Pathways for Strengthening Lived Experience Leadership for Transformative Systems Change: Reflections on Research and Collective Change Strategies.

INTRODUCTION: The Activating Lived Experience Leadership (ALEL) project was a South Australian participatory action research project that aimed to improve the ways lived experience is recognised, valued and integrated across mental health and social sector systems. ALEL was completed during 2019-2021, where it engaged 182 participants in generating community action and research knowledge. OBJECTIVE: Our paper discusses the project's processes of building a collective partnership among lived experience leaders and other leaders from within the sector, so that the actions and strategies identified through research could be implemented by systems-level impact. We describe the collaborative process and key learnings that resulted in eight key action areas for transformative systems change in South Australia. METHODS: The project invited a diverse range of self-identified lived experience and other leaders to be involved in a PAR process featuring formal qualitative research (focus groups, surveys and interviews) as well as community development activities (leaders' summit meetings, consultations, training and community of practice meetings). These processes were used to help us describe the purpose, achievements and potential of lived experience leadership. Project priorities and systems-level analysis was also undertaken with lived experience sector leaders and project advisors across two leaders' summit meetings, integrating research outcomes with sector planning to define high-level actions and a vision for transformational change. RESULTS: Participatory action research as informed by systems change and collective impact strategies assisted the project to generate detailed findings about the experiences and complexities of lived experience leadership, and collective responses of how systems could better support, be accountable to and leverage lived experience perspectives, experience and peer-work approaches. CONCLUSION: Systems change to define, value and embed lived experience leadership benefits from collective efforts in both formal research and sector development activities. These can be used to generate foundational understandings and guidance for working together in genuine ways for transforming mental health and social sector systems, experience and outcomes. PUBLIC CONTRIBUTION: Members of lived experience communities codesigned the project, and contributed to project governance and the development of all findings and project reports.

Development of a complex intervention to strengthen municipality-based breastfeeding support to reduced social inequity in breastfeeding.

BACKGROUND: Breastfeeding is the ideal nutrition for infants and protects infants and mothers from a range of adverse health outcomes during their lifespan. In Denmark, while the breastfeeding initiation rate is high, only 14% of mothers meet the World Health Organization's recommendation of exclusive breastfeeding at six months. Furthermore, a notable social inequity exists among those who achieve this recommendation. Knowledge of effective interventions to reduce breastfeeding inequity is limited. A previous hospital-based intervention succeeded in increasing breastfeeding duration. However, most breastfeeding support is provided in Danish municipalities by health visitors. This called for adapting the intervention to the health visiting program and developing an intensified intervention addressing the social inequity in breastfeeding. This article describes the adaptation and development process of a municipality-based intervention. METHODS: During a 15-month period in 2020-21, the municipal intervention was iteratively developed using a three-stage framework for developing complex health interventions described by Hawkins et al. The three stages were 1) need assessment and stakeholder consultation, 2) co-production and 3) prototyping. The process was inspired by O'Cathain et al.'s principles for a user-centred, co-created and theory- and evidence-based approach, involving parents and health visitors. RESULTS: In stage 1, we identified the needs and priorities of the target groups of the intervention. In stage 2, the intervention was developed through action research design and inspired by Duus' 'learning cycles' as the method to enhance motivation and ownership and to strengthen the implementation process by creating a joint room for learning and reflection with health visitors and developers. In stage 3, the intervention was tested for feasibility and usefulness during a 2.5-month period accompanied by monthly dialogue meetings with health visitors and developers. In this period, the intervention was refined based on the gathered experiences and was subsequently prepared for evaluation. CONCLUSION: The description of the development of this complex intervention, aimed at increasing breastfeeding duration and reducing inequity, offers breastfeeding practitioners and researchers a transparent foundation for continuously improving breastfeeding support and a methodology for complex intervention development. TRIAL REGISTRATION: Registered at Clinical Trials NCT05311631.

Deepening our understanding: Collaboration through online peer-to-peer participatory action research with children.

Child-led research is growing globally, yet there are still limitations for children's leadership in all phases of research. This article, co-written with adult and child researchers, examines child-led research undertaken online with 9 children from Ontario and Quebec over a one-year period. The article explores the process of participating in and collaborating on an online peer-to-peer participatory action research project from the brainstorming stage to recruitment, design, data collection, analysis, and dissemination of knowledge. While much literature exists on older children and youth leading research, this research provides a unique contribution to the literature on the possibilities of creating space for children ages 11 to 14 to lead research. This article finds that the child researchers most valued: (1) Play and fun; (2) Engaging in new experiences; and (3) Learning. The article concludes that child-led research is feasible, and it can create better research and provide a transformative opportunity for child and adult researchers.

Listen up! perspectives of people of color who use augmentative and alternative communication in the United States.

Every individual has a fundamental right to communicate and access equal opportunities to fully participate in society. However, this right may not be fully manifested for individuals with communication access needs especially those from underrepresented groups. This project had two aims, to determine 1) the specific experiences, challenges, and aspirations related to the cultural identities of people of color (POC) who use augmentative and alternative communication (AAC) and 2) how AAC service providers and manufacturers can support POC AAC users in a culturally and linguistically responsive manner. We conducted an online, asynchronous focus group with seven participants over eight weeks. The participants' responses were coded qualitatively. Seven major themes were identified: AAC is a Culture, AAC System Features, Self-Identity as a Person of Color who uses AAC, Experience with Service Providers, Improvements to the Field of AAC, Racial Inequities in AAC Support, and Future Research. Suggestions are provided regarding how service providers and manufacturers can serve as better allies to support POC who use AAC.

Evaluating the efficacy of computer games-based learning intervention in enhancing English speaking proficiency.

The use of learning games in education, particularly for second language (L2) acquisition, has gained significant traction recently, establishing game-based learning as a notable academic discipline. This study examines how computer game-based learning influences ESL undergraduates' speaking abilities, comparing traditional teaching methods with game-based teaching techniques. The study employed action research utilizing a control-experimental groups technique with a sample of 60 learners. Data were collected through observation sessions, interviews, as well as pre-tests and post-tests on English speaking skills. Upon comparing the scores of the control and experimental groups, the experimental group showed greater improvement in speaking skills. This study provides significant insights into the area of game-based learning using computers, particularly among international students in ESL contexts.

Co-Designing Nurse Practitioner Roles in a Tertiary Hospital: A Qualitative Exploration of Patterns and Underlying Dynamics.

AIMS: To explore patterns and dynamics during the co-design process of nurse practitioners' role development in three departments in a Belgian tertiary hospital. DESIGN: Participatory action research was utilised in conjunction with principles of a Grounded Theory approach to explore patterns and dynamics. METHODS: Sixteen meetings were conducted between January and June 2021 with interdisciplinary teams to develop the roles. Thirteen exploratory interviews were held with the stakeholders involved between March and June 2022. All meetings and interviews were recorded and transcribed verbatim. Data were systematically analysed using researcher triangulation and thematic analysis. RESULTS: Stakeholders' initial conception of the nurse practitioner roles affected development. A dynamic interplay of individual, team-related and contextual (e.g., financial and legal) factors shaped these conceptions. Through co-design, stakeholders' conception evolved as insights were shared, misconceptions challenged and perspectives broadened. Physicians generally the developmental process, while nursing leadership was more fragmented. CONCLUSION: This study identifies patterns and dynamics in interdisciplinary teams during the developmental process. The key findings underpin the crucial role of stakeholders' conceptions, use of co-design and leadership in this process. Therefore, a thorough understanding of initial conceptions is ess, and efforts should be directed towards providing sufficient knowledge and experience to prevent misconceptions. Additionally, this study emphasises the significance of a balanced team composition that incorporates diverse conceptions of the role. Finally, actions should be taken to empower leadership among nurses. IMPACT: Identified dynamics offer insights for healthcare organisations developing nurse practitioner roles. Educational institutions can use these insights to enhance healthcare professionals' curricula, preparing healthcare professionals for evolving advanced nursing roles and leadership. Additionally, it emphasises the necessity for policy work to establish a legal framework for nurse practitioners in Belgium. REPORTING METHOD: The 'Standards for Reporting Qualitative Research' were used for reporting. PATIENT OR PUBLIC CONTRIBUTION: This study did not involve direct participation from patients or the public.

Evaluation and Optimisation of a Patient Portal Implementation: An Action Research Approach.

Patient portals can support care delivery and have demonstrated mixed impacts on patients, clinicians and health services. These variable impacts are primarily due to barriers to uptake and challenges associated with successfully implementing patient portals. As little is currently known about how implementation barriers can be addressed in practice, this project used an action research approach to evaluate and optimise the implementation of a patient portal in a real-world setting. Whilst the study is ongoing, the preliminary findings are reported in this paper, along with plans to use the findings to improve the portal in the next round of the action research cycle.

The association between dexterity and upper limb impairment during stroke recovery.

Introduction: Stroke-induced upper limb disabilities can be characterized by both motor impairments and activity limitations, commonly assessed using Fugl-Meyer Motor Assessment for Upper Extremity (FMMA-UE) and Action Research Arm Test (ARAT), respectively. The relationship between the two assessments during recovery is largely unstudied. Expectedly they diverge over time when recovery of impairment (restitution) plateaus, but compensation-driven improvements still occur. The objective of this study is to evaluate the alignment between FMMA-UE and ARAT in defining upper limb functional recovery categories by ARAT scores. We aimed to establish cut-off scores for both measures from the acute/early subacute, subacute and chronic stages of stroke recovery. Methods: Secondary analysis of four prospective cohort studies (acute/early subacute: n = 133, subacute: n = 113, chronic: n = 92) stages post-stroke. Receiver operating characteristic curves calculated the area under the curve (AUC) to establish optimal FMMA-UE cut-offs based on predefined ARAT thresholds distinguishing five activity levels from no activity to full activity. Weighted kappa was used to determine agreement between the two assessments. We used minimally clinically important difference (MCID) and minimal detectable change (MDC95) for comparison. Results: FMMA-UE and ARAT scores showed no relevant divergence across all recovery stages. Results indicated similar cut-off scores in all recovery stages with variability below MCID and MDC95 levels. Cut-off scores demonstrated robust AUC values from 0.77 to 0.86 at every recovery stage. Only in highly functional patients at the chronic stage, we found a reduced specificity of 0.55. At all other times sensitivity ranged between 0.68 and 0.99 and specificity between 0.71 and 0.99. Weighted kappa at the acute/early subacute, subacute and chronic stages was 0.76, 0.83, and 0.81, respectively. Discussion: Our research shows a strong alignment between FMMA-UE and ARAT cut-off scores throughout stroke recovery, except among the subgroup of highly recovered patients at the chronic stage. Discrepancies in specificity potentially stem from fine motor deficits affecting dexterity outcomes that are not captured by FMMA-UE. Additionally, the high congruence of both measures suggests they are not suited to distinguish between restitution and compensation. Calling for more comprehensive assessment methods to better understand upper limb functionality in rehabilitation.

Fostering a Trusting Relationship With Family in Dementia Special Care Units: A Participatory Action Research Project.

AIM: To explore experiences of nursing home staff in implementing self-designed interventions to foster trusting relationships with family in practice. DESIGN: This qualitative study used a Participatory Action Research approach. METHODS: Data collection included focus groups (n = 15), interviews (n = 28) and observations (n = 5). A holistic narrative approach was used for data analysis, resulting in co-constructed narratives representing experiences of nursing home staff in implementing four different interventions in five Dutch dementia special care units in nursing homes. The data collection period began in August 2021 and ended in April 2022. RESULTS: Nursing home staff implemented self-designed interventions to foster trusting relationships with family, including initiating informal conversations, sharing residents' 'happy' moments, discussing mutual expectations, and being more aware of families' emotional burdens. Identified facilitators emphasise the importance of reciprocity, familiarity, transparency, realistic goal setting and empathy. Identified barriers are related to moral uncertainty in balancing competing demands, conflicting social norms, prioritising hands-on care tasks over family contact and lack of courage to act. CONCLUSION: Nursing home staff conclude that their interventions contribute positively to building and maintaining a trusting relationship with families. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Sharing the narratives of nursing home staff with peers would support them in implementing interventions to foster trust. Regular Moral Case Deliberations can be used to address moral uncertainty. Collective dialogue among nursing home staff can be useful in establishing new social norms that prioritise family involvement. Conversation skills training can empower nursing home staff. IMPACT: Trust between nursing home staff and families can be improved by implementing the conducted interventions. REPORTING METHOD: This report adheres to the standards for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

The regional development and implementation of home-based stroke rehabilitation using participatory action research.

PURPOSE: This study aims to overcome the challenges experienced in the regional development and implementation of home-based stroke rehabilitation (HBSR) and to understand the change process needed. MATERIALS AND METHODS: Using participatory action research (PAR), participants and researchers collaboratively produced knowledge and took action to improve the offered HBSR. Different methods for data generation and analysis were used, depending on the aim of the PAR phase and the participants' stages of change. The Consolidated Framework for Implementation Research (CFIR) was used to select implementation strategies and to evaluate the implementation process. RESULTS: Developing and implementing HBSR resulted in multiple products that promoted the implementation of a regional stroke network and affiliated work arrangements. Work arrangements were embodied in a stroke care pathway, follow-up tool, and expertise requirements. Evaluating the PAR process identified participants being able to take the lead, being facilitated by others, and making progress visible, as implementation facilitators. Collaborating within a primary care project can be challenging but is considered essential and has a positive impact on multiple levels. Also, the implementation of HBSR calls for multiple implementation strategies reflecting multiple CFIR constructs. CONCLUSION: This study highlights the complexity and achievements of developing and implementing HBSR using PAR.

When developing home-based stroke rehabilitation, important topics concern: interprofessional collaboration, follow-up care, professional expertise, attention to the social network and "invisible consequences" of stroke, case management, and supporting self-management.When developing a regional stroke network, viewpoints and work arrangements should be documented, for example through a stroke care pathway, and a tool for follow-up care. This can overcome the challenges experienced regarding interprofessional collaboration while delivering home-based stroke rehabilitation.When implementing a complex intervention such as home-based stroke rehabilitation, participatory action research can be used to empower professionals and to facilitate the development of practical solutions to experienced implementation problems in the community.When developing home-based stroke rehabilitation and/or executing participatory action research, facilitation by a person with an overview of the project is important to guide the knowledge transformation process.

Adapting Complicated Grief Therapy for Use With People With Intellectual Disabilities: An Action Research Study.

BACKGROUND: There is established evidence of complicated grief among people with an intellectual disability. This paper describes the process of adapting complicated grief therapy (CGT) for this population. METHOD: Action research documented the adaptation of CGT. Qualitative methods included analysing meeting notes, reflective interviews with two members of the team involved in adapting the materials, and interviews with six professionals working in disability settings who reviewed the adapted materials. RESULTS: Key processes included adapting the standardised tools that form part of CGT and developing adapted approaches to abstract concepts related to death, dying and bereavement. Key therapeutic components such as imaginal revisiting and the role of significant others required adaptation for implementation with people with intellectual disabilities. CONCLUSION: The importance of adapting evidence-based therapies for people with intellectual disabilities is emphasised. This research provides an adapted form of an established therapy for piloting with this population.

Effectiveness of an intervention program to develop e-cigarette control leaders at the University in Lampang Province, Thailand.

INTRODUCTION: The use of e-cigarettes is increasing worldwide, especially among young adults. Due to the health risks, this study aimed to assess undergraduate students' e-cigarette use and attitudes toward them, and evaluate the effectiveness of an intervention program to develop e-cigarette control leaders at the University in Lampang province, Thailand. METHODS: Participatory action research (PAR) was conducted among 46 undergraduate students. To assess the situations of undergraduate students' e-cigarette use and attitudes toward them, in-depth interviews were conducted with 18 of those students - nine users and nine non-users. The remaining 28 were student leaders who were given questionnaires and took part in focus groups to evaluate the effectiveness of the intervention program in developing e-cigarette control leaders. Descriptive statistics and the Wilcoxon signed rank test were used to analyze quantitative data. The qualitative data were analyzed using a thematic analysis of the content. This study took place at the University in Lampang province, Thailand, in 2023. RESULTS: Regarding the use of e-cigarettes on the part of undergraduate students and their attitudes about their use, the majority of users stated that e-cigarettes were accessible, appealing, and more socially acceptable than conventional cigarettes. However, most non-users cited vapor smell and health impacts as their main reason for not using e-cigarettes. The intervention program to develop leaders in e-cigarette control could significantly enhance the leaders' knowledge (p<0.001) and attitude regarding e-cigarettes (p=0.001). After their anti-e-cigarette campaign, the soft skills and managerial abilities of the leaders in e-cigarette control improved, and the knowledge and attitude regarding e-cigarettes of undergraduate students who attended the campaign also increased. CONCLUSIONS: The intervention program to develop leaders in e-cigarette control resulted in positive outcomes. This program could enhance the leaders' knowledge and attitude regarding e-cigarettes. Their soft skills and managerial abilities in e-cigarette control also improved.

An engagement framework for the authentic co-design of a consent and healthy relationships intervention with upper-secondary students.

Introduction: The objective of this demand driven research is to co-design an intervention for upper-secondary students that addresses issues of consent and healthy relationships. In this paper, we (university researchers, student co-researchers, school staff), present the engagement framework that has been critical to the project's development and planned implementation. Methods: An iterative co-design approach grounded in a participatory research approach is currently being adopted. Student co-researchers from three independent secondary schools on Whadjuk Nyungar Country in Boorloo/Perth, Western Australia, have been engaged as co-researchers in the design of the intervention. Supplementary quantitative and qualitative data from students enrolled at each school site is also being collated to further inform the intervention design. Student co-researchers will provide insights on the overarching design of the intervention including: the scope of key concepts they want to learn, interpretation of supplementary data, and the development of contextually relevant educative content. Results: Retrospective and prospective components of the engagement framework are described and supported with applied examples where applicable. Preliminary results demonstrate the imperative of adopting iterative co-design, and the efficacy of our authentic engagement framework. A draft intervention has been formalized and will soon undergo piloting. The co-design process has already resulted in an intervention that differs from the initial program first conceptualized by university researchers. Conclusion: Imperative to our engagement framework is centering students as experts of their lived experience. It is anticipated that this engagement framework will provide insights around the feasibility, value, and necessity for authentic engagement of upper-secondary school students in the design of their consent and healthy relationship education.

Optimising remote health workforce retention: protocol for a program of research.

BACKGROUND: Nowhere is optimising healthcare staff retention more important than in primary health care (PHC) settings in remote Australia, where there are unacceptably high rates of staff burnout and turnover. Ensuing consequences for the remote health services and the community are acute - staffing shortfalls in clinics; organisational instability; excessive costs associated with frequent staff recruitment and orientation; diminished access to PHC for patients in need; and lack of continuity of patient care; all of which further entrench poor health outcomes for the community. Optimising remote healthcare staff retention is critical in order to provide high quality and continued PHC. Currently, however, there is paucity of knowledge to inform targeted and effective retention strategies in remote health services. This research program seeks to develop a stronger evidence base to understand (i) what retention strategies are effective in improving morale, job satisfaction, intention to remain in the job, and consequent length of service for remote healthcare staff; (ii) how best to 'bundle' these strategies for different health workforce groups; and (iii) how these 'bundles' work in different service contexts. METHODS: This paper describes a five-year implementation research program in partnership with twelve remote Aboriginal and Torres Strait Islander Community Controlled Health Services (ATSICCHS) in the Northern Territory and Queensland, Australia. Overall methodology follows a participatory action research approach which incorporates co-design and realist elements. The program comprises two broad phases involving evidence consolidation and synthesis (Phase 1), and co-design, implementation, and prospective evaluation of 'bundles' of retention strategies (Phase 2) to improve retention of healthcare staff in participating ATSICCHSs. DISCUSSION: This innovative research program has the potential to develop a comprehensive evidence base required to optimise health workforce retention in remote health services. This new evidence will strengthen understanding of what 'bundles' of retention strategies are effective, for which groups of employees, and how they work to improve staff retention.

Applying a Participatory Action Research Approach to Engage an Australian Culturally and Linguistically Diverse Community around Human Papillomavirus Vaccination: Lessons Learned.

Globally, migrant and culturally and linguistically diverse (CALD) communities are known to have inequitable access to HPV vaccination. One participatory research approach used to engage CALD communities around vaccination is participatory action research (PAR), but we know little about the use of PAR to engage priority migrant and CALD communities around school and HPV vaccination. To address this gap, we partnered with our local Multicultural Health Service to understand how the largest CALD group in our region of New South Wales, Australia, engages with their local school and HPV vaccination program. Through a long-standing PAR relationship, we used a participatory research method (World Café) approach to explore the level of awareness and engagement a multi-generational community member had concerning HPV vaccination. We acted by sharing a co-designed information website to answer the community's questions about HPV vaccination. We then evaluated these engagements with surveys, focus groups and online analytic platforms. Last, we reflected with project partners and health service stakeholders on the overall project outcomes and shared our learnings. In our discussion, we shared our lessons learned and contributed to a wider conversation about the benefits, challenges, and practicalities of using PAR to engage a priority CALD community around HPV vaccination.

Targeting emotion dysregulation in depression: an intervention mapping protocol augmented by participatory action research.

BACKGROUND: Depression is a highly prevalent and often recurrent condition; however, treatment is not always accessible or effective in addressing abnormalities in emotional processing. Given the high prevalence of depression worldwide, identifying and mapping out effective and sustainable interventions is crucial. Emotion dysregulation in depression is not readily amenable to improvement due to the complex, time-dynamic nature of emotion; however, systematic planning frameworks for programs addressing behavioral changes can provide guidelines for the development of a rational intervention that tackles these difficulties. This study proposes an empirical and theoretical art-based emotion regulation (ER) intervention using an integrated approach that combines intervention mapping (IM) with participatory action research (PAR). METHODS: We used the IM protocol to identify strategies and develop an intervention for patients with major depressive disorder (MDD). As applied in this study, IM comprises six steps: (a) determining the need for new treatments and determinants of risk; (b) identifying changeable determinants and assigning specific intervention targets; (c) selecting strategies to improve ER across relevant theories and research disciplines; (d) creating a treatment program and refining it based on consultations with an advisory group; (e) developing the implementation plan and conducting a PAR study to pilot-test it; and (f) planning evaluation strategies and conducting a PAR study for feedback on the initial testing. RESULTS: Following the steps of IM, we developed two frameworks for an art-based ER intervention: an individual and an integrative framework. The programs include four theory- and evidence-based ER strategies aimed mainly at decreasing depressive symptoms and improving ER in patients with MDD. We also developed a plan for evaluating the proposed intervention. Based on our preliminary PAR studies, the intervention was feasible and acceptable for adoption and implementation in primary care settings. CONCLUSION: The application of IM incorporated with PAR has resulted in an intervention for improving ER in depression. While changing behavior is perceived as a challenging and elaborate task, this method can be useful in offering a clear structure for developing rational interventions. Further refinement is necessary through rigorous research.

Constructing Sacred Containers for Participatory Action Research: An Embodied Mindfulness Arts-Based Practice.

College campuses are sites of institutional betrayal and interpersonal harm for too many survivors of gender-based violence. In pursuit of change aligned with empowerment frameworks and feminist epistemologies, many of us create spaces for impacted students to engage in participatory action research and learning. This article describes a mindfulness, arts-based embodied practice for transforming settings and positioning participants as visionaries and experts on safety, power, and well-being. Through intentional dyadic and collective discussion, the Sacred Containers form the foundation for a coconstructed community. This article describes the rationale, process, impact, and recommendations via student and faculty reflections across four cohorts.

Facing Power: Navigating Power Dynamics in a Youth Participatory Action Research Project Situated within a Healthcare Setting.

Youth Participatory Action Research (YPAR) is oftentimes cited as a method guided by social justice principles to uplift youth voice and pursue youth priorities in research. However, to uphold these principles, YPAR researchers must address how youth and adults alike negotiate power differentials to be equal partners in research and scholarship. We explore YPAR power sharing through a reflexive thematic analysis of in-depth, semi-structured interviews (n= 42) and focus groups (n=2) conducted at three timepoints (baseline, mid-point, and exit) with youth (n=8) and adult (n=6) researchers engaged in a YPAR exploring health equity at a large, safety-net hospital. Our analyses suggest that both youth and adult researchers negotiate power dynamics in a YPAR at every stage of the project. YPAR researchers made four recommendations to negotiate power: 1) preserve time for relationship building, 2) structure group expectations, 3) require training for adults working with youth of color, and 4) designate youth-only spaces. This study provides an in-depth analysis of youth and adult reflections on power across a YPAR project. Our findings indicate that YPAR requires significant investment in resources, including time to reflect on and process power, transparent and structured expectations, and ongoing training to uphold principles of YPAR.

Improving the quality of clinical training in maternal and neonatal health in undergraduate nursing students: a participatory action research.

BACKGROUND: Improving the quality of clinical training is synonymous with accomplishing nursing education goals and improving the quality of nursing care. This study aimed to improve the quality of clinical training in Maternal and Neonatal Health (MNH) in nursing students. METHODS: This action research was conducted in two cycles from June 2017 to June 2018. The study setting was the School of Nursing and Midwifery of Lorestan University of Medical Sciences in southwest Iran. The participants were nursing students, faculty members, clinical trainers, educational managers, and teaching personnel. In the first cycle, semi-structured interviews were held with stakeholders to identify clinical problems and improvement strategies. Based on the results of these sessions, the changes needed to improve the quality of clinical training were planned and implemented. The weaknesses and strengths of the implemented changes were then identified through group discussions with the stakeholders. In the second cycle, a second plan was carried out to correct the weaknesses of the changes planned in the first cycle, and the modifications were implemented and evaluated. RESULTS: The main three categories extracted included an unsystematic curriculum and inadequate monitoring, inadequate resources and facilities, and the student's lack of motivation. The measures taken for improvement included holding communication workshops, developing and internalizing logbooks, reducing the number of students in clinical training groups, using modern clinical training methods, and changing clinical evaluation methods. CONCLUSION: Improving communication skills among the students, trainers, and hospital personnel and using modern clinical training methods, such as conceptual maps, triple jumps, and clinical skill centers, are the best strategies for improving clinical training in MNH nursing students.

Community-Based Participatory Research: Lessons and Challenges. Symposium Special Communication.

KNOWLEDGE TRANSFER STATEMENT: Community-based participatory research is an equitable and wholesome approach that aims to respectfully collaborate with the communities that it seeks to impact. It offers everyone a seat at the table when trying to create transformative clinical, behavioral, and health services change. Oral health scientists and program implementers can apply this framework for research and programming in communities where past approaches have not necessarily benefited the peoples or their communities in an equitable manner.