Uncovering the Benefits of Participatory Research: Implications of a Realist Review for Health Research and Practice

Jagosh, J., Macaulay, A. C., Pluye, P., Salsberg, J., Bush, P. L.,Henderson, J., Sirett, E., Wong, G., Cargo, M., Herbert, C. P.,Seifer, S. D., Green, L. W., Greenhalgh, T. (2012). Uncovering the benefits of participatory research: Implications of a realist review for health research and practice. Milbank Quarterly, 90(2), 311–346. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3460206/
Context: Participatory research (PR) is the co-construction of research through partnerships between researchers and people affected by and/or responsible for action on the issues under study. Evaluating the benefits of PR is challenging for a number of reasons: the research topics, methods, and study designs are heterogeneous; the extent of collaborative involvement may vary over the duration of a project and from one project to the next; and partnership activities may generate a complex array of both short- and long-term outcomes.
Methods: Our review team consisted of a collaboration among researchers and decision makers in public health, research funding, ethics review, and community-engaged scholarship. We identified, selected, and appraised a large-variety sample of primary studies describing PR partnerships, and in each stage, two team members independently reviewed and coded the literature. We used key realist review concepts (middle-range theory, demi-regularity, and context-mechanism-outcome configurations [CMO]) to analyze and synthesize the data, using the PR partnership as the main unit of analysis.
Findings: From 7,167 abstracts and 591 full-text papers, we distilled for synthesis a final sample of twenty-three PR partnerships described in 276 publications. The link between process and outcome in these partnerships was best explained using the middle-range theory of partnership synergy, which demonstrates how PR can (1) ensure culturally and logistically appropriate research, (2) enhance recruitment capacity, (3) generate professional capacity and competence in stakeholder groups, (4) result in productive conflicts followed by useful negotiation, (5) increase the quality of outputs and outcomes over time, (6) increase the sustainability of project goals beyond funded time frames and during gaps in external funding, and (7) create system changes and new unanticipated projects and activities. Negative examples illustrated why these outcomes were not a guaranteed product of PR partnerships but were contingent on key aspects of context.
Conclusions: We used a realist approach to embrace the heterogeneity and complexity of the PR literature. This theory-driven synthesis identified mechanisms by which PR may add value to the research process. Using the middle-range theory of partnership synergy, our review confirmed findings from previous PR reviews, documented and explained some negative outcomes, and generated new insights into the benefits of PR regarding conflicts and negotiation between stakeholders, program sustainability and advancement, unanticipated project activity, and the generation of systemic change.
This paper shows the benefits of Participatory Research (i.e. collaboration or co creation between academic and non-academic researchers and stakeholders). This paper presents a realist review of the literature. “A realist review differs from empirically focused qualitative or quantitative methods in a number of ways, including its theory-driven and abductive (informed-intuitive) approach to understanding context, mechanism, and outcome (CMO) configurations.” The focus on context, mechanism and outcome shapes the literature review and highlights that depending on the context of the research and the mechanism of the research Participatory Research (PR) can create benefits and unintended consequences hence outcomes.
Kudos to the authors who have included academic and decision maker/community partners on their team and as co-authors on the paper. This makes this project and this paper a participatory exercise, walking the talk. Something that a number of articles profiled in this journal club have failed to do.
The authors chose the theory of partnership synergy to use to frame analysis and PR outcomes. The authors cite literature that “defined synergy as combining the perspectives, resources, and skills of a group of people to “create something new and valuable together—a whole that is greater than the sum of its individual parts.” This theoretical underpinning illustrates the power of partnerships to create mutual benefits for community and campus collaborators. It requires that stakeholders recognize and value “the collective knowledge, resources, relationships and capacity through the alignment of purpose, values and goals.” This alignment is key to successful PR.
The realist review presented in this paper outlines seven impacts of PR:
Culturally appropriate and logistically sound research

  • This generates research outcomes that makes sense to and have relevance to all stakeholders

PR generates recruitment capacity

  • Not recruitment of research subjects but recruitment to advisory boards, to program implementation and to recruitment of respondents to interventions and research projects

PR develops capacity and competence of stakeholders

  • Working outside of your cultural norms creates capacity for future work for academic and non-academic stakeholders

PR generates disagreements between the co-governing stakeholders during decision making processes, resulting in both positive and negative outcome for subsequent program planning

  • Disagreements based on lack of cultural cohesion and understanding allow research to be redirected into mutually beneficial ways

PR synergy accumulates in cases of repeated successful outcomes in partnering thus increasing the quality of outputs and outcomes over time

  • Ultimately we believe it was the strength of the personal relationships with the study staff that kept participants engaged in the study.” This underscores the importance of personal relationships in successful PR.

Partnership synergy accumulates capacity to sustain project goals beyond funded time frames and during gaps in external funding

  • Important because funding is always tight for academics but especially for community partners.

PR generates systemic changes and new unanticipated projects and activities

  • Partnerships were capable of effecting systemic changes beyond their immediate project goals because of their integration into local contexts.”

A couple of thoughts on two of these
PR develops capacity and competence of stakeholders. How often do you send graduate students into the field to collect data? How often have your trained community members to collect data? The former is an important part of graduate student education, for sure. But no capacity has been built for community. By training community members to be co-researchers you not only provide them with short term funded work as they collected data for the study but you build skill sets that remain behind in community.
PR generates systemic changes and new unanticipated projects and activities. We all work in systems (see this journal club post for thoughts on systems). At some point a portfolio of PR projects adds up to a system and the relationships begin to transcend transactional projects based on relationships between individuals to support institutional relationships. People come and go but institutions tend to endure. An institution could be a university. It could be a community organization or a collective of individuals with sustained, shared interests such as a faith group.
What this paper doesn’t do is talk about the challenges of PR. We know from experience and from the literature that PR is challenged by issues of time (and capacity), culture (partially addressed in this review) and power. While time (or lack of it, especially for community partners) is acknowledged, power (or the lack of equitable distribution of power) is a challenge that seems to underpin many issues in PR. Authentic partnership balance resources (including funding), decision making and engagement throughout the research cycle.
Questions for brokers:

  1. If alignment of purpose, values and goals is key to successful PR what are you doing in your knowledge mobilization practice to secure this alignment?
  2. This paper provides the academic lens to “nothing about us without us”. What types of research projects have you experienced where those directly affected by the research are not merely subjects of the research but are collaborators throughout the research project?
  3. What can be done to balance power in community campus collaborations? How can you share resources and decision making to foster authentic partnerships?

ResearchImpact-RéseauImpactRecherche is producing this journal club series as a way to make the evidence and research on knowledge mobilization more accessible to knowledge brokers and to create on line discussion about research on knowledge mobilization. It is designed for knowledge brokers and other knowledge mobilization stakeholders. Read the article. Then come back to this post and join the journal club by posting your comments.