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The Working Together Relationship
Dr Katherine FroggattSenior Lecturer
International Observatory on End of Life CareLancaster University, UK
Structure
• Background – Working together in health research
• Case study of an end of life peer education research project
• Review – Understanding how we worked together– Implications
Working together in research
Consenting Consulting Co-operative Collaborative Collective action
Involvement Token For users For and with users
With and by users
Led by users
User role Representation Tasks assigned
Opinions considered
Sharing knowledge
Users’ agenda
Researcher role
Researchers cede no roles
Directs research
Decides about research
Facilitates research
May be absent
Researcher in control
Shared control
Tripp (1998)
Users in control
Case study
Improving public awareness of end of life issues among older people in
North Lancashire: A peer education approach
Funded by North Lancashire PCT
Acknowledgements
• Lancaster Peer Education Team: Gail Capstick, Oliver Coles, Deirdre Jacks, Susan Lockett, Irene McGill, Jill Robinson, Janet Ross-Mills
• Mary Matthiesen, Conversations for Life• Jane Seymour, University of Nottingham
Aims and Objectives
Aim:
• To pilot a locally appropriate peer education programme on end of life issues for older adults
Objectives
• To design a personal portfolio to hold individually tailored end of life resources and information;
• To undertake public end of life workshops for older members of the general public and their advocates;
• To identify future partnerships for ongoing end of life public awareness work.
Participatory Action Research
• Key principles– Working with– Incorporating different ways of knowing
• People’s experiences• Practical impact
– Bringing about a change• Using cycles of action and review
Participation with older people
• Integral to study– Designed and undertaken by Lancaster Peer
Education for End of Life Care group– Comprises members of general public, retired
and/or active in working with older adults about issues of learning, plus researcher (KF)
Methods
• Strand 1: Development of personal end of life information and resources portfolio
• Monthly meetings – September 2009 to March 2010 (prior and ongoing)– Record of meetings - notes– Personal reflections
Strand 2: Development of a community workshop on end of life issues
• Two workshops– Older adults– Advocates (health and social care professionals
and volunteers from public and voluntary sector)
• Preparation facilitated by external adviser Mary Mattheisen from Conversations for Life
Process of portfolio development
Examination of end of life issues
Identify information and resources
Review resources
Develop portfolio
Use the portfolio
Revise
Share portfolio with others
Revise
Looking to the Future portfolio
• Introduction to the Portfolio• Who am I?• Personal Details• Life Contacts• Health Information• Important Documents• How I want to be cared for now and in the future• Anticipating Future Changes• After I Die• Further Information• Resources• Background
Workshop Content
Three sections
• What are some things to think about?
• How to begin planning• How to talk about these
issues
Structure
• Personal stories• Facilitated table
discussions• Feedback and wrap
up
WorkshopsAttended by 35 participants
Workshop 1 – 21 older participants– 18 women; 3 men
• Age– All participants were over 55 years old, – 17 (85%) over 65 years old– 7 (35%) over 75 years old
Workshop 2 – 14 professional and advocate participants• 11 women; 3 men • (1 older women)• Hospital, hospice, care home and voluntary sector
backgrounds• Nurses, doctors, social workers
Workshop Evaluation
• Recognition of:– Shared concerns re future planning– Importance of doing this work and timing for this– Need to find practical ways to plan and talk to others
• Portfolio - overall positively reviewed– Clear and comprehensive; identified as useful– But
• How to ensure someone knows about it • How to keep information safe• How to access to resources for people without web access• For some too much to address at once
In summary
• Met our aims and objectives– Piloted a local peer education initiative– Designed a personal portfolio– Undertaken public end of life workshops– Identified future partnerships and further work
Making sense of how we worked together
•Continuum of involvement
•Quality criteria for approach chosen
Consenting Consulting Co-operative Collaborative Collective action
Peer educators
x √ √ √ x
Workshop participants
√ √ x x x
Continuum of involvement
Quality criteria for action research (Reason 2007)
• The extent to which worthwhile practical purposes are addressed
• Levels of democracy and participation • The different ways of knowing engaged with
during the study• The extent to which the research has been
and continues to be responsive and developmental
Quality Indicator As applied in the studyWorthwhile practical purposes - Yes
• Ageing and dying are universal human experiences. • Present in national and local health policy • Present as an issue in people’s lives
Democracy and participation - Yes
• Project designed and undertaken together• Project group meetings ensured shared responsibility for the project• Workshops increased participation to wider population
Different ways of knowing present - Yes
• Experiential knowing - used personal experiences• Presentational knowing - use of stories• Propositional knowing - review of resources, writing of report, publications and presentations • Practical knowing – running workshops/writing portfolio
Responsive and developmental - Yes
• Builds upon previous research• Ongoing review through monthly meetings• Peer educators developed skills and knowledge• Workshop participants requested further sessions• Further series of community education sessions
Froggatt et al,(in press)
In conclusion• Participatory action research offers one way to work
together within research• In end of life peer education project we worked
together: engagement and participation present for individuals and groups.
• This facilitated development of:– peer group of educators– new knowledge and change– local spaces (events) for this to happen
References
• Froggatt K with Capstick C, Coles O, Jacks D, Lockett S, McGill I, Robinson J, Ross-Mills J, Matthiesen M. Addressing End of Life Issues through Peer Education and Action Research. In Stern T, Rauch F, Schuster A Townsend A. Action Research, Innovation and Change: International and Interdisciplinary Perspectives. Routledge, London. (In Press)
• Reason, P. (2007) Choice and quality in action research. Journal of Management Inquiry 15(2), 187-203.
• Tripp, D. Critical incidents in action inquiry. In: Shaklock G, & Smyth J. eds Being reflexive in critical educational and social research. London, Falmer Press 1998.: 36-49.