G.C. Jacobs

Conflicting demands and the power of defensive routines in participatory action research

Participation has been of ongoing interest in the field of action research and the New Health Promotion movement, but it is not without tensions and problems. This article presents the challenge of containing the conflicting demands of personal empowerment, practical advancement and theory building in a community-based participatory action research project ‘Aspiring to Healthy Living in The Netherlands’. A Participatory Action Research (PAR) methodology was chosen because of its contribution to empowerment of the community of older people, which was one of the project goals. Besides that, the project aimed at the development of an intervention program for encouraging healthy living amongst older people in The Netherlands and contributing to the knowledge base on healthy living, by analyzing narratives from the participants. However, when time pressure rose, the empowerment goal started to collide with academic and practical aims, and the dialogue within the project team became obstructed leading to a return to the traditional routine of applied research and the accompanying power relationships, with implications for the learning in and about the project. This article starts with a short review of the literature on community participation in health research and the challenges of learning participatory action research, followed by a description of the PAR project and the process of participation, using the ladder of Pretty as a tool to highlight different levels of participation in different project stages. By using the theory of organizational learning developed by Argyris and Schön (Argyris, 1993; Argyris & Schön, 1978), insights will be provided into the attempts of a relatively inexperienced team to create a participatory and dialogic research project, and the problems in keeping reflection and learning going within a context of external pressure.

Imagining the Flowers, but Working the Rich and Heavy Clay: Participation and Empowerment in Action Research for Health.

Participation of the ‘target group’ is a key concept in working on empowerment in health education. However, it raises many questions and is not without struggle. I will discuss the findings from a study into the state of the art of empowerment in health education, which includes a literature review and the analysis of eight Dutch health‐promotion projects. An important finding is that participation is not an unequivocal concept. Professionals working in health education strongly disagree on the value, goals and meaning of participation. Moreover, in working on empowerment, a tension exists—between the ideal of participatory, ‘bottom‐up’ approaches on the one hand; and the ‘top‐down’ structure of health education programmes, on the other. I will argue for a ‘realistic approach’ in which the practice of health promotion is taken as the starting point to work on empowerment. After all, imagining the flowers is easy, but working the rich and heavy clay is the challenge.

“Take Control or Lean Back?” Barriers to Practicing Empowerment in Health Promotion

During the past few decades, health promotion has increasingly focused on the empowerment of deprived communities and is shifting from a top—down approach to a participatory practice, aimed at helping people to gain control over their lives and health. Previous research shows that this shift is not without problems. In the Netherlands, an action learning program on empowerment was developed to help health promotion practitioners in this transition. Twenty-four practitioners from different fields of health promotion took part in a 6-month program. Qualitative data were collected from different sources and methods and were analyzed using a thematic analysis. The findings threw light on a core dilemma in health promotion practice and several barriers to bringing empowerment into practice, both on a personal level and in relationship to the community and the wider institutional context. The implications of this study for the empowerment ethos of health promotion and its feasibility within the current West European policy context are discussed.

Empowerment of Marginals: Strategic Paradoxes

This article is about the disability movement in the Netherlands and its strategies for empowerment of disabled people. Only since the end of 2003 has the Netherlands enjoyed anti‐discrimination legislation for disabled people. But, how important actually is legislation for the empowerment of disabled people? To answer this question, we take a closer look at social movements and their involvement in empowerment and active citizenship. We criticise the disregard of differences and care in notions of active citizenship and propose instead the idea of a ‘varied society’ based on the notions of diverse and ‘careful citizenship’. One of our main arguments is that empowerment strategies necessary to create this kind of society are above all bottom‐up strategies. However, the highly organised disability movement in the Netherlands is confronted with strategic paradoxes that have ‘de‐powering’ consequences. Based on these paradoxes, five recommendations for the disability movement in the Netherlands are presented.

The Development of Critical Being? Reflection and reflexivity in an Action Learning Programme for Health Promotion Practitioners in The Netherlands.

Public health is a major focus of government policy worldwide and an expanding area of practice that includes an array of professionals and disciplines. Since the 1980s ‘empowerment’ of individuals and communities to gain greater control over the factors that influence their health has become the focus of many national and local policies and practices. In The Netherlands, where the current study is undertaken, empowerment has only recently found its way in the health promotion discourse and a review study found that practitioners feel incapable to transform their current practice in line with the new discourse. Therefore, an action learning programme on empowerment was developed to support practitioners in this process and evaluated using a qualitative case-study approach. In this paper, the process and outcomes of reflection as experienced and described by the practitioners in the action learning programme, are discussed against the background of notions of reflection and reflexivity, critical being and critical pedagogy.

Developing critical understanding by teaching action research to undergraduate psychology students

Action research assumes the active engagement of the stakeholders, such as the community, in the research, and a multiple‐level process of reflection in order to evaluate and monitor the actions taken. This makes action research a suitable methodology to increase the critical understanding of the participants. In this paper we describe the challenge of teaching action research within the context of an undergraduate community health psychology module. The module was designed using principles from transformative learning, critical pedagogy and action learning. The module took place over one semester; and 15 students (13 females, two males) took part in it. We discuss the background to the module development and the alignment of the learning objectives with the teaching and assessment methods, and reflect upon the students’ experiences in the module and the learning outcomes. We conclude by addressing the major challenges involved in teaching action research to increase critical understanding: the ability to engage in deep learning of undergraduate psychology students; our role and expectations as tutors on the course; and the current higher education system in which action science yet has to find a place.

‘A guided walk in the woods’: boundary crossing in a collaborative action research project

Abstract This article discusses the ideal and practice of collaboration in a collaborative action research project in which university researchers work together with staff from the field of primary education. A qualitative case study was conducted using the theory of boundary crossing to make sense of the ways collaboration took place within the project team. The main theme, also a major dilemma in the project, referred to the transition from a democratic towards a more directive approach within the project design after the first year. The members of the project team took shifting and ambivalent positions within the project as they were trying to cross boundaries between the different goals of the project. Also, boundary objects on different levels contributed to the collaboration. We conclude that clear boundaries between groups or a strong shared identity, as proposed by an insider–outsider model of action research and the notion of first-order democracy, are not helpful in complex collaborative action research projects. Instead, we need the development of second-order democracy means in order to cross boundaries and sustain a critical dialogue about differences.

Designing the plane while flying it: concept co-construction in a collaborative action research project.

Abstract In the field of collaborative action research (CAR), the quality of the collaborative partnerships between university researchers and practitioners has received much attention. Most accounts focus on three areas: the question how to organise and optimise the encounter of these ‘worlds’ of scientific and practical reasoning; the professional development and emancipation of practitioners; and the enhancement of the practical utility of a CAR-project. In this article, we look at CAR projects from a different angle and explore the question how theoretical concepts are co-constructed in CAR-projects, thereby acquiring both practical as well as scientific relevance. We have focused on the participatory process of conceptualization during a CAR project in primary education, in order to find out how a key concept in the considered project is co-constructed and operationalized in multidisciplinary communities of practices. Both the theoretical validity of the concept is evaluated as well as the validity of collaboration. An ‘hourglass’ model is introduced for analysing participation in CAR projects, holding a more relational and dialogic interpretation of participation than the ‘Participation Ladder’ model. Furthermore, a heuristic approach to conceptualization in CAR projects is proposed.

Actieonderzoek: de praktijk centraal

A ctieonderzoek is een vorm van wetenschappelijk praktijkgericht onderzoek. Het draagt bij aan kennis die relevant is voor of toepasbaar is in de praktijk doordat het ingaat op vraagstukken uit de praktijk, bij professionals, cliënten of organisaties. Typerend voor actieonderzoek is dat het zowel gericht is op verandering van praktijken én op het ontwikkelen van kennis omtrent die verandering.1 Dit kan betrekking hebben op diverse processen: a) de ontwikkeling of het leren van (groepen) personen of professionals; b) verbetering van praktijken (zoals methodieken, procedures of werkculturen) en/of; c) veranderingen in organisaties of (fysieke) leefomgevingen. Kenmerkend voor actieonderzoek is dat het veranderdoel (de ‘actie’) centraal staat en het kennisdoel secundair is. Dit in tegenstelling tot de meeste andere vormen van onderzoek die worden uitgevoerd. VORmeN Er zijn diverse vormen van actieonderzoek. De verschillen zitten in de doelen, de opvattingen die eraan ten grondslag liggen en de mate waarin het onderzoek participatief van aard is. We gaan verder in op de vorm die in het laatste decennium steeds meer aandacht krijgt: participatief actieonderzoek.2 Kenmerkend is de actieve deelname van direct belanghebbenden in diverse onderdelen van het actieonderzoek. Er wordt geen onderzoek gedaan ‘over’ of ‘voor’ de praktijk, maar samen met belanghebbenden uit die praktijk. Zij brengen zelf de vragen en kwesties naar voren.

Patient autonomy in home care: Nurses’ relational practices of responsibility

Background: Over the last decade, new healthcare policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disability within the community. For professional caregivers in home care, such as nurses, this requires a shift from a caring attitude towards the promotion of patient autonomy. Aim: To explore how nurses in home care deal with the transformation towards fostering patient autonomy and self-care. Research design and context: A case study was conducted in a professional development course (‘learning circle’) for home care nurses, including participant observations and focus groups. The theoretical notion of ‘relational agency’ and the moral concept of ‘practices of responsibility’ were used to conduct a narrative analysis on the nurses’ stories about autonomy. Participants: Eight nurses, two coaches and two university lecturers who participated in the learning circle. Ethical considerations: Informed consent was sought at the start of the course and again, at specific moments during the course of the learning circle. Findings: Three main themes were found that expressed the moral demands experienced and negotiated by the nurses: adapting to the person, activating patients’ strengths and collaboration with patients and informal caregivers. Discussion: On a policy and organisational level, the moral discourse on patient autonomy gets intertwined with the instrumental discourse on healthcare budget savings. This is manifested in the ambiguities the nurses face in fostering patient autonomy in their daily home care practice. To support nurses, critical thinking, moral sensitivity and trans-professional working should be part of their professional development. Conclusion: The turn towards autonomy in healthcare raises moral questions about responsibilities for care. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together.