Data collection for Public Health Decision making can

Data collection for Public Health Decision making: can the use of Participatory Action Research (PAR) add value? Dr. Orest Sebastian Masue, Dr. Mackfallen G. Anasel & Dr. Idda Lyatonga Swai 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 1

Introduction • Public health decision making is an important task in Health Systems Management that involves setting of goals, developing strategies, and outlining activities and schedules to accomplish the goals. • In order to be able to make good public health decisions, collection of valid and reliable data is of paramount importance • The collected data should then be processed to yield information which is essential for decision making 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 2

Purpose of the paper • This paper seeks to accomplish the following tasks: – it delineates the meaning of data and the link between data and information; – it analyzes the importance of quality data in public health decision making – it shows the meaning, origin, process and value of using PAR in the collection of data for Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference public health decision making Centre 10/2/2020 3

Meaning of data • Is a representation of facts, concepts or instructions in a formalized manner suitable for communication, interpretation, or processing by humans or by automatic means. • Data can be either in numerical (quantitative) or narrative text and image forms (qualitative). 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 4

The link between data &information • There is a close link between data and information. • Information usually implies data that is organized in a meaningful way so that it gives meaning to the person receiving it. • Thus, the link between data and information is that the former is raw material for the latter. • Information is a result of transformation of raw data through the so called data 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 5

Why do we need quality data for public health decision making? • Data can help cut costs by avoiding uninformed public health decisions through promotion of evidence based decision making • It helps to increase transparency and accountability in both decision making and implementation of the decisions • Helps to enhance effectiveness in public health interventions • Data provides the basis for public health decisions Annual Health Monitoring and Evaluation 10/2/2020 Conference, Seascape Hotel & Conference Centre 6

Meaning of PAR • PAR is one of the qualitative approaches to research and learning that uses different methods to address issues or possibilities identified and defined by a particular community. • It is about improvement of practice through creation of knowledge in social groups. • PAR creates new ways of working, interacting, and knowing that are consistent with the affected community’s dispositions. 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 7

PAR… • It is a systematic inquiry with the collaboration of those affected by the issue being studied, for purposes of education and taking action or effecting change • Participatory research attempts to present people as researchers themselves in pursuit of answers to the questions of their daily struggle and survival • Participatory research attempts to break down the distinction between the researchers and the researched, the subjects and objects of knowledge production by the participation of the people-for. Annualprocess Health Monitoring and Evaluation themselves in the of gaining and creating Conference, Seascape Hotel & Conference Centre knowledge. 10/2/2020 8

PAR… • PAR, In process research a seen only as not of is creating knowledge, but also (simultaneously) as education and development of consciousness, and of mobilization for action • PAR creates knowledge that is useful and meaningful. It validates local knowledge by recognizing that participants are capable of analyzing the situation and develop solutions to the challenges that face them. • It also questions common assumptions about what counts as knowledge; and recognizes that Annual Health Monitoring and Evaluation 10/2/2020 9 Conference, Seascape Hotel & Conference knowledge is the meaning that people attribute to Centre

Principles of PAR • Community is recognized as a unit of identity: – Defined common geographical location – Or dispersed geographical location but sharing some common interests – Explicit engagement • PAR makes use of the strengths and resources within the community by supporting and reinforcing social structures, processes, and existing knowledge in the community that help them work Annual Health Monitoring and Evaluation together to improve their lives. 10/2/2020 10 Conference, Seascape Hotel & Conference Centre

Principles PAR… • PAR is a collaborative partnership in all phases of the research. • It involves community members at every phase , including but not limited to: – problem definition, – data collection, – Analysis and interpretation of results, and – application of the results to address community concerns. • This may involve applying skills from outside the community, focusing on issues identified by the Annual Health Monitoring and Evaluation community and create situations in which all parties can Conference, Seascape Hotel & Conference 10/2/2020 11 Centre

Principles of PAR… • PAR Integrates knowledge and action for mutual benefit of all partners. Though the research project itself might not include a direct action component, all parties must have a commitment to applying the research results to a social change effort intended to benefit all partners. • PAR Promotes a co-learning and empowering process that attends to social inequalities. It recognize the inherent inequalities between marginalized communities and researchers, and in turn attempt to address these by emphasizing knowledge of community members and sharing information, resources and decision-making power. • PAR involves a cyclical and iterative process. It involves trustbuilding, partnership development and maintenance in all Annual Health Monitoring and Evaluation 10/2/2020 12 Conference, Seascape Hotel & Conference phases of the research. Centre

Principles of PAR… • PAR disseminates findings and knowledge gained to all partners in a respectful and understandable language that acknowledges all participants’ contributions and ownership of the knowledge production. 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 13

The Origin of PAR • PAR can be traced to the work of Kurt Lewin (1944), who is considered the founder of action research • Lewin introduced the term action research as a tactic to studying a social system while attempting to impart changes at the same time • emphasis was on the importance of clientorientated attempts to solving particular social problems 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 14

Origin • PAR can also be traced to Paulo Freire (Adult Educationist), who believed that critical reflection was crucial for personal and social change • Freire’s PAR was concerned with empowering the poor and marginalized members of society about issues pertaining to literacy, land reform analysis, and the community (Freire, 1970). 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 15

Origin… • For Freire, human consciousness brings a reflection on material reality, whereby critical reflection is already action. 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 16

PAR process 1. Choose the issue: what is the issue? Expertise and experience is important here. A clear research question has to be framed 2. Choose participants & research team 3. Organizing Funding & other resources 4. Choosing methodological approach: How will evidence be gathered? 5. Data analysis: How will the data be analyzed 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 17

PAR process… 6. Interpretation of the results 7. How will the team act on the results? What and How? 8. Evaluation of the project: how far the intentions of no. 7 above have been realized? 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 18

Key methods • In-depth interviews • Participant observation • FGDs 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 19

Strengths • PAR recognizes and values that people are social beings, within political, economic, and social contexts • It addresses issues of significance to the flourishing of human persons, their communities, and the wider ecology in which we participate • PAR empowers the participants, hence sense of ownership of and support to the decision/interventions • PAR is an educative process 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 20

CHALLENGES • Funding • Divergence of perspectives, values, and abilities among community member • Consensus for determining what social issues require attention and the timeframe • If not well managed particularly the issue of power imbalances PAR can be disastrous 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 21

CONCLUDING THOUGHTS • Evidence from the literature has shown that PAR is a challenging methodological approach to gathering information for public health decision making. • However, the adequacy of PAR methodology in ensuring that the affected parties get opportunity to analyze their own situation and develop appropriate solutions to the challenges that they face is explicit. • This leads us to the conclusion that PAR can add value to public health decision making insofar as it enhances a sense of ownership and commitment by local community members to the implementation of the Annual Health Monitoring and Evaluation decisions. Conference, Seascape Hotel & Conference 10/2/2020 Centre 22

REFERENCES Armstrong, R. , Waters, E. , Moore, L. , Dobbins, M. , Pettman, T. , Burns, C. , . . . & Petticrew, M. (2014). Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting. Implementation Science, 9(1), 188. Brownson, R. C. , Baker, E. A. , Deshpande, A. D. , & Gillespie, K. N. (2017). Evidence-based public health. Oxford University Press. Cargo, M. , & Mercer, S. L. (2008). The value and challenges of participatory research: strengthening its practice. Annu. Rev. Public Health, 29, 325 -350. Coulter, A. , Parsons, S. , Askham, J. (2008). Where are the patients in decision-making about their own care? World Health Organization. Baum, F. , Mac. Dougall, C. , & Smith, D. (2006). Participatory action research. Journal of Epidemiology & Community Health, 60(10), 854 -857. 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 23

REFERENCES… Green, Lawrence W. ; M. Anne George; Mark Daniel; C. James Frankish; Carol P. Herbert; William R. Bowie and Michel O’Neill (2003). “Appendix C: Guidelines for Participatory Research in Health Promotion, ” in Minkler, Meredith and Nina Wallerstein(eds), Community-Based Participatory Research for Health. San Francisco, CA: Jossey-Bass Inc. Israel, B. A. , Schulz, A. J. , Parker, E. A. , & Becker, A. B. (1998). Review of community-based research: assessing partnership approaches to improve public health. Annual review of public health, 19(1), 173202. Processes: Systematic Review. PLo. S ONE 6(7): e 21704. Mac. Donald, C. (2012). Understanding participatory action research: A qualitative research methodology option. The Canadian Journal of Action Research, 13(2), 34 -50. Minkler, M. , & Wallerstein, N. (Eds. ). (2011). Community-based participatory research for health: From process to outcomes. John Wiley & Sons. Annual Health Monitoring and Evaluation Orton L, Lloyd-Williams F, Taylor-Robinson D, O'Flaherty M, Capewell S 10/2/2020 24 Conference, Seascape Hotel & Conference Centre (2011) The Use of Research Evidence in Public Health Decision

REFERENCES… Wallerstein, N. , & Duran, B. (2010). Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity. American journal of public health, 100(S 1), S 40 -S 46. 10/2/2020 Annual Health Monitoring and Evaluation Conference, Seascape Hotel & Conference Centre 25