Background and Objectives Given population aging, the meaningful involvement of older adults in influencing policy and programs through participatory action research (PAR) is increasingly vital. PAR holds promise for equitable participation, co-learning, community mobilization, and personal and social transformation, however, little scholarly attention has been given to critically evaluating how PAR has been taken up with older adults. The objective of this review was to critically evaluate the use of PAR with older adults. Research Design and Methods A critical interpretive synthesis (CIS) of 40 PAR studies with older adults was conducted. Critical engagement with the articles identified dominant tendencies, limits of these tendencies, and proposed ways forward. Results Within the majority of articles reviewed, older adults were not prominent partners in PAR given their often limited involvement in designing the research questions, learning research skills and knowledge, and implementing findings for change. Furthermore, power differentials between researchers and older adults were evident, as older adults were often positioned as participants rather than partners. Finally, this article demonstrates various boundaries on the foci of studies related to inclusivity and sustainability. Discussion and Implications This study revealed that the promises PAR holds are often not fully realized in projects with older adults, given that they are rarely positioned as equitable partners, co-learners, or agents for change. The findings have the potential to stimulate further uptake of PAR research with an older adult population, highlighting areas for change in systems and research practices.
Within research addressing issues of social justice, there is a growing uptake of participatory action research (PAR) approaches that are ideally committed to equitable participation of community members in all phases of the research process in order to collaboratively enact social transformation. However, the utilization of such approaches has not always matched the ideal, with inconsistencies in how participation and action are incorporated. "Participation" within various research processes is displayed differently, with the involvement of community members varying from full participation to their involvement as simply participants for data collection. Similarly, "action" is varyingly enacted from researchers proposing research implications for policy and practice to the meaningful involvement of community members in facilitating social change. This inconsistency in how PAR is utilized, despite widespread publications outlining key principles and central tenets, suggests there are challenges preventing researchers from fully embracing and enacting the central tenets of equitable participation and social transformation. This article intends to provide one way forward, for scholars intending to more fully enact the central tenets of PAR, through critically discussing how, and to what extent, the principles of PAR were enacted within 14 key exemplars of PAR conducted with older adults. More specifically, we display and discuss key principles for enacting the full commitment of PAR, highlight a critical appraisal guide, critically analyze exemplars, and share strategies that researchers have used to address these commitments. The critical appraisal guide and associated research findings provide useful directions for researchers who desire to more fully embrace commitments and practices commensurate with enacting the promise of PAR for equitable collaboration and social transformation.
P oor access to specialist physicians and allied health professionals (hereafter referred to as "specialists") and long wait times are pervasive problems facing many health care systems. 1 Relative to its international peers, Canada struggles to provide timely access to care. 2 Canadian wait times between referral and appointment are twice as long as they were 25 years ago, increasing from an average of 9.3 weeks in 1993 to 19.8 weeks in 2018. 3 Currently, most outpatient clinicians use a "multiple-queue, multiple-server" model to manage their referrals and wait lists, whereby each clinician has a separate queue. 4 As such, clinicians of the same specialty, working in the same region, may have different approaches to managing referral and wait lists, potentially leading to inequitable and suboptimal patient outcomes. In contrast, single-entry models assemble patients referred to specific specialists in a given jurisdiction into a single queue, thereby allowing each patient to see the first available specialist. The single-entry model consists of a centralized intake (i.e., referrals are received through a single point of entry) or a pooled referral system (i.e., merging of multiple waiting lists), along with a centralized, coordinated approach to triage (i.e., appointments arranged according to urgency). 5 The single-entry model is based on queuing theory 6 and has been proven successful in operational fields such as the airline industry. 5 In health care, the benefits of this model are thought to relate to rebalancing of supply (i.e., clinician availability) and demand (i.e., the number of referrals). 4 In addition, sicker patients may be seen faster with a central intake system, whereby the patient is referred to an available provider according to urgency. Although single-entry models may prevent duplicate and cancelled appointments, they may also limit choice and reduce satisfaction. 4 A prior review
Indigenous Peoples in Canada continue to experience racism and discrimination when accessing health care. Competencies of health care staff urgently need to be improved through cultural safety education and training programs to inform culturally appropriate and safe care practice among care providers serving Indigenous individuals and families. This paper explores current educational strategies, the perspectives of Indigenous and non-Indigenous care providers on training approaches, and recommendations for improving training. Qualitative semi-structured interviews were conducted with 31 participants to explore the current provision of culturally appropriate and safe care. Interviews were voice recorded and transcribed verbatim, and a thematic analysis was completed. The three key themes related to training that emerged from data analysis were (a) addressing the knowledge gaps, (b) challenges of current training approaches, and (c) recommendations for improvements in training. Each key theme had three subthemes that were further explored. Cultural safety training is a long and iterative process that has the potential to change care providers’ behaviours and attitudes. Various challenges to existing education and training included issues with implementation, limited follow up with health care staff to support practice changes, and/or limited commitment from senior leadership to change organizational policies and practices. As such, there is a clear need for systemic change within health care institutions to support staff participating in cultural safety training and to put that training into practice to create a culturally safe space for Indigenous individuals seeking health care.
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