Cultivating the power of partnerships in feminist participatory action research in women's health

Gender-affirming medical treatment for adolescents: a critical reflection on "effective" treatment outcomes

BACKGROUND

The scrutiny surrounding gender-affirming medical treatment (GAMT) for youth has increased, particularly concerning the limited evidence on long-term treatment outcomes. The Standards of Care 8 by the World Professional Association for Transgender Health addresses this by outlining research evidence suggesting "effective" outcomes of GAMT for adolescents. However, claims concerning what are considered "effective" outcomes of GAMT for adolescents remain implicit, requiring further reflection.

METHODS

Using trans negativity as a theoretical lens, we conducted a theory-informed reflexive thematic analysis of the literature cited in the "Research Evidence" section of the SOC8 Adolescents chapter. We selected 16 articles that used quantitative measures to assess GAMT outcomes for youth, examining how "effective" outcomes were framed and interpreted to uncover implicit and explicit normative assumptions within the evidence base.

RESULTS

A total of 44 different measures were used to assess GAMT outcomes for youth, covering physical, psychological, and psychosocial constructs. We identified four main themes regarding the normative assumptions of "effective" treatment outcomes: (1) doing bad: experiencing distress before GAMT, (2) moving toward a static gender identity and binary presentation, (3) doing better: overall improvement after GAMT, and (4) the absence of regret. These themes reveal implicit norms about what GAMT for youth should achieve, with improvement being the benchmark for "effectiveness."

DISCUSSION

We critically reflect on these themes through the lens of trans negativity to challenge what constitutes "effective" GAMT outcomes for youth. We explore how improvement justifies GAMT for youth and address the limitations of this notion.

CONCLUSIONS

We emphasize the need for an explicit discussion on the objectives of GAMT for adolescents. The linear narrative of improvement in GAMT for adolescents is limited and fails to capture the complexity of GAMT experiences. With currently no consensus on how the "effectiveness" of GAMT for adolescents is assessed, this article calls for participatory action research that centers the voices of young TGD individuals.

Justice for Women After Sexual Assault: A Critical Interpretive Synthesis

Justice after sexual assault is often understood and enacted through the criminal legal system such that the outcomes are binary (i.e., justice is achieved or not achieved). Previous research indicates that survivors have specific wants and needs following an assault in order to experience justice, which may or may not align with current practices. We conducted a critical interpretive synthesis of 5 databases to create a sampling frame of 4,203 records; the final analysis included 81 articles, book chapters, and policy documents. Results indicate that justice is an individualized and dynamic process which may include the experience of voice, connectedness, participating in a process, accountability, and prevention. The experiences of safety and control are central to each of these domains. Survivors may seek and enact these justice domains through several avenues, including the criminal justice and legal systems, restorative justice, medical/mental health spaces, activism, art, and social media. Existing actors within currently available justice systems, including legal, medical, and mental health personnel should encourage survivors to identify and define their own experience of justice, including locating helpful behaviors rooted in safety and control, and resist a binary model of justice. Extant systems should therefore be flexible and accessible to help survivors realize their preferred modes of justice.

"Empowerment for Us by Us (E4UBU)": Developing a Model of Empowerment Using Feminist Participatory Methods with LBQT+ Persons Assigned Female at Birth in Western Kenya

Lesbian, bisexual, queer, trans and other gender diverse persons assigned female at birth (heretofore referred to as "LBQT+ persons") in Western Kenya experience intersectional oppression and stigma. This stigma can manifest in acts of sexual and gender-based violence (SGBV) and sexual and gender minority (SGM)-based violence, as well as various forms of discrimination-all of which have been linked to disproportionately higher levels of negative health outcomes for this group. Despite these challenges, many LBQT+ persons have been able to gain personal and collective power and thrive in this oppressive environment. The Empowerment for Us by Us (E4UBU) project is a mixed methods feminist participatory research study focused on exploring how LBQT+ persons conceptualize and define empowerment for themselves, and to understand their perspectives on how feelings of power and powerlessness influence their physical and mental health. This paper focuses on data from the first phase of the study, in which qualitative in-depth interviews were conducted with 40 LBQT+ persons (ages 19 to 50) from Kisumu and Homa Bay in Western Kenya. A participatory interpretive phenomenological analysis was conducted to understand the lived experiences of LBQT+ persons as they navigate intersectional oppression and its influence on their experiences of empowerment and subsequent health outcomes. Findings from this analysis were presented to two different focus groups composed of participants who had participated in the in-depth interviews to gather their insights on the interpretations of the interviews as a form of member checking. Findings revealed that "empowerment" was not experienced and viewed by LBQT+ persons as a monolithic construct, but rather a process through which LBQT+ persons are able to transform negative forces of intersectional oppression and powerlessness into experiences of power and subsequent individual and collective action and impact-all leading to improved mental health and well-being. This process is facilitated at several junctures by participatory seeking and attainment of community-appropriate resources at multiple socio-ecological levels that, when accessed with sufficient intensity, frequency, and duration, enhance one's journey through the process of empowerment. These facilitation junctures are viewed as likely points of focus for public health intervention. Analysis also revealed that the process of empowerment is dependent on the context within which the process is occurring, the specific issues being faced, and the population of focus. Recommendations for how this model can be used for future research and practice to improve the lives of LBQT+ persons in Kenya are discussed.

Observed consensus on research priorities for the hypertriglyceridemia patient registry

BACKGROUND

Priority setting in health research has been described as essential due to disparities within and between countries and populations. Commercial benefits to the pharmaceutical industry may increase the generation and use of regulatory Real-World Evidence which has recently been reported in the literature. Research must be steered by valuable priorities. This study's objective is to identify key gaps in the knowledge of triglyceride-induced acute pancreatitis by generating a list of potential research priorities for a Hypertriglyceridemia Patient Registry.

METHOD

The Jandhyala Method was used to observe the consensus of expert opinion from ten specialist clinicians in the treatment of triglyceride-induced acute pancreatitis across the US and EU.

RESULTS

Ten participants completed the consensus round of the Jandhyala method and generated 38 unique items which they all agreed with. The items were included in the generation of research priorities for a hypertriglyceridemia patient registry and presented a novel application of the Jandhyala method for the development of research questions, in aid of the validation of a core dataset.

CONCLUSION

The TG-IAP core dataset and research priorities combined can develop a globally harmonized framework where TG-IAP patients can be observed simultaneously using the same set of indicators. This will increase knowledge of the disease and facilitate higher-quality research by addressing issues related to incomplete data sets in observational studies. Furthermore, validation of new tools will be enabled, and diagnosis and monitoring will be improved as well as the detection of changes in disease severity and subsequent disease progression, improving the management of patients with TG-IAP overall. This will inform personalized patient management plans and improve patient outcomes along with their quality of life.

How should communities be meaningfully engaged (if at all) when setting priorities for biomedical research? Perspectives from the biomedical research community

BACKGROUND

There is now rising consensus that community engagement is ethically and scientifically essential for all types of health research. Yet debate continues about the moral aims, methods and appropriate timing in the research cycle for community engagement to occur, and whether the answer should vary between different types of health research. Co-design and collaborative partnership approaches that involve engagement during priority-setting, for example, are common in many forms of applied health research but are not regular practice in biomedical research. In this study, we empirically examine the normative question: should communities be engaged when setting priorities for biomedical research projects, and, if so, how and for what purpose?

METHODS

We conducted in-depth interviews with 31 members of the biomedical research community from the UK, Australia, and African countries who had engaged communities in their work. Interview data were thematically analysed.

RESULTS

Our study shows that biomedical researchers and community engagement experts strongly support engagement in biomedical research priority-setting, except under certain circumstances where it may be harmful to communities. However, they gave two distinct responses on what ethical purpose it should serve-either empowerment or instrumental goals-and their perspectives on how it should achieve those goals also varied. Three engagement approaches were suggested: community-initiated, synergistic, and consultative. Pre-engagement essentials and barriers to meaningful engagement in biomedical research priority-setting are also reported.

CONCLUSIONS

This study offers initial evidence that meaningful engagement in priority-setting should potentially be defined slightly differently for biomedical research relative to certain types of applied health research and that engagement practice in biomedical research should not be dominated by instrumental goals and approaches, as is presently the case.

Navigating midwifery solidarity: A feminist participatory action research framework

BACKGROUND

A core aspect of midwifery philosophy is the optimisation of normal physiology; however, this has been challenged as a radical idea in the medicalisation of birth. Research has demonstrated the benefits of midwifery in improving outcomes for both mothers and babies. The understanding of midwifery benefits fails to reach wider sociocultural contexts as births becomes more medicalised. Midwifery research requires an action arm, to help translate theory to practice and mobilise midwives in solidarity with women towards action and change.

AIM

The aim of this article is to describe a Feminist Participatory Action Research (FPAR) by establishing the philosophical underpinnings, theory and methodology with an exemplar.

METHODS

FPAR has two distinct yet intertwined parts, a research arm and an action arm. The study was conducted using FPAR, and collaboration with nine women, who led transformative action within their community. The exemplar details the use of the FPAR framework.

FINDINGS

A FPAR framework was developed through this research to guide researchers aiming to use the FPAR design. The framework details four steps: 1. Create, 2. Collaborate, 3. Consider, and 4. Change. The iterative FPAR cycles were shown in this study to centre women in the research and guide the community research group towards transformative action.

CONCLUSION

FPAR is shown in this project to assist midwifery researchers to realise solidarity and provides support for other midwifery researchers in applying feminist theory and participatory methodologies to bring about transformation within their research.

Feminist Social Vision: Seeing Through the Lens of Marginalized Perceivers

Social vision research, which examines, in part, how humans visually perceive social stimuli, is well-positioned to improve understandings of social inequality. However, social vision research has rarely prioritized the perspectives of marginalized group members. We offer a theoretical argument for diversifying understandings of social perceptual processes by centering marginalized perspectives. We examine (a) how social vision researchers frame their research questions and who these framings prioritize and (b) how perceptual processes (person perception; people perception; perception of social objects) are linked to group membership and thus comprehensively understanding these processes necessitates attention to marginalized perceivers. We discuss how social vision research translates into theoretical advances and to action for reducing negative intergroup consequences (e.g., prejudice). The purpose of this article is to delineate how prioritizing marginalized perspectives in social vision research could develop novel questions, bridge theoretical gaps, and elevate social vision's translational impact to improve outcomes for marginalized groups.

Developing an obesity research agenda with British Pakistani women living in deprived areas with involvement from multisectoral stakeholders: Research priority setting with a seldom heard group

INTRODUCTION

British Pakistani women have exceptionally high rates of obesity and yet are seldom heard in a research priority setting concerning weight management. The objectives of this study were (i) to ascertain what multisectoral professionals perceive to be the most pressing unmet obesity needs or topic areas that need more research in relation to Pakistani women living in deprived areas of Bradford and (ii) to determine the top 10 obesity health priorities for this group to develop an obesity research agenda.

METHODS

A two-step process was adopted using the following: (i) a survey of a wide range of multisectoral professional stakeholders (n = 159) and (ii) a ranking exercise involving Pakistani women living in deprived areas of Bradford (n = 32) to select and prioritize their top 10 obesity health concerns and unmet needs from a list of 31 statements identified in the survey and previous research. Survey data were analysed using inductive content analysis and themes were identified. Themes were translated into statements to be ranked by Pakistani women. The ranking exercise was conducted by telephone either via voice or video call. Data were analysed using a reverse scoring system.

RESULTS

Survey responses were grouped into statements reflecting the following three categories: education needs; healthy behaviour barriers and mental well-being. The highest rankings were given by Pakistani women to statements on mental health and the need for education. The top 10 prioritized statements were developed with members of the public into an obesity research agenda that reflected the target population.

CONCLUSION

Actively engaging British Pakistani women in setting research priorities provided a unique opportunity to understand the key areas they think are important for future research. The culminating research agenda can be used by researchers to advance the field of obesity research in Pakistani communities, thus producing research outputs that are relevant to and have impact in this population.

PATIENT OR PUBLIC CONTRIBUTION

Participants in the ranking exercise collected data. Public contributors were involved in developing the prioritized statements into a research agenda.

Exploring the obesity concerns of British Pakistani women living in deprived inner-city areas: A qualitative study

Introduction

British South Asians have a higher prevalence of overweight and obesity than the wider population. Bradford (UK), with its high Pakistani presence and levels of economic deprivation, has exceptionally high instances, especially in deprived areas where many Pakistanis reside. British Pakistani women in Bradford are more likely to be overweight and obese. There is uncertainty on how these women can be aided to manage their weight. Therefore, the objective of this study was to explore the obesity concerns of Pakistani women living in deprived inner‐city areas of Bradford.

Methods

Three focus groups interviews were carried out with 23 Pakistani women living in deprived areas of Bradford. Data were analysed thematically.

Results

This exploratory study identified a wide range of concerns that women had around managing their weight. Participants disclosed distrust in information given around medication, conflicting dietary information and reported low levels of trust in women‐only organized physical activities. Cultural barriers were identified, which included the gender role of the woman, the lack of culturally appropriate dietary advice, cultural misunderstandings of what constitutes a healthy diet and healthy weight, the lack of culturally suitable exercise facilities and conforming to family and community expectations. Other concerns were language barriers around a lack of understanding, the inability to read Urdu and reliance on others to translate information.

Conclusion

These findings have implications for researchers, local authorities, policy makers and others with an interest in reducing the rates of obesity in this population. Recommendations include training health practitioners to be culturally aware of the diet and eating practices of this community, exploring different ways to support socially isolated women to be more physically active at home, addressing physical activity and diet misconceptions and designing obesity management information materials appropriate for a range of literacy levels.

Patient or Public Contribution

Public contributors were involved in the development of the interview guide and design of the research. A pilot focus group with participants not included in the present paper was used to help test and refine the focus group questions. Interview transcripts were member checked by participants, and participants assisted with data analysis.

Achieving inclusive research priority-setting: what do people with lived experience and the public think is essential?

Background

Engagement of people with lived experience and members of the public is an ethically and scientifically essential component of health research. Authentic engagement means they are involved as full partners in research projects. Yet engagement as partnership is uncommon in practice, especially during priority-setting for research projects. What is needed for agenda-setting to be shared by researchers and people with lived experience and/or members of the public (or organisations representing them)? At present, little ethical guidance exists on this matter, particularly that which has been informed by the perspectives of people with lived experience and members of the public. This article provides initial evidence about what they think are essential foundations and barriers to shared decision-making in health research priority-setting and health research more broadly.

Methods

An exploratory, qualitative study was conducted in 2019. 22 semi-structured interviews were performed with key informants from the UK and Australia.

Results

Three main types of foundations were thought to be essential to have in place before shared decision-making can occur in health research priority-setting: relational, environmental, and personal. Collectively, the three types of foundations addressed many (but not all) of the barriers to power sharing identified by interviewees.

Conclusions

Based on study findings, suggestions are made for what researchers, engagement practitioners, research institutions, and funders should do in their policy and practice to support meaningful engagement. Finally, key international research ethics guidelines on community engagement are considered in light of study findings.

Navigating Ethical Issues in Photovoice: Balancing the Principles of Community-Based Participatory Research Ethics with Institutional Review Board Requirements

This article reflects on ethical issues that arose during the course of two different evaluation projects that used photovoice method to engage with marginalized populations. The evaluations serve as case studies for a critical discussion about potential barriers that researchers may face when employing photovoice method while trying to balance the principles of community-based participatory research with the requirements of Institutional Review Boards. We reflect on ethical dilemmas related to the meaning of photography within the cultural context of participants' lives, the compensation of participants as collaborators, and the representation and dissemination of participant photos. We conclude by examining how researchers may approach ethical requirements without compromising the important collaborative relationships central to photovoice method. We additionally call on researchers to engage with ethics review committees to create a new "participant-researcher" category with its own set of protocols that recognizes the nuanced role members of disenfranchised communities play in the research process.

Empowering Maasai women behind the camera: Photovoice as a tool for trachoma control

BACKGROUND

Photovoice is a method used to help engage community members to understand local realities and promote social change. Photovoice uses cameras in the hands of participants as a tool to visually document a specified topic. Photos taken by participants allow for reflection and stimulate dialog on an issue to ideally lead to social change. Trachoma, hyperendemic in Maasai communities in Northern Tanzania, is the commonest infectious cause of blindness worldwide, caused by chlamydia trachomatis. The bacterial infection commonly occurs in childhood and over many years repeated infections leads to inflammation and scarring of the eyelid. Often as adults this leads to the upper eyelid turning inward and eyelashes scratching the eye, resulting in pain and eventually blindness. We used photovoice as a tool for Maasai women to share their lived experiences of educating peers on trachoma and ultimately empowering women in this society.

METHODS

This public engagement intervention was conducted September thru October 2017. We held a workshop on trachoma control for 20 Maasai women including use of photovoice method. Women were asked to disseminate information from the trachoma control workshop to their community and to capture their experiences using disposable cameras. Five weeks post-workshop we facilitated a discussion and women displayed photos of the successes and challenges they encountered as advocates for trachoma control in their community.

INTERVENTION OUTCOMES

It was observed throughout the process and at the photo discussion meeting, that women articulated empowerment by this experience; as educators, agents of change and a source of valued information.

CONCLUSION

Photovoice should be considered for future interventions as a communication tool on health issues and to empower women to be ambassadors for health promotion.

A participatory action research study exploring midwives' understandings of the concept of burnout in Ireland

INTRODUCTION

In depth exploration of the burnout phenomenon among midwives is sparse. The concept has been extensively studied, but predominantly reports rates and evaluates interventions to reduce burnout. A definition has yet to be offered in the literature from a midwifery perspective.

AIMS

To explore midwives' understandings of burnout, professionally and personally, in the context of contemporary maternity care in Ireland.

METHODS

This was a Two-phase Participatory Action Research study. Five co-operative inquiry meetings were held with practising midwives (n=21) over a six-month period between October 2018 and March 2019, in a large, urban teaching maternity hospital in Dublin, Ireland.

FINDINGS

We found that multiple factors contributed to midwives' perceptions and understandings of the concept of burnout. Midwives defined burnout as persistent stress and exhaustion, with an associated reduction of their individual coping abilities, motivation, empathy and/or efficacy, is unique to the individual and is primarily, in the midwifery context, caused and inextricably linked to excessive workload.

CONCLUSION

Burnout is a complex concept with many entities and its significance and impact within the midwifery profession highlights the importance of its exploration and understanding. This study is the first of its kind to explore, with midwives, the concept of burnout. The elements of stress and exhaustion in the definition mirror existing definitions in the literature.

Perceptions of and barriers to HIV testing of women in Indonesia

Indonesia’s 2014 health reforms advocated for universal health coverage for all Indonesians. The reforms made provision for integrated human immunodeficiency virus (HIV) programmes, with testing available at community health centres and hospitals for pregnant women and women of childbearing age. The question remains, though, as to whether testing has been effective. This article focuses on barriers women face accessing HIV testing and presents findings from the experiences of 18 HIV-positive women. To triangulate findings, interviews were conducted with 26 health workers, 9 non-governmental organisation workers and 12 HIV stakeholders. The article examines barriers to pregnant women’s access to HIV tests, showing that barriers relate to women not having reproductive health rights. It highlights reproductive rights noted in the Respectful Maternity Care Charter, and violations to them relevant to HIV testing in pregnancy. Five reported rights violations include: women being unable to access information; being unable to make informed decisions; having no right to confidentiality and privacy; experiencing ongoing discrimination; and having no right to timely HIV testing. The failure of Indonesia to protect these rights contributes to women being denied HIV testing. Findings show the need for increased HIV testing services for pregnant women and assert that health personnel and programme policy-makers need to be held accountable for the protection and fulfilment of women’s rights in respect of HIV testing. The findings show that policy makers must make changes to ensure health services improve, health professionals must be better trained, and women’s socio-cultural and political contexts must be considered.

Im/moral healthcare: HIV and universal health coverage in Indonesia

In 2014, Indonesia reinvigorated its commitment to the provision of a universal health care system by introducing the National Health Insurance Program (Jaminan Kesehatan Nasional, JKN), with the aim of increasing access to health care for all sectors of society. A key question that emerges in the current climate is: how can Indonesia ensure people can access HIV health care? This question is critically important given Indonesia is on the verge of passing a law criminalising all sex outside of marriage. If passed, anyone presenting with HIV will be suspected ipso facto of involvement in criminal activity (e.g. them or their partner having sex outside of marriage and/or using intravenous drugs). In this environment, preventing transmission of HIV from mother to child becomes more difficult. In exploring these issues, we argue that, in a time of populist morality, Indonesia must give significant attention to how universal health coverage can prevent HIV transmission, particularly from mother to child. We offer three key strategies for Indonesia to implement in this regard: removing health care provision from a moral framework; de-idealising the category of woman; and repositioning shame and stigma around HIV.

What Contributions, if Any, Can Non-Indigenous Researchers Offer Toward Decolonizing Health Research?

Four non-Indigenous academics share lessons learned through our reflective processes while working with Indigenous Australian partners on a health research project. We foregrounded reflexivity in our work to raise consciousness regarding how colonizing mindsets-that do not privilege Indigenous ways of knowing or recognize Indigenous land and sovereignty-exist within ourselves and the institutions within which we operate. We share our self-analyses and invite non-Indigenous colleagues to also consider socialized, unquestioned, and possibly unconscious assumptions about the dominance of Western paradigms, asking what contributions, if any, non-Indigenous researchers can offer toward decolonizing health research. Our processes comprise of three iterative features-prioritizing attempts to decolonize ourselves, acknowledging the necessary role of discomfort in doing so, and moving through nonbinary and toward nondualistic thinking. With a nondual lens, working to decolonize ourselves may itself be seen as one contribution non-Indigenous researchers may offer to the collective project of decolonizing health research.

‘Come Back at Us’: Reflections on Researcher-Community Partnerships during a Post-Oil Spill Gulf Coast Resilience Study

This paper presents findings from eight post-hoc interviews with individuals representing the key community partner organizations that facilitated and hosted data collection for an in-person mixed-methods survey about disaster resilience and preparedness in three communities on the Gulf Coast (U.S.) impacted by the Deepwater Horizon oil spill and numerous disasters from natural hazards. We submit our analysis of these follow-up interviews with community partners as a case study to provide a set of recommendations for future community-engaged research practices, particularly in the field of environmental and disaster resilience. Input from community partners stressed the importance of engaging with local community brokers to enhance trust in research; researcher-partner communication; and researcher interaction with community residents that respects local knowledge and culture. The partners indicated that even communities that have often been the subjects of post-disaster studies are receptive to research participation, especially when the effects of disasters are long-term and ongoing. Recommendations include using research methodologies that are congruent with post-disaster community characteristics such as educational attainment; collaborating with community partners to disseminate research findings; and incorporating theories and practices that center critical reflection and consider power dynamics when working with communities that have experienced disaster and trauma.

Uncovering nursing students' views of their relationship with educators in a university context: A descriptive qualitative study

INTRODUCTION

Power dynamics is a key element in the educator-student relationship, and can be influential to the learning outcomes of students.

BACKGROUND

Power relations are inherent in the interaction between educators and students. The educator-student relationship is still an under-explored area of power dynamics.

AIM

The aim of the study was to investigate nursing students' perceptions of the power dynamics in the educator-student relationship in a university learning context in order to offer educators some understanding of how such a relationship was perceived by students.

DESIGN

A descriptive qualitative study using focus group inquiry.

METHODS

Through convenience sampling, a total of 56 students were recruited and eight focus group interviews were conducted. Thematic analysis was adopted to capture the meanings extracted from the student narratives.

RESULTS

Four core themes of the educator-student relationship were identified. Referring to these themes, some implications were drawn, such as the significance of the educator-student relationship; an educator's power matters; and polarized views among the students on whether or not an educator should be a friend.

CONCLUSIONS

The power dynamics varied depending on an educator's personality, communication skills, ability to effectively monitor large classes, and teaching style. More efforts are needed to investigate the preferred conceptions and types of educator-student relationships in order to evaluate the impact that these have on learning.

How to do (or not to do)… gender analysis in health systems research

Gender-the socially constructed roles, behaviours, activities and attributes that a given society considers appropriate for males, females and other genders-affects how people live, work and relate to each other at all levels, including in relation to the health system. Health systems research (HSR) aims to inform more strategic, effective and equitable health systems interventions, programs and policies; and the inclusion of gender analysis into HSR is a core part of that endeavour. We outline what gender analysis is and how gender analysis can be incorporated into HSR content, process and outcomes Starting with HSR content, i.e. the substantive focus of HSR, we recommend exploring whether and how gender power relations affect females and males in health systems through the use of sex disaggregated data, gender frameworks and questions. Sex disaggregation flags female-male differences or similarities that warrant further analysis; and further analysis is guided by gender frameworks and questions to understand how gender power relations are constituted and negotiated in health systems. Critical aspects of understanding gender power relations include examining who has what (access to resources); who does what (the division of labour and everyday practices); how values are defined (social norms) and who decides (rules and decision-making). Secondly, we examine gender in HSR process by reflecting on how the research process itself is imbued with power relations. We focus on data collection and analysis by reviewing who participates as respondents; when data is collected and where; who is present; who collects data and who analyses data. Thirdly, we consider gender and HSR outcomes by considering who is empowered and disempowered as a result of HSR, including the extent to which HSR outcomes progressively transform gender power relations in health systems, or at least do not further exacerbate them.

Significance of action plans in the development of occupational well-being in the schools of Finland and Estonia

This article is part of a long term project "Promoting the Occupational Well-Being of School Staff-Action Research Project in Finland and Estonia, 2009-2014." The purpose of this article is to describe the significance of action plans in the promotion of the occupational well-being of primary and upper secondary school staff in Finland and Estonia from 2010 to the turn of the year 2011-2012. An electronic open questionnaire was sent to occupational well-being groups in Finland (N=18) and in Estonia (N=39). In Finland, the questionnaire was responded to by 16 (n=16) occupational well-being groups, and in Estonia, by 38 (n=38) groups. The qualitative data were analyzed using the inductive-deductive method and content analysis. The obtained results indicate that the schools had named goals for action plans in all aspects of the promotion of occupational well-being in schools (worker and work, working conditions, professional competence, working community) and that these goals were mainly realized in the schools in a systematic way. Schools felt that the action plan for occupational well-being helped them to set goals for occupational well-being and that the planned actions were realized in a more systematic way than before.

The Impact of Qualitative Research on the “Real World”

Knowledge translation (KT) remains an elusive term that has no unified definition in the health or social sciences. The wide scope of what KT is in practice invites creativity in disseminating research findings. In this article, we describe innovative KT initiatives based on different methodologies of qualitative research we conducted in the fields of psycho-oncology and mental health. These include medical and public education, training mental health clinicians, national policy recommendations, and clinical interventions in the health field. As academic researchers, we bear a responsibility to the public we are intended to serve with our qualitative research. We argue that researchers need to take KT seriously and think deeply about not only what we research but also the ways in which we translate that knowledge to make the maximum possible positive impact on the communities we study and serve.

Voices from the street: exploring the realities of family homelessness

Homelessness threatens the health and well-being of thousands of families in the United States, yet little is known about their specific needs and how current services address them. To fill this knowledge gap, we explored the experiences of homelessness families in Detroit, Michigan. We targeted homeless mothers and their caseworkers for study to see if the perceptions of needs and services were in alignment. Using focus groups and content analysis, we identified four overarching themes that illustrate homeless mothers' experience with homelessness. We then analyzed data from caseworkers to look specifically for similarities and differences in their perceptions. Key findings included reports of family histories of violence, poverty, social isolation, and a lack of informal support as contributing to homelessness. The differing perspectives of mothers and their caseworkers regarding how best to move forward highlight how current programs and services may not be meeting the needs of this growing and vulnerable cohort.

An exploration of social justice intent in photovoice research studies from 2008 to 2013

In an age where digital images are omnipresent, the use of participant photography in qualitative research has become accessible and commonplace. Yet, scant attention is paid to the social justice impact of photovoice amongst studies that have used this innovative method as a way to promote social justice. There is a need to review this method to understand its contributions and possibilities. This literature review of photovoice research studies (i) explores whether authors implicitly or explicitly related the methodologies to their aims of promoting social justice (methodology-method fit) and (ii) outlines the social justice research impact of photovoice findings using the framework of social justice awareness, amelioration and transformation. PubMed, Scopus, PsycINFO and Web of Science databases were searched from the years 2008-13 using the following keywords: photovoice; photonovella; photovoice and social justice; and photovoice and participatory action research. Of the 30 research studies reviewed, only thirteen identified an underlying methodology guiding the photovoice method. The social justice impacts emphasized were more related to social justice awareness (n = 30) than amelioration (n = 11) or transformation (n = 3). Future researchers using photovoice as a way to promote social justice are encouraged to assess and plan for the social justice impact desired.