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Participation has been of ongoing interest in the field of action research and the New Health Promotion movement, but it is not without tensions and problems. This article presents the challenge of containing the conflicting demands of personal empowerment, practical advancement and theory building in a community-based participatory action research project 'Aspiring to Healthy Living in The Netherlands'. A Participatory Action Research (PAR) methodology was chosen because of its contribution to empowerment of the community of older people, which was one of the project goals. Besides that, the project aimed at the development of an intervention program for encouraging healthy living amongst older people in The Netherlands and contributing to the knowledge base on healthy living, by analyzing narratives from the participants. However, when time pressure rose, the empowerment goal started to collide with academic and practical aims, and the dialogue within the project team became obstructed leading to a return to the traditional routine of applied research and the accompanying power relationships, with implications for the learning in and about the project. This article starts with a short review of the literature on community participation in health research and the challenges of learning participatory action research, followed by a description of the PAR project and the process of participation, using the ladder of Pretty as a tool to highlight different levels of participation in different project stages. By using the theory of organizational learning developed by Argyris and Schö n (Argyris, 1993; Argyris & Schö n, 1978), insights will be provided into the attempts of a relatively inexperienced team to create a participatory and dialogic research project, and the problems in keeping reflection and learning going within a context of external pressure.

The turn towards autonomy in healthcare raises moral questions about responsibilities for care. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together.

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