A study on participatory experiences in cultural and tourism commercial spaces

Due to the uniqueness and interactivity of its scenario, the cultural and tourism commercial space consistently enriches and enhances the user experience while satisfying users' consumption and shopping. However, there is limited research on the participatory aspect of cultural tourism business spaces from the perspective of users. To this end, the present study investigates the participatory experience of cultural tourism commercial spaces by selecting 305 tourists who visited Huaihai Street in Suzhou for consumption and entertainment and quantifies the relationship between the public's flow experience, aesthetic judgments, and behavioral outcomes using a structural equation modeling approach. The results of the study confirm that aesthetic judgments and flow experiences positively impact behavioral outcomes and that flow experiences also affect aesthetic judgments and behavioral outcomes. These findings contribute to a better understanding of the significance of user participation in cultural tourism business spaces.

Challenges and promising solutions to engaging patients in healthcare implementation in the United States: an environmental scan

BACKGROUND

One practice in healthcare implementation is patient engagement in quality improvement and systems redesign. Implementers in healthcare systems include clinical leadership, middle managers, quality improvement personnel, and others facilitating changes or adoption of new interventions. Patients provide input into different aspects of health research. However, there is little attention to involve patients in implementing interventions, especially in the United States (U.S.), and this might be essential to reduce inequities. Implementers need clear strategies to overcome challenges, and might be able to learn from countries outside the U.S.

METHODS

We wanted to understand existing work about how patients are being included in implementation activities in real world U.S. healthcare settings. We conducted an environmental scan of three data sources: webinars, published articles, and interviews with implementers who engaged patients in implementation activities in U.S. healthcare settings. We extracted, categorized, and triangulated from data sources the key activities, recurring challenges, and promising solutions using a coding template.

RESULTS

We found 27 examples of patient engagement in U.S. healthcare implementation across four webinars, 11 published articles, and seven interviews, mostly arranging patient engagement through groups and arranging processes for patients that changed how engaged they were able to be. Participants rarely specified if they were engaging a population experiencing healthcare inequities. Participants described eight recurring challenges; the two most frequently identified were: (1) recruiting patients representative of those served in the healthcare system; and (2) ensuring processes for equitable communication among all. We matched recurring challenges to promising solutions, such as logistic solutions on how to arrange meetings to enhance engagement or training in inclusivity and power-sharing.

CONCLUSION

We clarified how some U.S. implementers are engaging patients in healthcare implementation activities using less and more intensive engagement. It was unclear whether reducing inequities was a goal. Patient engagement in redesigning U.S. healthcare service delivery appears similar to or less intense than in countries with more robust infrastructure for this, such as Canada and the United Kingdom. Challenges were common across jurisdictions, including retaining patients in the design/delivery of implementation activities. Implementers in any region can learn from those in other places.

Stakeholder Analysis as a strategic tool in framing collaborative governance arenas for marine litter monitoring

Monitoring and assessment of marine litter requires multi-stakeholder involvement at national and subnational levels. Collaborative governance approaches are important, but often fail without adequate effort towards identifying and engaging stakeholders with appropriate profiles for the issue at stake. Stakeholder Analysis (SA) is increasingly used to ensure efficient governance arrangements. Our hypothesis is that SA contributes to collaborative governance processes for marine litter policies. We explored a pioneer participatory process in Brazil, where SA was applied to identify, categorize, and prioritize stakeholders, and analyze their power and interest, for the Strategic Plan for Monitoring and Assessing Marine Litter in the state of São Paulo. A top-down/bottom-up approach revealed that snowball sampling complemented the stakeholder assemblage identified by the consultation of experts. Prioritization of data-related stakeholders streamlined the participatory process. The interest-power matrix evaluated stakeholders' influences, guiding specific engagement strategies. We highlight the significance of SA in collaborative governance and mobilizing key stakeholders for effective marine litter monitoring initiatives, contributing to the global agenda to combat marine pollution.

Co-creation of self-management support during inpatient stroke rehabilitation

Objective

This study aimed to identify priority self-management skills and behaviours in partnership with stroke survivors, and to co-create approaches to support self-management during inpatient stroke rehabilitation.

Methods

Three stroke survivors and two communication partners participated in the three-stage Participatory Action Research project with embedded co-design processes after undertaking inpatient rehabilitation at a metropolitan tertiary hospital.

Results

Participants identified key factors influencing self-management during inpatient rehabilitation including motivation, emotional well-being, and fatigue. Three approaches to support people to self-manage post-stroke were co-created. (1) A health professional concierge and early family meeting. (2) A peer support person. (3) Adapting the hospital environment.

Conclusion

Findings suggest post-stroke self-management support should commence during inpatient rehabilitation to optimise its research-informed benefits. This support should focus on empowering stroke survivors and their key support people through active involvement in decision-making, and provision of multi-modal individualised education. The impact of hospital environments on emotional-wellbeing and self-management post-stroke also requires further investigation.

Innovation

The identification of a health professional concierge as a co-designed solution to the current challenges with self-management support is an innovative recommendation for practice. The findings support changes to the traditional processes of rehabilitation towards a consumer and family-led practices.

Multi-country collaborative citizen science projects to co-design cardiovascular disease prevention strategies and advocacy: findings from Ethiopia, Malawi, Rwanda, and South Africa

BACKGROUND

Cardiovascular diseases (CVD) were responsible for 20.5 million annual deaths globally in 2021, with a disproportionally high burden in sub-Saharan Africa (SSA). There is growing evidence of the use of citizen science and co-design approaches in developing interventions in different fields, but less so in the context of CVD prevention interventions in SSA. This paper reports on the collaborative multi-country project that employed citizen science and a co-design approach to (i) explore CVD risk perceptions, (ii) develop tailored prevention strategies, and (iii) support advocacy in different low-income settings in SSA.

METHODS

This is a participatory citizen science study with a co-design component. Data was collected from 205 participants aged 18 to 75 years in rural and urban communities in Malawi, Ethiopia and Rwanda, and urban South Africa. Fifty-one trained citizen scientists used a mobile app-based (EpiCollect) semi-structured survey questionnaire to collect data on CVD risk perceptions from participants purposively selected from two communities per country. Data collected per community included 100-150 photographs and 150-240 voice recordings on CVD risk perceptions, communication and health-seeking intentions. Thematic and comparative analysis were undertaken with the citizen scientists and the results were used to support citizen scientists-led stakeholder advocacy workshops. Findings are presented using bubble graphs based on weighted proportions of key risk factors indicated.

RESULTS

Nearly three in every five of the participants interviewed reported having a relative with CVD. The main perceived causes of CVD in all communities were substance use, food-related factors, and litter, followed by physical inactivity, emotional factors, poverty, crime, and violence. The perceived positive factors for cardiovascular health were nutrition, physical activity, green space, and clean/peaceful communities. Multi-level stakeholders (45-84 persons/country) including key decision makers participated in advocacy workshops and supported the identification and prioritization of community-specific CVD prevention strategies and implementation actions. Citizen science-informed CVD risk screening and referral to care interventions were piloted in six communities in three countries with about 4795 adults screened and those at risk referred for care. Health sector stakeholders indicated their support for utilising a citizen-engaged approach in national NCDs prevention programmes. The citizen scientists were excited by the opportunity to lead research and advocacy.

CONCLUSION

The collaborative engagement, participatory learning, and co-designing activities enhanced active engagement between citizen scientists, researchers, and stakeholders. This, in turn, provided context-specific insights on CVD prevention in the different SSA settings.

Enhancement of scoping review methodology to reflect Aboriginal and Torres Strait Islander ways of knowing, being and doing

OBJECTIVE

This paper argues for the enhancement of scoping review methods to incorporate Indigenous ways of knowing, being, and doing for more effective understandings of evidence of importance to Indigenous populations.

METHODS

Scoping review methodology typically aims to understand existing evidence and support translation of evidence into practice. Levac and colleagues (2010) scoping review methodology stages: 1) Identify the research question; 2) Identify relevant studies; 3) Study selection; 4) Charting the data; 5) Collating, summarising, and reporting results; and 6) Consultation were considered from the perspective of Indigenous knowledges and adapted accordingly.

RESULTS

An enhanced method better aligns with Indigenous methodologies which are based on relationality, collaboration, partnership, reciprocity, and benefit. Consultation was redefined in this enhancement as partnership and integrated throughout scoping review stages, which are underpinned by key methodological principles.

CONCLUSIONS

Enhancement of scoping review stages with Indigenous ways of knowing, being, and doing has the potential to strengthen the utility of scoping review methods to better meet the needs of and ensure relevance for Indigenous populations.

IMPLICATIONS FOR PUBLIC HEALTH

These enhancements can increase the potential for knowledge translation and implementation of culturally relevant evidence-based approaches into practice for Indigenous populations and for other populations who experience health inequities.

Cultural adaptations and methodological innovations to group model building for the systems actions to reduce malnutrition in all its forms in Southeast Asian countries and China (SYSTAM CHINA-SEACS International Consortium) project

BACKGROUND

Group Model Building (GMB) is a participatory system dynamics method increasingly used to address complex public health issues like obesity. GMB represents a set of well-defined steps to engage key stakeholders to identify shared drivers and solutions of a given problem. However, GMB has not yet been applied specifically to develop multi-duty interventions that address multiple inter-related issues such as malnutrition in all its forms (MIAIF). Moreover, a recent systematic review of empirical applications of a systems approach to developing obesity interventions found no published work from non-western, low- and middle-income countries (LMICs). In this paper we describe adaptations and innovations to a common GMB process to co-develop systemic MIAIF interventions with Chinese decision-makers.

METHODS

We developed, piloted and implemented multiple cultural adaptations and two methodological innovations to the commonly used GMB process in Fang Cheng Gang city, China. We included formal, ceremonial and policy maker engagement events before and between GMB workshops, and incorporated culturally tailored arrangements during participant recruitment (officials of the same seniority level joined the same workshop) and workshop activities (e.g., use of individual scoring activities and hand boards). We made changes to the commonly used GMB activities which enabled mapping of shared drivers of multiple health issues (in our case MIAIF) in a single causal loop diagram. We developed and used a 'hybrid' GMB format combining online and in person facilitation to reduce travel and associated climate impact.

RESULTS

Our innovative GMB process led to high engagement and support from decision-makers representing diverse governmental departments across the whole food systems. We co-identified and prioritised systemic drivers and intervention themes of MIAIF. The city government established an official Local Action Group for long-term, inter-departmental implementation, monitoring and evaluation of the co-developed interventions. The 'hybrid' GMB format enabled great interactions while reducing international travel and mitigating limitations of fully online GMB process.

CONCLUSIONS

Cultural and methodological adaptations to the common GMB process for an Asian LMIC setting were successful. The 'hybrid' GMB format is feasible, cost-effective, and more environmentally friendly. These cultural adaptations could be considered for other Asian settings and beyond to address inter-related, complex issues such as MIAIF.

An emerging framework for digital mental health design with Indigenous young people: a scoping review of the involvement of Indigenous young people in the design and evaluation of digital mental health interventions

BACKGROUND

Indigenous young people worldwide possess unique protective factors that support wellbeing. However, they experience mental illness at higher rates than their non-indigenous counterparts. Digital mental health (dMH) resources can increase access to structured, timely, and culturally tailored mental health interventions by reducing structural and attitudinal barriers to accessing treatment. The involvement of Indigenous young people in dMH resource development is recommended, however, no guidelines exist on how this can best be facilitated.

METHODS

A scoping review examining processes to involve Indigenous young people in developing or evaluating dMH interventions was conducted. Studies reported between 1990 and 2023 involving Indigenous young people aged 12-24 years, originating from Canada, the USA, New Zealand, and Australia, in the development or evaluation of dMH interventions were eligible for inclusion. Following a three-step search process, four electronic databases were searched. Data were extracted, synthesized, and described under three categories: dMH intervention attributes, study design, and alignment with research best practice. Best practice recommendations for Indigenous research and participatory design principles derived from the literature were identified and synthesised. Included studies were assessed against these recommendations. Consultation with two Senior Indigenous Research Officers ensured Indigenous worldviews informed analysis.

RESULTS

Twenty-four studies describing eleven dMH interventions met inclusion criteria. Studies included formative, design, pilot, and efficacy studies. Overall, most included studies demonstrated a high degree of Indigenous governance, capacity building, and community benefit. All studies adapted their research processes to ensure that local community protocols were followed and most aligned these within an Indigenous research paradigm. Formal agreements regarding existing and created intellectual property and implementation evaluations were rare. Outcomes were the primary focus of reporting, with limited detailed descriptions of governance and decision-making processes or strategies for managing predictable tensions between co-design stakeholders.

CONCLUSIONS

This study identified recommendations for undertaking participatory design with Indigenous young people and evaluated the current literature against these criteria. Common gaps were evident in the reporting of study processes. Consistent, in-depth reporting is needed to allow assessment of approaches for this hard-to-reach population. An emergent framework, informed by our findings, for guiding the involvement of Indigenous young people in the design and evaluation of dMH tools is presented.

TRIAL REGISTRATION

Available via osf.io/2nkc6.

Adaptation of the trauma group intervention 'Teaching Recovery Techniques' for online delivery: A participatory design and usability study

BACKGROUND

Video-telehealth delivery of trauma-based care is promising and may help address structural and perceptual barriers to receiving support. However, existing evidence relies heavily on samples from adult populations. There is potential to transfer existing child and adolescent trauma interventions to a video-telehealth delivery format; but, this requires careful consideration. The aim of this project was to adapt a group-based intervention called Teaching Recovery Techniques for online delivery and investigate the usability of the new intervention format.

METHODS

A qualitative needs assessment was performed (n = 3 intervention leaders, 4 youth), followed by participatory workshops and advisory panel consultation to generate adaptation recommendations. Usability testing was performed in two cycles; the first tested the adapted manual with intervention leaders (n = 5), and the second tested newly developed digital resources with youth (n = 5).

RESULTS

The needs assessment uncovered a number of issues that, when generating recommendations, were distilled into three topics: safety, participation and learning. Recommendations included safety rules, an emergency response protocol, communication strategies, and guidance on group composition and intervention delivery. Usability testing indicated acceptability but highlighted the need for more detailed and explicit guidance, particularly on safety processes.

DISCUSSION

The present study demonstrates the potential for delivery format to affect intervention feasibility and acceptability, and provides recommendations that can be used to guide the transfer of other group-based mental health interventions to an online format. The young people, parents and professionals involved in the project provided rich and varied perspectives, which illustrated the value of broad stakeholder engagement.

Flourishing together: research protocol for developing methods to better include disabled people's knowledge in health policy development

BACKGROUND

To positively impact the social determinants of health, disabled people need to contribute to policy planning and programme development. However, they report barriers to engaging meaningfully in consultation processes. Additionally, their recommendations may not be articulated in ways that policy planners can readily use. This gap contributes to health outcome inequities. Participatory co-production methods have the potential to improve policy responsiveness. This research will use innovative methods to generate tools for co-producing knowledge in health-related policy areas, empowering disabled people to articulate experience, expertise and insights promoting equitable health policy and programme development within Aotearoa New Zealand. To develop these methods, as an exemplar, we will partner with both tāngata whaikaha Māori and disabled people to co-produce policy recommendations around housing and home (kāinga)-developing a nuanced understanding of the contexts in which disabled people can access and maintain kāinga meeting their needs and aspirations.

METHODS

Participatory co-production methods with disabled people, embedded within a realist methodological approach, will develop theories on how best to co-produce and effectively articulate knowledge to address equitable health-related policy and programme development-considering what works for whom under what conditions. Theory-building workshops (Phase 1) and qualitative surveys (Phase 2) will explore contexts and resources (i.e., at individual, social and environmental levels) supporting them to access and maintain kāinga that best meets their needs and aspirations. In Phase 3, a realist review with embedded co-production workshops will synthesise evidence and co-produce knowledge from published literature and non-published reports. Finally, in Phase 4, co-produced knowledge from all phases will be synthesised to develop two key research outputs: housing policy recommendations and innovative co-production methods and tools empowering disabled people to create, synthesise and articulate knowledge to planners of health-related policy.

DISCUSSION

This research will develop participatory co-production methods and tools to support future creation, synthesis and articulation of the knowledge and experiences of disabled people, contributing to policies that positively impact their social determinants of health.

Using participatory system dynamics learning to support Ryan White Planning Council priority setting and resource allocations

The Ryan White CARE Act provides federal dollars supporting low income people living with HIV/AIDS (PLWH). Regional Ryan White Planning Councils (RWPC) are responsible for setting priorities and deciding CARE Act fund allocations, using local data to identify greatest need. However, RWPC are challenged with interpreting complex epidemiological, service utilization, and community needs data to inform priority setting and resource allocations. We piloted system dynamics (SD) learning, using a validated HIV care continuum SD simulation model calibrated to one northeastern U.S. Ryan White funding area. The pilot applied systems thinking to understand the complex HIV care continuum and to simulate and compare outcomes of various resource allocation decisions. Three scripted workshops provided opportunities to learn the SD modeling process and simulation tool, simulate various resource allocations, and compare population health outcomes. Mixed methods evaluation documented the SD modeling process, member responses to the modeling sessions, and attitudes regarding benefits and limitations of SD modeling for RWPC decision-making. Despite high member turnover and complexity of the SD model, members could understand the simulation model and propose strategies to seek greatest improvements in HIV care retention, viral suppression, and reduced infections. Findings suggests the value of SD modeling to assist RWPC decisions.

Co-designing an intervention to prevent rheumatic fever in Pacific People in South Auckland: a study protocol

Background

Rheumatic fever is an autoimmune condition that occurs in response to an untreated Group A Streptococcus throat or skin infection. Recurrent episodes of rheumatic fever can cause permanent damage to heart valves, heart failure and even death. Māori and Pacific people in Aotearoa New Zealand experience some of the highest rates globally, with Pacific children 80 times more likely to be hospitalised for rheumatic fever and Māori children 36 times more likely than non-Māori, non-Pacific children. Community members from the Pacific People’s Health Advisory Group, research officers from the Pacific Practice-Based Research Network and University of Auckland researchers identified key health priorities within the South Auckland community that needed to be addressed, one of which was rheumatic fever. The study outlined in this protocol aims to co-design, implement, and evaluate a novel intervention to reduce rheumatic fever rates for Pacific communities in South Auckland.

Methods

This participatory mixed-methods study utilises the Fa’afaletui method and follows a three-phase approach. Phase 1 comprises a quantitative analysis of the rheumatic fever burden within Auckland and across New Zealand over the last five years, including sub-analyses by ethnicity. Phase 2 will include co-design workshops with Pacific community members, families affected by rheumatic fever, health professionals, and other stakeholders in order to develop a novel intervention to reduce rheumatic fever in South Auckland. Phase 3 comprises the implementation and evaluation of the intervention.

Discussion

This study aims to reduce the inequitable rheumatic fever burden faced by Pacific communities in South Auckland via a community-based participatory research approach. The final intervention may guide approaches in other settings or regions that also experience high rates of rheumatic fever. Additionally, Māori have the second-highest incidence rates of rheumatic fever of all ethnic groups, thus community-led approaches ‘by Māori for Māori’ are also necessary.

Trial registration

The Australian New Zealand Clinical Trial Registry has approved the proposed study: ACTRN12622000565741 and ACTRN12622000572763.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-022-01701-9.

Standardised data on initiatives-STARDIT: Beta version

BACKGROUND AND OBJECTIVE

There is currently no standardised way to share information across disciplines about initiatives, including fields such as health, environment, basic science, manufacturing, media and international development. All problems, including complex global problems such as air pollution and pandemics require reliable data sharing between disciplines in order to respond effectively. Current reporting methods also lack information about the ways in which different people and organisations are involved in initiatives, making it difficult to collate and appraise data about the most effective ways to involve different people. The objective of STARDIT (Standardised Data on Initiatives) is to address current limitations and inconsistencies in sharing data about initiatives. The STARDIT system features standardised data reporting about initiatives, including who has been involved, what tasks they did, and any impacts observed. STARDIT was created to help everyone in the world find and understand information about collective human actions, which are referred to as 'initiatives'. STARDIT enables multiple categories of data to be reported in a standardised way across disciplines, facilitating appraisal of initiatives and aiding synthesis of evidence for the most effective ways for people to be involved in initiatives. This article outlines progress to date on STARDIT; current usage; information about submitting reports; planned next steps and how anyone can become involved.

METHOD

STARDIT development is guided by participatory action research paradigms, and has been co-created with people from multiple disciplines and countries. Co-authors include cancer patients, people affected by rare diseases, health researchers, environmental researchers, economists, librarians and academic publishers. The co-authors also worked with Indigenous peoples from multiple countries and in partnership with an organisation working with Indigenous Australians.

RESULTS AND DISCUSSION

Over 100 people from multiple disciplines and countries have been involved in co-designing STARDIT since 2019. STARDIT is the first open access web-based data-sharing system which standardises the way that information about initiatives is reported across diverse fields and disciplines, including information about which tasks were done by which stakeholders. STARDIT is designed to work with existing data standards. STARDIT data will be released into the public domain (CC0) and integrated into Wikidata; it works across multiple languages and is both human and machine readable. Reports can be updated throughout the lifetime of an initiative, from planning to evaluation, allowing anyone to be involved in reporting impacts and outcomes. STARDIT is the first system that enables sharing of standardised data about initiatives across disciplines. A working Beta version was publicly released in February 2021 (ScienceforAll.World/STARDIT). Subsequently, STARDIT reports have been created for peer-reviewed research in multiple journals and multiple research projects, demonstrating the usability. In addition, organisations including Cochrane and Australian Genomics have created prospective reports outlining planned initiatives.

CONCLUSIONS

STARDIT can help create high-quality standardised information on initiatives trying to solve complex multidisciplinary global problems.

Participatory variety selection of groundnut (Arachis hypogaea L.) in Taricha Zuriya district of Dawuro Zone, southern Ethiopia

Groundnut is a leguminous seed that contains a lot of oil and protein with high energy content. However, improved varieties were hardly evaluated based on farmers' preference criteria and their participation. Therefore, a participatory variety selection was carried out in Taricha Zuriya district in Dawuro Zone on the mother-baby approach on farmers' fields in the 2019 and 2020 main cropping seasons, aiming at evaluating the performance of groundnut varieties through farmers' participation and assessing their preference criteria. Six released groundnut varieties were tested using a randomized complete block design with four replicates at farmers' fields. The mother trial was done at one model farmer field (all four replications on one field), whereas the baby trials were done at four farmers' fields by considering farmers as replication per village. Combined analysis of variance for two years showed a highly significant (P < 0.001) to significant (P < 0.01) differences among groundnut varieties for grain yield, days to 50 % flowering, days to maturity, seeds per pod, pods per plant, 100 seed weight, except for both stand count at emergence and harvest. Among the tested varieties, BaHajidu (1805.84 kg ha^-1) was identified as the best yielding groundnut variety, followed by Bulki-01 (1805.50 kg ha^-1) and Werer-963 (1780.0 kg ha^-1), respectively, while Werer-962 variety has a lower yield (1536.30 kg ha^-1). Bulki-01 (96), BaHajidu (90), and Werer- 963 (76) obtained higher score values as preferred by farmers, whereas lower score values were observed for Manipinter variety (45). The aforementioned varieties Bulki-01, BaHajidu and Werer-963 were also preferred using selection criteria set by farmers as 1^st, 2^nd, and 3^rd in rank order respectively. Hence, based on farmers' preference values and biological data, these three groundnut varieties were recommended for pre-extension demonstration and large-scale production in Dawuro Zone and areas with similar agro-ecologies.

How have smallholder farmers used digital extension tools? Developer and user voices from Sub-Saharan Africa, South Asia and Southeast Asia

Digital extension tools (DETs) include phone calls, WhatsApp groups and specialised smartphone applications used for agricultural knowledge brokering. We researched processes through which DETs have (and have not) been used by farmers and other extension actors in low- and middle-income countries. We interviewed 40 DET developers across 21 countries and 101 DET users in Bihar, India. We found DET use is commonly constrained by fifteen pitfalls (unawareness of DET, inaccessible device, inaccessible electricity, inaccessible mobile network, insensitive to digital illiteracy, insensitive to illiteracy, unfamiliar language, slow to access, hard to interpret, unengaging, insensitive to user's knowledge, insensitive to priorities, insensitive to socio-economic constraints, irrelevant to farm, distrust). These pitfalls partially explain why women, less educated and less wealthy farmers often use DETs less, as well as why user-driven DETs (e.g. phone calls and chat apps) are often used more than externally-driven DETs (e.g. specialised smartphone apps). Our second key finding was that users often made - not just found - DETs useful for themselves and others. This suggests the word ‘appropriation’ conceptualises DET use more accurately and helpfully than the word ‘adoption’. Our final key finding was that developers and users advocated almost ubiquitously for involving desired users in DET provision. We synthesise these findings in a one-page framework to help funders and developers facilitate more useable, useful and positively impactful DETs. Overall, we conclude developers increase DET use by recognizing users as fellow developers – either through collaborative design or by designing adaptable DETs that create room for user innovation.

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How is ICT (video, mobile apps, SMS etc) used in agricultural knowledge brokering?

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We interviewed 40 developers and 101 users of digital extension tools.

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Fifteen pitfalls commonly constrained use of digital extension tools by farmers.

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Farmers actively appropriated, not just passively adopted, digital extension tools.

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Creating room for user innovation increases use of digital extension tools.

Stakeholder dialogue on dilemmas at work as a workplace health promotion intervention including employees with a low SEP: a Responsive Evaluation

Background

The aim of this study was to evaluate the perceived changes of an innovative workplace health promotion intervention and evaluation. In this study, a bottom-up approach was taken to define the central themes and relevant outcomes of an intervention. These central themes and relevant outcomes of the intervention were defined together with stakeholders, including employees with a low socioeconomic position.

Methods

The intervention consisted of a series of structured stakeholder dialogues in which dilemmas around the – by employees defined —health themes were discussed. The intervention was implemented in a harbor service provider with approximately 400 employees. Over a two-year period, 57 participants engaged in eight dialogues of one hour. 15 interviews and six participant observations took place for the evaluation of the intervention.

Results

Together with the stakeholders, high workload and mental health were defined as central themes for the dialogue intervention in the male-dominated workplace. The dialogue intervention contributed to changes, on different levels: individual, team, and organization. Overall, the stakeholder dialogues advanced the understanding of factors contributing to high workload and mental health. In reply to this, several actions were taken on a organizational level.

Conclusions

Taking a bottom-up approach in WHP allows to understand the health issues that are important in the daily reality of employees with a low socioeconomic position. Through this understanding, workplace health promotion can become more suitable and relevant for employees with a low socioeconomic position.

Trial registration

Netherlands Trial Register (NRT): NL8051. Registration date: 28/09/2019, Retrospectively registered https://www.trialregister.nl

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12802-z.

Developing socio-ecological scenarios: A participatory process for engaging stakeholders

Deltas are experiencing profound demographic, economic and land use changes and human-induced catchment and climate change. Bangladesh exemplifies these difficulties through multiple climate risks including subsidence/sea-level rise, temperature rise, and changing precipitation patterns, as well as changing management of the Ganges and Brahmaputra catchments. There is a growing population and economy driving numerous more local changes, while dense rural population and poverty remain significant. Identifying appropriate policy and planning responses is extremely difficult in these circumstances. This paper adopts a participatory scenario development process incorporating both socio-economic and biophysical elements across multiple scales and sectors as part of an integrated assessment of ecosystem services and livelihoods in coastal Bangladesh. Rather than simply downscale global perspectives, the analysis was driven by a large and diverse stakeholder group who met with the researchers over four years as the assessment was designed, implemented and applied. There were four main stages: (A) establish meta-framework for the analysis; (B) develop qualitative scenarios of key trends; (C) translate these scenarios into quantitative form for the integrated assessment model analysis; and (D) a review of the model results, which raises new stakeholder insights (e.g., preferred adaptation and policy responses) and questions. Step D can be repeated leading to an iterative learning loop cycle, and the process can potentially be ongoing. The strong and structured process of stakeholder engagement gave strong local ownership of the scenarios and the wider process. This process can be generalised for widespread application across socio-ecological systems following the same four-stage approach. It demands sustained engagement with stakeholders and hence needs to be linked to a long-term research process. However, it facilitates a more credible foundation for planning especially where there are multiple interacting factors.

Process evaluation of a complex workplace intervention to prevent musculoskeletal pain in nursing staff: results from INTEVAL_Spain

Background

INTEVAL_Spain was a complex workplace intervention to prevent and manage musculoskeletal pain among nursing staff. Process evaluations can be especially useful for complex and multifaceted interventions through identifying the success or failure factors of an intervention to improve the intervention implementation.

Objectives

This study performed a process evaluation of INTEVAL_Spain and aimed to examine whether the intervention was conducted according to the protocol, to investigate the fulfilment of expectations and the satisfaction of workers.

Methods

The intervention was a two-armed cluster randomized controlled trial and lasted 1 year. The process evaluation included quantitative and qualitative methods. Quantitative methods were used to address the indicators of Steckler and Linnan’s framework. Data on recruitment was collected through a baseline questionnaire for the intervention and the control group. Reach and dose received were collected through participation sheets, dose delivered and fidelity through internal registries, and fulfilment of expectations and satisfaction were collected with two questions at 12-months follow-up. Qualitative methods were used for a content analysis of discussion groups at the end of the intervention led by an external moderator to explore satisfaction and recommendations. The general communication and activities were discussed, and final recommendations were agreed on. Data were synthesized and results were reported thematically.

Results

The study was performed in two Spanish hospitals during 2016-2017 and 257 workers participated. Recruitment was 62 and 51% for the intervention and the control group, respectively. The reach of the activities ranged from 96% for participatory ergonomics to 5% for healthy diet. The number of sessions offered ranged from 60 sessions for Nordic walking to one session for healthy diet. Fidelity of workers ranged from 100% for healthy diet and 79% for participatory ergonomics, to 42 and 39% for Nordic walking and case management, respectively. Lowest fidelity of providers was 75% for case management and 82% for Nordic walking. Fulfilment of expectations and satisfaction ranged from 6.6/10 and 7.6/10, respectively, for case management to 10/10 together for the healthy diet session. Discussion groups revealed several limitations for most of the activities, mainly focused on a lack of communication between the Champion (coordinator) and the workers.

Conclusions

This process evaluation showed that the implementation of INTEVAL_Spain was predominantly carried out as intended. Process indicators differed depending on the activity. Several recommendations to improve the intervention implementation process are proposed.

Trial registration

ISRCTN15780649.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00716-x.

Quick and dirty or rapid and informative? Exploring a participatory method to facilitate implementation research and organizational change

PURPOSE

The purpose is explore an approach to acquire, analyze and report data concerning an organizational change initiative that combines knowledge generation and knowledge use, and contrast that with a method where knowledge generation and use is separated. More specifically, the authors contrast a participatory group workshop with individual interviews analyzed with thematic analysis, focusing on information about the change process and its perceived practical relevance and usefulness.

DESIGN/METHODOLOGY/APPROACH

Participants were managers responsible for implementing a broad organizational change aiming to improve service quality (e.g. access and equity) and reduce costs in a mental health service organization in Sweden. Individual interviews were conducted at two points, six months apart (i1: n = 15; i2: n = 18). Between the interviews, a 3.5-h participatory group workshop was conducted, during which participants (n = 15) both generated and analyzed data through a structured process that mixed individual-, small- and whole-group activities.

FINDINGS

Both approaches elicited substantive information about the content, purpose and process of change. While the content and purpose findings were similar across the two data sources, the interviews described how to lead a change process, whereas the workshop yielded concrete information about what to do. Benefits of interviews included personal insights about leading change while the workshop provided an opportunity for collective sense-making.

ORIGINALITY/VALUE

When organizational stakeholders work through the change process through a participatory workshop, they may get on the same page, but require additional support to take action.

Participatory Research Approaches with Youth: Ethics, Engagement, and Meaningful Action

In this manuscript, we explore the promise and challenges of youth participatory action research (YPAR), paying particular attention to ethical issues and power dynamics that emerge in the context of research partnerships between youth and adults. We begin by reviewing the key tenets of YPAR and then go on to discuss how these tenets are often at odds with dominant approaches to research. We describe the tension between the values of YPAR and the systems and structures embedded in the academy. Further, we elucidate how adultism and the capitalist nature of the academy intersect with white supremacy culture, posing significant barriers to meaningful youth participation in community research partnerships. We then describe ways in which participatory scholars can disrupt these systems as well as larger paradigm shifts in the culture of academia that will be required to elevate youth voices and to amplify their efforts for equity.

Participatory Methodologies With Adolescents: A Research Approach Used to Explore Structural Factors Affecting Alcohol Use and Related Unsafe Sex in Tanzania

Multiple methodological approaches have been used to explore adolescent alcohol use and related sexual behaviors, ranging from surveys to assessments of alcohol outlet density. Although surveys can capture the extent of alcohol use, they do not allow for a contextualized understanding of young people's voiced experiences with alcohol, including sociocultural, gendered and environmental pressures to consume, and related engagement in sex. The mapping of alcohol outlets provides physical density information, but infrequently from youths' perspectives. Traditional qualitative methods like in-depth interviews and focus group discussions do allow for a more nuanced understanding of adolescents' experiences, but they can be limited by the use of semi-structured guides that may negatively impact the fluidity of discussion. We seek to contribute to the methodological approaches utilized with adolescents by demonstrating how contextualized data were captured from Tanzanian adolescents' experiences of alcohol and sex, which are sensitive topics in many African countries. We collected data in secondary schools and youth centers across four sites in Dar es Salaam, the largest and most diverse city in Tanzania. As a complement to in-depth interviews, archival reviews, and a systematic mapping of alcohol availability, participatory methodologies such as photovoice, story writing, and drawing allowed Tanzanian youth to offer more honest, descriptions of lived experiences with their physical and social environment in relation to alcohol use and related sexual behavior patterns. Through participatory methods, study participants were able to discuss behaviors that are viewed as social transgressions, sensitive topics like violence in relation to sex, and views around their own self-agency. The use of a methodological toolkit including participatory methodologies enabled youth to trust the researchers and share sensitive information in a relatively short period of time, overcoming some of the challenges of traditional qualitative methods.

Engaging young people in the design of a sexual reproductive health intervention: Lessons learnt from the Yathu Yathu ("For us, by us") formative study in Zambia

BACKGROUND

Meeting the sexual and reproductive health (SRH) needs of adolescents and young people (AYP) requires their meaningful engagement in intervention design. We describe an iterative process of engaging AYP to finalise the design of a community-based, peer-led and incentivised SRH intervention for AYP aged 15-24 in Lusaka and the lessons learnt.

METHODS

Between November 2018 and March 2019, 18 focus group discussions, eight in-depth interviews and six observations were conducted to assess AYP's knowledge of HIV/SRH services, factors influencing AYP's sexual behaviour and elicit views on core elements of a proposed intervention, including: community-based spaces (hubs) for service delivery, type of service providers and incentivising service use through prevention points cards (PPC; "loyalty" cards to gain points for accessing services and redeem these for rewards). A total of 230 AYP (15 participated twice in different research activities) and 21 adults (only participated in the community mapping discussions) participated in the research. Participants were purposively selected based on age, sex, where they lived and their roles in the study communities. Data were analysed thematically.

RESULTS

Alcohol and drug abuse, peer pressure, poverty, unemployment and limited recreation facilities influenced AYP's sexual behaviours. Adolescent boys and young men lacked knowledge of contraceptive services and all AYP of pre and post exposure prophylaxis for HIV prevention. AYP stated a preference for accessing services at "hubs" located in the community rather than the health facility. AYP considered the age, sex and training of the providers when choosing whom they were comfortable accessing services from. PPCs were acceptable among AYP despite the loyalty card concept being new to them. AYP suggested financial and school support, electronic devices, clothing and food supplies as rewards.

CONCLUSIONS

Engaging AYP in the design of an SRH intervention was feasible, informative and considered responsive to their needs. Although AYP's suggestions were diverse, the iterative process of AYP engagement facilitated the design of an intervention that is informed by AYP and implementable.

TRIAL REGISTRATION

This formative study informed the design of this trial: ClinicalTrials.gov, NCT04060420. Registered 19 August, 2019.

In Our Own Words: The Complex Sensory Experiences of Autistic Adults

Autistic adults commonly experience sensory reactivity differences. Sensory hyperreactivity is frequently researched, whilst hyporeactivity and seeking, and experiences across domains, e.g., vision, are often neglected. Therefore, we aimed to understand more about the sensory experiences of autistic adults. We conducted a mixed-methods study, co-produced with stakeholders; recruiting 49 autistic adults who completed an online survey. Firstly, quantitative results and content analysis enhanced our understanding of sensory input/contexts associated with sensory hyperreactivity, hyporeactivity, and seeking across modalities. Secondly, thematic analysis developed themes relating to 'Outcomes', 'Control', 'Tolerance and management', and 'The role of other people', informing a theoretical model of sensory reactivity differences in autistic adults. These findings have implications for support services and improving quality of life for autistic adults.

Co-production in nursing and midwifery education: A systematic review of the literature

OBJECTIVES

Co-producing aspects of nursing and midwifery education is increasingly being used in higher education to try to improve student learning and meet standards set by some professional accreditation bodies. This review aims to identify and synthesise evidence on this pedagogical approach.

DESIGN

Systematic review.

DATA SOURCES

Searches were conducted in CINAHL, ERIC, MEDLINE, and PubMed.

REVIEW METHODS

Four bibliographical databases were searched using relevant search terms between 2009 and 2019. Titles, abstracts, and full text papers were screened. Pertinent data were extracted and critical appraisal undertaken. Data were analysed using the framework approach and findings presented in a narrative summary.

RESULTS

Twenty-three studies were included. Two overarching themes emerged. The first focused on the impact of co-production on nursing and midwifery students, service users, and carers which had five subthemes; 1) acquiring new knowledge and skills, 2) gaining confidence and awareness, 3) building better relationships, 4) feeling vulnerable, and 5) attaining a sense of pride or enjoyment. The second theme centred on factors affecting how co-production was delivered which had three subthemes; 1) human interactional approach, 2) pedagogic quality, and 3) organisational environment.

CONCLUSION

This review provides a comprehensive update of the literature on co-production in nursing and midwifery education. Tentative evidence exists that participatory approaches could improve learning and positively impact on nursing and midwifery students, service users, and carers. Educators should consider adopting co-production and including students, service users, carers, practice staff, and other relevant stakeholders in this pedagogical process. However, more rigorous research examining how effective co-production is in improving learning over traditional methods is warranted given the additional resources required to deliver it.

Involvement of Indigenous young people in the design and evaluation of digital mental health interventions: a scoping review protocol

BACKGROUND

Indigenous young people worldwide are at greater risk of developing mental health concerns due to ongoing inequity and disadvantage. Digital mental health (dMH) interventions are identified as a potential approach to improving access to mental health treatment for Indigenous youth. Although involvement in the development and evaluation of dMH resources is widely recommended, there is limited evidence to guide engagement of Indigenous young people in these processes. This scoping review aims to examine the methods used to involve Indigenous young people in the development or evaluation of dMH interventions.

METHODS

Articles published in English, involving Indigenous young people (aged 10-24 years) in the development or evaluation of dMH interventions, originating from Australia, New Zealand, Canada and the USA will be eligible for inclusion. PubMed, Scopus and EBSCOhost databases (Academic Search Premiere, Computer and Applied Science complete, CINAHL, MEDLINE, APA PsychArticles, Psychology and Behavioural Sciences collection, APA PsychInfo) will be searched to identify eligible articles (from January 1990 onwards). Infomit and Google Scholar (limited to 200 results) will be searched for grey literature. Two reviewers will independently screen citations, abstracts and full-text articles. Study methods, methodologies, dMH intervention details, participant information and engagement, and dissemination methods will be extracted, analysed (utilising content analysis), and qualitatively assessed for alignment with best practice ethical guidelines for undertaking Indigenous health research. A narrative summary of findings will be presented. Reporting will follow the Consolidated Criteria for Strengthening Reporting of Health Research involving Indigenous peoples (CONSIDER) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines.

DISCUSSION

To date, there are no reviews which analyse engagement of Indigenous young people in the development and evaluation of dMH interventions. This review will appraise alignment of current practice with best practice guidelines to inform future research. It will highlight appropriate methods for the engagement of young people in study processes, providing guidance for health practitioners, policy makers, and researchers working in the field of Indigenous youth and dMH.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework ( osf.io/2nkc6 ).

Involving elderly research participants in the co-design of a future multi-generational cohort study

BACKGROUND

It has been proposed that the existing ASPirin in Reducing Events in the Elderly Extension observational cohort study (ASPREE-XT) would provide a platform for a future multigenerational research study (MGRS). An advert was sent to 14,268 participants (aged 74 years and older, from Australia, and located in both metropolitan and rural locations) to invite them to share views and preferences about being involved in the co-design of a future MGRS, as their preferences were not known. The objective of this article is to report as a case study the process of involving study participants and how this impacted the co-design of a proposed multi-generational research study, using a novel standardised reporting tool.

METHODS

We used participatory action research to involve elderly research participants in the co-design of a proposed multi-generational cohort study between 2017 and 2019 using newsletters, telephone interviews and an in-person workshop. We used the novel 'Standardised Data on Initiatives Alpha Version 0.1' (STARDIT 0.1) to plan and report how participant involvement activities positively impacted the study design.

RESULTS

Fifty-nine ASPREE-XT participants were interviewed by telephone and 18 participants attended a face-to-face event. Involving participants positively impacted the proposed study design by improving the research objectives, developing protocols, influencing funding decisions and improving ethics applications. Learning points included the importance of maintaining the ideals of ASPREE-XT (respect, quality and transparency); research participants' preference for the option of receiving results (including genetic results); participants' need for involvement in decisions about recruitment, data access, governance and other ethical issues; and the preference for different communication methods, including both face-to-face and online methods. Data from the process indicated it was highly valued by all stakeholders, including research participants, study staff and lead investigators. Involvement of participants was described by a lead study investigator of ASPREE-XT as "enormously helpful".

CONCLUSIONS

This case study demonstrates that including participants in the design of a research study positively impacted the study design, participants and researchers. Using a standardised reporting tool to describe the methods and impacts provides a way for learning from this case study to inform future research studies planning to involve people.

Involving people affected by a rare condition in shaping future genomic research

BACKGROUND

There is evidence that involving potential participants and the public in co-designing research can improve the quality of the study design, recruitment and acceptability of the research, but appropriate methodologies for doing this are not always clear. In this study we co-designed a way of involving people affected by a rare genomic disease in shaping future genomic research about the condition. The aim was to report the process, experiences and outcomes of involving people in genomic research in a standardised way, in order to inform future methods of involvement in research co-production.

METHOD

Participants were recruited from an online community hosted by an Australian-based rare disease charity and were over the age 18 years. Once people gave consent, we shared learning resources with participants and invited them to complete an online survey before joining a two-week facilitated online discussion, followed by a second online survey. We used the novel tool 'Standardised Data on Initiatives - Alpha Version 0.1' (STARDIT) to map preferences, plan involvement and report any outcomes from the process, with quantitative data analysed descriptively and qualitative data thematically analysed.

RESULTS

Of the 26 people who gave consent and completed the initial survey, 15 participated in the online discussion and 12 completed the follow-up survey. STARDIT was used to report six outcomes from the process, including 60% of participants' responses showing a change towards 'widening' their view of who should be involved in research to include more people. Outcomes also included an improved understanding of research and how to be involved. Participants enjoyed online discussions, found learning resources useful and asked to stay involved in the research process. The partner organisation reported that a similar online discussion will be used in future research prioritisation processes.

CONCLUSION

Involving people in co-designing the process improved the study design, ensuring it met the needs of participants. Whilst the study includes participants from only one disease group, using STARDIT allowed us to map people's preferences and report the methods and outcomes from involving people, providing a way for learning from this case study to inform future research studies beyond the discipline of public health genomics.

Co-creating local socioeconomic pathways for achieving the sustainable development goals

The Sustainable Development Goals (SDGs) recognise the importance of action across all scales to achieve a sustainable future. To contribute to overall national- and global-scale SDG achievement, local communities need to focus on a locally-relevant subset of goals and understand potential future pathways for key drivers which influence local sustainability. We developed a participatory method to co-create local socioeconomic pathways by downscaling the SDGs and driving forces of the shared socioeconomic pathways (SSPs) via a local case study in southern Australia through contextual analysis and community engagement. We linked the SSPs and SDGs by identifying driving forces and describing how they affect the achievement of local SDGs. We co-created six local socioeconomic pathways with the local community which track towards futures with different levels of fulfilment of the SDGs and each encompasses a narrative storyline incorporating locally-specific ideas from the community. We tested and validated the local pathways with the community. This method extends the SSPs in two dimensions-into the broader field of sustainability via the SDGs, and by recontextualizing them at the local scale. The local socioeconomic pathways can contribute to achieving local sustainability goals from the bottom up in alignment with global initiatives.

Together Helping Reduce Youth Violence for Equity (ThrYve): Examining the Development of a Comprehensive Multisectoral Approach to Youth Violence Prevention

Comprehensive approaches to youth violence prevention are needed to simultaneously address multiple risk factors across socioecological levels. ThrYve (Together Helping Reduce Youth Violence for Equity) is a collaborative initiative focused on addressing broader factors influencing youth violence, including social determinants of health. Using a participatory approach, the development of ThrYve is examined through an empirical case study. Through a Systems Advisory Board (SAB), ThrYve deploys multiple strategies that support cross-sector collaboration involving over 40 partners across 13 community sectors. Based on the Institute of Medicine's model for public health action in communities, the SAB identified 87 change levers (i.e., program, policy, practice changes) to support community and systems-level improvements. As a result of the collaborative process, in the first couple of years, ThrYve facilitated 85 community actions and changes across sectors. The changes aligned with identified risk and resilience needs of the youth served in the community. The findings further support prior research, which suggests disparities related to gender may influence risk and resilience factors for youth violence. The study also indicates the importance of continuing to examine academic performance as a factor related to youth resilience.

Integrating sexual and reproductive health into health system strengthening in humanitarian settings: a planning workshop toolkit to transition from minimum to comprehensive services in the Democratic Republic of Congo, Bangladesh, and Yemen

Background

Planning to transition from the Minimum Initial Service Package for Sexual and Reproductive Health (SRH) toward comprehensive SRH services has been a challenge in humanitarian settings. To bridge this gap, a workshop toolkit for SRH coordinators was designed to support effective planning. This article aims to describe the toolkit design, piloting, and final product.

Methods

Anchored in the Health System Building Blocks Framework of the World Health Organization, the design entailed two complementary and participatory strategies. First, a collaborative design phase with iterative feedback loops involved global partners with extensive operational experience in the initial toolkit conception. The second phase engaged stakeholders from three major humanitarian crises to participate in pilot workshops to contextualize, evaluate, validate, and improve the toolkit using qualitative interviews and end-of-workshop evaluations. The aim of this two-phase design process was to finalize a planning toolkit that can be utilized in and adapted to diverse humanitarian contexts, and efficiently and effectively meet its objectives. Pilots occurred in the Democratic Republic of Congo for the Kasai region crisis, Bangladesh for the Rohingya humanitarian response in Cox’s Bazar, and Yemen for selected Governorates.

Results

Results suggest that the toolkit enabled facilitators to foster a systematic, participatory, interactive, and inclusive planning process among participants over a two-day workshop. The approach was reportedly effective and time-efficient in producing a joint work plan. The main planning priorities cutting across settings included improving comprehensive SRH services in general, healthcare workforce strengthening, such as midwifery capacity development, increasing community mobilization and engagement, focusing on adolescent SRH, and enhancing maternal and newborn health services in terms of quality, coverage, and referral pathways. Recommendations for improvement included a dedicated and adequately anticipated pre-workshop preparation to gather relevant data, encouraging participants to undertake preliminary study to equalize knowledge to partake fully in the workshop, and enlisting participants from marginalized and underserved populations.

Conclusion

Collaborative design and piloting efforts resulted in a workshop toolkit that could support a systematic and efficient identification of priority activities and services related to comprehensive SRH. Such priorities could help meet the SRH needs of communities emerging from acute humanitarian situations while strengthening the overall health system.

Exploring Community Mental Health Systems - A Participatory Health Needs and Assets Assessment in the Yamuna Valley, North India

Background: In India and global mental health, a key component of the care gap for people with mental health problems is poor system engagement with the contexts and priorities of community members. This study aimed to explore the nature of community mental health systems by conducting a participatory community assessment of the assets and needs for mental health in Uttarkashi, a remote district in North India.

Methods: The data collection and analysis process were emergent, iterative, dialogic and participatory. Transcripts of 28 in-depth interviews (IDIs) with key informants such as traditional healers, people with lived experience and doctors at the government health centres (CHCs), as well as 10 participatory rural appraisal (PRA) meetings with 120 people in community and public health systems, were thematically analysed. The 753 codes were grouped into 93 categories and ultimately nine themes and three meta-themes (place, people, practices), paying attention to equity.

Results: Yamuna valley was described as both ‘blessed’ and limited by geography, with bountiful natural resources enhancing mental health, yet remoteness limiting access to care. The people described strong norms of social support, yet hierarchical with entrenched exclusions related to caste and gender, and social conformity that limited social accountability of services. Care practices were porous, pluralist and fragmented, with operational primary care services that acknowledged traditional care providers, and trusted resources for mental health such as traditional healers (malis) and government health workers (accredited social health activists. ASHAs). Yet care was often absent or limited by being experienced as disrespectful or of low quality.

Conclusion: Findings support the value of participatory methods, and policy actions that address power relations as well as social determinants within community and public health systems. To improve mental health in this remote setting and other South Asian rural locations, community and public health systems must dialogue with the local context, assets and priorities and be socially accountable.

Using Technology to Scale up Youth-Led Participatory Action Research: A Systematic Review

PURPOSE

Rapid advances in technology create opportunities for adolescents to influence practice and policy in health and other domains. Technology can support the scaling of Youth-Led Participatory Action Research (YPAR), in which adolescents conduct research to improve issues that affect them. We present the first known published systematic review of the use of technology to scale YPAR.

METHODS

A systematic review of the empirical literature was conducted from 2000 to 2018 using databases PsycARTICLES, PsycINFO, and PubMed. The review included peer-reviewed articles of YPAR studies involving adolescents (aged 10-19 years) using technology for scaling. Appraisal of papers included the role of technology and consistency with YPAR principles.

RESULTS

Nine peer-reviewed YPAR publications focusing on a range of health issues with adolescents aged 11-19 years were identified. Technology included Facebook (most common), Twitter, Instagram, Skype, e-mail, blogs, and personalized mapping applications. Overall, technology was primarily used for adolescent participants to gather data. The appraisal revealed the complexities inherent in conducting YPAR using technology across multiple sites, with different adults in supportive roles and varying levels of opportunities for adolescent engagement.

CONCLUSIONS

This review provides insights at the intersection of youth-led research and technology, highlighting opportunities in a changing technological landscape and the challenges of YPAR at scale.

Feasibility of a clinic-delivered adolescent and pediatrician communication intervention on patient participatory behaviors and behavior change: TIC TAC pilot study

OBJECTIVES

Pediatrician-adolescent communication can improve adolescent health. We conducted a two-arm design to pilot-test an intervention that randomized adolescents to receive a Feedback Guide to promote engaged conversations. We hypothesized that adolescents who received the Guide would be more participatory.

METHODS

We recruited 12 pediatricians and 29 adolescents. Clinic staff enrolled adolescents using a tablet that enabled consenting, assessment of high-risk behaviors, and audio recording of encounters. We surveyed adolescents immediately and two months after the encounter.

RESULTS

Adolescents who received the intervention were more participatory than adolescents who did not. Pediatricians counseled on 20 of 32 high-risk behaviors with no significant arm differences. At follow-up, adolescents changed 9 of 32 behaviors; 6 were among 4 of adolescents in the intervention arm. Adolescents in the intervention arm were also more likely to report that counseling would help them change their behavior; these encounters were slightly longer than control arm encounters.

CONCLUSIONS

We confirmed feasibility of a streamlined approach to enrolling and audio recording encounters. The Feedback Guide improved adolescent participation and might have helped them adopt healthier behaviors.

PRACTICE IMPLICATIONS

Adolescents can be primed to be participatory and can change their behaviors after a meaningful encounter with their pediatrician.

Assessing the Efficacy of a PhotoVoice-Informed HIV Stigma Training for Health Care Workers

HIV stigma is a harmful social phenomenon present in United States (US)-based health care settings. This study assessed the efficacy of a participatory PhotoVoice-informed stigma reduction training program focusing on people living with HIV (PLWH) and targeting health care workers. Seventy-three (N = 73) participants were assessed at baseline (T1), within approximately a week of the training (T2), and at a 3-month follow-up (T3) regarding their HIV/AIDS knowledge, attitudes towards PLWH, and observations of enacted HIV stigma. Findings indicated that the training increased knowledge and improved attitudes (β = 0.56, p < 0.01; β = 0.58, p < 0.01, respectively) at T2, but these effects diminished at T3 (β = - 0.03, p > 0.05; β = - 0.29, p > 0.05, respectively). The training did not, however, have an impact on observations of enacted stigma at T2 (β = 0.10, p > 0.05) or at T3 (β = 0.02, p > 0.05). Additional participatory stigma reduction programs that involve diverse groups of health care workers, offer salient study incentives, include time-saving training methods, and comprise a variety of stigma measures, may be particularly beneficial.

Between power and perception: Understanding youth perspectives in participatory monitoring and evaluation (PM&E) in Ghana

Participatory monitoring and evaluation (PM&E) approaches have been touted as an important concept for local participation in social interventions programmes. Utilizing a process analysis approaches, the PM&E data gathered through key informant interviews, formal surveys, and policy frameworks were analyzed. The study revealed three dominant power struggles between youth and programme implementers in three districts at the Greater Accra region, Ghana. The first and pervasive form of power dynamics involves the youth and programme implementers. The second involves a variety of arrangements with the government on one hand and implementers and youth on the other side. The third is who qualifies to be a beneficiary and for that matter participate in the PM&E. In these three forms of power struggles the paper reveals superior implementers control of who participate in the programme PM&E and at what stage in the process. The power imbalance between programme implementer and target beneficiaries impeded the level of beneficiaries' participation in the PM&E.

Co-design of improved climbing bean production practices for smallholder farmers in the highlands of Uganda

We evaluated the usefulness of a co-design process to generate a relevant basket of options for climbing bean cultivation in the context of a large-scale project. The aim was to identify a range of options sufficiently diverse to be of interest for farmers of widely-different resource endowment. The co-design process consisted of three cycles of demonstration, evaluation and re-design in the eastern and southwestern highlands of Uganda in 2014-2015. Evaluations aimed to distinguish preferences of farmers between the two areas, and among farmers of different gender and socio-economic backgrounds. Farmers, researchers, extension officers and NGO staff re-designed treatments for demonstrations in the next season. Climbing bean yields and evaluation scores varied between seasons and sites. Evaluation scores were not always in line with yields, revealing that farmers used multiple evaluation criteria next to yield, such as marketability of varieties, availability of inputs and ease of staking methods. The co-design process enriched the basket of options, improved the relevance of options demonstrated and enhanced the understanding of preferences of a diversity of users. Developing options for resource-poor farmers was difficult, however, because they face multiple constraints. The basket of options developed in this study can be applied across the East-African highlands, with an 'option-by-context' matrix as a starting point for out-scaling. The study also showed, however, that consistent recommendations about the suitability of technologies for different types of farmers were hard to identify. This highlights the importance of a basket of options with flexible combinations of practices rather than developing narrowly specified technology packages for static farm types.

The importance of systems thinking, context, and inclusion when studying the feasibility of expanding the FoodShare (SNAP) outreach program to rural communities of Northern Wisconsin

Evaluators often neglect to question whether a program has been appropriately designed for a new context prior to a feasibility study's commencement. In this paper, we document the results of a case study that closely examined context when determining the feasibility of implementing a FoodShare outreach program in rural northern Wisconsin. Using community-based participatory mixed methods, we examine how stakeholder engagement led to both study refinement and a more comprehensive understanding of community food security based on contextual factors and systems thinking. Lessons learned when conducting feasibility studies from this perspective are provided to improve evaluation practice.

Predictive, Personalized, Preventive and Participatory (4P) Medicine Applied to Telemedicine and eHealth in the Literature

The main objective of this work is to provide a review of existing research work into predictive, personalized, preventive and participatory medicine in telemedicine and ehealth. The academic databases used for searches are IEEE Xplore, PubMed, Science Direct, Web of Science and ResearchGate, taking into account publication dates from 2010 up to the present day. These databases cover the greatest amount of information on scientific texts in multidisciplinary fields, from engineering to medicine. Various search criteria were established, such as ("Predictive" OR "Personalized" OR "Preventive" OR "Participatory") AND "Medicine" AND ("eHealth" OR "Telemedicine") selecting the articles of most interest. A total of 184 publications about predictive, personalized, preventive and participatory (4P) medicine in telemedicine and ehealth were found, of which 48 were identified as relevant. Many of the publications found show how the P4 medicine is being developed in the world and the benefits it provides for patients with different illnesses. After the revision that was undertaken, it can be said that P4 medicine is a vital factor for the improvement of medical services. It is hoped that one of the main contributions of this study is to provide an insight into how P4 medicine in telemedicine and ehealth is being applied, as well as proposing outlines for the future that contribute to the improvement of prevention and prediction of illnesses.

The body language of place: A new method for mapping intergenerational "geographies of embodiment" in place-health research

Research on place and health has grown rapidly in recent years, including examining the physiological embodiment of place-based exposures. While this research continues to improve understanding of why place matters, there is particular need for work capable of revealing: 1) which places matter, i.e. spatially-specific notions of "place"); 2) how these places matter-processes and mechanisms of the physiological embodiment of place; and 3) potential intergenerational and life stage differences in place-embodiment experiences/perceptions. The research presented here seeks to make contributions in each of these areas through developing the "geographies of embodiment" concept. Drawing from a multi-method intergenerational community-based participatory research project examining place and health, the research presented here specifically highlights X-Ray Mapping as a new methodology to elucidate subjective notions of place-embodiment within place-health research. Participants were recruited as parent-child dyads and trained in four participatory research methods, including X-Ray Mapping. Participants used X-Ray Mapping and a multimedia-enabled web-based mapping platform to map their "geographies of embodiment". X-Ray Mapping results revealed that 49% of youth place-embodiment locations were spatially outside of their residential census tract-with 75% of positive place-embodiment locations outside, and 66% of negative place-embodiment locations inside. Overall, 67% of youth and adult positive place-embodiment locations were outside of their residential census tract. Through mapping "geographies of embodiment" via participatory methods like X-Ray Mapping, we can gain greater insight into what is embodied (i.e. specific experiences/exposures), and where (i.e. spatially-specific). These gains could improve development of quantitative place-health metrics and enhance efforts to uncover/intervene on the "pathways of embodiment"-specifically, those elements of local social, political, economic, and environmental contexts that constitute expressions of social inequality.

Team Science, Justice, and the Co-Production of Knowledge

Science increasingly consists of interdisciplinary team-based research to address complex social, biomedical, public health, and global challenges through a practice known as team science. In this article, I discuss the added value of team science, including participatory team science, for generating scientific knowledge. Participatory team science involves the inclusion of public stakeholders on science teams as co-producers of knowledge. I also discuss how constructivism offers a common philosophical foundation for both community psychology and team science, and how this foundation aligns well with contemporary developments in science that emphasize the co-production of knowledge. I conclude with a discussion of how the co-production of knowledge in team science can promote justice.

The complexities and contradictions in participatory research with vulnerable children and young people: A qualitative systematic review

Participatory research carried out by or with children, has become a well-established and valuable part of the research landscape investigating children's lives, views and needs. So too has a critical agenda about its ethical implications and methodological complexities. One criticism is that the involvement of children who may be considered 'vulnerable' or 'marginalised' has been slower to take root within mainstream participatory practice. This means that there has been less focus on how groups such as disabled children or children affected by abuse or neglect can shape and challenge adult-dominated types of knowledge and decision-making that are likely to affect them. This article reports on the findings of a qualitative systematic literature review of thirteen contemporary papers. The review was undertaken by a UK team in 2017. The included articles explored some core ethical and methodological issues involved in carrying out participatory research with vulnerable children and young people. It reports on three themes: 1) The extent to which participatory spaces could recalibrate opportunities and attention given to marginalised and silenced groups; 2) The ways in which these children and young people could develop skills and exercise political and moral agency through participatory activity, and, 3) How to facilitate meaningful engagement with individuals and groups and reconcile this with a critical appreciation of the important but limited nature of research as means of political and social change. The review provides a unique, contemporary analysis of participatory research with vulnerable children, illuminating in particular its conceptual complexities and contradictions, particularly regarding power, empowerment and voice. Its overall utility and interest is augmented by the disciplinary and geographical breadth of the included articles, rendering it relevant to many contexts and countries.

PhotoVoice is a feasible method of program evaluation at a center serving adults with autism

The purpose of this small-scale pilot study, was to assess the feasibility of PhotoVoice as a participatory method of program evaluation for the Hussman Center for Adults with Autism (HCAA), a community-based center in greater Baltimore, MD. PhotoVoice is a data collection method that uses photography to give informants, in this case three adults with autism spectrum disorder (ASD), the opportunity to voice their opinions, concerns, and ideas for programs they participate in. This participatory approach serves to empower individuals and communities, and increases the likelihood that the generated information will be used and recommendations will be implemented. Although some challenges to implementation have been described in the literature, PhotoVoice has also been shown to improve the quality and validity of findings. This benefit is especially relevant when targeting feedback from individuals such as those with ASD, whose voices have to date been underrepresented in the literature. In conducting a PhotoVoice pilot study, the researchers sought to determine its effectiveness as a data collection method and to identify potential roadblocks that may affect applicability to a larger study. Collected photographs and feedback allowed for rich analysis and interpretation. Researchers determined that PhotoVoice was a feasible participatory method of program evaluation that highlighted the strengths and capabilities of the community, and could enable informants to have a collaborative role in shaping a program designed to address their needs. Based on the outcomes of this pilot study, it is recommended that PhotoVoice be used in a larger population of adults with ASD.

Reflecting on Participatory, Action-Oriented Research Methods in Community Psychology: Progress, Problems, and Paths Forward

This paper provides a critical reflection on participatory action research (PAR) methods as they pertain to community psychology. Following a brief review of the fundamental aspects of PAR, key developments in the field are examined. These developments include the redefinition of the research enterprise among groups such as Indigenous and consumer/survivor communities, challenges that attend the "project" framing of PAR, academic and practice context challenges, and important domains in which PAR methods need to become more engaged (e.g., social media and disenfranchised youth). Three illustrative case studies of programs of work in the areas of youth homelessness, consumer/survivor engagement, and Indigenous research are provided to illustrate these contemporary challenges and opportunities in the field. The authors make the argument that without an effort to reconsider and redefine PAR, moving away from the stereotypical PAR "project" frame, these methods will continue to be poorly represented and underutilized in community psychology.

Engaging stakeholders: lessons from the use of participatory tools for improving maternal and child care health services

Background

Effective stakeholder engagement in research and implementation is important for improving the development and implementation of policies and programmes. A varied number of tools have been employed for stakeholder engagement. In this paper, we discuss two participatory methods for engaging with stakeholders – participatory social network analysis (PSNA) and participatory impact pathways analysis (PIPA). Based on our experience, we derive lessons about when and how to apply these tools.

Methods

This paper was informed by a review of project reports and documents in addition to reflection meetings with the researchers who applied the tools. These reports were synthesised and used to make thick descriptions of the applications of the methods while highlighting key lessons.

Results

PSNA and PIPA both allowed a deep understanding of how the system actors are interconnected and how they influence maternal health and maternal healthcare services. The findings from the PSNA provided guidance on how stakeholders of a health system are interconnected and how they can stimulate more positive interaction between the stakeholders by exposing existing gaps. The PIPA meeting enabled the participants to envision how they could expand their networks and resources by mentally thinking about the contributions that they could make to the project. The processes that were considered critical for successful application of the tools and achievement of outcomes included training of facilitators, language used during the facilitation, the number of times the tool is applied, length of the tools, pretesting of the tools, and use of quantitative and qualitative methods.

Conclusions

Whereas both tools allowed the identification of stakeholders and provided a deeper understanding of the type of networks and dynamics within the network, PIPA had a higher potential for promoting collaboration between stakeholders, likely due to allowing interaction between them. Additionally, it was implemented within a participatory action research project. PIPA also allowed participatory evaluation of the project from the perspective of the community. This paper provides lessons about the use of these participatory tools.

Electronic supplementary material

The online version of this article (doi:10.1186/s12961-017-0271-z) contains supplementary material, which is available to authorized users.

Using Participatory System Dynamics Modeling to Examine the Local HIV Test and Treatment Care Continuum in Order to Reduce Community Viral Load

Achieving community-level goals to eliminate the HIV epidemic requires coordinated efforts through community consortia with a common purpose to examine and critique their own HIV testing and treatment (T&T) care system and build effective tools to guide their efforts to improve it. Participatory system dynamics (SD) modeling offers conceptual, methodological, and analytical tools to engage diverse stakeholders in systems conceptualization and visual mapping of dynamics that undermine community-level health outcomes and identify those that can be leveraged for systems improvement. We recruited and engaged a 25-member multi-stakeholder Task Force, whose members provide or utilize HIV-related services, to participate in SD modeling to examine and address problems of their local HIV T&T service system. Findings from the iterative model building sessions indicated Task Force members' increasingly complex understanding of the local HIV care system and demonstrated their improved capacity to visualize and critique multiple models of the HIV T&T service system and identify areas of potential leverage. Findings also showed members' enhanced communication and consensus in seeking deeper systems understanding and options for solutions. We discuss implications of using these visual SD models for subsequent simulation modeling of the T&T system and for other community applications to improve system effectiveness.

A qualitative study to identify parents' perceptions of and barriers to asthma management in children from South Asian and White British families

Background

Over one million children receive treatment for asthma in the UK. South Asian children experience excess morbidity and higher rates of hospitalization than the White population. This study aimed to explore perceptions and experiences of asthma and asthma management in British South Asian and White British families, to identify barriers to optimal management and to inform culturally appropriate interventions to improve management.

Methods

A qualitative methodology, using semi-structured interviews was adopted. Members of 30 families from six major South Asian ethnic-religious groups were purposively sampled (n = 49). For comparison, 17 White British parents were interviewed. Topics included understandings of asthma; day-to-day management; interactions with health care providers and the perceived quality of healthcare services. Data were analyzed using interpretive thematic analysis, facilitated by NVivo. Similarities and differences between South Asian and White families were analysed across key themes.

Results

Many of the problems facing families of a child with asthma were common to South Asian and White British families. Both had limited understanding of asthma causes and triggers and expressed confusion about the use of medications. Both groups reported delays in receiving a clear diagnosis and many experienced what was perceived as uncoordinated care and inconsistent advice from health professionals. No family had received an asthma plan. South Asian families had more difficulty in recognising severity of symptoms and those with limited English faced additional barriers to receiving adequate information and advice about management due to poor communication support systems. South Asian parents reported higher levels of involvement of wider family and higher levels of stigma. Attendance at the emergency department was related to previous experience, difficulties in accessing primary care, lack of knowledge of alternatives and difficulties in assessing severity.

Conclusions

Barriers to optimal asthma management exist at the individual family, community and healthcare systems levels. Culturally sensitive, holistic and collaboratively designed interventions are needed. Improved communication support for families with lower proficiency in English is required. Healthcare professionals need to ensure that families receive an asthma plan and make greater efforts to check families’ understandings of asthma triggers, use of medications, assessment of asthma severity and accessing help.

Using participatory methods to design an mHealth intervention for a low income country, a case study in Chikwawa, Malawi

BACKGROUND

mHealth holds the potential to educate rural communities in developing countries such as Malawi, on issues which over-burdened and under staffed health centres do not have the facilities to address. Previous research provides support that mHealth could be used as a vehicle for health education campaigns at a community level; however the limited involvement of potential service users in the research process endangers both user engagement and intervention effectiveness.

METHODS

This two stage qualitative study used participatory action research to inform the design and development of an mHealth education intervention. First, secondary analysis of 108 focus groups (representing men, women, leadership, elderly and male and female youth) identified four topics where there was a perceived health education need. Second, 10 subsequent focus groups explored details of this perceived need and the acceptability and feasibility of mHealth implementation in Chikwawa, Malawi.

RESULTS

Stage 1 and Stage 2 informed the design of the intervention in terms of target population, intervention content, intervention delivery and the frequency and timing of the intervention. This has led to the design of an SMS intervention targeting adolescents with contraceptive education which they will receive three times per week at 4 pm and will be piloted in the next phase of this research.

CONCLUSION

This study has used participatory methods to identify a need for contraception education in adolescents and inform intervention design. The focus group discussions informed practical considerations for intervention delivery, which has been significantly influenced by the high proportion of users who share mobile devices and the intervention has been designed to allow for message sharing as much as possible.

Exploring adaptations to climate change with stakeholders: A participatory method to design grassland-based farming systems

Research is expected to produce knowledge, methods and tools to enhance stakeholders' adaptive capacity by helping them to anticipate and cope with the effects of climate change at their own level. Farmers face substantial challenges from climate change, from changes in the average temperatures and the precipitation regime to an increased variability of weather conditions and the frequency of extreme events. Such changes can have dramatic consequences for many types of agricultural production systems such as grassland-based livestock systems for which climate change influences the seasonality and productivity of fodder production. We present a participatory design method called FARMORE (FARM-Oriented REdesign) that allows farmers to design and evaluate adaptations of livestock systems to future climatic conditions. It explicitly considers three climate features in the design and evaluation processes: climate change, climate variability and the limited predictability of weather. FARMORE consists of a sequence of three workshops for which a pre-existing game-like platform was adapted. Various year-round forage production and animal feeding requirements must be assembled by participants with a computerized support system. In workshop 1, farmers aim to produce a configuration that satisfies an average future weather scenario. They refine or revise the previous configuration by considering a sample of the between-year variability of weather in workshop 2. In workshop 3, they explicitly take the limited predictability of weather into account. We present the practical aspects of the method based on four case studies involving twelve farmers from Aveyron (France), and illustrate it through an in-depth description of one of these case studies with three dairy farmers. The case studies shows and discusses how workshop sequencing (1) supports a design process that progressively accommodates complexity of real management contexts by enlarging considerations of climate change to climate variability and low weather predictability, and (2) increases the credibility and salience of the design method. Further enhancements of the method are outlined, especially the selection of pertinent weather scenarios.

YouTube as a crowd-generated water level archive

In view of the substantial costs associated with classic monitoring networks, participatory data collection methods can be deemed a promising option to obtain complementary data. An emerging trend in this field is social media mining, i.e., harvesting of pre-existing, crowd-generated data from social media. Although this approach is participatory in a broader sense, the users are mostly not aware of their participation in research. Inspired by this novel development, we demonstrate in this study that it is possible to derive a water level time series from the analysis of multiple YouTube videos. As an example, we studied the recent water level rise in Dahl Hith, a Saudi Arabian cave. To do so, we screened 16 YouTube videos of the cave for suitable reference points (e.g., cave graffiti). Then, we visually estimated the distances between these points and the water level and traced their changes over time. To bridge YouTube hiatuses, we considered own photos taken during two site visits. For the time period 2013-2014, we estimate a rise of 9.5m. The fact that this rise occurred at a somewhat constant rate of roughly 0.4m per month points towards a new and permanent water source, possibly two nearby lakes formed from treated sewage effluent. An anomaly in the rising rate is noted for autumn 2013 (1.3m per month). As this increased pace coincides with a cluster of rain events, we deem rapid groundwater recharge along preferential flow paths a likely cause. Despite the sacrifice in precision, we believe that YouTube harvesting may represent a viable option to gather historical water levels in data-scarce settings and that it could be adapted to other environments (e.g., flood extents). In certain areas, it might provide an additional tool for the monitoring toolbox, thereby possibly delivering hydrological data for water resources management.

Using participant-empowered visual relationship timelines in a qualitative study of sexual behaviour

This study examines how the use of participant-empowered visual relationship timelines adds to the quality of an ongoing qualitative data collection in a case study examining the influence of emotions on sexual risk-taking and perceptions of HIV risk among men who have sex with men. Gay and bisexual men (n = 25) participated in a 10-week, three-phase study. During a baseline in-depth interview, participants created a visual timeline using labelled stickers to retrospectively examine their dating/sexual histories. Participants then completed three web-based quantitative personal relationship diaries, tracking sexual experiences during follow-up. These data were extracted and discussed in a timeline-based debrief interview. The visual cues assisted with data collection by prompting discussion through the immediate identification of patterns, opportunities for self-reflection, and rapport-building. The use of flexible data collection tools also allowed for a participant-empowered approach in which the participant controlled the interview process. Through this process, we learned strategies for improving a participant-empowered approach to qualitative research, including: allowing visual activities to drive the interview, using flexible guidelines to prompt activities, and using discrete imagery to increase participant comfort. It is important that qualitative data collection utilise more participatory approaches for gains in data quality and participant comfort.