Abstract
Background
Despite international evidence supporting community participation in health for improved health outcomes and more responsive and equitable health systems there is little practical evidence on how to do this. This work sought to understand the process involved in collective implementation of a health-related local action plan developed by multiple stakeholders.
Methods
Communities, government departments and non-government stakeholders convened in three iterative phases of a participatory action research (PAR) learning cycle. Stakeholders were involved in problem identification, development, and implementation of a local action plan, reflection on action, and reiteration of the process. Participants engaged in reflective exercises, exploring how factors such as power and interest impacted success or failure.
Results
The local action plan was partially successful, with three out of seven action items achieved. High levels of both power and interest were key factors in the achievement of action items. For the achieved items, stakeholders reported that continuous interactions with one another created a shift in both power and interest through ownership of implementation processes. Participants who possessed significant power and influence were able to leverage resources and connections to overcome obstacles and barriers to progress the plan. Lack of financial support, shifting priorities and insufficient buy-in from stakeholders hindered implementation.
Conclusion
The process offered new ways of thinking and stakeholders were supported to generate local evidence for action and learning. The process also enabled exploration of how different stakeholders with different levels of power and interest coalesce to design, plan, and act on evidence. Creation of safe spaces was achievable, meanwhile changing stakeholders’ level of power and interest was possible but challenging. This study suggests that when researchers, service providers and communities are connected as legitimate participants in a learning platform with access to information and decision-making, a shift in power and interest may be feasible.
Despite international evidence supporting community participation in health for improved health outcomes and more responsive and equitable health systems there is little practical evidence on how to do this. This work sought to understand the process involved in collective implementation of a health-related local action plan developed by multiple stakeholders.
Methods
Communities, government departments and non-government stakeholders convened in three iterative phases of a participatory action research (PAR) learning cycle. Stakeholders were involved in problem identification, development, and implementation of a local action plan, reflection on action, and reiteration of the process. Participants engaged in reflective exercises, exploring how factors such as power and interest impacted success or failure.
Results
The local action plan was partially successful, with three out of seven action items achieved. High levels of both power and interest were key factors in the achievement of action items. For the achieved items, stakeholders reported that continuous interactions with one another created a shift in both power and interest through ownership of implementation processes. Participants who possessed significant power and influence were able to leverage resources and connections to overcome obstacles and barriers to progress the plan. Lack of financial support, shifting priorities and insufficient buy-in from stakeholders hindered implementation.
Conclusion
The process offered new ways of thinking and stakeholders were supported to generate local evidence for action and learning. The process also enabled exploration of how different stakeholders with different levels of power and interest coalesce to design, plan, and act on evidence. Creation of safe spaces was achievable, meanwhile changing stakeholders’ level of power and interest was possible but challenging. This study suggests that when researchers, service providers and communities are connected as legitimate participants in a learning platform with access to information and decision-making, a shift in power and interest may be feasible.
| Original language | English |
|---|---|
| Article number | e0288524 |
| Number of pages | 23 |
| Journal | PloS ONE |
| Volume | 18 |
| Issue number | 7 |
| Early online date | 27 Jul 2023 |
| DOIs | |
| Publication status | Published - 27 Jul 2023 |
Bibliographical note
Funding: LD acquired funding for this study. This study was funded by the Joint Health Systems Research Initiative from Department for International Development/MRC/Welcome Trust/Economic and Social Research Council under MR/N005597/1 and MR/P014844/1. https://wellcome.org/grant-funding/funded-people-and-projects. This work was nested within the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), supported by the Faculty of Health Sciences, University of then Witwatersrand and the Medical Research Council, South Africa. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Acknowledgments
The authors would like to thank all community stakeholders, government, and NGO stakeholders study participants for agreeing to be part of the process, and for sharing their time, knowledge, and perspectives. Thanks also to the Verbal Autopsy with Participatory Action Research (VAPAR) team and staff of the Medical Research Council (MRC)/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), especially Simon Khoza, Khanyisa Ngobeni and Palesa Mataboge. Permissions have been secured for the reproduction of all images.
Data Availability Statement
he author’s study protocol does not allow to share the qualitative data beyond the research team to protect stakeholders and organizations confidentiality. Providing this data publicly would violate the ethics approval received for this study. However, relevant excerpts of the data underlying the results presented here are available from the corresponding author upon reasonable request. Where authors are not available, data may be requested from achds@abdn.ac.uk.Keywords
- Community-Based Participatory Research
- Health Priorities
- Health Services Research
- Humans
- Public Health
- South Africa
Access to Document
- Hove_etal_OI_Participatory_Action_Research_VoR
© 2023 Hove et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. https://creativecommons.org/licenses/by/4.0/