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ACTION RESEARCH

A USEFUL METHOD OF

PROMOTING CHANGE IN

PRIMARY CARE


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PRESENTED BY :1. Arif Winarno

2. Bambang Wicaksono

3. Budi Antomi

4. Endy Kurniawan

5. Nur Wahid


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CONTENT

1. Introduction

2. Background

3. Objective4. Discussion

5. Method

6. Result

7. Conclusion


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INTRODUCTION

The quality of care provided in health services is nolonger taken for granted. In order to improve healthcare, methods of changing doctors behavior havebeen explored, and so far there appear to be no easy

solution. In education, industry, and more recently, in nursing,

action research has been used to facilitate changeand improve the service provided. It is also to b agood method of bridging the gap between research

and practice. However, there are few publishedexamples of action research being used to improveprimary health care.


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The aim of this paper is to discus the benefits and

difficulties of using action research in primary care

using our research as an example. In order to do this,

we have outlined the range of methods used in our

study and have provided an overview of the results.


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Background

Action research has been used successfully

to promote change in disciplines other thanmedicine, but there are few examples of its

use in primary care.

Objective

We aimed to discuss the benefits and

difficulties of using action research inprimary care using the example of child

health surveillance provision in general

practice.


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DISCUSSION If the data generated from the practice meetings and

the interviews with health visitors and GPs areconsidered, using an action research model toinvolve primary health care staff in the research

process was succesful In term of the spectrum of action research

methodology, the study was more experimentalthan empoweringor more technicalthanemancipatory. The researcher designed the

project and pre-determined its time table andoutcome measures


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Although this study was at

experiment/technical end of the

action research spectrum, thehealth visitors involved thought

the process had been useful in

enabling them to reflect on andchange their provision of child

health surveillance


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METHOD Twenty-eight general practices were randomly allocated into two

groups. Action research was used to promote change in 14

practices by facilitating practice meetings and by providing

written feedback.

The other 14 practices received written feedback alone. The two

groups of practices were compared using the following: (i) semi-

structured interviews with one health visitor and GP from each

practice; (ii) observation of baby clinics; (iii) questionnaires to

parents; and (iv) return rates of child health surveillance reviews

from the personal child health record.


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RESULT

All 14 practices in the action research arm of the

study met as individual practice teams and

decided to make changes to their provision of

child health surveillance. Ten practices auditedtheir child health surveillance as a result. More

health visitors in the action research practices

than in the comparison practices reported

changes to child health surveillance, audit,communication and use of the personal child

health record.


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The majority of health visitors and GPs

thought involvement in the action

research process was beneficial.

However, we were unable to show astatistically significant difference

between the two groups of practices in

baby clinic provision, parentsatisfaction or the return rate of child

health surveillance reviews.


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CONCLUSION

Our study suggests that action research is asuccessful method of promoting change inprimary care. However, measuring the impactof change is difficult. There continues to be a

need for research on improving quality ofcare in health and quantitative technique willbe required. Action research can besuccessful method for investigating andimprovement in health care. We conclude that

using action research to involve primary careteams in the evaluation of service provisionpromotes teamwork, decision making, audit,and change


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