Abstract
I offer my editorial as a conversation starter. And I am happy to announce that we have made reader engagement that much easier with our new readers’ comments section as well as a newly revamped blog. We’d love to have benefit of your comments too: http://arj-journal.blogspot.com.
In this issue there is quite a theme around the value of action research in the new healthcare. What I am labeling ‘new’ is really the broad move to manage chronic illnesses such as obesity that have come to burden healthcare budgets everywhere. It is a relatively recent phenomenon to see such uptake of action research in mainstream healthcare. Working with the behaviors and social systems of patients to manage chronic illness is however precisely what action researchers are good at. Obesity, for example, results in large part from the social environment with its cues around impoverished food availability that are socially reinforced by family and peers. The environment cannot simply be ‘cured’ with individual insulin prescriptions alone. Action researchers bring a more relational paradigm that connects with the companionable values that also animate conventional healthcare researchers, for example, a drive toward practical benefit and a deep concern for the stakeholders/patients. Our ways of working and our value around partial objectivity have been quite different however.
For conventional science, replication and generalizability are the significant outcomes made (at least theoretically) possible when validity is constituted with replication and generalizability as central concerns. For action researchers, with its integration of subjectivity as a central feature of a relational paradigm, replication and generalizability are entirely reimagined as a practice of building related networks through which findings can spread and garner more co-researching. Bjørn Gustavsen (2003) argues that action research needs to be understood less in terms of individual projects and more about creating and supporting social networks of linked up action researchers engaged with similar issues. In the case of healthcare research this means designing our work so as to link up with like-minded colleagues who are working with healthcare patients as co-researchers, thus amplifying and sharing findings available through our networks.
Speaking of action research network colleagues, I want to acknowledge the work of Svante Lifvergren, MD, who leads the healthcare arena for us with the journal and himself leads a Swedish based healthcare network with global reach at Chalmers, http://www.chi.chalmers.se. Thanks Svante! By the way I should mention that Svante is an editor for the special issue on action research and healthcare. Read the call and send your papers: http://arj.sagepub.com/site/cfp/cfp_action_research_healthcare.pdf.
In our first of the new blog posts we blogged about Lauren S. Seifert’s ‘Self-regulation in disability: Migraine management as action research.’ Lauren picks up on the new trend in which people, without formal medical training, track data to monitor their health. In this we see the power of information, heretofore thought unsuitable for non-technically trained people, becoming accessible and actionable. This allows for better preparation if serious health threats arise. But more than that, it is close to the heart of the democratizing sensibilities of all action researchers. It is also what doctors call ‘patient activation’ -- that is, becoming knowledgeable about and active in one’s own health maintenance. Clearly, the more people become active in their own health, the better the health outcomes for individuals and the healthcare systems in which they receive their care. In Lauren’s article we see a nice combination of the three basic types of action research. In the first person, we learn of her managing her own chronic health condition with the expertise that suffering often brings. We see how first-person expertise allows for more choiceful second-person collaborations with family, friends, and professionals. Beyond that third-person resources can also be helpful. Ultimately, we see in Lauren’s article how managing one’s life can be perceived as ongoing cycles of participatory action research, whereby a person engages others in order to stay well. I find this article intriguing for showing us the democratization of medicine through action inquiry. And I look forward to seeing it spread through action research networks.
Jon Fieldhouse and Steve Onyett offer ‘Community mental health and social exclusion: Working appreciatively towards inclusion.’ A group of mental health service managers, practitioners, service users and representatives from the Further Education community worked together for 18 months to promote social inclusion for local service users and used appreciative inquiry and co-operative inquiry methods to explore and enhance this work. This article discusses the methodological nuances of this fusion of approaches. It underlines the benefits of an appreciative approach for addressing historically rooted patterns of practice within statutory mental health services, and highlights how harnessing an extended epistemology can bring together impetus from ‘top down’ and ‘bottom up’ to create actionable plans. The article describes what was learned about optimal inter-agency working and about trying to be a change agent in a large organization. It concludes with reflections on the suitability of participatory action research methods for developing community-orientated mental health services.
Fatemeh Adili, Isabel Higgins and Tina Koch offer ‘Inside the PAR group: The group dynamics of women learning to live with diabetes.’ They tell of their research alongside older Australian women who were newly diagnosed with type II diabetes. They asked women to talk about their self-management and learning post-diagnosis and continued to talk with them for 12 months. Having built relationships, they convened 10 PAR group sessions held over six months. They suggest that a closer look at the group’s working reveals a better understanding of its democratic process, and that the theoretical models provide tools for closer scrutiny. The cyclical nature of the PAR process promoted reflection and learning among women. Women learnt more about diabetes and themselves through mutual engagement and self-directed activities. The authors conclude that group learning was a powerful dynamic in helping women to live with a chronic illness.
Cathryn Mary Josif, Lesley Barclay, Sarah Bar-Zeev, Sue Kildea and Maureen Brittin offer ‘How participatory action research supported improvements to the postnatal discharge summary system used for remote dwelling Aboriginal mothers and infants in the Top End of Australia’. This article describes and analyses the participatory action research (PAR) process used by researchers working with policy leaders and clinicians to facilitate health service improvement around postnatal discharge planning processes for Aboriginal women and their newborn infants. Stringer’s (2007) working principles of PAR – participation, relationships, inclusion and communication – were used by researchers as a framework to describe a process of engagement for the research. Application of these principles prompted changes to the discharge planning process and policy within the health system. Hospital service providers have formed a working group that meets to discuss issues around the discharge process and work continues to review and strengthen the discharge process. Hospital management reported that the changes resulted in improvements, with more likelihood that correct information is being received by the appropriate health professional in a timely manner.
Working more generally with issues around social innovation, Laura Burney Nissen and Ann Curry-Stevens offer ‘Evolving on purpose: Results of a qualitative study to explore how public youth system reform advocates apply anti-oppressive practice frameworks in a collaborative training and action process.’ This article reports on a national training initiative to determine the transformative impact of the training on staff, services, and the system itself. Participants valued the creation of ‘safe spaces’ to discuss their experiences of racism and oppression in the various youth service systems. Transformative learning theory is utilized as a backdrop to the experience of interpreting participant reactions and learning experiences. Results suggest that their framework for organizing renewed efforts to reduce disparities in justice and other service delivery systems is useful. We may hope to see it more widely used in action research oriented networks.
In closing, a change in pace with the Note from the field by Juanjuan Zhao and Alan Wight. They offer their interview with Bob Dick that is contextualized and reflected upon: ‘A practitioner in the academy: An interview with Bob Dick.’ We like to include these more conversationally toned articles from time to time as they offer a personal vantage on what makes action researchers tick. Bob retired recently and we miss him. He had written one of the more popular features of the journal namely an annual review of action research books and materials. In his interview we meet someone who has devoted his life to learning in the context of practice and being an excellent teacher by encouraging just that in others. He says there is no point in offering advice, yet he offers advice I find particularly helpful – let us each do what we do well. This is important in the work and world of scholar practitioners as we often bring very different talents and may compare too much and appreciate too little. Bob mentions speed of intervention and different comfort levels with moving from tacit knowledge which I also find to be a critical difference among scholars and practitioners. Thank you Bob for all you’ve contributed to action research.