Review question/objective

This scoping review seeks to locate and describe international literature related to how action research methodology has been applied in studies in the healthcare context. Specifically the review will:

- Map descriptions of action research methodology - the extent to which study participants are engaged in the research process.

- Identify if research findings, conclusions and recommendations provide evidence of knowledge/capacity building and action/social change.

Background

Challenging the positivist view of science, participatory research (PR) approaches are largely used in qualitative research.1,2,3,4 Kurt Lewin is recognized to be the first author to propose PR. He coined the term action research (AR) in the 1940s in order to provide a framework in which to "solve practical problems through a research cycle involving planning, action, and investigating the results of the action".3(p27) Through his work Lewin introduced the Northern tradition of PR, which addresses practical goals of system improvement or change.

Participatory research has evolved over time and the original goals of the methodology have evolved as well.1,3,4,5 The Southern tradition of PR brings another perspective in that its finality is emancipation through critical consciousness and social justice. This tradition was highly influenced by Paulo Freire and other Latin American authors in the 1960s and 1970s.3 Compared to the more pragmatic stance of the Northern tradition of PR, the Southern tradition emphasizes large-scale structural forces, conflict of interest, inequalities and change that reduces oppression.4,5 Philosophically, the Southern tradition of AR belongs to the critical paradigm which integrates theory and practice and is concerned with the emancipation of self, autonomy, responsibility, knowledge and practice.6 It also examines issues of power, and envisions new opportunity and social change/transformation, that is, a "social process whereby the values, attitudes, or institutions of society, such as education, family, religion, and industry become modified. It includes both the natural process and action programs initiated by members of the community".7(para1)

Minkler and Wallerstein4 admit that there is a wide range of terms to describe PR. In this review we adopt the term "action research" which is widely used in the UK, Australia and New Zealand. However, studies that identify a methodological framework, such as community-based action research (popular in the US and Canada), participatory action research and participatory research (used in developing countries), mutual inquiry, feminist participatory research, community-partnered participatory research5, collaborative research, co-operative inquiry, participatory rural appraisal, and participatory learning research8, will be considered. We assume that independent of the terms used to describe PR, there are core principles and characteristics shared by all, including AR.

In general, AR calls explicitly for action, meaning research participants are involved in the process of decision making.2,9 Therefore AR has abandoned the neutrality prerogative from the start, as the researchers are also participants of the research process and work together with no one person or group having more power or influence over the other.10,11,12

Action research presents two main objectives: problem solution and knowledge construction13, allowing for system development and local community capacity building.4,8 Whilst AR principles are well defined in literature, Tripp14,15 and Franco16 argue that the term "action research" as used in the Northern tradition has been used vaguely to designate some practical transformation of or insight into the action. However, they highlight that AR as a theoretical and methodological academic procedure demands accuracy, even though different epistemological positions are applied to the methodology.

In the healthcare field, AR approaches have the potential to improve people's health and decrease health disparities3,17 "by bridging gaps between research and practice, addressing social justice, and creating conditions that facilitate people's control over the determinants of their health".17(p326) The International Collaboration Participatory Health Research17 (ICPHR), which is an international collaboration group of participatory health researchers, adopted the term "participatory health research" (PHR) to discuss, analyze and build knowledge around the theme of PHR. The group seeks to clarify the role of PHR in informing intervention design and decision-making on health issues. It provides no definitive description for this approach and believes it is not confined to a narrow set of epistemological principles, meaning there is no single umbrella paradigm that describes PHR. Thus, ICPHR considers PHR as fitting within an array of PR paradigms.

Participatory health research does however have some distinguishable features that are consistent with AR. The first PHR feature is that every participant involved in the research is active in the process, despite the spectrum of participation levels. The goal of PHR is to maximize the involvement of the research participants, thus the research process is conducted by a group. This principle leads to another belief that PHR should be conducted in a specific place and time, and be sympathetic to cultural differences and the reality of daily life and work of participants.8

The International Collaboration Participatory Health Research also claims that PHR aims for transformation through human agency, meaning positive social change should be the result of the research process which is simultaneously a learning process. Critical reflexivity is encouraged, enabling "participants to recognize their current situation and the socio-political causes of health and illness, particularly dynamics related to social exclusion, and how to be involved in finding solutions".18(p11)

Participatory health research as ICPHR conceives it is consistent with the Southern AR tradition. Both share core principles and are sometimes considered to be synonymous. This strengthens the rationale of the authors for using AR to describe the group of methodologies that fall under PR. Considering that a scoping study examines "the extent, range and nature of research activity[horizontal ellipsis]to determine the value of undertaking a full systematic review[horizontal ellipsis]to summarize and disseminate research findings[horizontal ellipsis]to identify research gaps in the existing literature"19(p. 21), we propose a scoping review to map the relevant literature. This scoping review will be conducted in accordance with the Joanna Briggs Institute's methodology for the conduct of scoping reviews as described in the 2015 JBI Reviewers' Handbook.20 This scoping review aims to publicize and disseminate findings about AR and identify relevant issues which may advance evidence-based health care and inform systematic reviews. This scoping review is part of a doctorate project which may lead to a systematic review focusing on uncovering AR methodology evidence.

Some authors have proposed the use of AR as a framework for implementation of evidence-based practice in various settings.21,22,23 Hence, the Critical Paradigm is one of three JBI conceptualizations of prominent research paradigms. Expanded knowledge of the methodologies that fall within this paradigm presents opportunities that can lead to greater understandings of the methodological issues. Application of this expanded knowledge will be evidenced by identification of systematic review research questions, better critical appraisal skills, and increased ability to make recommendations for practice or policy based on the findings of research done in this paradigm.

Inclusion criteria

Types of participants

This review will consider any professional healthcare provider, patient or recipient of healthcare involved in action healthcare research.

Types of intervention(s)/phenomena of interest

Concept: This scoping review will consider studies which use action research as a methodology.

Context: This scoping review will consider action research studies that take place in healthcare.

Types of studies

This review will consider qualitative and quantitative primary research that illustrates the action research methodology and methods used, the research process, and the outcomes or findings (e.g. knowledge building, problem solving, action and others). Primary studies published and unpublished (grey literature) will also be included.

Search strategy

The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of MEDLINE and CINAHL will be undertaken followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. Reviewers intend to contact authors of primary studies or reviews for further information if this is relevant.

Studies published in English, Spanish and Portuguese will be considered for inclusion in this review. Those languages were included as 90% of scientific yield is in English. The justification for Spanish and Portuguese is due to Paulo Freire's (Brazilian author) influence in participatory research done in Latin America.

There will not be a date limit in the search.

The databases to be searched will include:

MEDLINE

CINAHL

SCOPUS

WEB OF SCIENCES

SOCIAL SCIENCES

ERIC

PSYCH INFO

LILACS

HEALTH SOURCE: NURSING/ACADEMIC EDITION

SCIENCE DIRECT.

The search for unpublished studies will include:

Google Scholar

Back tracking of references.

Initial keywords to be used will be:

"action research" OR "community-based participatory research" OR "community-based action research" OR "participatory research" OR "mutual inquiry" OR "feminist participatory research" OR "community-partnered participatory research" OR "collaborative research" OR "co-operative inquiry" OR "participatory rural appraisal" OR "participatory learning research"

"healthcare disparities" OR "social change" OR "social justice" OR "social transformation" OR "health inequalit*" OR inequalit* OR "social participation" OR Collaboration OR "problem solving" OR "capacity building"

Method*

Databases that are not from healthcare field: "public health practice" OR "health promotion" OR "health planning" OR "health education"

Assessment of methodological quality

As it is a scoping review no assessment is required.

Data extraction

Extracting the results:

A draft charting table was developed at the protocol stage to record the key information of the source that is relevant to the review question. A scoping review data extraction instrument was previously developed (Appendix I); however this may be further refined for use for at the review stage. Some key information that may be charted is as follows:

Author(s)

Year of publication

Source origin/country and/or city of origin

Aim/purpose

Approach

AR cited principles

Citing of authors

AR cycle

Type of participation

Social change

Knowledge building

Data synthesis

The results will be presented as a map of the data in a logical, diagrammatic or tabular form, and in a descriptive format that aligns to the objective and scope of the review.

The tables and charts will show results as in the table for results extraction.

The results summary will logically describe the aims or purposes of the reviewed sources, the methodologies applied and results that relate to the review questions.

The results will be classified under main conceptual categories that will be obtained during the results extraction. For each category, a clear explanation will be provided.

Conflicts of interest

There are no potential conflicts of interest.

Acknowledgements

Purdue University Calumet, for mentoring.

Programa Especial Pro-Ensino na Saude - edital n[degrees]24/2010/CAPES, for researcher scholarship.

Sciences Without Borders - CNPq/CAPES, for international exchange scholarship.

References