Table 4

Examples of participatory methods in implementation research

Participatory action researchThere have been several cluster randomised trials evaluating the effect of women’s groups using participatory learning and action (PLA) to improve the delivery of essential newborn care practices, on neonatal mortality.28 Women’s groups involve a four-phase PLA cycle. Phase 1 identifies and prioritises problems during pregnancy, delivery, and post partum; phase 2 plans the action; phase 3 implements locally feasible strategies to address the priority problems, and; phase 4 assesses their activities.28 This methodology draws on Paolo Freire’s work, which when applied to health infers that health education is more empowering if it involves dialogue and problem solving, rather than message giving.103
Human-centred designThe Adolescent 360 (A360) project aimed to improve uptake of contraceptives among adolescent girls in Ethiopia, Nigeria and Tanzania. A360 used a human-centred design approach to develop interventions tailored to each country in conjunction with adolescents and other key stakeholders.104
Interventions included financial messaging to support adolescents and their husbands with family planning in Ethiopia, entrepreneurial skills and contraceptive counselling among young Tanzanian girls, maternal and child health and skill building sessions for adolescents and their husbands in Northern Nigeria and health literacy and skill-building for unmarried adolescents in Southern Nigeria. Implementation and evaluation of each intervention included active engagement of stakeholders as well as the development of an extensive knowledge exchange platform.
PhotovoiceA study in rural Nepal that aimed to investigate whether community based participatory research can help women in a vulnerable low-income country understand and adapt to important environmental challenges related to climate change and whether this activity can help promote mental health.105
Participants learnt how to use cameras and then formulated questions related to climate change and mental health (eg, how will water scarcity affect our well-being?’). Participants took photos related to their questions and shared their images during sessions with other participants, where they talked about the photos using a standard photovoice discussion format. In the final session, the research team and participants reviewed the themes that had emerged from the discussions and showcased their photos in the community.
Findings suggested that photovoice can help identify local and existing resources, generate adaptive strategies and promote mental health.
Participatory Theory of Change (ToC) methodsThe Programme for Improving Mental healthcare (PRIME) was a large multicountry study that aimed to provide research evidence for the integration of mental healthcare into primary healthcare in Ethiopia, India, Nepal, South Africa and Uganda.106 PRIME used ToC workshops to develop a structured logical and evidence-based ToC map for a mental healthcare plan in each district that contextualised the plans and obtained stakeholder buy in.21 22