How to use participatory action research in primary care.

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Abstract
Objective. The aim of the article is to demonstrate the usefulness of participatory action research (PAR) in primary care. The author used PAR firstly to develop a deeper understanding of mutual participation in the doctor–patient encounter and secondly to apply this learning in a rural cross-cultural practice setting. Method. PAR was done with four patient groups. Four patients with terminal illnesses formed groups with their family members, neighbours and friends. Seven meetings were held with each group over a period of 6 months. The meetings were conducted in Tsonga, which is the local vernacular. All the meetings were audio-taped. The primary question for each meeting was how the group could work together to achieve the best possible health outcome for the patient. Additionally, the author, who facilitated the meetings, kept a reflective diary, including field notes over the research period. One member of each group kept a written record of each meeting. Three free attitude interviews were conducted with the author over the research period to elicit the development of his understanding about mutual participation in the doctor–patient encounter. The recorded meetings and interviews were transcribed and translated and themes subsequently identified using the transcripts. The reflective diary was analysed similarly. A model was constructed to depict the themes and their interrelatedness. The model was interpreted and conclusions were drawn. Results. The PAR process had a positive effect on the doctor–patient encounter. PAR greatly resembles a mutual participatory doctor–patient encounter. The research facilitator had certain basic tenets in order to facilitate participation. The patients who participated actively benefited most. Basic interviewing techniques were used to facilitate the mutual participation in PAR. Conclusions. PAR is very applicable in primary care. The principles of PAR such as mutual collaboration, reciprocal respect, co-learning and acting on results from the enquiry are essential in the doctor–patient relationship. Self-awareness, the ability to self-critique and reflect in a deep manner using such tools as a reflective diary are essential for nurturing the development of effective primary health care workers and consequently care structures for the patients and their families.