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1What is Action Research?This chapter focuses on: What action research isThe purposes of conducting action researchThe development of action researchWhat is involved in action researchThe models and definitions of action researchThe key characteristics of action researchThe philosophical worldview of the action researcherExamples of action research projects.IntroductionAction research – which is also known as Participatory Action Research(PAR), community-based study, co-operative enquiry, action science andaction learning – is an approach commonly used for improving conditionsand practices in a range healthcare environments (Lingard et al., ;Whitehead et al.). It involves healthcare practitioners conductingsystematic enquiries in order to help them improve their own practices,which in turn can enhance their working environment and the workingenvironments of those who are part of it – clients, patients, and users. Thepurpose of undertaking action research is to bring about change in specificcontexts, as Parkin describes it. Through their observations andcommunications with other people, healthcare workers are continuallymaking informal evaluations and judgements about what it is they do. Thedifference between this and carrying out an action research project is thatduring the process researchers will need to develop and use a range of skills01-Koshy et al.-4092-Ch-01.indd 103/09 5:08:45 PM

AC T I O N R E S E A R C H I N H E A LT H C A R E2to achieve their aims, such as careful planning, sharpened observation andlistening, evaluation, and critical reflection.Meyer maintains that action research’s strength lies in its focus ongenerating solutions to practical problems and its ability to empower practitioners, by getting them to engage with research and the subsequentdevelopment or implementation activities. Meyer states that practitionerscan choose to research their own practice or an outside researcher can beengaged to help to identify any problems, seek and implement practicalsolutions, and systematically monitor and reflect on the process and outcomes of change. Whitehead et al. point out that the place of actionresearch in health promotion programmes is an important and yet relatively unacknowledged and understated activity and suggest that this stateof affairs denies many health promotion researchers a valuable resource formanaging effective changes in practice.Most of the reported action research studies in healthcare will have beencarried out in collaborative teams. The community of enquiry may haveconsisted of members within a general practice or hospital ward, generalpractitioners working with medical school tutors, or members within ahealthcare clinic.The users of healthcare services can often be included in anaction research study; as such they are not researched on as is the case in muchof traditional research. This may also involve several healthcare practitionersworking together within a geographical area. Multidisciplinary teams canoften be involved (for example, medical workers working with social workteams). Action research projects may also be initiated and carried out bymembers of one or two institutions and quite often an external facilitator(from a local university, for example) may be included. All the participatingresearchers will ideally have to be involved in the process of data collection,data analysis, planning and implementing action, and validating evidence andcritical reflection, before applying the findings to improve their own practiceor the effectiveness of the system within which they work.Purposes of conducting action researchIn the context of this book, we can say that action research supports practitioners in seeking out ways in which they can provide an enhanced quality of healthcare. With this purpose in mind, the following features of theaction research approach are worthy of consideration (Koshy, : 1): Action research is a method used for improving practice. It involves action, evaluation,and critical reflection and – based on the evidence gathered – changes in practiceare then implemented.01-Koshy et al.-4092-Ch-01.indd 203/09 5:08:45 PM

W H AT I S A C T I O N R E S E A R C H ?3 Action research is participative and collaborative; it is undertaken by individualswith a common purpose.It is situation-based and context specific.It develops reflection based on interpretations made by the participants.Knowledge is created through action and at the point of application.Action research can involve problem solving, if the solution to the problem leadsto the improvement of practice. In action research findings will emerge as action develops, but these are notconclusive or absolute. Later in this chapter we shall explore the various definitions of actionresearch.Hughes presents a convincing argument for carrying out actionresearch in healthcare settings. Quoting the declaration of the WorldHealth Organization (1946) that ‘health is a state of complete physical,mental and social well being and not merely the absence of disease orinfirmity’, Hughes stresses that our health as individuals and communitiesdepends on environmental factors, the quality of our relationships, and ourbeliefs and attitudes as well as bio-medical factors, and therefore in orderto understand our health we must see ourselves as inter-dependent withhuman and non-human elements in the system we participate in. Hughesadds that the holistic way of understanding health, by looking at the wholeperson in context, is congruent with the participative paradigm of actionresearch.The following extract coming from an action researcher (includedby Reason and Bradbury in the introduction to their Handbook of ActionResearch) sums up the key notion of action research being a useful approachfor healthcare professionals:For me it is really a quest for life, to understand life and to create what I callliving knowledge – knowledge which is valid for the people with whom I workand for myself. (Marja Liisa Swantz, in Reason and Bradbury, : 1)So what is this living knowledge? As Reason and Bradbury (: 2)explain, the primary purpose of action research is to produce practicalknowledge that is useful to people in the everyday conduct of their lives.They maintain that action research is about working towards practicaloutcomes and that it is also about ‘creating new forms of understanding,since action without reflection and understanding is blind, just as theorywithout action is meaningless’ and that the participatory nature of actionresearch ‘makes it only possible with, for and by persons and communities,ideally involving all stakeholders both in the questioning and sense makingthat informs the research, and in the action which is its focus’. Meyer describes action research as a process that involves people and social01-Koshy et al.-4092-Ch-01.indd 303/09 5:08:45 PM

4AC T I O N R E S E A R C H I N H E A LT H C A R Esituations that have the ultimate aim of changing an existing situation forthe better.In the following sections of this chapter we will trace the developmentof action research as a methodology over the past few decades and thenconsider the different perspectives and models provided by experts in thefield. Different models and definitions of action research are exploredand an attempt is made to identify the unique features of action researchthat should make it an attractive mode of research for healthcare practitioners. Examples of action research projects undertaken by healthcarepractitioners in a range of situations are provided later in this chapter.The development of action research: a brief backgroundWhether the reader is a novice or is progressing with an action researchproject, it would be useful to be aware of how action research has developed as a method for carrying out research over the past few decades.The work of Kurt Lewin (1946), who researched extensively on socialissues, is often described as a major landmark in the development ofaction research as a methodology. Lewin’s work was followed by that ofStephen Corey and others in the USA, who applied this methodologyfor researching into educational issues. In Britain, according to Hopkins, the origins of action research can be traced back to the SchoolsCouncil’s Humanities Curriculum Project (1967–72) with its emphasison an experimental curriculum and the re-conceptualisation of curriculum development. The most well known proponent of actionresearch in the UK has been Lawrence Stenhouse, whose seminal(1975) work An Introduction to Curriculum Research and Developmentadded to the appeal of action research for studying the theory andpractice of teaching and the curriculum. In turn, educational actionresearchers including Elliott (1991) have influenced action researchersin healthcare settings.What is involved in action research?Research is about generating knowledge. Action research createsknowledge based on enquiries conducted within specific and oftenpractical contexts. As articulated earlier, the purpose of action researchis to learn through action that then leads on to personal or professionaldevelopment. Action research is participatory in nature, which led01-Koshy et al.-4092-Ch-01.indd 403/09 5:08:45 PM

W H AT I S A C T I O N R E S E A R C H ?TFLECRE5PLANACT & OBSERVEREVISEDPLANREFLEACTFIGURE 1.1CT& O BSERVEKemmis and McTaggart’s action research spiralKemmis and McTaggart (: 595) to describe it as participatoryresearch. The authors state that action research involves a spiral of selfreflective cycles of: Planning a change.Acting and observing the process and consequences of the change.Reflecting on these processes and consequences and then replanning.Acting and observing.Reflecting.And so on Figure 1.1 illustrates the spiral model of action research proposedby Kemmis and McTaggart (: 564), although the authors do not01-Koshy et al.-4092-Ch-01.indd 503/09 5:08:46 PM

6AC T I O N R E S E A R C H I N H E A LT H C A R Erecommend that this is used as a rigid structure. They maintain that inreality the process may not be as neat as the spiral of self-contained cyclesof planning, acting and observing, and reflecting suggests. These stages,they maintain, will overlap, and initial plans will quickly become obsoletein the light of learning from experience. In reality the process is likely tobe more fluid, open, and responsive.We find the spiral model appealing because it gives an opportunity tovisit a phenomenon at a higher level each time and so to progress towardsa greater overall understanding. By carrying out action research using thismodel, one can understand a particular issue within a healthcare contextand make informed decisions with an enhanced understanding. It istherefore about empowerment. However, Winter and Munn-Giddings point out that the spiral model may suggest that even the basicprocess may take a long time to complete. A review of examples of studies included in this book and the systematic review of studies using theaction research approach by Waterman et al. show that the periodof a project has varied significantly, ranging from a few months to one ortwo years.Several other models have also been put forward by those who havestudied different aspects of action research and we shall present some ofthese later in this section. Our purpose in doing so is to enable the readerto analyse the principles involved in these models which should, in turn,lead to a deeper understanding of the processes involved in actionresearch. No specific model is being recommended here and as the readermay have already noticed they have many similarities. Action researchersshould always adopt the models which suit their purpose best or adaptthese for use.The model employed by Elliot (1991: 71) shares many of the featuresof that of Kemmis and McTaggart and is based on Lewin’s work of the1940s. It includes identifying a general idea, reconnaissance or factfinding, planning, action, evaluation, amending plan and taking secondaction step, and so on, as can be seen in Figure 1.2. Other models, suchas O’Leary’s (: 141) cycles of action research shown in Figure 1.3,portray action research as a cyclic process which takes shape as knowledge emerges.In O’Leary’s model, for example, it is stressed that ‘cycles convergetowards better situation understanding and improved action implementation; and are based in evaluative practice that alters between action andcritical reflection’ (: 140). O’Leary sees action research as an experiential learning approach, to change, where the goal is to continuallyrefine the methods, data, and interpretation in light of the understandingdeveloped in each earlier cycle.01-Koshy et al.-4092-Ch-01.indd 603/09 5:08:46 PM

7W H AT I S A C T I O N R E S E A R C H ?Identifyinginitial ideaReconnaissance(fact-finding and analysis)CYCLE 1General planAction steps 1Action steps 2Action steps 3Implementaction steps 1Monitor implementationand effects‘Reconnaissance’(explain any failure toimplement, and effects)Revise general ideaAmended planAction steps 1CYCLE 2Action steps 2Action steps 3Implement nextaction stepsMonitor implementationand effects‘Reconnaissance’(explain any failure toimplement, and effects)Revise general ideaAmended planAction steps 1CYCLE 3Action steps 2Action steps 3Implement nextaction stepsMonitor implementationand effects‘Reconnaissance’(explain any failure toimplement, and effects)FIGURE 1.2Elliot’s action research model.SOURCE: Ellliot, J. Action Research for Educational Change, p.71 1991. Reproduced with thekind permission of the open University Press. All rights reserved.01-Koshy et al.-4092-Ch-01.indd 703/09 5:08:47 PM

AC T I O N R E S E A R C H I N H E A LT H C A R E8observe(research/data collection)reflect(critical reflexivity)act(implementation)plan(strategic action plan)obse