A Handbook for Action Research in Health and Social Care

Carol Munn-Giddings, Richard Winter

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134590698
• Edition: 1
• Topic: Médecine
• Subtopic: Santé générale

Action research is a form of research closely linked to practice which can readily be undertaken by practitioners and service users. This handbook offers a comprehensive guide to action research as a strategy for inquiry and development in health and social care. It can be used by individuals or groups working independently on their own projects or as a basis for a tutor-led course. It features
* an introduction to the theories behind action research and other forms of research related to it
*lively case studies from social work, nursing, mental health care and community work
* a step-by-step study guide.
The theoretical section of the book provides a general definition of action research, compares action research with other forms of social research, outlines the nature of a 'culture of inquiry' in the workplace, and describes the links between action research and service-user research, management, community development, evaluation, reflective practice, feminist research and anti-racist research.
This practical study guide covers issues such as preparing a proposal, ethics and principles of procedure, gathering and analysing data, writing a report, the links between action research and critical reflection. It will be particularly useful for groups wishing to undertake action research on an independent basis

Part I

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The nature of action research

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Chapter 1

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Introduction

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Prologue

This book is about the use of action research as a strategy for inquiry and development. It proposes a form of social research which is not a separate, specialised, technical activity but one which is closely linked to practice and which can be undertaken by practitioners and service-users. It presents a general theoretical explanation, a series of specific examples illustrating a variety of approaches and contexts, and detailed practical guidance for those wishing to undertake an action research project.

The book is particularly addressed to managers, service-users, staff workers and educators involved in social and health care and community development but those concerned with teaching and with management more generally will also find almost all the arguments and examples applicable to their own contexts. We have in mind several rather different forms of inquiry, and the following list gives an idea of the range of contexts and people we hope to address:

• efforts on the part of staff in caring organisations (hospitals, social services departments, voluntary agencies, residential facilities, day centres, etc.) to develop their care work with patients/clients/service-users;

• efforts on the part of service-user groups to develop their own services and/or improve the quality of services provided, either by gathering the views of service-users or by working in partnership with staff;

• efforts on the part of professional educators/trainers/tutors to facilitate the development of community, health and social care practices and to foster ‘professional’ learning;

• efforts on the part of managers to improve the quality of services through developing managerial processes and relationships;

• efforts on the part of community-based staff in mobilising efforts to develop and promote community action and support facilities such as advice and drop-in centres.

This variety means that it is sometimes difficult to find words which will seem exactly appropriate for all our anticipated readers. In particular, such words as ‘work’ and ‘practice’ are intended to refer to all the activities listed above, whether undertaken by managers, educators, service-users or social and health care staff and community workers (with or without professional qualifications). Similarly, the term ‘practice context’ is intended to refer to service-user group meetings, hospitals, care agencies and educational/training processes. If sometimes our phrasing seems to be excluding some of these activities, we apologise: our arguments about action research and our examples of practical work are fully intended to be relevant for the whole variety of readers and contexts indicated above.

Outline structure of the book

As indicated in the Preface, the book may be used in different ways by readers with different purposes. As a handbook, it is not necessarily intended to be read straight through.

The next section of this chapter introduces the concept of action research through discussion of a specific example, and ends with a preliminary ‘definition’.

Chapter 2 explores further how action research is different from other forms of research, arguing that it is an extension of ‘reflective practice’ in professional work and showing how it is different from (but related to) conventional quantitative research and conventional qualitative research. It shows how action research transforms key aspects of the inquiry process and ends with an account of ‘cultures of inquiry’ in the workplace.

Chapter 3 presents the range and variety of action research, discussing key themes of power, validity, collaboration, and reflection on personal experience, drawn from:

service-user research

community development

theories of management and organisational change

theories of critical reflection and evaluation

educational action research

feminist research

anti-racist research

Part II (Chapters 4-14) illustrates further the variety of action research, comprising a series of contrasting reports of practical projects from differing contexts: nursing, social work, community development, professional education and service-user research. Each report is complete and self-explanatory, and provides for those interested in undertaking an action research project a possible way of focusing, planning and carrying out a useful piece of work. Together, these chapters demonstrate in practical detail action research's range of purposes, research relationships, results, methods, and styles of reporting.

Part II provides comprehensive step-by-step guidance on planning and undertaking an action research project. It contains detailed discussion documents, developed for action research courses over many years, to support each stage of work: clarifying the nature of the project, practical planning, consideration of ethical issues, data gathering, data analysis and writing a research report. It is particularly intended for readers who are about to undertake a research project, and includes advice on how to use the other sections of the book to inform their work at different stages.

Finally, Part IV provides a brief ‘theoretical’ justification for action research to reassure those who are concerned that it may lack the rigour and objectivity of ‘proper research’. This part of the book may be of particular interest to senior managers and those responsible for allocating research funding, in contexts where action research often finds difficulty in gaining recognition and support. The argument of Part IV complements earlier arguments derived from the action research literature (in Part I) to provide a more general grounding for action research's intellectual and professional rationale.

What is ‘action research’?

In discussions of methods for social research, professional development and organisational change, the term ‘action research’ is both appealing and yet somewhat mysterious. Its ambiguity is easy to see: ‘action research’ suggests a single activity which is simultaneously a form of inquiry and a form of practical action. Clearly, any ‘research’ process involves some form of ‘action’ (interviewing, distributing questionnaires, etc.), but ‘action research’ refers to something rather different. It suggests the possibility of a form of social research which involves people in a process of change, which is based in professional, organisational or community action, and which is thus no longer beset by the age-old problem of the gap between ‘theory’ and ‘practice’. (We all know jokes about, for example, professors of physics who can't change a fuse and psychologists who can't manage their own personal relationships.) At the same time, it proclaims an ideal of practical work which is also a form of learning for those involved (action as research). Hence its appeal.

Putting these ideas together, then, ‘action research’ refers to a process which alternates continuously between inquiry and action, between practice and ‘innovative thinking’ (Hart, 2000) – a developmental spiral of practical decision-making and evaluative reflection. It is both reflective practice and practice-based research. A nice idea, perhaps (you say), but what does it really involve? Is it feasible, and if so what does it achieve? Is it really ‘research’? If so, in what sense? In what sense are its outcomes ‘valid’ and/or generalisable? Is it a worthwhile use of precious time? It sounds like hard work: is it worth it? Who benefits? Does it have a sound basis, or is it just a wishy-washy ideal? These are some of the questions we hope to answer in this book.

An introductory example/practical exercise

In order to get some feel for the processes of an action research project and how they differ from other sorts of research, imagine the following scenario. Your organisation has had a windfall: suddenly the sum of £4,000 is available; this will pay for, say, seventy hours of someone's time to investigate an aspect of the work that you are engaged in; and it is up to you to say what the focus of the inquiry should be.

(Before you read any further, make a note of such a topic – something that strongly affects your current work and which you really wish you understood better than you currently do.)

Having decided on your topic, now imagine that you have received the money on condition that the inquiry is carried out by a professional research worker from the organisation's research department or from a university or other external body. What would you ask the researcher to do, and what sort of outcomes would you expect by the end of the inquiry process? And now, in contrast, imagine a slightly different scenario: it is stipulated that you must carry out the inquiry yourself, with the £4,000 being used to ‘cover’ the work you usually do. (Again the time available is seventy hours, to be structured as you wish – perhaps two weeks full time or three hours a week for about four months.) What activities would you engage in, and what outcomes would you expect? Finally, consider the probable differences between these two contrasting situations: what differences might there be in the way you and the outside researcher set about conducting the inquiry, what different conclusions might emerge, and how might the two inquiry processes have a different impact on the work situation?

Let us now consider a concrete example, which reveals, in a preliminary way, some important clues to the nature of action research. Barbara Stansell, a social worker, was, in 1997, responsible for a small team of staff working in a centre for people with learning difficulties. She was worried by what seemed to be an unacceptably high rate of staff absence due to sickness (Stansell, 1997). If resources had been available she could have commissioned an outside researcher to interview the staff and collect their explanations for their absences, together with their proposals for any changes which might improve matters. She might also have asked the researcher to collect comparative data on rates of absence in other, similar teams, in the hope that some useful patterns might emerge, indicating the factors influencing staff absence rates – the size of the team, the profile of its members in terms of age, gender and family situation, the type of client, type of neighbourhood served, level of service-user involvement, etc. At the end of the work, Barbara would have received a report containing a collection of different possible ‘reasons’ for staff absence (some offered by the staff, some in the form of suggested contextual influences) and some positive proposals. This would have been, let us say, a piece of ‘conventional’ social research.

But, in this case, Barbara undertook the inquiry herself, as an ‘action research’ project. And as soon as she began to consider how to approach her staff interviews, she realised that to focus directly on staff absence and sickness might seem so threatening as to be merely counterproductive for all concerned. Instead she needed to focus, positively, on how to improve staff morale, and that decision eventually resulted in her project being very largely concerned with her own management style, and especially with the contradictions in her attempts to be ‘democratic’. (She thought of herself as leaving her staff plenty of scope for their own decisions, but found that in many ways she was much more ‘directive’ than she had thought.) So part of her work involved, for example, discussions with her staff as to how the arrangements for group meetings might be used to increase a sense of participation and achievement. What had started out as a proposal on the part of a manager to ‘interview’ individuals thus became a much more long-term project which was collaborative, focused on the staff group as a whole, and self-evaluative.

Commentary

This example is drawn from an organisational context: it happened to be a day-centre staff team, but it could easily have been a hospital ward or a service-user group. And one can also see how a similar set of alternatives might arise in the context of community work or service-user research, if one was worried about, let us say, the apparent under-utilisation of an Advice and Support Centre. So what general conclusions can we draw?

To begin with, we may note that action research is an approach to social research – understanding how human beings interact with one another, and how we respond to events and situations. Next, it is clear that action research is concerned just as much with the process of inquiry as with its ‘findings’: any research process creates relationships, and action research is concerned that its long-term impact on relationships should be positive as well as illuminating. Even more importantly, action research emphasises the value of insights derived from practical involvement in a situation, rather than the contribution of supposedly ‘objective’ methods applied by outsiders. An outsider acting on Barbara's original formulation of the problem could have done considerable damage to what were already fragile relationships: it was Barbara's concern for her team that led her to realise that the project needed to be refocused. And it is doubtful whether the comparative data would have offered Barbara as much guidance on the nature of her ‘problem’, and what to do about it, as the collaborative process she set up with her staff.

Action research seeks to bridge the ever-present gap between ‘theory’ and practice. It does so in two ways. It places value on the experiential basis for knowledge and it emphasises the practical motive for developing one's understanding:

Action researchers … are inclined to see the development of theory or understanding as a by-product of the improvement of real situations, rather than [seeing] application as a by-product of advances in ‘pure’ theory.

(Carr and Kemmis, 1986: 28)

Action research might be defined as: the study of a social situation with a view to improving the quality of action within it.

(Elliott, 1991: 69)

In other words, action research is based on the assumption that increased understanding will flow from our commitment to try to bring about practical changes.

Finally, it is important to notice the ‘political’ ideal underlying action research. Action research starts from the belief that knowledge about human situations can be generated from our commitment to practical situations, and that our practical involvement can in itself create the understanding which our circumstances require. So we do not need to be dependent on outside experts on social science theory and methodology in order to be able to formulate issues or to determine appropriate methods. Action research is therefore about establishing inquiry processes which are specifically designed to be ‘empowering’ for the subjects of the inquiry. There is a danger of this becoming mere rhetoric: for many of us, encounters with the reality of power are both depressing and distressing, and ‘action research’ doesn't magically change this. But the concept of empowerment is of central importance. It embodies action research's fundamental optimism concerning people's ability and willingness to work together constructively, and also an ideal of democratic participation and responsible citizenship. Action research envisages a process whereby our understanding of ourselves and of the social world in which we are engaged can be developed and deepened as a direct consequence of our practical commitments. For action research, hierarchies of power and status (between academic and practical knowledge, between researchers and practitioners, between professionals and their clients, between experts and laypersons) are seen as inhibiting and impoverishing the creation and distribution of knowledge.

A definition?

Some of the statements already presented could be taken as ‘definitions’ of action research. And by the time you have read further you will probably want to construct your own definition. But at this stage, as a start, we might suggest the following.

Action research is the study of a social situation carried out by those involved in that situation in order to improve both their practice and the quality of their understanding.

Chapter 2

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Action research as an approach to inquiry and development

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The cycle of action and reflection as a model of ‘work’

We have already noted that action research can be seen as a model of ‘work’ as well as a model of ‘research’ (see Chapter 1, p. 5). This chapter presents a general outline of action research from each of these perspectives in turn and concludes with a brief discussion of how we might try to bring the two together by attempting to create a ‘culture of inquiry’ in practice settings. This first main section presents action research in terms of a model of work, involving a continuous cycle of action and reflection. However, the term ‘action research’ immediately brings us face to face with the word ‘research’. So we need to start by showing how ‘research’ can be reinterpreted in a way which brings out its potential link with the tasks and processes of ‘work’, i.e. practical interactions between colleagues, between staff and service-users, between staff and managers, and between service-users in group meetings, etc.

What does ‘research’ mean?

Dictionaries are useful here, as a starting point. They remind us that ‘research’ means to search ‘again’ or repeatedly, and that ‘search’ is connected with the Latin circare, to go round. So we can suggest that to research means to look at something ‘from all sides’ or from several different points of view. It is in this sense that we can understand ‘research’ as examining something ‘carefully’, ‘intensively’, ‘closely’, ‘critically’ in order to ‘discover’ something we did not know before (Shorter Oxford English Dictionary; Concise Oxford Dictionary of English Etymology).

Also, we live in a culture where research is conventionally seen as a specialised role, whose particular t...