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April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
April 3, 2009  Participatory  Action  Research
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April 3, 2009 Participatory Action Research

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  • 1. Participatory Action Research: Partnership With An Indigenous Guatemalan PHC Program Southwest region
  • 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. 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 &amp; 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. Background <ul><li>Guatemala, Central America </li></ul><ul><ul><li>&gt;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. Coastal Village home
  • 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 &amp; Training Team
  • 7. Building Stove
  • 8. Improved Stoves
  • 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. 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. Framework <ul><li>Participatory Action Research: </li></ul><ul><ul><li>With &amp; 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. 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. 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. 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. Training
  • 16. Practice
  • 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. Findings (Coastal Villages)
  • 19. Running Water
  • 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. 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. 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. 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. THANK YOU!

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