Evidence, Power, and Policy Change in Community-Based Participatory Research

Freudenberg, Nicholas; Tsui, Emma K.

doi:10.2105/ajph.2013.301471

Cited by 130 publications

(73 citation statements)

References 35 publications

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“…However, the critics view it as a risk that could strain relationships and therefore undermine implementation of project. [22,33,34] This study indeed registered some discontentment among stakeholders with the high and wide level of involvement.…”

Section: Discussionmentioning

confidence: 56%

“…The study focused on looking at experiences of stakeholders at higher levels of authority within district level health systems, rather than those of community level stakeholders, which have been studied more extensively. [21,22] Thus, the aim of this article is to explore stakeholders’ experiences of the PAR approaches about strengthening local health systems capacity, such as management, which is essential for sustaining effective interventions to improve maternal and neonatal health outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Experiences of using a participatory action research approach to strengthen district local capacity in Eastern Uganda

Tetui

Coe

Hurtig

et al. 2017

Global Health Action

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Background: To achieve a sustained improvement in health outcomes, the way health interventions are designed and implemented is critical. A participatory action research approach is applauded for building local capacity such as health management. Thereby increasing the chances of sustaining health interventions. Objective: This study explored stakeholder experiences of using PAR to implement an intervention meant to strengthen the local district capacity. Methods: This was a qualitative study featuring 18 informant interviews and a focus group discussion. Respondents included politicians, administrators, health managers and external researchers in three rural districts of eastern Uganda where PAR was used. Qualitative content analysis was used to explore stakeholders’ experiences. Results: ‘Being awakened’ emerged as an overarching category capturing stakeholder experiences of using PAR. This was described in four interrelated and sequential categories, which included: stakeholder involvement, being invigorated, the risk of wide stakeholder engagement and balancing the risk of wide stakeholder engagement. In terms of involvement, the stakeholders felt engaged, a sense of ownership, felt valued and responsible during the implementation of the project. Being invigorated meant being awakened, inspired and supported. On the other hand, risks such as conflict, stress and uncertainty were reported, and finally these risks were balanced through tolerance, risk-awareness and collaboration. Conclusions: The PAR approach was desirable because it created opportunities for building local capacity and enhancing continuity of interventions. Stakeholders were awakened by the approach, as it made them more responsive to systems challenges and possible local solutions. Nonetheless, the use of PAR should be considered in full knowledge of the undesirable and complex experiences, such as uncertainty, conflict and stress. This will enable adequate preparation and management of stakeholder expectations to maximize the benefits of the approach.

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Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Experiences of using a participatory action research approach to strengthen district local capacity in Eastern Uganda

Tetui

Coe

Hurtig

et al. 2017

Global Health Action

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“…Addressing SDH requires an understanding of the impact of macroeconomic policies and social policies on the health. Evidence-based policies must be relevant and integrated into health systems to function efficiently (28)(29)(30)(31). Based on the conceptual framework of social determinants of health inequality, this research aimed to determine the effect of macroeconomic policies on the social-health inequality in Iran based on expert opinion and identify the drivers of SDH in Iran.…”

Section: Introductionmentioning

confidence: 99%

Macroeconomic policies and increasing social-health inequality in Iran

Zaboli

Seyedin

Malmoon

2014

Int J Health Policy Manag

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Background: Health is a complex phenomenon that can be studied from different approaches. Despite a growing research in the areas of Social Determinants of Health (SDH) and health equity, effects of macroeconomic policies on the social aspect of health are unknown in developing countries. This study aimed to determine the effect of macroeconomic policies on increasing of the social-health inequality in Iran. Methods: This study was a mixed method research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect the data along with a multiple attribute decision-making method for the quantitative phase of the research in which the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was employed for prioritization. The NVivo and MATLAB softwares were used for data analysis. Results: Seven main themes for the effect of macroeconomic policies on increasing the social-health inequality were identified. The result of TOPSIS approved that the inflation and economic instability exert the greatest impact on social-health inequality, with an index of 0.710 and the government policy in paying the subsidies with a 0.291 index has the lowest impact on social-health inequality in the country. Discussion: It is required to invest on the social determinants of health as a priority to reduce health inequality. Also, evaluating the extent to which the future macroeconomic policies impact the health of population is necessary.

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“…On the one hand, Sørensen et al's work implies a broader perspective on population groups; on the other hand, it could put even more emphasis on the need for structural changes. In times when the crucial role of social determinants of health is increasingly being recognised, effective solutions have to involve tackling inequities and the structures that produce them (Freudenberg and Tsui 2014). This is even more important given continuing corporate efforts to frame the control of health risks, such as smoking or obesity, as personal responsibilities (Dorfman et al 2014).…”

mentioning

confidence: 99%

“…Such structural factors need to be recognised for what they are: crucial determinants of health. In the long run, raising awareness of these factors may help individuals to take responsibility for alleviating social injustice, for example by becoming socially active or reconsidering for whom to vote in the next election (Freudenberg and Tsui 2014). So a careful balance is needed: health literacy initiatives should strengthen agency, but they should not shift the responsibility for structural changes to the individual.…”

mentioning

confidence: 99%