Partnership between Practitioners and ResearchersParticipatory Action Research in Pharmacy Practice

The Angina Pectoris Patient and the Pharmacy

Authors: Associate Professor Ellen Westh Sørensen, Assistant Professor Lotte Stig NørgaardDepartment of Social PharmacyRoyal Danish School of Pharmacy

Steering GroupPractitioners, 7 Pharmacy students, 4Researchers, 4

Purpose of the lecture:

To present and discuss Participatory Action Research (PAR), The advantages/disadvantages.

Disposition:

1. The story of the project The Angina Pectoris Patient and the Pharmacy seen as participatory action research

2. What is PAR3. Discussion of advantages/disadvantages of PAR

PurposeThe overall purpose of the study to quality develop pharmacy practice and pharmacy practice research in the area of pharmaceutical care, leading to a better drug use for the patient

Step 1 General idea and general objective January 1998 * Negotiation between researchers and

internship preceptors about a pharmacy practice research project

* A steering group is established

Step 2 The project plan is developedFeb-July 1998

• The steering group decides at two meetings the subject of the research, the design, and data collection • The first draft project plan is made by the researchers• The project is presented and discussed with interest parts • Preparing of materials for the pharmacies: theoretical frame, research questions, interviews, questionnaires, instruction to the students and the pharmacies• Meeting, critique on all parts from the steering group

Research questions:

• What are the angina patients drug related experiences, knowledhe, perceptions, problems and how do they act in relation to these problems?

• What are the Pharmacy staffs perceptions of the patients’ experiences, knowledge, problems and actions, and how do they act in relation to these patients?

• What are the similarities and differences between the users and the professionals perspectives?

• How are the cooperation about implementation and development of a new pharmacy practice established between the researchers and the practitioners, what learning processes are started for the pharmacy students, what changes are started in the pharmacy, and what directions does it take?

Theories used in the project:

• User perspective

• Pharmaceutical care

• Participatory action research

The purpose for the three working parts in the study:•For the pharmacies:Enhancement of the pharmacies advice/pharmaceutical care to angina pectoris patients through involvement of the user perspective•For the pharmacy students:Involvement in pharmaceutical care in the pharmacy, insight into the angina pectoris patient, experience in pharmacy practice research•For the researchers/teachers:Study the above 2 + Study and improve the implementation process.In this case collect experiences from the use of participatory action research

Step 3 ACTION: The pilot study Aug-Dec 1998• The pilot study was carried out in 7 pharmacies• Invitation to the internship pharmacies• The students interview two patients each, and

distribute questionnaires to the staff• The steering group make an analysis of the patient

interviews and the staff questionnaires• The students and the preceptor presents the results

in their pharmacy, comparing the patient data with the staff data

Step 4 Evaluation of Action: The pilot studyDec-Feb1998-1999

• The preceptors discuss the results at their yearly meeting

• The researchers discuss the results with researchers at Pharmakon

• The steering group evaluates and make decision for changes.

• The students and preceptors from the pilot pharmacies discuss the pilot study with the steering group.

The overall subject, the idea and design works well

Changes:

• More emphasis on discussion of the results in the pharmacy

• More responsibility to the preceptor• Refine the theory, data collection instruments and work

schedule for the students • Better registration of effect on the pharmacies• Better registration of effect on the pharmacy students • More focus on the implementation process

More changes

•The hospital pharmacies and Norwegian pharmacies want to participate

•Extension and exchange of group members in the project group

•The work in the main study is delegated to 4 subgroups: Interview, questionnaire, hospital, process

Step 5 ACTION: The Main StudyFeb-Aug1999

• Planning of the main study

• The main study is carried out in the pharmacies - 45 out of 71 pharmacies

Step 6 Evaluation and reflection on results from step 1-5

August 1999

• What happened in the pharmacies, what changes do they want?

• What did the students learn and what changes do they need for their curriculum?

• How did the implementation process work, did it start a process for the practitioners and the students - and in which direction?

Step 7 ACTION STEP 3, August 1999 Pilot study

Step 8 ReflectionFeb 2000

Step 9 ACTION STEP 4,Feb-Aug 2000 Main study

A spiral of steps each of which is composed of a circle of :

planning

action

observing and

reflecting

What is Participatory Action Research?

PAR is research which involvespractitioners in the research process from the initial design of the project through data gathering and analysis tofinal conclusion and actions arising outof the research.

Characteristics of Participatory Action Research

• Collaboration between researcher and practitioner

• Solution of practical problems• Change in current practice• Development of theory

PAR and Conventional Research: The Research Process Compared(after Cornwall and Jewkes, soc.sci.med. 1995, 1667-76)

PAR Conventional ResearchPAR Conventional Research

What is the research for? Action/change Describe/explain/understand

Who is the research for? Practitioners Institutional, personal and prof.

interests

Whose knowledge counts? Practitioners’ Scientists’

Topic choice influenced by? Practitioners’ Funding priorities, institutional

priorities agendas

Methodology chosen for? Empowerment, Objectivity and truth

mutual learning

What is emphasised? Process Outcomes

PAR and Conventional Research: The Research Process Compared

(continued)PAR Conventional ResearchPAR Conventional

ResearchWho takes part in the stages of the research

process?

Problem identification Practitioners Researcher

Data collection Practitioners Researcher

Interpretation Practitioners’ Disciplinary concepts/

concepts frameworks

Analysis Practitioners Researcher

Presentation of findings Accessible and useful Academics and funding body

for practitioners

Action on findings Integral to the Separate

process

Who owns the results? Shared The researcher

Who takes action? Practitioners External agencies

What is emphasised? Process Outcomes

The problems with PAR research:

•Criticism: it is subjective

•No publishing in research journals

•Extremely time demanding, stretches over long

time, cannot be planned as other research;

demands very motivated practitioners

•The researcher: besides research qualifications

also project leader/consultant qualifications

•For practitioners, besides professional skills

and

engagement, knowledge about research method

Advantages to action

research

•Learning a part of the

project

•Fruitful both ways

•Close to research as well as

practice