Participatory action research to pilot a model of mental health service user involvement in an Ethiopian rural primary healthcare setting: study protocol

Abstract

Background: Involvement of service-users at all levels of the mental health system is a policy imperative in many countries internationally. However, putting policy into practice seems complex; little is known about how best to involve service users and efforts are often criticized for being tokenistic. In low-and-middle income countries, less attention has been given to the roles of service users within mental health systems. The proposed study is part of a larger project intended to develop service-user involvement in mental health system strengthening in Ethiopia. A Theory of Change (ToC) model has already been developed through a participatory approach. This study protocol aims to describe the theoretical background and methods to pilot this model using participatory action research (PAR) and explore participants' experience of involvement. Methods: The proposed study will apply a PAR approach situated in critical social theory and conduct a phenomenological case study to find out participants' experience of involvement. This will be conducted in three stages. The focus of Stage 1 will be to(i) establish a Research Advisory Group (RAG), and Research Participant Group (RPG) at district and primary healthcare facility levels, respectively, and (ii) identify and prioritize potential areas of concern for involvement in the domains of advocacy, service planning and development, monitoring and improving service quality. In Stage 2, we will work with the RPG to develop a plan of action for the selected area. Stage 3 will aim to assist the RPG to implement and evaluate the plan of action. Process indicators and observation will be combined with in-depth interviews with participants to elicit their experiences of involvement. Thematic content analysis will be used. Discussion: The participatory approach to mental health service user involvement in health system strengthening employed by this study will support the implementation of solutions through locally relevant and contextualized actions. Findings from this study will contribute to the body of knowledge towards understanding the complexity of implementation of service user involvement and refine the ToC model for transferability to similar settings.

Using participatory action research to pilot a model of service user and caregiver involvement in mental health system strengthening in Ethiopian primary healthcare: a case study

“…The pilot implementation process was guided by a PAR approach situated in critical social theory; details of the theoretical background have been described in the study protocol [ 12 ], briefly described here. PAR was selected as a suitable approach, previously applied to this area and providing practical strategies for involvement of service-users in numerous domains of mental health systems (e.g., planning, research, service quality improvement, and advocacy) [ 12 ]. Critical social theory-informed PAR, which positions PAR within a critical onto-epistemology (Critical Participatory Action Research; hereafter, CPAR), provides a theory-informed basis for the kinds of relationship that need to be developed among individuals, institutions and other key stakeholders in a particular initiative [ 12 ].…”

“…PAR was selected as a suitable approach, previously applied to this area and providing practical strategies for involvement of service-users in numerous domains of mental health systems (e.g., planning, research, service quality improvement, and advocacy) [ 12 ]. Critical social theory-informed PAR, which positions PAR within a critical onto-epistemology (Critical Participatory Action Research; hereafter, CPAR), provides a theory-informed basis for the kinds of relationship that need to be developed among individuals, institutions and other key stakeholders in a particular initiative [ 12 ]. CPAR acknowledges the marginalization of service-users and seeks to create a communicative space for ethical relationships.…”

“…In order to address these gaps and provide a more inclusive participatory and contextually useful ToC, we choose to use a Participatory Action Research (PAR) approach as a heuristic to support implementation of the ToC as detailed elsewhere [ 12 ]. This is in line with theory of action, which advocates for the need to insert action mechanisms into programs to activate ToCs[ 13 ].…”

Clinician attitude towards safety in medication management: a participatory action research study in an emergency department

“…PAR is an approach which facilitates change through involving participants and focusing on their attitudes. 18 PAR has been demonstrated to engender positive attitudes on the basis of organisational citizenship, including in healthcare settings, and increases clinician perceptions of self-worth and competence. 19 We aimed to address the following question: Can engaging in PAR improve clinicians' attitude towards medication safety and medication management in the ED?…”

The Role of Participatory Action Research on Clinicians’ Attitudes toward Medication Management

“…This study employs Participatory Action Research (PAR) with the aim of facilitating medication management implementation and driving a process of collaborative enquiry. PAR is an approach which facilitates change through involving participants and focusing on their attitudes (10). PAR has been demonstrated to engender positive attitudes on the basis of organizational citizenship, including in healthcare settings, and increases clinician perceptions of self-worth and competence (11).…”