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Reflections on using diaries in the action research process
- 1. But I wrote it down! Experience of using diaries to promote reflective practice among district health management teams in three African countries Comfort Mshelia, University of Leeds, UK
- 2. Plan for my talk • Overview of PERFORM project • Why diaries? • Use of diaries in PERFORM • Reflections • Conclusion
- 3. Overview • Title : Supporting decentralised management to improve health workforce performance • Acronym: PERFORM • Study countries: Ghana, Tanzania, Uganda • Funded by the European Commission (FP7) • 4-year project which started in August, 2011.
- 4. • Problem: Lack of adequate and well-performing health workers. • PERFORM is focused on improving health workforce performance in sub-Saharan Africa. • Assumption: Strengthening district health management will lead to improvement in health workforce performance. Background
- 5. • The research: – is taking place in three districts in each of the three African countries. – Will study how management strengthening can be used, and under what conditions, to enhance workforce performance. • Comparative analysis of the findings will add new knowledge as to the effects of different country contexts on these interventions. Research design
- 6. Action research Cycle Plan - Describe and analyse the problem they face - Identify and plan solutions Act Implement the changes needed Observe Observe the effects of the implemented changes Reflect Reflect on the process and the effects of changes made Lewin, K. (1958) Group decision and social change. In Readings in social psychology, ed. Maccoby, E. E., Newcomb, T. M., & Hartley, E. L., 197-211. New York,NY: Holt, Rinehart, Winston. Action Research cycle
- 7. Partners School of Public Health, University of Ghana, Ghana Institute of Development Studies, University of Dar-es- salaam, Tanzania School of Public Health, College of Health Sciences, Makerere , Uganda Swiss Tropical and Public Health Institute, Switzerland Nuffield Centre for International Health and Development, University of Leeds, UK Liverpool School of Tropical Medicine, UK
- 8. Why diaries? • Need to record what was done and how it was done • Other options considered: learning history
- 9. What we did • Designed a template including prompts • This was introduced to the District Health Management Teams (DHMTs) by the CRTs • Freedom to adapt to context
- 10. What we did (2) Prompts How we chose this bundle of strategies -describe the bundle of strategies How we implemented a bundle of strategies Why we implemented in this way How we have observed the effects of the strategies What were the effects (and unintended effects) of the strategies What worked well What worked not so well What we would change next time Any changes in the environment that may affect the process and results
- 11. How are the diaries used? • Examples of use of diaries in health systems research is lacking • Interviewed DHMTs in the 9 study districts. • Interviewed members of each of the country research teams
- 12. Use of Diaries • Purpose: – To record what is implemented – To record how it was implemented – Tool to encourage reflection and learning • To follow the Action Research cycle
- 13. Reflections - Consistency in what is being recorded - Encourage learning from other’s experiences - Increased organisation - Time constraints - Workload issues - Access to the diary - Reflection
- 14. Key messages • Need to consult with users at the design stage • Use a clear and simple template • Link the diary to existing processes/practices such as meetings • Adequate support to the users
- 15. Conclusion • Will the diaries have contributed to management strengthening? • Will the diaries have contributed to improvements in workforce performance?
- 16. Thank you!