Recently PAR has been used more frequently in rich countries. The project developed innovative and engaging ways for staff and community members to work together effectively. A community action cycle was developed whereby problems were identified and prioritised, joint planning took place, and the plan was implemented and then evaluated in a participatory way. The project built on and strengthened existing women's networks and the staff played the part of facilitators rather than educators. The work by Howard‐Grabman 15 provides a typical description of developing a community plan to tackle maternal and neonatal health problems in rural Bolivia. 12 Initially PAR was mainly used in low income countries for needs assessment (see for example De Kroning and Martin 13) and planning and evaluating health services (for examples see collection in Minkler and Wallerstein 14). 11, 11a An example of this interest is the special edition of the Journal of Interprofessional Care, with an editorial and 16 articles reporting on PAR. Through the 1990s more participatory research was reported and textbooks including PAR became more common. By contrast, in the 1980s and in earlier decades, very little research using PAR was reported in health journals. In the 21st century PAR is increasingly used in health research. The degree to which this is possible in health research will differ as will the willingness of people to be involved in research PAR advocates that those being researched should be involved in the process actively. Most health research involves people, even if only as passive participants, as “subjects” or “respondents”. ![]() Thirdly, PAR contrasts with less dynamic approaches that remove data and information from their contexts. By contrast new paradigm science and PAR posits that the observer has an impact on the phenomena being observed and brings to their inquiry a set of values that will exert influence on the study. The hallmark of positivist science is that it sees the world as having a single reality that can be independently observed and measured by objective scientists preferably under laboratory conditions where all variables can be controlled and manipulated to determine causal connections. Wadsworth 7 sees PAR as an expression of “new paradigm science” that differs significantly from old paradigm or positivist science. The researched cease to be objects and become partners in the whole research process: including selecting the research topic, data collection, and analysis and deciding what action should happen as a result of the research findings. Secondly, PAR pays careful attention to power relationships, advocating for power to be deliberately shared between the researcher and the researched: blurring the line between them until the researched become the researchers. The resultant action is then further researched and an iterative reflective cycle perpetuates data collection, reflection, and action as in a corkscrew action. Action is achieved through a reflective cycle, whereby participants collect and analyse data, then determine what action should follow. Firstly, it focuses on research whose purpose is to enable action. ![]() PAR differs from conventional research in three ways. From these roots PAR grew as a methodology enabling researchers to work in partnership with communities in a manner that leads to action for change. This perspective was strongly supported by the work of Freire, 4 who used PAR to encourage poor and deprived communities to examine and analyse the structural reasons for their oppression. 3 Adult educators in low income countries drew on these intellectual perspectives to develop a form of research that was sympathetic to the participatory nature of adult learning. ![]() 2 It affirms that experience can be a basis of knowing and that experiential learning can lead to a legitimate form of knowledge that influences practice. 1 It reflects questioning about the nature of knowledge and the extent to which knowledge can represent the interests of the powerful and serve to reinforce their positions in society. ![]() Participatory action research (PAR) differs from most other approaches to public health research because it is based on reflection, data collection, and action that aims to improve health and reduce health inequities through involving the people who, in turn, take actions to improve their own health.
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