care ◽  
Family Based ◽  
Care System

Assessments of Stress of Conscience, Perceptions of Conscience, Burnout, and Social Support Before and After Implementation of a Participatory Action-Research-Based Intervention

2016 ◽  
Vol 26 (2) ◽  
pp. 205-223 ◽  
Author(s):  
Eva Ericson-Lidman ◽  
Johan Åhlin
Keyword(s):  
Social Support ◽  
Action Research ◽  
Participatory Action Research ◽  
Statistical Tests ◽  
Participatory Action ◽  
Before And After ◽  
Stress Of Conscience ◽  
Nonparametric Statistical ◽  
Difficult Situations

Interventions aiming to constructively address stress of conscience are rare. The aim of the study was to compare assessments of stress of conscience, perceptions of conscience, burnout, and social support among health care personnel (HCP) working in municipal residential care of older adults, before and after participation in a participatory action research (PAR) intervention aiming to learn to constructively deal with troubled conscience. Questionnaire data were collected at baseline and at follow-up (1-year interval; n = 29). Descriptive statistics and nonparametric statistical tests were used to make comparisons between baseline and follow-up. HCP gave significantly higher scores to the question, “Are your work achievements appreciated by your immediate superior?” at follow-up compared with baseline. No significant differences in levels of stress of conscience and burnout at follow-up were found. The results suggested that a PAR intervention aiming to learn HCP to deal with their troubled conscience in difficult situations could be partially successful.

We are women! We are ready! Amplifying women’s voices through feminist participatory action research

2021 ◽  
Vol 21 (2) ◽  
pp. 85-100
Author(s):  
Tracy Mcdiarmid ◽  
Alejandra Pineda ◽  
Amanda Scothern
Keyword(s):  
Action Research ◽  
Participatory Action Research ◽  
Women's Leadership ◽  
Lessons Learned ◽  
Women's Movements ◽  
Transformative Change ◽  
Women's Development ◽  
Participatory Action ◽  
Women's Voices

Gender equality requires incremental and transformative change which occurs over generations. Strengthening women’s movements through collective action and learning is a key strategy in achieving such change. Capturing those changes in the voices of diverse women is critical to ethical, feminist, participatory evaluation. The purpose of this article is to explore the strengths, benefits and challenges in using Feminist Participatory Action Research (FPAR) to evaluate a women’s leadership programme. This article demonstrates the rationale and context for FPAR providing a brief overview of feminist approaches to evaluation and an outline of the key elements of FPAR that have influenced recent evaluative activities by the International Women’s Development Agency (IWDA). The case study of the Women’s Action for Voice and Empowerment (WAVE) programme is then presented to demonstrate the application of FPAR. Findings indicate the potential of this framework to influence evaluation design to strengthen the capacity of diverse women as co-evaluators; build on and generate knowledge as a resource of and for the women who create, own and share it; and, design evaluative spaces that promote authentic and inclusive forms of evidence. This article discusses insights from the findings, reflections and the lessons learned on using a FPAR framework.

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