Participatory Action Research (PAR) approaches and methods have seen an explosion of recent interest in the social and environmental sciences. PAR involves collaborative research, education and ...action which is oriented towards social change, representing a major epistemological challenge to mainstream research traditions. It has recently been the subject of heated critique and debate and rapid theoretical and methodological development.
This book captures these developments, exploring the justification, theorisation, practice and implications of PAR. It offers a critical introduction to understanding and working with PAR in different social, spatial and institutional contexts. The authors engage with PAR’s radical potential, while maintaining a critical awareness of its challenges and dangers. The book is divided into three parts. The first part explores the intellectual, ethical and pragmatic contexts of PAR; the development and diversity of approaches to PAR; recent poststructuralist perspectives on PAR as a form of power; the ethic of participation; and issues of safety and well-being. Part two is a critical exploration of the politics, places and practices of PAR. Contributors draw on diverse research experiences with differently situated groups and issues including environmentally sustainable practices, family livelihoods, sexual health, gendered experiences of employment, and specific communities such as people with disabilities, migrant groups, and young people. The principles, dilemmas and strategies associated with participatory approaches and methods including diagramming, cartographies, art, theatre, photovoice, video and geographical information systems are also discussed. Part three reflects on how effective PAR is, including the analysis of its products and processes, participatory learning, representation and dissemination, institutional benefits and challenges, and working between research, action, activism and change.
The authors find that a spatial perspective and an attention to scale offer helpful means of negotiating the potentials and paradoxes of PAR. This approach responds to critiques of PAR by highlighting how the spatial politics of practising participation can be mobilised to create more effective and just research processes and outcomes. The book adds significant weight to the recent critical reappraisal of PAR, suggesting why, when, where and how we might take forward PAR’s commitment to enabling collaborative social transformation. It will be particularly useful to researchers and students of Human Geography, Development Studies and Sociology.
1. Introduction: Connecting People, Participation and Place Part 1: Reflection 2. Participatory Action Research: Origins, Approaches and Methods 3. Participation as a Form of Power: Retheorising Empowerment and Spatialising Participatory Action Research 4. Participatory Action Research: Making a Difference to Theory, Practice and Action 5. Toward a Participatory Ethics 6. Participatory Action Research and Researcher Safety Part 2: Action 7. Environment and Development: (Re)Connecting Community and Commons in New England Fisheries, USA 8. Working Towards and beyond Collaborative Resource Management: Parks, People and Participation in the Peruvian Amazon 9. Researching Sexual Health: Two Participatory Action Research Projects in Zimbabwe 10. Gender and Employment: Participatory Social Auditing in Kenya 11. Inclusive Methodologies: Including Disabled People in Participatory Action Research in Scotland and Canada 12. Working with Migrant Communities: Collaborating with the Kalayaan Centre in Vancouver, Canada 13. Peer Research with Youth: Negotiating (Sub)Cultural Capital, Place and Participation in Aotearoa/New Zealand 14. Participatory Diagramming: A Critical View from North East England 15. Participatory Cartographies: Reflections from Research Performances in Fiji and Tanzania 16. Participatory Art: Capturing Spatial Vocabularies in a Collaborative Visual Methodology 17. Participatory Theatre: ‘Creating a Source for Staging an Example’ in the USA 18. Photovoice: Insights into Marginalisation through a ‘Community Lens’ in Saskatchewan, Canada 19. Uniting People with Place Using Participatory Video in Aotearoa/New Zealand: A Ngati Hauiti Journey 20. Participatory GIS: The Humboldt/West Humboldt Park Community GIS Project, Chicago, USA Part 3: Reflection 21. Participatory Data Analysis 22. Participatory Learning: Opportunities and Challenges 23. Beyond the Journal Article: Representations, Audience and the Presentation of Participatory Action Research 24. Linking Participatory Research to Action: Institutional Challenges 25. Relating Action to Activism: Theoretical and Methodological Reflections. Conclusion 26. Conclusion: The Space(s) and Scale(s) of Participatory Action Research: Constructing Empowering Geographies?
Sara Kindon is a Senior Lecturer in Human Geography and Development Studies at Victoria University of Wellington, Aotearoa/New Zealand. Her research interests focus on participation, visuality and cross-cultural research. She has worked in Costa Rica, Indonesia and in rural and urban contexts in Aotearoa/New Zealand.
Rachel Pain is a social geographer at Durham University in the UK. Her research interests include fear, well-being and social justice. She is currently conducting PAR with young asylum seekers, refugees and locally born young people in north east England.
Mike Kesby is a Lecturer in Human Geography at the University of St Andrews, Scotland, UK. His research interests include participatory methods, HIV education programs, gender relations and children’s geographies. He works predominately in rural Zimbabwe.
Kesby reviews and ultimately challenges some recent pointed criticisms of participatory action research, and in the process of doing so he reformulates the conception of empowerment, which has been ...especially important to these kinds of research projects. His own research has been on HIV/Aids education for women in Zimbabwe.
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In this paper we offer a critique and an alternative to current proposals to include the economic and social impacts of research in the next UK audit of academic research. In contrast to most ...responses from UK academics, our argument is for impact; while the growing marketisation of knowledge is to be deplored, resources and activities within universities do have a vital role to play in progressive social change. The problem is that the current proposals will produce and retrench an elite model of power/knowledge relationships. We propose an understanding of impact based on the co-production of knowledge between universities and communities, modelled in research practice in participatory geographies. This is more likely to result in more equitable and radically transformative impacts of knowledge, making us socially accountable rather than driven by economic accountancy.
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Dispensing antibiotics without prescription is among the major factors leading to antimicrobial resistance. Dispensing of antibiotics without prescription has negative impact at the individual and ...societal level leading to poor patient outcomes, and increased risks of resistant bacteria facilitated by inappropriate choice of antibiotics doses/courses. Antimicrobial resistance is a global public health threat which is projected to cause 10 million deaths by 2050 if no significant actions are taken to address this problem This study explored the practices and motives behind dispensing of antibiotics without prescription among community drug outlets in Tanzania. Finding of this study provides more strategies to antibiotics stewardship intervention. In-depth interviews with 28 drug dispensers were conducted for three months consecutively between November 2019 and January 2020 in 12 community pharmacies and 16 Accredited Drug Dispensing Outlets (ADDOs) in the Mwanza, Kilimanjaro and Mbeya regions of Tanzania. Transcripts were coded and analyzed thematically using NVivo12 software. Majority of dispensers admitted to providing antibiotics without prescriptions, selling incomplete courses of antibiotics and not giving detailed instructions to customers on how to use the drugs. These practices were motivated by several factors including customers’ pressure/customers’ demands, business orientation-financial gain of drug dispensers, and low purchasing power of patients/customers. It is important to address the motives behind the unauthorized dispensing antibiotics. On top of the existing regulation and enforcement, we recommend the government to empower customers with education and purchasing power of drugs which can enhance the dispensers adherence to the dispensing regulations. Furthermore, we recommend ethnographic research to inform antibiotic stewardship interventions going beyond awareness raising, education and advocacy campaigns. This will address structural drivers of AMR such as poverty and inadequate government health services, and the disconnect between public messaging and/or policy and the public itself.
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Over-the-counter antibiotic access is common in low-and-middle-income countries and this may accelerate antimicrobial resistance. Our study explores critical aspects of the drug seller-client ...interaction and antibiotic dispensing patterns for simulated COVID-19 symptoms during the pandemic in two study sites in Tanzania and Uganda, countries with different government responses to the pandemic.
Research assistants posing as clients approached different types of drug sellers such as pharmacies (Pharms), drug shops (DSs), and accredited drug dispensing outlets (ADDOs) in Mwanza, Tanzania (nPharms = 415, nADDOs = 116) and Mbarara, Uganda (nPharms = 440, nDSs = 67), from June 10 to July 30, 2021. The mystery clients held no prescription and sought advice for simulated COVID-19 symptoms from the drug sellers. They documented the quality of their interaction with sellers and the type of drugs dispensed.
Adherence to COVID-19 preventive measures and vigilance to COVID-19 symptoms was low in both sites but significantly higher in Uganda than in Tanzania. A higher percentage of drug sellers in Mbarara (Pharms = 36%, DSs = 35%, P-value = 0.947) compared to Mwanza (Pharms = 9%, ADDOs = 4%, P-value = 0.112) identified the client's symptoms as possibly COVID-19. More than three-quarters of drug sellers that sold prescription-only medicines in both Mbarara (Pharms = 86%, DSs = 89%) and Mwanza (Pharms = 93%, ADDOs = 97%) did not ask the MCs for a prescription. A relatively high percentage of drug sellers that sold prescription-only medicines in Mwanza (Pharms = 51%, ADDOs = 67%) compared to Mbarara (Pharms = 31%, DSs = 42%) sold a partial course without any hesitation. Of those who sold antibiotics, a higher proportion of drug sellers in Mbarara (Pharms = 73%, DSs = 78%, P-value = 0.580) compared to Mwanza (Pharms = 40% ADDOs = 46%, P-value = 0.537) sold antibiotics relevant for treating secondary bacterial infections in COVID-19 patients.
Our study highlights low vigilance towards COVID-19 symptoms, widespread propensity to dispense prescription-only antibiotics without a prescription, and to dispense partial doses of antibiotics. This implies that drug dispensing related to COVID-19 may further drive AMR. Our study also highlights the need for more efforts to improve antibiotic stewardship among drug sellers in response to COVID-19 and to prepare them for future health emergencies.
The overuse of antimicrobial medicines is a global health concern, including as a major driver of antimicrobial resistance. In many low- and middle-income countries, a substantial proportion of ...antibiotics are purchased over-the-counter without a prescription. But while antibiotics are widely available, information on when and how to use them is not.
We aimed to understand the acceptability among experts and professionals of sharing information on antibiotic use with end users - patients, carers and farmers - in Uganda, Tanzania and Malawi.
Building on extended periods of fieldwork amongst end-users and antibiotic providers in the three countries, we conducted two workshops in each, with a total of 44 medical and veterinary professionals, policy makers and drug regulators, in December 2021. We carried out extensive documentary and literature reviews to characterise antibiotic information systems in each setting.
Participants reported that the general public had been provided information on medicine use in all three countries by national drug authorities, health care providers and in package inserts. Participants expressed concern over the danger of sharing detailed information on antibiotic use, particularly that end-users are not equipped to determine appropriate use of medicines. Sharing of general instructions to encourage professionally-prescribed practices was preferred.
Without good access to prescribers, the tension between enclaving and sharing of knowledge presents an equity issue. Transitioning to a client care-centred model that begins with the needs of the patient, carer or farmer will require sharing unbiased antibiotic information at the point of care.
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This paper explores the contribution that geographers can make to debates about the nature and utility of participatory approaches. It argues for a constructive reconciliation between these ...approaches and the growing poststructural critique of participation. Through an examination of the similarities and entanglements between power and empowerment it highlights the centrality of geographical issues to understanding how participation works and how its resources might be distanciated beyond the arenas of participatory projects to produce empowering effects elsewhere.
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IntroductionAntimicrobial resistance (AMR) is a global health threat that requires urgent research using a multidisciplinary approach. The biological drivers of AMR are well understood, but factors ...related to treatment seeking and the social contexts of antibiotic (AB) use behaviours are less understood. Here we describe the Holistic Approach to Unravel Antibacterial Resistance in East Africa, a multicentre consortium that investigates the diverse drivers of drug resistance in urinary tract infections (UTIs) in East Africa.Methods and analysisThis study will take place in Uganda, Kenya and Tanzania. We will conduct geospatial mapping of AB sellers, and conduct mystery client studies and in-depth interviews (IDIs) with drug sellers to investigate AB provision practices. In parallel, we will conduct IDIs with doctors, alongside community focus groups. Clinically diagnosed patients with UTI will be recruited from healthcare centres, provide urine samples and complete a questionnaire capturing retrospective treatment pathways, sociodemographic characteristics, attitudes and knowledge. Bacterial isolates from urine and stool samples will be subject to culture and antibiotic sensitivity testing. Genomic DNA from bacterial isolates will be extracted with a subset being sequenced. A follow-up household interview will be conducted with 1800 UTI-positive patients, where further environmental samples will be collected. A subsample of patients will be interviewed using qualitative tools. Questionnaire data, microbiological analysis and qualitative data will be linked at the individual level. Quantitative data will be analysed using statistical modelling, including Bayesian network analysis, and all forms of qualitative data analysed through iterative thematic content analysis.Ethics and disseminationApprovals have been obtained from all national and local ethical review bodies in East Africa and the UK. Results will be disseminated in communities, with local and global policy stakeholders, and in academic circles. They will have great potential to inform policy, improve clinical practice and build regional pathogen surveillance capacity.
Worldwide, antimicrobial resistance is increasing rapidly and is associated with misuse of antimicrobials. The HATUA study (a broader 3-country study) investigated the antibiotic dispensing practices ...of pharmaceutical providers to clients, particularly the propensity to dispense without prescription. A cross-sectional study using a 'mystery client' method was conducted in 1148 community pharmacies and accredited drugs dispensing outlets (ADDO) in Mwanza (
= 612), Mbeya (
= 304) and Kilimanjaro (
= 232) in Tanzania. Mystery clients asked directly for amoxicillin, had no prescription to present, did not discuss symptoms unless asked when asked reported UTI-like symptoms and attempted to buy a half course. Dispensing of amoxicillin without prescription was common 88.2, 95%CI 86.3-89.9%, across all three regions. Furthermore, the majority of outlets sold a half course of amoxicillin without prescription: Mwanza (98%), Mbeya (99%) and Kilimanjaro (98%). Generally, most providers in all three regions dispensed amoxicillin on demand, without asking the client any questions, with significant variations among regions
-value = 0.003. In Mbeya and Kilimanjaro, providers in ADDOs were more likely to do this than those in pharmacies but no difference was observed in Mwanza. While the Tanzanian government has laws, regulations and guidelines that prohibit antibiotic dispensing without prescription, our study suggests non-compliance by drug providers. Enforcement, surveillance, and the provision of continuing education on dispensing practices is recommended, particularly for ADDO providers.
Completion of tuberculosis (TB) treatment presents several challenges to patients, including long treatment duration, medication adverse-effects and heavy pill burden. WHO emphasize the need for ...patient-centered TB care, but such approaches require understanding of patient experiences and perceptions.
In 2020, we nested a qualitative study within a clinical trial that recruited 128 HIV-TB co-infected adults in Kampala receiving rifampicin-based TB treatment, alongside anti-retroviral therapy. A purposively selected sub-sample of 46 trial participants contributed to nine gender segregated focus group discussions. Of these, 12 also participated in in-depth interviews. Sessions were recorded, transcribed verbatim and translated from local languages into English. Thematic analysis focused on drug adverse-effects, use of self-prescribed medications and barriers to treatment adherence.
Patients seemed more concerned about adverse effects that clinicians sometimes overlook such as change in urine color. Those who remembered pre-treatment counselling advice were disinclined to manage adverse-effects by self-prescription. Difficulty in accessing a medical practitioner was reported as a reason for self-medication. Obstacles to adherence included stigma (especially from visible adverse-effects like “red urine”), difficulties with pill size and number, discomfort with formulation and medication adverse effects.
Tailored pre-treatment counselling, improved access to clinical services, and simpler drug administration will deliver more patient-centered care.
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