Elements for harnessing participatory action research to strengthen health managers’ capacity: a critical interpretative synthesis
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Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
Health Research Policy and Systems
Abstract
Health 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.
Methods: A 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.
Results: Five 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.
Conclusions: The 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.
Description
Keywords
Participatory Action Research, Factors, Harnessing, Health managers’ capacity, Systems thinking, Implementation research
Citation
Tetui, M., Zulu, J. M., Hurtig, A. K., Ekirapa-Kiracho, E., Kiwanuka, S. N., & Coe, A. B. (2018). Elements for harnessing participatory action research to strengthen health managers’ capacity: a critical interpretative synthesis. Health Research Policy and Systems, 16(1), 1-14. https://doi.org/10.1186/s12961-018-0306-0