Elements for harnessing participatory action research to strengthen health managers’ capacity: a critical interpretative synthesis

Abstract

BackgroundHealth managers play a key role in ensuring that health services are responsive to the needs of the population. Participatory action research (PAR) is one of the approaches that have been used to strengthen managers’ capacity. However, collated knowledge on elements for harnessing PAR to strengthen managers’ capacity is missing. This paper bridges this gap by reviewing existing literature on the subject matter.MethodsA critical interpretive synthesis method was used to interrogate eight selected articles. These articles reported the use of PAR to strengthen health managers’ capacity. The critical interpretive synthesis method’s approach to analysis guided the synthesis. Here, the authors interpretively made connections and linkages between different elements identified in the literature. Finally, the Atun et al. (Heal Pol Plann, 25:104–111, 2010) framework on integration was used to model the elements synthesised in the literature into five main domains.ResultsFive elements with intricate bi-directional interactions were identified in the literature reviewed. These included a shared purpose, skilled facilitation and psychological safety, activity integration into organisational procedures, organisational support, and external supportive monitoring. A shared purpose of the managers’ capacity strengthening initiative created commitment and motivation to learn. This purpose was built upon a set of facilitation skills that included promoting participation, self-efficacy and reflection, thereby creating a safe psychological space within which the managers interacted and learnt from each other and their actions. Additionally, an integrated intervention strengthened local capacity and harnessed organisational support for learning. Finally, supportive monitoring from external partners, such as researchers, ensured quality, building of local capacity and professional safety networks essential for continued learning.ConclusionsThe five elements identified in this synthesis provide a basis upon which the use of PAR can be harnessed, not only to strengthen health managers’ capacity, but also to foster other health systems strengthening initiatives involving implementation research. In addition, the findings demonstrated the intricate and complex relations between the elements, which further affirms the need for a systems thinking approach to tackling health systems challenges.

From physical to online spaces in the age of the #FeesMustFall protests: A Critical Interpretative Synthesis of writing centres in emergency situations

“…Fourthly, the identified articles were subjected to quality assessment. I used a two-pronged approach that scrutinises the papers for either inclusion or exclusion (Dixon-Woods et al 2017, Tetui et al 2018. Five factors were used to determine the quality of the papers: (i) clarity in the aims and objectives of the research, (ii) the appropriateness of the research design to the aims and objectives, (iii) the researcher's clear account of the process that led to the findings, (iv) the sufficiency of the data to support the interpretations, and (v) the appropriateness of the methods of analysis.…”

“…This included the identification of key concepts that each study dealt with in comparison with the other studies (Dixon-Woods et al 2017), and an assessment of the existence of contradictions and possible explanations thereof (Pound et al 2005). Following this was the interpretation of the concepts and their possible application to an online writing centre (Tetui et al 2018). The literature on CIS does not state that a chronological analysis has to be followed (Dixon-Woods et al 2017, Pound et al 2005, Tetui et al 2018.…”

“…This contribution uses Critical Interpretative Synthesis (CIS), a methodology that is used to describe, interpret, and challenge findings for meaning, context, and influence in order to answer theoretical questions rather than produce definitive claims of effect (Dixon-Woods et al 2017, Tetui et al 2018. CIS borrows principles from systematic review and uses them with qualification through the critical examination of decisions made by authors while conducting and publishing their research and practice (McFerran et al 2017).…”

“…The CIS methodology has its roots in medical research based on some of the principles from systematic reviews (Ako-Arrey et al , Tetui et al 2018). According to Dixon-Woods et al (2017), CIS can be used in research settings other than medical literature by applying the principles of this methodology to other settings.…”

“…The complexities of this literature lie in the various themes that underlie the research on writing centres. Secondly, CIS permits the development of new concepts and theories through interpretation (Tetui et al 2018). These concepts may be based on the available literature or the themes that inform the operation of physical writing centres on an online platform.…”