Participatory development of nursing curricula - a Global North-South partnership between Norwegian and Ethiopian universities.

Participatory Action Research in Health Care

Participatory Action Research (PAR) is a methodology often used in social sciences, which involves groups of people in action, reflection and iterative change. In PAR, ‘traditional’ researchers become participants, and people who comprise ‘traditional’ participants become researchers, facilitating cohesiveness and communication within the team. However, PAR is less used in healthcare, despite the complexity of providing and receiving health and social care. Development and testing of the delivery of new models of care is an area with increasing service-user participation, but often with no structured or formalised framework to embed end-users. This may be due in part to the complex ethical and governance systems in healthcare research, and the lack of practical guidance on using PAR as a research method within this context. We carried out a PAR project to develop and evaluate the implementation of a new model of care for the assessment and management of respiratory conditions in the community (MISSION ABC). The care model delivered a community-based multidisciplinary clinic involving healthcare staff from both primary and secondary care. Regular sessions were held for participants (including patients, healthcare staff, research staff) to discuss observations, reflections and suggestions for the development and delivery of the care model. At the end of the project, meetings were held with representatives from the different groups of participants to discuss overall views about the study and ethics and research governance challenges specifically. We present key perspectives from various stakeholders involved in the PAR process, highlighting benefits and challenges. Specific challenges relating to ethical and governance approvals encountered in the set-up and delivery of the project are described. These include the design of the study protocol, approaches to consent, presentation of study information within the current ethical and regulatory frameworks and maintaining the flexibility of study methods and roles of participants throughout the study period. Recommendations for improvement in the research pathway that PAR researchers could adopt to enable a meaningful and successful PAR approach are made, in addition to suggestions for overarching ethics and governance frameworks. Developing new models of healthcare benefits significantly from collaboration with stakeholders so that the design and delivery are feasible and acceptable to all. However, the current UK research approvals and governance frameworks present challenges to design and successfully deliver PAR studies in healthcare; we present possible solutions.

Higher education is facing disruptive changes in many fields. Students wants to have the option of learning anywhere, anytime and in any format. Universities need to develop and deliver to future students a complete learning ecosystem. At the same time universities are facing challenges such as growing costs and the pressure to give the students the knowledge, competence, skills and ability to continuously adapt to future job environments. As a consequence, many universities are investigating new ways of collaboration and sharing resources to cater to the demands of students, industry and society. An example of this collaboration is a new joint master between the two largest Universities in Norway: University of Oslo (UiO) and Norwegian University of Science and Technology (NTNU). In this paper, we present the lessons learned from almost two years of teaching and learning in the new joint master's programme, "Music, Communication and Technology" (MCT), between NTNU and UiO. This programme is a run in a two-campus learning space built as a two-way, audio-visual, high-quality, low-latency communication channel between the two campuses, called "The Portal". Moreover, MCT is the subject of research for the SALTO (Student Active Learning in a Two campus Organisation) project, where novel techniques in teaching and learning are explored, such as team-based learning (TBL), flipped classroom, and other forms of student active learning. Educational elements in this master, provides the student with 21st century skills and deliver knowledge within humanities, entrepreneurship and technology. We elaborate on the technical, pedagogical and learning space-related challenges toward delivering teaching and learning in these cross-university settings. The paper concludes with a set of strategies that can be used to improve student active learning in different scenarios.

Childhood overweight is considered a complex problem influenced by a range of factors, including energy balance-related behaviours (EBRBs) and interacting drivers of these behaviours. There is growing support that applying a systems approach is required to tackle complex problems resulting in actions that attempt to change the system's dynamics. Additionally, a participatory approach is advocated to include the lived experience of the population of interest both in the understanding of the system as well as the development, implementation and evaluation of relevant actions. We therefore combined Intervention Mapping, Participatory Action Research (PAR) and system dynamics in the development, implementation and evaluation of actions contributing to healthy EBRBs together with adolescents. Four PAR groups comprising of 6-8 adolescent co-researchers (10-14 years) and 1-2 adult facilitators met weekly during 3-4 years. The structured Intervention Mapping protocol guided the process of the systematic development, implementation and evaluation of actions. System dynamics tools were included for the creation of Causal Loop Diagrams and development of systemic actions. Our approach comprised six steps that were executed by the PAR groups: (1) build Causal Loop Diagrams for each EBRB through peer research and identify overarching mechanisms, (2) determine leverage points using the Intervention Level Framework, (3) develop action ideas, (4) develop detailed actions including an implementation plan, (5) implement and, (6) evaluate the actions. PAR ensured that the actions fitted the lived experience of the adolescents, whilst system dynamics promoted actions at different levels of the system. The Intervention Mapping protocol ensured that the actions were theory-based. The main challenge involved integrating system dynamics within our practise in cooperation with adolescent co-researchers. We experienced that combining Intervention Mapping, PAR and system dynamics worked well in developing, implementing and evaluating actions that target different levels of the system that drive adolescents' EBRBs. This study serves as an example to other studies aimed at developing, implementing and evaluating actions using a participatory and systems approach.

<p>Human infants share common biological and developmental needs in the postnatal period that are optimally met during intimate contact with their mother or primary caregiver. In the case of infants hospitalised in tertiary-level neonatal intensive care units (NICUs), there is a departure from instinctual caregiving and nurturing found in the mother-infant pair, due in part, to a model of care which supports maternal-infant separation. This can lead to suboptimal physiological responses, altered neurobiology and life-long negative health effects. The social construction of neonatal care currently positions it within the paradigm of biomedical science. Where family-centred, developmental care frameworks have been integrated, and Kangaroo Mother Care (KMC) has been embedded into caregiving routines, enhanced patient, whānau/family, staff and organisational outcomes have been found. This study is underpinned by the importance of KMC for the enhancement of infant and whānau/families’ health and developmental outcomes. Despite its classification as an evidence-based practice, and recommendations by the World Health Organisation for its use in all healthcare settings, KMC is inconsistently applied. The highly complex and contextual nature of the environments where medically-dependent babies are cared for is acknowledged. There is a need for health services to explore innovative research approaches, through a social science lens, to assist in the implementation of KMC. This thesis illustrates one such approach. The purpose of this study was to explore and activate improvement of the KMC programme within one NICU in Aotearoa New Zealand using Participatory Action Research (PAR). The research was theoretically informed by Als’ developmental biology and care theories, D’Agata’s Infant Medical Trauma model, and the Foucauldian concept of power/knowledge through a critical feminist lens. A participatory approach was chosen in the hope that transformation of KMC practice would be achieved and embedded within this NICU. In addition, I intended to contribute to the emerging body of evidence calling for the collaboration of all community members toward enhanced quality of KMC. Multiple methods were used to capture data relating to the NICU’s KMC programme through audit, observation and interview of key stakeholders. Project planning included the conventions of PAR generally applied to research using this methodology. Three iterative cycles of exploration, implementation and evaluation of the KMC programme were envisaged within this setting. Active participation with multiple NICU stakeholders was planned for, forming the basis of action-based change and improvement of KMC. However, the three-cycle process was not achieved within the time limitations of my research, with field work finishing at the conclusion of the first exploratory cycle. This thesis describes the unfolding processes of PAR, as well as the inclusion of a secondary discourse analysis and parental perspectives from local and global literature. Key findings showed inconsistently documented KMC and the near-absence of KMC practice for a significant group of babies. Whilst the benefit of KMC was embedded in the understanding of participants, this knowledge did not translate to practice. There was an unrealistic optimism about the functioning of KMC by most of the stakeholders. In addition, participants expressed ambiguity about their programme, contributing to and influenced by suboptimal KMC education and training. A pathway to improvement of their KMC programme was lacking, and the lines of responsibility for it were unclear. This factor undoubtedly contributed to the difficulties of implementing a full PAR project. Whilst parental, staff and organisational factors were found to influence KMC implementation, arguably the greatest effect on the intervention were the power relations inherent within the normative technocratic, biomedical paradigm. Power relations constituting what was considered authoritative knowledge, and who was authorised to speak, impacted on the participatory nature of the research itself. This resulted in the research not proceeding past the first PAR exploratory cycle through to rounds of implementation and evaluation. This thesis describes participatory inquiry into one KMC programme in the high-income NICU setting, through the lenses of multiple participants within the context of Aotearoa New Zealand. These were not previously known. It also provides an example of how Foucauldian- and feminist-informed PAR methodology may be used within the NICU setting for inquiry into KMC, an intervention positioned outside of the normative biomedical framework.</p>

Recognised as a powerful tool for improving practice, action research is proving invaluable in nursing.

To facilitate staff transition from an open-plan to a two-cot neonatal intensive care unit design. In 2012, an Australian regional neonatal intensive care unit transitioned from an open-plan to a two-cot neonatal intensive care unit design. Research has reported single- and small-room neonatal intensive care unit design may negatively impact on the distances nurses walk, reducing the time they spend providing direct neonatal care. Studies have also reported nurses feel isolated and need additional support and education in such neonatal intensive care units. Staff highlighted their concerns regarding the impact of the new design on workflow and clinical practice. A participatory action research approach. A participatory action group titled the Change and Networking Group collaborated with staff over a four-year period (2009-2013) to facilitate the transition. The Change and Networking Group used a collaborative, cyclical process of planning, gathering data, taking action and reviewing the results to plan the next action. Data sources included meeting and workshop minutes, newsletters, feedback boards, subgroup reports and a staff satisfaction survey. The study findings include a description of (1) how the participatory action research cycles were used by the Change and Networking Group: providing examples of projects and strategies undertaken; and (2) evaluations of participatory action research methodology and Group by neonatal intensive care unit staff and Change and Networking members. This study has described the benefits of using participatory action research to facilitate staff transition from an open-plan to a two-cot neonatal intensive care unit design. Participatory action research methodology enabled the inclusion of staff to find solutions to design and clinical practice questions. Future research is required to assess the long-term effect of neonatal intensive care unit design on staff workload, maintaining and supporting a skilled workforce as well as the impact of a new neonatal intensive care unit design on the neonatal intensive care unit culture. A supportive work environment for staff is critical in providing high-quality health care.

Background - Facilitator capacity is critical for the effectiveness of community-based early warning systems (CBEWS) in disaster risk reduction. Facilitators serve as intermediaries translating complex hazard data into actionable insights that enable communities to respond effectively to disasters. In Indonesia, where disaster risk is high, facilitators play an essential role in protecting lives and livelihoods at the grassroots level. Urgency of Research - Despite their importance, capacity-building approaches for CBEWS facilitators often employ top-down training methods that fail to engage facilitators as active agents in their own learning. Current programs lack participatory approaches that leverage facilitators' contextual knowledge and experience, undermining the sustainability and relevance of capacity-building initiatives. There is an urgent need for innovative, participatory approaches that position facilitators as co-creators of knowledge. Research Objectives - This study aimed to describe the process and outcomes of implementing participatory action research (PAR) to enhance the capacity of CBEWS program facilitators in nonformal education settings, investigating how PAR supports facilitator understanding of CBEWS concepts, develops contextual and adaptive facilitation skills, cultivates reflective capacity, and identifies enabling and inhibiting factors. Research Method - This qualitative descriptive study was conducted between 2021 and 2024 across seven disaster-prone Indonesian provinces: Central Java, East Java, West Java, Banten, South Kalimantan, Gorontalo, and Bali. Forty-five CBEWS facilitators participated in PAR cycles involving planning, action, observation, and reflection stages. Data were collected through 60+ hours of participatory observation, 20 in-depth interviews, 8 focus group discussions, and document analysis. Thematic analysis was employed to identify patterns and themes. Research Findings - Three dimensions of capacity development emerged: enhanced understanding of CBEWS concepts applicable to specific disaster contexts; improved contextual and adaptive facilitation skills enabling tailoring of approaches to community needs and creation of inclusive learning environments; and cultivated reflective capacity for systematic practice improvement. Enabling factors included institutional support, facilitator openness to learning, and collaborative researcher-facilitator relationships. Inhibiting factors included limited time for reflection, dual roles as implementers and learners, and organizational barriers. Research Conclusion & Novelty - Participatory action research effectively develops facilitator capacity when supported by institutional commitment and multi-year engagement. This approach provides a viable model for community-based disaster risk reduction programs, contributing to both adult learning theory in nonformal education settings and practical disaster risk reduction implementation.

Background: Stunting remains a significant public health issue, particularly in low-resource settings where maternal knowledge and dietary practices influence child nutrition. Empowering mothers through participatory approaches is an effective strategy for addressing this challenge. Objectives: This study examined the reflective process within the Participatory Action Research (PAR) framework to empower mothers to enhance their child nutrition through local food resources. It specifically focuses on the critical reflections that shape the effectiveness of empowerment. Methods: This study employed PAR with a focus on the reflection stage, to assess the effectiveness of maternal empowerment in utilizing local food for stunting prevention. Quantitative assessments including structured questionnaires were administered to 50 randomly selected participants. A paired t-test was conducted to analyze changes in knowledge and attitudes, with statistical significance set at p-value<0.05. Results: The reflection phase revealed a significant increase in maternal knowledge and attitude post-intervention. The mean knowledge score improved from 14.70±3.09 to 29.60±0.97 (p-value=0.001), while the attitude score increased from 11.50±3.06 to 19.30±1.52 (p-value=0.001). The maternal empowerment program was well received, with trained health cadres and PKK (family welfare movement) mothers playing a crucial role in fostering sustainable behavioral change in stunting prevention. Conclusions: Critical reflection on PAR enhances the effectiveness of maternal empowerment. These findings offer practical insights for policymakers and public health practitioners in designing adaptive community-driven nutritional interventions. Integrating reflective practices ensures that stunting prevention programmes are contextually relevant, sustainable, and scalable across diverse sociocultural settings.

This article describes the use and effectiveness of the participatory action research (PAR) framework to better understand community members' perceptions and risks of pandemic influenza. In 2009, the H1N1 influenza pandemic affected Indigenous populations more than non-Indigenous populations in Oceania and the Americas. Higher prevalence of comorbidities (diabetes, obesity, asthma and chronic obstructive pulmonary disease) as well as pregnancy in Indigenous communities may have contributed to the higher risks of severe disease. Social disparity, institutionalised racism within health services and differences in access to culturally safe health services have also been reported as contributors to disadvantage and delayed appropriate treatment. Given these factors and the subsequent impact they had on Australian Aboriginal and Torres Strait Islander communities, the authors set out to ensure that the Australian national, state and territory pandemic plans adequately reflected the risk status of Aboriginal and Torres Strait Islander peoples and promoted meaningful engagement with communities to mitigate this risk. A national study explored the views of Aboriginal and Torres Strait Islander people and their experiences with H1N1 and used a qualitative PAR framework that was effective in gaining deep understandings from participants. Aboriginal and Torres Strait Islander community-controlled organisations and health services were involved in the implementation, interpretation and monitoring of this project. As a result, important features of the implementation of this PAR framework with Aboriginal and Torres Strait Islander communities and organisations emerged. These features included the importance of working in a multidisciplinary team with Aboriginal and Torres Strait Islander researchers; the complexities and importance of obtaining multi-site human research ethics approval processes; the importance and value of building the research capacity of both experienced and novice researchers in PAR; the need to use localised sampling protocols; and the process of undertaking a collective research process and enacting action research and feedback. The most effective responses of this project were embedded in pre-existing relationships with individuals within organisations that had been established over a long period of time between Aboriginal medical services and investigators; however, research relationships established specifically for the purposes of the project were less successful because of changes in personnel and organisational support. The participatory approach used in this study has the potential to be applied to vulnerable populations in other countries.

This paper discusses the emergence of Participatory Action Research (PAR), and its use with individuals with cognitive disabilities. A brief history of PAR is given, with a focus on its uses for empowerment and self-determination for persons with disabilities. Using literature-based standards for participatory, action and emancipatory research approaches, a 3-year research project with goals of increasing community participation by adults with developmental disabilities is described and evaluated. The "Transition into Community Life" project used an adapted form of the "Farmer-back-to-Farmer" PAR model (Rhoades & Booth, 1982), and the article discusses the successes and challenges of the model in a context quite different from how it was originally designed. The author describes lessons learned concerning the use of PAR with people with developmental disabilities. The article concludes with a brief discussion of the feasibility of PAR with individuals with cognitive challenges.

There is increasing emphasis on the need for collaboration between practice and academic leaders in health care research. However, many problems can arise owing to differences between academic and clinical goals and timelines. In order for research to move forward it is important to name and address these issues early in a project. In this article we use an example of a participatory action research study of ethical practice in nursing to highlight some of the issues that are not frequently discussed and we identify the impact of things not-named. Further, we offer our insights to others who wish to be partners in research between academic and practice settings. These findings have wide implications for ameliorating misunderstandings that may develop between nurse leaders in light of collaborative research, as well as for participatory action research.

BackgroundMalaria remains a significant public health issue in Indonesia. Most of the endemic areas are in the eastern parts of Indonesia, but there are a few remaining foci of persistent endemic malaria in Java, particularly in Menoreh Hills, a region bordering three districts of two provinces on this island. Despite a commitment to build a partnership to eliminate cross-border malaria, there is a lack of understanding of how this partnership might be translated into an implementable strategic plan. The study aims to provide evidence of how a participatory approach was used to strengthen the cross-border collaboration and stakeholders’ capacity to develop a joint strategic, operational, and costing plan for cross-border malaria elimination.MethodsA participatory action research was conducted from January to August 2017, involving participants from the village, district, provincial, and national levels. This study was conducted in seven phases, including document review, focus group discussions (FGDs), planning and costing workshops, and a dissemination meeting. A total of 44 participants from primary health centres (PHC) and 27 representatives of affected villages in three districts, 16 participants from the district and provincial malaria programmes and planning bureaus, and 11 participants from the national level were involved in the processes. Data on priority issues, costing, programme coverage, and administration were collected. Thematic coding and feedback were used for analysis.ResultsProblems identified by stakeholders included low community awareness and participation in malaria prevention, high mobility across three districts, lack of financial and human resources, lack of inter-district coordination, and poor implementation of migration surveillance. Cross-border strategies identified to address malaria were improving cross-border migration surveillance, strengthening the network, governance, and advocacy of malaria control implementation across borders, and developing the malaria information system. A working group composed of the three districts’ representatives authorized to decide on cross-border issues will be created.ConclusionsThe participatory approach was applicable in cross-border malaria planning for within-country settings and useful in enhancing stakeholders’ capacities as implementers. While done in a participatory way, the joint plan crafted was a non-binding agreement; stakeholders should advocate to ensure adequate funds are poured into mobilizing the programme.

Enhancing women's participation in decision-making in artisanal fisheries in the Anlo Beach fishing community, Ghana

To explore, advance and evaluate mental health practices in a rural general paediatric unit through participatory action research. A participatory action research approach guided this study, providing an opportunity for nursing staff to become actively involved in the design, direction and outcomes of the research. A 16-bed paediatric unit of a rural general hospital. A purposive convenience sample of all paediatric nursing staff (n = 20; of 24 nurses). In the first phase of this study, focus groups were conducted to explore the experiences of nurses. Participants considered mental health to be a specialist discipline area and the role of the mental health nurse to be complex. They felt that their lack of training and experience with mental health issues was detrimental to the delivery of optimal patient care. There was concern about differing approaches to treatment, relationships with other mental health services and the suitability of the ward environment for young people with a mental health problem. Participants called for training by qualified mental health staff and the development of policies and clinical guidelines to facilitate their delivery of care to patients with a mental health problem in an acute medical environment. There is a clear need for nursing specialities to work together to ensure that optimal care is given to patients admitted to general hospital with a mental health issue. Given the absence of accessible specialist child mental health inpatient units in regional and remote areas, upskilling paediatric nurses must be a priority.