Health Care

Action research represents a minority of all health research but is increasingly recognized as an approach that adds relevance to the health research process and its outcomes. It continues to garner attention as health systems face increasing accountability by those who fund them and those they serve and as health research funders come under increasing pressure to demonstrate not only that they generate new knowledge but that this knowledge is translated into better health and more effective health systems and services.

As has been the case in many areas where new knowledge is intended to create action, research in health has suffered from a tension between the needs of evidence-based rigour and contextual sensitivity. Health practice at the clinical, community or population levels should be founded on the best available evidence for what works, but it is mired in the provisos of what works for whom, when, where and in what circumstances. The creation of evidence-based knowledge has historically privileged various internal validities over external ones. Calls have therefore been made to increase the contextual relevance, [Page 393]and thus applicability, of research results by creating evidence-based practices (procedures, interventions, programmes, policies) from practice-based evidence. This includes evidence derived from real practice settings, such as clinics, hospitals, community health centres, communities and populations. It further implies that stakeholders within those settings should be equitably engaged in creating this evidence, from identifying the gaps or needs through undertaking research and interpreting research results, to implementing, evaluating and disseminating the findings. At all levels, from the clinic to the whole population, those who must act on the results of research, be they clinicians, service managers, patients, health organizations, communities or policymakers, are much more likely to do so if they have been involved in the research process and the results meet their personal or practice needs and goals. Therefore, the various levels of health research have increasingly adopted a participatory, action-oriented approach.