De-romanticising dialogue in collaborative health care research: a critical, reflexive approach to tensions in an action research project's initial phase

Abstract

In the current socio-political conjuncture, collaborative, dialogic forms of knowledge production abound and are idealised as democratic and inclusive. The aim of the article is to contribute to the body of critical, reflexive analyses of collaborative research by analysing how complex dynamics of exclusion as well as inclusion create tensions in researchers’ attempts to establish collaborative relations in the initial phase of an action research project. The analysis applies a framework combining Bakhtinian dialogic communication theory and Foucauldian theory to explore inclusion and exclusion in the tensional interplay of multiple voices whereby certain voices dominate. Finally, the article offers a typology of ideal types of collaborative research relations that can be used in the initial research phase as a platform for reflexive discussion between researchers and potential collaborative partners about their respective understandings of collaboration and dialogue and corresponding expectations about the research process and results.

Minding the Gap Between the Policy and Practice of Patient-Centeredness: Cocreating a Model for Tensional Dialogue in the “Active Patient Support” Program

“…However, the reviews tend to refer to collaborative decision-making either as if it were a straightforward process, or as if it could become straightforward were the dimensions of patient-centeredness to be properly followed. A starting-point for this article is that the understanding of collaborative decision-making as a straightforward process reflects a general tendency in the dialogic turn to romanticize dialogue as a purely inclusive process in which participants engage in "authentic" communication characterized by symmetrical power relations (Phillips, 2011;Phillips et al, 2012Phillips et al, , 2013Phillips et al, , 2018. In this article, we apply a theoretical frameworkbased on a combination of Bakhtin's theory of dialogue and Foucault's theory of power/knowledge and discourse-that theorizes dialogue in patient-centered communication as complex processes of tension-ridden meaning-making involving dynamics of exclusion as well as inclusion.…”

Working together to co-produce better health: The experience of the Collaboration for Leadership in Applied Health Research and Care for Northwest London

“…Similar dialogical reflexive approaches have been used previously to examine collaborative practice in knowledge co-production. 17 During the dialogue, we attempted to clarify each other’s perspectives and produce useful insights to help us understand our collaboration and help others, by uncovering the facilitators and pitfalls that we encountered and bringing the intangible to the surface. The dialogue reflected on our 10 years of collaboration, which included four years of ethnographic work.…”

Breaking monologues in collaborative research: bridging knowledge systems through a listening-based dialogue of wisdom approach

“…These approaches have focused their efforts on developing methodological tools to transform the participants into active agents in a co-creation process (Phillips and Napan 2016). However, some dialogic methodologies tend to romanticise dialogue, ignoring or minimising the impact of power-knowledge tensions on collaborative spaces (Phillips et al 2018). This position is in strong contradiction with the identified and reported recurring challenges encountered when implementing collaborative work, such as the difficulties of building trust, understanding each other's perspectives, and recognising the value of different knowledge systems (e.g.…”

“…It is not our intention to dismiss dialogue in collaborative processes. Although dialogue discourse constitutes a form of governance in which knowledge, power and subjectivities end up reducing the possibilities of an inclusive dialogue where all kinds of being and knowledge are recognised and equally valuable (Phillips et al 2018;Hill et al 2019). We believe that communication skills, in particular the ability to dialogue, is an integral part of qualitative research methodologies (Fals-Borda and Rahman 1991).…”

“…Critical analysis of collaborative approaches, conducted by communication researchers, argue that expressions like 'equal footing', 'empowerment', 'participation', and 'dialogue' are buzzwords, turning dialogue and participation into empty discourses (Phillips and Napan 2016). They called for de-romanticising dialogue, arguing that practices which neglect the tensions of power-knowledge arising from the diversity of interests, values and expectations present in a multi-knowledge-holders exchange could exacerbate exclusion instead of promoting inclusion (Phillips et al 2018).…”