Paula L. Bush

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.

A realist evaluation of community-based participatory research: partnership synergy, trust building and related ripple effects

BackgroundCommunity-Based Participatory Research (CBPR) is an approach in which researchers and community stakeholders form equitable partnerships to tackle issues related to community health improvement and knowledge production. Our 2012 realist review of CBPR outcomes reported long-term effects that were touched upon but not fully explained in the retained literature. To further explore such effects, interviews were conducted with academic and community partners of partnerships retained in the review. Realist methodology was used to increase the understanding of what supports partnership synergy in successful long-term CBPR partnerships, and to further document how equitable partnerships can result in numerous benefits including the sustainability of relationships, research and solutions.MethodsBuilding on our previous realist review of CBPR, we contacted the authors of longitudinal studies of academic-community partnerships retained in the review. Twenty-four participants (community members and researchers) from 11 partnerships were interviewed. Realist logic of analysis was used, involving middle-range theory, context-mechanism-outcome configuration (CMOcs) and the concept of the ‘ripple effect’.ResultsThe analysis supports the central importance of developing and strengthening partnership synergy through trust. The ripple effect concept in conjunction with CMOcs showed that a sense of trust amongst CBPR members was a prominent mechanism leading to partnership sustainability. This in turn resulted in population-level outcomes including: (a) sustaining collaborative efforts toward health improvement; (b) generating spin-off projects; and (c) achieving systemic transformations.ConclusionThese results add to other studies on improving the science of CBPR in partnerships with a high level of power-sharing and co-governance. Our results suggest sustaining CBPR and achieving unanticipated benefits likely depend on trust-related mechanisms and a continuing commitment to power-sharing. These findings have implications for building successful CBPR partnerships to address challenging public health problems and the complex assessment of outcomes.

Systematic mixed studies reviews: updating results on the reliability and efficiency of the Mixed Methods Appraisal Tool.

This commentary is an update of results regarding an novative critical appraisal tool, called the ‘Mixed ethods Appraisal Tool’ (MMAT), which were published two papers in the International Journal of Nursing udies. In August 2014, the first paper was mentioned as e of the ‘most cited articles’ on the journal’s website luye et al., 2009). The second paper reported a pilot test the MMAT reliability and efficiency (Pace et al., 2012). e MMAT checklist includes two screening questions and items corresponding to five methodological domains: alitative research, randomized controlled trials (RCTs), n-randomized studies (NRS), quantitative descriptive dies, and mixed methods studies (MMS). The MMAT is sed on a constructionist theory and has been content lidated: for each domain, items were developed from the erature as well as consultations and workshops with perts (Pace et al., 2012; Pluye et al., 2009, 2011). The MMAT is a unique tool (http://mixedmethodsappraisaltoolpublic.pbworks.com) that allows reviewers to concomitantly assess the methodological quality of studies with diverse designs (qualitative, quantitative and MMS) included in systematic mixed studies reviews (Crowe and Sheppard, 2011). Critical appraisal constitutes a key stage of systematic reviews, but appraising the methodological quality of studies with diverse designs remains challenging. The MMAT was designed to help overcome this challenge. The MMAT is recommended by the National Institute of Excellence in Health Services in Québec (INESS). To date, authors of more than 50 published systematic mixed studies reviews have used the MMAT, and MMAT developers have provided counsel on using the MMAT to 29 researchers, from multiple disciplines, in Australia, Belgium, Canada, China, Denmark, Germany, Netherlands, New Zealand, Switzerland, UK, and USA. Mixed studies review is a new, and increasingly popular, form of literature review that includes studies with diverse designs (qualitative, quantitative and mixed methods) and addresses complex review questions (Pluye and Hong, 2014). Mixed studies reviews consist of mixed methods research applied to the field of literature reviews, and combine the strengths of quantitative and qualitative research (http://toolkit4mixedstudiesreviews.pbworks. com). This commentary is aimed to update results on the reliability and efficiency of the MMAT, specifically the new 2011 version (MMAT-v2011) (Pluye et al., 2011). There is a growing need for a tool like the MMAT, and as per our two previous papers, a need for additional supporting evidence for the MMAT. In previous work, we tested the pilot version of the MMAT (Pace et al., 2012) and results indicated that R T I C L E I N F O

Assessing the outcomes of participatory research: protocol for identifying, selecting, appraising and synthesizing the literature for realist review

BackgroundParticipatory Research (PR) entails the co-governance of research by academic researchers and end-users. End-users are those who are affected by issues under study (e.g., community groups or populations affected by illness), or those positioned to act on the knowledge generated by research (e.g., clinicians, community leaders, health managers, patients, and policy makers). Systematic reviews assessing the generalizable benefits of PR must address: the diversity of research topics, methods, and intervention designs that involve a PR approach; varying degrees of end-user involvement in research co-governance, both within and between projects; and the complexity of outcomes arising from long-term partnerships.MethodsWe addressed the above mentioned challenges by adapting realist review methodology to PR assessment, specifically by developing inductively-driven identification, selection, appraisal, and synthesis procedures. This approach allowed us to address the non-uniformity and complexity of the PR literature. Each stage of the review involved two independent reviewers and followed a reproducible, systematic coding and retention procedure. Retained studies were completed participatory health interventions, demonstrated high levels of participation by non-academic stakeholders (i.e., excluding studies in which end-users were not involved in co-governing throughout the stages of research) and contained detailed descriptions of the participatory process and context. Retained sets are being mapped and analyzed using realist review methods.ResultsThe librarian-guided search string yielded 7,167 citations. A total of 594 citations were retained after the identification process. Eighty-three papers remained after selection. Principle Investigators (PIs) were contacted to solicit all companion papers. Twenty-three sets of papers (23 PR studies), comprising 276 publications, passed appraisal and are being synthesized using realist review methods.DiscussionThe systematic and stage-based procedure addressed challenges to PR assessment and generated our robust understanding of complex and heterogeneous PR practices. To date, realist reviews have focussed on evaluations of relatively uniform interventions. In contrast our PR search yielded a wide diversity of partnerships and research topics. We therefore developed tools to achieve conceptual clarity on the PR field, as a beneficial precursor to our theoretically-driven synthesis using realist methods. Findings from the ongoing review will be provided in forthcoming publications.

Promising school-based strategies and intervention guidelines to increase physical activity of adolescents

This narrative review describes the available scientific evidence regarding promising school-based strategies to increase physical activity of adolescents. We conducted a literature search for studies published up to 2011, regarding adolescent physical activity intervention studies that resulted in increased physical activity (regardless of measurement) and reviewed 52 intervention articles and 21 review articles. We identified several promising strategies and grouped into five broad intervention guidelines. These guidelines are as follows: (i) design multi-component interventions that foster the empowerment of members of the school community; (ii) develop improvements to Physical Education curricula as a strategy to promote physical activity to adolescents; (iii) design and implement non-curricular programmes and activities to promote physical activity; (iv) include computer-tailored interventions during the implementation and monitoring of physical activity promotion programmes and (v) design and implement specific strategies that respond to the interests and needs of girls. On the basis of our review of the adolescent physical activity promotion literature, we suggest that these five guidelines should be taken into account in school-based interventions geared towards achieving an increase in adolescent physical activity.

Perceived barriers to healthcare for persons living in poverty in Quebec, Canada: the EQUIhealThY project

IntroductionEnsuring access to timely and appropriate primary healthcare for deprived patients is an issue facing all countries, even those with universal healthcare systems. There is a paucity of information on how patients living in a context of material and social deprivation perceive barriers in the healthcare system. This study combines the perspectives of persons living in poverty and of healthcare providers to explore barriers to responsive care for underserved persons with a view to developing equity-focused primary care.MethodsIn this participatory action research we used photovoice, together with a method known as ‘merging of knowledge and practice’ developed by ATD Fourth World, an international community organization working to eradicate poverty. The study was conducted in two teaching primary care practices in the Canadian province of Quebec. Participants consisted of 15 health professionals and six members of ATD Fourth World; approximately 60 group meetings were held. Data were analyzed through thematic analysis, in part with the involvement of persons living in poverty.ResultsThree main barriers to responsive care in a context of poverty were highlighted by all participants: the difficult living conditions of people living in poverty, the poor quality of interactions between providers and underserved patients, and the complexity of healthcare system organization and functioning.ConclusionOur research revealed that unhealthy living conditions prevent persons living in poverty from accessing quality healthcare and maintaining good health. Also, the complexity of the healthcare system’s organization and functioning has a negative impact on the interactions with healthcare providers. Changes in policy and practice are needed to address those barriers and to achieve greater equity and provide more responsive care for persons living in poverty.

Physical Activity Promotion Among Underserved Adolescents: “Make It Fun, Easy, and Popular”

There is a paucity of studies regarding noncurricular physical activity promotion interventions among adolescents, and even less such research pertaining to underserved youth. This article describes the development and implementation of a noncurricular, school-based physical activity promotion program designed for a multiethnic, underserved population of adolescents. The program’s impact on leisure-time physical activity (LTPA) and on physical activity enjoyment (PAE) is also presented. The 16-week program, named FunAction, utilizes social marketing principles. Control (n = 90) and intervention (n = 131) students are assessed pre- and postintervention for levels of LTPA and PAE. Results indicate that although the program did not contribute to an increase in LTPA or PAE among intervention group students, participation in the program was elevated. This study offers preliminary evidence that noncurricular physical activity promotion programs that apply social marketing principles can be effective in engaging multiethnic, underserved adolescents in physical activity.

Role of Individual and School Factors in Physical Activity Patterns of Secondary-Level Spanish Students

BACKGROUND While the importance of individual and school factors as correlates of overall youth physical activity has been demonstrated by previous research, less is known about the relationship of these factors with specific patterns of physical activity during adolescence. Thus, the purpose of this study was to examine the association of selected individual and school factors with patterns of physical activity based on a sum index of physical activity in a population-based sample of Spanish adolescents. METHODS One thousand and eighty-four students aged 12 to 17 years completed a self-report survey once during school hours. In addition to participation in physical activity outside of school hours, the following variables were included in the analysis: gender, age, weight status, physical self-perceptions, evaluation of the school physical education experience, and type of school (public vs private). Multinomial logistic regression was used to model the associations among the variables and to calculate odd ratios (ORs) and 95% confidence intervals (CIs) for each pattern of physical activity. RESULTS The physical self-perceptions variable was the most consistent individual correlate of physical activity across participation patterns (ORs ranging from 4.29 to 1.88, CIs ranging from 2.16-8.54 to 1.10-3.21). Regarding the school variables included in this study, both were linked with participation in physical activity, but evaluation of the physical education experience showed the most consistent associations across activity patterns (ORs 2.49-2.17, CIs 1.49-4.15 to 1.25-3.74). CONCLUSION Physical education programs may benefit adolescents with different physical activity participation preferences regardless of important individual characteristics and broader school factors.

Medical education for equity in health: a participatory action research involving persons living in poverty and healthcare professionals

BackgroundImproving the knowledge and competencies of healthcare professionals is crucial to better address the specific needs of persons living in poverty and avoid stigmatization. This study aimed to explore the needs and expectations of persons living in poverty and healthcare professionals in terms of medical training regarding poverty and its effects on health and healthcare.MethodsWe conducted a participatory action research study using photovoice, a method using photography, together with merging of knowledge and practice, an approach promoting dialogue between different sources of knowledge. Nineteen healthcare professionals and persons from an international community organization against poverty participated in the study. The first phase included 60 meetings and group sessions to identify the perceived barriers between persons living in poverty and healthcare teams. In the second phase, sub-committees deployed action plans in academic teaching units to overcome barriers identified in the first phase. Data were analysed through thematic analysis, using NVivo, in collaboration with five non-academic co-researchers.ResultsFour themes in regard to medical training were highlighted: improving medical students’ and residents’ knowledge on poverty and the living conditions of persons living in poverty; improving their understanding of the reality of those people; improving their relational skills pertaining to communication and interaction with persons living in poverty; improving their awareness and capacity for self-reflection. At the end of the second phase, actions were undertaken such as improving knowledge of the living conditions of persons living in poverty by posting social assistance rates, and tailoring interventions to patients’ reality by including sociodemographic information in electronic medical records. Our findings also led to a participatory research project aiming to improve the skills and competency of residents and health professionals in regard to the quality of healthcare provided to persons living in poverty.ConclusionsMedical training and residency programs should aim to improve students’ and residents’ relational skills, more specifically their communication skills, as well as their awareness and capacity for self-reflection, by helping them to identify and recognize their biases, and limitations.

Toward an information management system for handling parenting information users' comments

Little is known about how their qualitative feedback can be used by information providers. In this study, researchers worked with information providers, ‘Naitre et grandir’ (N&G), to implement the Information Assessment Method (IAM) for assessing and improving parenting information. Qualitative feedback was collected from participants who visited the N&G website during the study period and who completed an IAM questionnaire. Using an Organizational Participatory Research approach, a coding manual for the identification of participants’ comments was created, and developed by the researchers in partnership with information providers. This manual was used by two coders for classifying participants’ comments. A 4‐step process was followed. For each step, a sample of comments were codes, coding was compared, and codes were further refined. At step‐4, the inter‐coder reliability was tested. This led to a reliable coding manual that will be used in the creation of an online system to facilitate the coding of comments, and provide selected comments to N&G editors on a weekly basis. This system can be adapted by other website editors.