Better integration of care within the health sector and between health and social care is seen in many countries as an essential way of addressing the enduring problems of dwindling resources, changing demographics and unacceptable variation in quality of care. Current research evidence about the effectiveness of integration efforts supports neither the enthusiasm of those promoting and designing integrated care programmes nor the growing efforts of practitioners attempting to integrate care on the ground. In this paper we present a methodological approach, based on the principles of participatory research, that attempts to address this challenge. Participatory approaches are characterised by a desire to use social science methods to solve practical problems and a commitment on the part of researchers to substantive and sustained collaboration with relevant stakeholders. We describe how we applied an emerging practical model of participatory research, the researcher-in-residence model, to evaluate a large-scale integrated care programme in the UK. We propose that the approach added value to the programme in a number of ways: by engaging stakeholders in using established evidence and with the benefits of rigorously evaluating their work, by providing insights for local stakeholders that they were either not familiar with or had not fully considered in relation to the development and implementation of the programme and by challenging established mindsets and norms. While there is still much to learn about the benefits and challenges of applying participatory approaches in the health sector, we demonstrate how using such approaches have the potential to help practitioners integrate care more effectively in their daily practice and help progress the academic study of integrated care.
In the first sections of this article I give a simple and general account of critical discourse analysis (CDA) and how it might contribute to the theoretical and methodological repertoire of political studies through its discourse-dialectical theory of how discourse figures as an aspect of social practices without reducing those practices to discourse. In the final section I give a short illustrative example of how a CDA approach to detailed textual analysis might also be applied to specific texts (or groups of texts) in the political arena: in the example I take the press release in which the national UK government heralded its recent 'empowerment' White Paper, 'Communities in
Rethinking Intertextuality in CDAIntertextuality -instances of texts linking to other texts (explicitly, implicitly, by referring to them or incorporating elements of them) -is a key concept with which CDA accounts for discursive elements in social relations of power and solidarity. However, 'intertextuality' has not been widely operationalised to chart existing relations of power and solidarity at the levels of discourse and orders of discourse. This article develops the methodological framework for intertextuality in CDA and makes that framework more congruent with its potential to analyse and critique social relations of power and solidarity through intertextuality than has been the case until now. It introduces three concepts: the inter-text, networks of inter-texts and typicality. It discusses two methodological options for creating a corpus for analysing networks of inter-texts and presents new analytical categories which recognise intertextual reference to whole texts. Crucially, it emphasises absence and ambiguity as key analytical foci for intertextuality.
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