KEYSTONE HPSR Initiative // Module 11: Participatory action research // Slideshow 1: A peek into Participatory Action Research This is the only slideshow of Module 11: Participatory action research, of the KEYSTONE Teaching and Learning Resources for Health Policy and Systems Research To access video sessions and slides for all modules copy and past the following link in your browser: http://bit.ly/25vVVp1 Module 11: Participatory action research Participatory action research (PAR) seeks to understand and improve the world by changing it, but does so in a manner that those affected by problems collectively act and produce change as a means to new knowledge. It specifically, recognizes the wealth of assets that community members bring to the processes of knowing, creating knowledge and acting on that knowledge to bring about change. This module focuses on the core concepts and frameworks of the PAR approach, its suitability to address health system problems and issues of rigour and ethics associated with this approach. There is 1 slideshow in this module. Module 11: Participatory action research -Module 11 Slideshow 1: A peek into Participatory Action Research The other modules in this series are: Module 1: Introducing Health Systems & Health Policy Module 2: Social justice, equity & gender Module 3: System complexity Module 4: Health Policy and Systems Research frameworks Module 5: Economic analysis Module 6: Policy analysis Module 7: Realist evaluation Module 8: Systems thinking Module 9: Ethnography Module 10: Implementation research Module 12: Knowledge translation Module 13: Research Plan Writing KEYSTONE is a collective initiative of several Indian health policy and systems research (HPSR) organizations to strengthen national capacity in HPSR towards addressing critical needs of health systems and policy development. KEYSTONE is convened by the Public Health Foundation of India in its role as Nodal Institute of the Alliance for Health Policy and Systems Research (AHPSR). The inaugural KEYSTONE short course was conducted in New Delhi from 23 February – 5 March 2015. In the process of delivering the inaugural course, a suite of teaching and learning materials were developed under Creative Commons license, and are being made available as open access resources. The KEYSTONE teaching and learning resources include 38 videos and 32 slide presentations organized into 13 modules. These materials cover foundational concepts, common approaches used in HPSR, and guidance for preparing a research plan. These resources were created and are made available through support and funding from the Alliance for Health Policy & Systems Research (AHPSR), WHO for the KEYSTONE initiative.

1. https://twitter.com/KeystoneHPSR
Building the HPSR CommunityBuilding HPSR Capacity
KEYSTONE
Inaugural KEYSTONE Course on Health Policy and Systems Research 2015
A peek into Participatory Action Research (PAR)

2. A peek into PAR
with
rakhal gaitonde

3. A Worker's Speech To A Doctor
Brecht
When we come to you
Our rags are torn off us
And you listen all over our naked body.
As to the cause of our illness
One glance at our rags would
Tell you more. It is the same cause that wears out
Our bodies and our clothes.
The pain in our shoulder comes
You say, from the damp; and this is also the reason
For the stain on the wall of our flat.
So tell us:
Where does the damp come from?

4. Objectives
• An appreciation of the “participatory”
perspective.
• The imperative for the “action” turn in
research.
• The core philosophy of PAR.
• The core methodology.
• Issues of ethics and reliability.

5. A participatory approach to a dengue
epidemic
• Setting – post-tsunami rehabilitation work,
building up a dynamic group of community
health workers.
• Discussion and the recognition of the simple
prevention strategy.
• Education strategy.
• Feedback and the inevitability of stored water.
• Drinking water or mosquito spray?

6. A story in Cuddalore
• https://www.youtube.com/watch?v=sQC2Q6
W9vjQ

7. PAR is….
• participatory;
• cooperative, engaging community members and
researchers in a joint process in which both con-
tribute equally;
• a co-learning process for researchers and community
members;
• a method for systems development and local
community capacity building;
• an empowering process through which participants
can increase control over their lives by nurturing com-
munity strengths and problem-solving abilities; and
• a way to balance research and action.

8. The development of PAR
• Two broad streams:
• Action Research of Kurt Lewin. ‘‘pioneering
approach toward social research which combined generation
of theory with changing the social research system through
the researcher acting on or in the social system’’.
• Participatory development – of the Latin
American struggle / Africa - Paulo Friere and
others. “the dialogical method …….with its accent on co-
learning and action based on critical reflection”

9. List of Core Principles
• Emergent development form. The concept of
co-creation. Multiple Epistemologies.

10. • Practical issues as the core for research. The
goal of research usable knowledge.
“not being a simple mirror held up to reality but a
hammer with which to shape it” – Brecht

11. • Participation and democracy – the distribution
of power.

12. • Knowledge in action – to understand a system
one must act on it and try to change it.
• .

13. • Human flourishing –
“as the peoples’ memory is only liberating when it
registers the substantial side of their pains and
happiness, when it nourishes and celebrates a
different tomorrow”. From the Latin America
Alternative Health Report

14. The PAR cycle (O’Hara, P. (2006)

15. PAR
• Participatory Action Research sees that action and
reflection must go together. Praxis cannot be divided
into a prior stage of reflection and a subsequent stage
of action. When action and reflection take place at the
same time they become creative and mutually
illuminate each other.
• Through praxis, critical consciousness develops, leading
to further action through which people cease to see
their situation as ‘dense, enveloping reality or a blind
alley’ and instead as ‘an historical reality susceptible of
transformation’. This transformative power is central to
participatory action.

16. Issues of Bias
• Fair subject selection requires that the goals
of the research, not the vulnerability or
privilege of the individuals and groups
involved.

17. Issues of validity
• Outcome validity – who benefits from the resolution of
the problem.
• Democratic validity – are all relevant stakeholders
participating fully.
• Process validity – the way problem is investigated and
process allows for ongoing learning and improvements.
• Catalytic validity – extent to which research
collaborators are invigorated to understand and change
social reality.
• Dialogical validity – review from critical dialogue with
peers about research findings and actions.

18. Validity depends on…
• How relevant the community involved
perceives the issues to be.
• How far the processes engage experiential
knowledge without losing information.
• Whether the research takes into account the
cultural context.
• Whether the collective process of analysis is
well-facilitated and rigorous.

19. Generalizability

20. Ethics in participatory research
• Community level risks as distinct from individual
level risks.
– Bias in who represents communities.
– Tension over whose interests are driving the process.
– Managing privacy and protecting information (DWT).
– Tension over how evidence and analysis is
documented and reported. Especially unfavorable and
negative information.
– Social Risks.

21. The Nobodies - Galeano
• Fleas dream of buying themselves a dog, and nobodies dream
of escaping poverty: that one magical day good luck will
suddenly rain down on them- will rain down in buckets. But
good luck doesn't even fall in a fine drizzle, no matter
how hard the nobodies summon it, even if their left hand is
tickling, or if they begin the new day with their right foot, or
start the new year with a change of brooms.
The nobodies: nobody's children, owners of nothing. The
nobodies: the no ones, the nobodied, running like rabbits,
dying through life, screwed every which way.
Who don't speak languages, but dialects.
Who don't have religions, but superstitions.
Who don't create art, but handicrafts.
Who don't have culture, but folklore.
Who are not human beings, but human resources.
Who do not have names, but numbers.
Who do not appear in the history of the world, but in the
police blotter of the local paper.
The nobodies, who are not worth the bullet that kills them

22. The divorce of research and analysis from pragmatic
efforts to remediate inequalities of access is a
tactical and moral error – it may be an error that
constitutes, in and of itself, a human rights abuse.
Paul Farmer

23. I referred to the following for my
presentation
• https://structuralhealth.wordpress.com/2012/03/29/a-workers-
speech-to-a-doctor/
• http://www.poemhunter.com/poem/the-nobodies-written-by-
eduardo-galeano/
• Reason, P. and Bradbury, H. eds., 2001. Handbook of action research:
Participative inquiry and practice. Sage.
• Lewenson R, Laurell AC, Hogstedt C, D’Ambruoso L, Shroff Z (2014)
Participatory action research in Health systems: a methods reader,
TARSC, AHPSR, WHO, IDRC Canada, EQUINET, Harare.

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