title: Culture change in long-term care: participatory action research and the role of the resident.
abstract: OBJECTIVE
  This study's purpose was to advance the process of culture change within long-term care (LTC) and assisted living settings by using participatory action research (PAR) to promote residents' competence and nourish the culture change process with the active engagement and leadership of residents.
  
  
  METHODS
  Seven unit-specific PAR groups, each consisting of 4-7 residents, 1-2 family members, and 1-3 staff, met 1 hour per week for 4 months in their nursing home or assisted living units to identify areas in need of improvement and to generate ideas for community change. PAR groups included residents with varied levels of physical and cognitive challenges. Residents were defined as visionaries with expertise based on their 24/7 experience in the facility and prior life experiences.
  
  
  RESULTS
  All PAR groups generated novel ideas for creative improvements and reforms in their communities and showed initiative to implement their ideas. Challenges to the process included staff participation and sustainability.
  
  
  CONCLUSIONS
  PAR is a viable method to stimulate creative resident-led reform ideas and initiatives in LTC. Residents' expertise has been overlooked within prominent culture change efforts that have developed and facilitated changes from outside-in and top-down. PAR may be incorporated productively within myriad reform efforts to engage residents' competence. PAR has indirect positive quality of life benefits as a forum of meaningful social engagement and age integration that may transform routinized and often ageist modes of relationships within LTC.
authors.affiliation: Department of Sociology, Hiram College, Hiram, OH 44234, USA. robinshura@gmail.com
authors.forename: Robin
authors.initials: R
authors.lastname: Shura
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Siders
authors.forename: Dale
authors.initials: D
authors.lastname: Dannefer
mesh_terms: D000203:Activities of Daily Living; D055812:Community-Based Participatory Research; D003468:Cultural Evolution; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D007857:Leadership; D008134:Long-Term Care / Q000639:trends; D009735:Nursing Homes / Q000458:organization & administration*; D009820:Ohio; D010865:Pilot Projects; D011788:Quality of Life