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

Abstract

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.

Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts

“…This approach comprised five main stages: (1) diagnosing, during which problems are identified; (2) action planning, during which alternative courses of action are considered and the best options selected; (3) taking action, during which selected courses of action are implemented; (4) evaluation, during which the actions taken and consequences are evaluated; and (5) specifying learning, during which key lessons are identified. Tetui et al [32] provide a detailed description of the participatory approach used in this paper.…”

Maternal and neonatal implementation for equitable systems. A study design paper

“…The rest of the nine papers share specific results [25–32]. In addition to this design paper, there is one more methodological paper that describes the PAR approach in more detail [33]. Two of the papers [25,26] summarize the results of the intervention on some of the key outcomes of the study (knowledge about maternal and newborn danger signs, birth preparedness and utilization of maternal and newborn health services and newborn care practices).…”

Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda

“…Collaboration in this manner enabled the testing of ideas during iterative cycles of action, review of data and reflection on experiences [42]. The pathways of change were not uniformly successful and at times they revealed new facets of implementation.…”

“…In Tanzania, CHWs and community financing of transport services for maternal health continued to be sustained beyond the original project timelines. Given the rising recognition of multi-sectoral action in improving health, these lessons on how to work with savings and transport groups have direct relevance for the Sustainable Development Goals [40,41].…”

“…Furthermore, facilitating wide stakeholder involvement entailed conflict, stress and uncertainty. Through this process of transformative learning to improve and sustain maternal health outcomes, tolerance, collaboration and being risk conscious emerged as critical values and skills for the partnerships involved [42].…”