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Implementation Science
Published in: Implementation Science 1/2009

Open Access 01-12-2009 | Debate

Implementation research design: integrating participatory action research into randomized controlled trials

Authors: Luci K Leykum, Jacqueline A Pugh, Holly J Lanham, Joel Harmon, Reuben R McDaniel Jr

Published in: Implementation Science | Issue 1/2009

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Abstract

Background

A gap continues to exist between what is known to be effective and what is actually delivered in the usual course of medical care. The goal of implementation research is to reduce this gap. However, a tension exists between the need to obtain generalizeable knowledge through implementation trials, and the inherent differences between healthcare organizations that make standard interventional approaches less likely to succeed. The purpose of this paper is to explore the integration of participatory action research and randomized controlled trial (RCT) study designs to suggest a new approach for studying interventions in healthcare settings.

Discussion

We summarize key elements of participatory action research, with particular attention to its collaborative, reflective approach. Elements of participatory action research and RCT study designs are discussed and contrasted, with a complex adaptive systems approach used to frame their integration.

Summary

The integration of participatory action research and RCT design results in a new approach that reflects not only the complex nature of healthcare organizations, but also the need to obtain generalizeable knowledge regarding the implementation process.
Literature
1.
Committee on Quality of Health Care in America: Crossing the quality chasm: a new health care system for the 21st century. 2001, Washington, DC: National Academy Press
2.
Wachter RM: The end of the beginning: patient safety five years after 'To Err is Human'. Health Affairs-Web Exclusive. 2004, W4: 534-545.
3.
Lenfant C: Clinical research to clinical practice--Lost in translation?. N Engl J Med. 2003, 349: 868-874. 10.1056/NEJMsa035507.CrossRefPubMed
4.
Asch SM, Kerr EA, Keesey J, Adams JL, Setodji CM, Malik S, McGlynn EA: Who is at greatest risk for receiving poor-quality health care?. N Engl J Med. 2006, 354: 1147-1156. 10.1056/NEJMsa044464.CrossRefPubMed
5.
Oxman AD: No magic bullet: a systematic review of 102 trials of interventions to improve professional practice. Canadian Medical Assoc J. 1995, 153: 1423-1431.
6.
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004, 8 (6): 1-72.CrossRef
7.
Oxman AD: No magic bullet: a systematic review of 102 trials of interventions to improve professional practice. Canadian Medical Assoc J. 1995, 153: 1423-1431.
8.
Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA: Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ. 1998, 317: 465-468.CrossRefPubMedPubMedCentral
9.
Solberg LI, Kottke TE, Brekke ML, Magnan S, Davidson G, Calomeni CA, Conn SA: Failure of a continuous quality improvement intervention to increase the delivery of preventive services. A randomized trial. Eff Clin Pract. 2000, 3 (3): 105-115.PubMed
10.
Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR: Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999, 282 (15): 1458-1465. 10.1001/jama.282.15.1458.CrossRefPubMed
11.
Weingarten SR, Henning JM, Badamgarov E, Knight K, Hasselbad V, Gano A, Ofman JJ: Interventions used in disease management programmes for patients with chronic illness - which ones work? Meta-analysis of published reports. BMJ. 2002, 325: 925-10.1136/bmj.325.7370.925.CrossRefPubMedPubMedCentral
12.
Katon W, Russo J, Von Korff M, Lin E, Simon G, Bush T, Ludman E, Walker E: Long-term effects of a collaborative care intervention in persistently depressed primary care patients. J Gen Intern Med. 2002, 17 (10): 741-748. 10.1046/j.1525-1497.2002.11051.x.CrossRefPubMedPubMedCentral
13.
Stroebel CK, McDaniel RR, Crabtree BF, Miller WL, Nutting PA, Stange KC: How complexity science can inform a reflective process for improvement in primary care practices. Joint Commission J Qual & Patient Safety. 2005, 31 (8): 438-446.
14.
McDaniel RR, Driebe DJ: Complexity Science and Health Care Management. Advances in Health Care Management. 2001, 2: 11-36.CrossRef
15.
16.
Miller WL, McDaniel RR, Crabtree BF, Stange KC: Practice jazz: understanding variation in family practices using complexity science. J Fam Pract. 2001, 50 (10): 872-878.PubMed
17.
Plsek P: Redesigning Health Care with Insights from the Science of Complex Adaptive Systems. Crossing the Quality Chasm: A New Heath System for the 21st Century. National Academy of Sciences. 2000, 309-322.
18.
Cilliers P: Complexity and Postmodernism: Understanding Complex Systems. 1998, New York, NY: Routledge
19.
Maguire S, McKelvey B, Mirabeau L, Oztas N: Complexity Science and Organization Studies. The Sage Handbook of Organization Studies. 2006, SAGE Publications, 165-214. 2CrossRef
20.
Litaker D, Tomolo A, Liberatore V, Stange K, Aron D: Using Complexity Theory to Build Interventions that Improve Health Care Delivery in Primary Care. J Gen Intern Med. 2006, 21 (Suppl): 30-34.CrossRef
21.
Leykum LK, Pugh J, Lawrence V, Parchman M, Noel P, Cornell J, McDaniel RR: Organizational interventions employing principles of complexity science have improved outcomes for patients with type II diabetes. Imp Sci. 2007, 2: 28-CrossRef
22.
Whyte WF: Participatory Action Research. 1991, Thousand Oaks, CA: Sage PublicationsCrossRef
23.
Waterman H, Tillen D, Dickson R, de Koning K: Action research: a systematic review and guidance for acceptance. Health Technology Assessment. 2001, 5 (23): 1-174.CrossRef
24.
Viswanathan M, Ammerman A, Eng E, Garlehner G, Lohr KN: Community-based participatory research: assessing the evidence. Evidence Report/Technology Assessment No. 99. 2004, Rockville, MD: AHRQ Publication 04-E022-2
25.
Khunti K, Stone MA, Bankart J, Sinfield P, Pancholi A, Walker S, Talbot D, Farooqi A, Davies MJ: Primary prevention of type-2 diabetes and heart disease: action research in secondary schools serving an ethnically diverse UK population. J Public Health. 2008, 30 (1): 30-31.CrossRef
26.
DiNapoli PP, Lewis JB: Understanding school-age obesity: through participatory action research. Am J Maternal Child Nursing. 2008, 33 (2): 104-110.CrossRef
27.
Brown DR, Hernandez A, Saint-Jean G, Evans S, Tafari I, Brewster LG, Celestin MJ, Gomez-Estefan C, Regelado F, Akal S, Nierenberg B, Kauschinger ED, Schwartz R, Page JB: A participatory action research pilot study of urban health disparities using rapid assessment response and evaluation. Am J Public Health. 2008, 98 (1): 28-38.CrossRefPubMedPubMedCentral
28.
Bradley HA, Puoane T: Prevention of hypertension and diabetes in an urban setting in South Africa: participatory action research with community health workers. Ethnicity & Disease. 2007, 17 (1): 49-54.
29.
Hills M, Mullett J, Carroll S: Community-based participatory action research: transforming multidisciplinary practice in primary health care. Pan Am J Public Health. 2007, 21: 125-135.CrossRef
30.
Gershon RR, Rubin MS, Qureshi KA, Canton AN, Matzner FJ: Participatory action research methodology in disaster research: results from the World Trade Center evacuation study. Disaster Medicine and Public Health Preparedness. 2008, 2 (3): 142-149.CrossRefPubMed
31.
Bloom HS: Learning More from Social Experiments: Evolving Analytic Approaches. 2000, New York, NY: Russel Sage Foundation
32.
Aaron KF, Stryer D: Moving from rhetoric to evidence-based action in health care. J Gen Int Med. 2003, 18: 589-591.CrossRef
33.
Hawkins P: A centennial tribute to Gregory Bateson 1904-1980 and his influence on the fields of organizational development and action research. Action Research. 2004, 2: 1-13.CrossRef
34.
Peters M, Robinson V: The origins and status of action research. J Applied Behavioral Science. 1984, 20 (2): 113-124.CrossRef
35.
Marsick VJ, Gephart MA: Action research: Building the capacity for learning and change. Human Resource Planning. 2003, 26: 14-18.
36.
Macaulay AC, Commanda LE, Freeman WL, Gibson N, McCabe ML, Robbins CM, Twohig PL: Participatory research maximizes community and lay involvement. BMJ. 1999, 319: 774-778.CrossRefPubMedPubMedCentral
37.
Elden M, Chisholm RF: Emerging varieties of action research: Introduction to the special issue. Human Relations. 1993, 46: 121-142.CrossRef
38.
Heron J: Co-Operative Inquiry: Research Into the Human Condition. 1996, Thousand Oaks, CA: Sage Publications
39.
Bray JN, Lee J, Smith LL, Yorks L: Collaborative Inquiry in Practice: Action, Reflection, and Making Meaning. 2000, Thousand Oaks, California: Sage Publications
40.
Kemmis S, McTaggart R: The Action Research Planner. 1988, Geelong: Deakin University, 3
41.
Deming WE: Out of the crisis. 1982, Cambridge, MA: MIT Press
42.
43.
44.
Hall JE: Professionalizing action research--a meaningful strategy for modernizing services?. J Nursing Mgmt. 2006, 14: 195-200.CrossRef
45.
Torbert W: The distinctive questions developmental action inquiry asks. Management Learning. 1999, 30: 189-206.CrossRef
46.
Cooperider DL, Srivastva S: Appreciative Inquiry in Organizational Life. Research in Organizational Change and Development. 1987, 1: 129-169.
47.
Reason P: Choice and quality in action research practice. J Mgmt Inquiry. 2006, 15: 187-203.CrossRef
48.
49.
Greenwood DJ, Levin M: Introduction to Action Research. 1998, Thousand Oaks, CA: Sage Publications
50.
Clemensen J, Larsen SB, Kyng M, Kirkevold M: Participatory design in health sciences: Using cooperative experimental methods in developing health services and computer technology. Qual Health Research. 2007, 17 (1): 122-130.CrossRef
51.
Glasson JB, Chang EM, Bidewell JW: The value of participatory action research in clinical nursing practice. Int J Nursing Practice. 2008, 14 (1): 34-39.CrossRef
52.
Westhues A, Ochocka J, Jacobson N, Simich L, Maiter S, Janzen R, Fleras A: Developing theory from complexity: reflections on a collaborative mixed method participatory action research study. Qual Health Research. 2008, 18 (5): 701-717.CrossRef
53.
Corbett AM, Francis K, Chapman Y: Feminist-informed participatory action research: a methodology of choice for examining critical nursing issues. Int J Nursing Practice. 2007, 13 (2): 81-88.CrossRef
54.
Goto K, Tiffany J, Pelto G, Pelletier D: Use of Q methodology to analyze divergent perspectives on participatory action research as a strategy for HIV/AIDS prevention. AIDS Education & Prevention. 2008, 20 (4): 301-311.CrossRef
55.
Esler DM: Participatory action research in indigenous health. Australian Family Physician. 2008, 37 (6): 457-459.PubMed
56.
Oscos-Sanchez MA, Lesser J, Kelly P: Cultural competence: a critical facilitator of success in community-based participatory action research. Issues in Mental Health Nursing. 2008, 29 (2): 197-200.CrossRefPubMed
Metadata
Title
Implementation research design: integrating participatory action research into randomized controlled trials
Authors
Luci K Leykum
Jacqueline A Pugh
Holly J Lanham
Joel Harmon
Reuben R McDaniel Jr
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2009
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-4-69

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