April 3, 2009 Participatory Action Research

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April 3, 2009 Participatory Action Research

  1. 1. Participatory Action Research: Partnership With An Indigenous Guatemalan PHC Program Southwest region
  2. 2. Acknowledgement <ul><li>Dr. Beverly McElmurry (chair) </li></ul><ul><li>Dr. Linda McCreary </li></ul><ul><li>Dr. Jerry Niederman </li></ul><ul><li>Dr. Kathleen Norr </li></ul><ul><li>Dr. Chang Park </li></ul><ul><li>Dr. Susan Swider </li></ul><ul><li>Embajadores Medicos (LifeWind) Guatemala </li></ul>
  3. 3. Dedication <ul><li>My God and Savior Jesus Christ. It is in Him that I live, and move, and have my being. </li></ul><ul><li>My loving parents who taught me to pursue knowledge, wisdom, and truth. </li></ul><ul><li>Dr Hugo & Miriam Gomez and family, Betty, Juven, and </li></ul><ul><li>Hermanos: Chepe, Florentine, Marcitos, Marcos, Felipe, Abel, Cirilo, Margarito, Apolinario, Obispo, Mariano, Nazario, Pio, and Santiago. Thank you for putting “feet to your faith”, and for allowing me to work with you. </li></ul>
  4. 4. Background <ul><li>Guatemala, Central America </li></ul><ul><ul><li>>7.6 million persons earn less than $1/day </li></ul></ul><ul><ul><li>Under-five mortality 47/1000 </li></ul></ul><ul><ul><ul><li>Acute respiratory illness (40%) </li></ul></ul></ul><ul><ul><ul><li>Acute diarrheal illness (12%) </li></ul></ul></ul>
  5. 5. Coastal Village home
  6. 6. Background cont. <ul><li>Embajadores Medicos (Life Wind) </li></ul><ul><ul><li>Guatemalan, faith-based, Primary Health Care organization </li></ul></ul><ul><ul><li>25 yrs. of health-promotion in indigenous villages </li></ul></ul><ul><ul><li>Participatory teaching and learning emphasis </li></ul></ul><ul><ul><li>Curriculum foci: </li></ul></ul><ul><ul><ul><li>spiritual </li></ul></ul></ul><ul><ul><ul><li>physical </li></ul></ul></ul><ul><ul><ul><li>environmental </li></ul></ul></ul><ul><ul><ul><li>economic </li></ul></ul></ul><ul><ul><ul><li>and social well-being </li></ul></ul></ul>Community Health Educators & Training Team
  7. 7. Building Stove
  8. 8. Improved Stoves
  9. 9. Purpose <ul><li>The purpose of this PHC descriptive case-study was to: </li></ul><ul><ul><li>expand current understanding of PAR, </li></ul></ul><ul><ul><li>highlight its key attributes, </li></ul></ul><ul><ul><li>identify strengths, and </li></ul></ul><ul><ul><li>discuss limitations of PAR methodology in the context of an indigenous community setting. </li></ul></ul>
  10. 10. Specific Aims <ul><li>Tool development for program evaluation </li></ul><ul><li>Pilot evaluation tool </li></ul><ul><li>Cross-sectional program evaluation </li></ul>
  11. 11. Framework <ul><li>Participatory Action Research: </li></ul><ul><ul><li>With & by the community </li></ul></ul><ul><ul><li>Community as partner </li></ul></ul><ul><ul><li>Direct community benefit </li></ul></ul><ul><ul><li>Shared power </li></ul></ul><ul><ul><li>Mutual learning </li></ul></ul><ul><ul><li>Practice-based, action-oriented </li></ul></ul><ul><ul><li>Dynamic process </li></ul></ul>
  12. 12. Overview Lit. Review (1) - 45 articles - Developed a PAR guiding framework Visit (1) 2 wks - Relationship building - Observation <ul><li>Visit (2) </li></ul><ul><li>2 wks </li></ul><ul><li>Observation </li></ul><ul><li>Planning </li></ul><ul><li>Negotiation </li></ul>Work in Guatemala Work in the U.S. 2005 2006 2007 2008 2009 Tool Development - Key goal setting <ul><li>Tool Development </li></ul><ul><li>Draft </li></ul><ul><li>Revisions </li></ul><ul><li>- Training </li></ul><ul><li>- Adaptation </li></ul><ul><li>Survey </li></ul><ul><li>Data collection </li></ul><ul><li>On-going analysis </li></ul><ul><li>Discussion </li></ul><ul><li>Adaptation </li></ul><ul><li>Preliminary Report </li></ul><ul><li>Jointly written </li></ul><ul><li>Translation </li></ul><ul><li>Dissemination </li></ul><ul><li>Lit. </li></ul><ul><li>Review (2) </li></ul><ul><li>- 36 articles </li></ul><ul><li>PAR methodology </li></ul><ul><li>Clarification </li></ul><ul><li>Recommendations </li></ul>
  13. 13. Tool Development <ul><li>Developed jointly, based on Embajadores Medicos’ curriculum </li></ul><ul><ul><li>Picture based </li></ul></ul><ul><ul><ul><li>40% literacy Benitez, 2007 </li></ul></ul></ul><ul><ul><li>Spanish language </li></ul></ul><ul><ul><ul><li>+ Mam and Quiche </li></ul></ul></ul><ul><ul><li>Nominal level data </li></ul></ul><ul><ul><li>Face validity </li></ul></ul><ul><ul><ul><li>Goal: future Guatemalan program’s independent use </li></ul></ul></ul>
  14. 14. Training <ul><li>14 Guatemalan training team members </li></ul><ul><ul><li>Joint decision-making for tool development </li></ul></ul><ul><ul><li>Scheduled trainings and survey visits </li></ul></ul><ul><li>8-45 community health educators per village (number varied) </li></ul><ul><ul><li>Voluntary participation </li></ul></ul><ul><ul><li>Return demonstration of correct tool use </li></ul></ul><ul><ul><li>Independently chose number of households to survey </li></ul></ul>
  15. 15. Training
  16. 16. Practice
  17. 17. Evaluation <ul><li>Eleven indigenous villages </li></ul><ul><ul><li>5 Coastal + 6 Mountain </li></ul></ul><ul><ul><li>Convenient sample </li></ul></ul><ul><ul><li>Determined by Guatemalan partners </li></ul></ul><ul><li>Adult household representatives (n=1,188) </li></ul><ul><ul><li>Verbal consent </li></ul></ul>Village Visit in the Rain
  18. 18. Findings (Coastal Villages)
  19. 19. Running Water
  20. 20. Limitations <ul><li>Pilot study </li></ul><ul><li>Cross-sectional design </li></ul><ul><ul><li>Unable to compare changes over time </li></ul></ul><ul><li>Nominal level data </li></ul><ul><ul><li>PAR can use higher level data. This is community-dependent. </li></ul></ul>
  21. 21. Strengths <ul><li>Addressed questions important to community members </li></ul><ul><li>Large sample size </li></ul><ul><li>Direct Community Benefit </li></ul><ul><ul><li>Joint tool and data ownership </li></ul></ul><ul><ul><li>Training and evaluation experience </li></ul></ul><ul><ul><li>Final report ownership for dissemination to donors </li></ul></ul>
  22. 22. Discussion <ul><li>Each phase of a PAR study must be accompanied by purposeful examination of: </li></ul><ul><ul><li>community members’ roles, </li></ul></ul><ul><ul><li>dynamics of power, </li></ul></ul><ul><ul><li>direction of knowledge flow, </li></ul></ul><ul><ul><li>whether the process retains dynamicity, and </li></ul></ul><ul><ul><li>whether a tangible benefit is identifiable by the community partners. </li></ul></ul>
  23. 23. Discussion <ul><li>Participatory Action Research partnership with communities is one of the most significant developments in community health-promotion research. </li></ul><ul><ul><ul><li>Community members’ perspectives and life-experience are incorporated. </li></ul></ul></ul><ul><ul><ul><li>Research has face validity and practical value to community members. </li></ul></ul></ul><ul><ul><ul><li>Sustainability of health promotion efforts is greater due to community ownership. </li></ul></ul></ul><ul><li>Participatory action research is a methodology with tremendous potential for bridging science with the everyday lives and health behaviors of community members. </li></ul>
  24. 24. THANK YOU!

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