1. Partnership between Practitioners and Researchers Participatory Action Research in Pharmacy Practice The Angina Pectoris Patient and the Pharmacy Authors: Associate Professor Ellen Westh Sørensen, Assistant Professor Lotte Stig Nørgaard Department of Social Pharmacy Royal Danish School of Pharmacy Steering Group Practitioners, 7 Pharmacy students, 4 Researchers, 4

2. Purpose of the lecture: To present and discuss Participatory Action Research (PAR), The advantages/disadvantages. Disposition: 1. The story of the project The Angina Pectoris Patient and the Pharmacy seen as participatory action research 2. What is PAR 3. Discussion of advantages/disadvantages of PAR

3. Purpose The overall purpose of the study to quality develop pharmacy practice and pharmacy practice research in the area of pharmaceutical care, leading to a better drug use for the patient

4. Step 1 General idea and general objective January 1998 * Negotiation between researchers and internship preceptors about a pharmacy practice research project * A steering group is established

5. Step 2 The project plan is developed Feb-July 1998 The steering group decides at two meetings the subject of the research, the design, and data collection The first draft project plan is made by the researchers The project is presented and discussed with interest parts Preparing of materials for the pharmacies: theoretical frame, research questions, interviews, questionnaires, instruction to the students and the pharmacies Meeting, critique on all parts from the steering group

6. Research questions: What are the angina patients drug related experiences, knowledhe, perceptions, problems and how do they act in relation to these problems? What are the Pharmacy staffs perceptions of the patients’ experiences, knowledge, problems and actions, and how do they act in relation to these patients? What are the similarities and differences between the users and the professionals perspectives? How are the cooperation about implementation and development of a new pharmacy practice established between the researchers and the practitioners, what learning processes are started for the pharmacy students, what changes are started in the pharmacy, and what directions does it take?

7. Theories used in the project: User perspective Pharmaceutical care Participatory action research

8. The purpose for the three working parts in the study: For the pharmacies: Enhancement of the pharmacies advice/pharmaceutical care to angina pectoris patients through involvement of the user perspective For the pharmacy students: Involvement in pharmaceutical care in the pharmacy, insight into the angina pectoris patient, experience in pharmacy practice research For the researchers/teachers: Study the above 2 + Study and improve the implementation process. In this case collect experiences from the use of participatory action research

9. Step 3 ACTION: The pilot study Aug-Dec 1998 The pilot study was carried out in 7 pharmacies Invitation to the internship pharmacies The students interview two patients each, and distribute questionnaires to the staff The steering group make an analysis of the patient interviews and the staff questionnaires The students and the preceptor presents the results in their pharmacy, comparing the patient data with the staff data

10. Step 4 Evaluation of Action: The pilot study Dec-Feb 1998-1999 The preceptors discuss the results at their yearly meeting The researchers discuss the results with researchers at Pharmakon The steering group evaluates and make decision for changes. The students and preceptors from the pilot pharmacies discuss the pilot study with the steering group.

11. The overall subject, the idea and design works well

12. Changes: More emphasis on discussion of the results in the pharmacy More responsibility to the preceptor Refine the theory, data collection instruments and work schedule for the students Better registration of effect on the pharmacies Better registration of effect on the pharmacy students More focus on the implementation process

13. More changes The hospital pharmacies and Norwegian pharmacies want to participate Extension and exchange of group members in the project group The work in the main study is delegated to 4 subgroups: Interview, questionnaire, hospital, process

14. Step 5 ACTION: The Main Study Feb-Aug 1999 Planning of the main study The main study is carried out in the pharmacies - 45 out of 71 pharmacies

15. Step 6 Evaluation and reflection on results from step 1-5 August 1999 What happened in the pharmacies, what changes do they want? What did the students learn and what changes do they need for their curriculum? How did the implementation process work, did it start a process for the practitioners and the students - and in which direction?

16. Step 7 ACTION STEP 3, August 1999Pilot study Step 8Reflection Feb 2000 Step 9 ACTION STEP 4, Feb-Aug 2000 Main study

17. A spiral of steps each of which is composed of a circle of : planning action observing and reflecting

18. What is Participatory Action Research? PAR is research which involves practitioners in the research process from the initial design of the project through data gathering and analysis to final conclusion and actions arising out of the research.

19. Characteristics of Participatory Action Research Collaboration between researcher and practitioner Solution of practical problems Change in current practice Development of theory

20. PAR and Conventional Research: The Research Process Compared (after Cornwall and Jewkes, soc.sci.med. 1995, 1667-76) PARConventional Research What is the research for?Action/changeDescribe/explain/understand Who is the research for?Practitioners Institutional, personal and prof. interests Whose knowledge counts?Practitioners’ Scientists’ Topic choice influenced by?Practitioners’Funding priorities, institutional priorities agendas Methodology chosen for?Empowerment, Objectivity and truth mutual learning What is emphasised?ProcessOutcomes

21. PAR and Conventional Research: The Research Process Compared (continued) PARConventional Research Who takes part in the stages of the research process? Problem identificationPractitionersResearcher Data collectionPractitioners Researcher InterpretationPractitioners’Disciplinary concepts/ concepts frameworks AnalysisPractitionersResearcher Presentation of findingsAccessible and useful Academics and funding body for practitioners Action on findingsIntegral to theSeparate process Who owns the results?SharedThe researcher Who takes action?PractitionersExternal agencies What is emphasised? ProcessOutcomes

22. The problems with PAR research: Criticism: it is subjective No publishing in research journals Extremely time demanding, stretches over long time, cannot be planned as other research; demands very motivated practitioners The researcher: besides research qualifications also project leader/consultant qualifications For practitioners, besides professional skills and engagement, knowledge about research method

23. Advantages to action research Learning a part of the project Fruitful both ways Close to research as well as practice