Uncovering the benefits of participatory research: implications of a realist review for health research and practice.
BACKGROUND
Participatory research (PR) is the co-construction of research through partnerships between researchers and people affected by and/or responsible for action on the issues under study. Evaluating the benefits of PR is challenging for a number of reasons: the research topics, methods, and study designs are heterogeneous; the extent of collaborative involvement may vary over the duration of a project and from one project to the next; and partnership activities may generate a complex array of both short- and long-term outcomes.


METHODS
Our review team consisted of a collaboration among researchers and decision makers in public health, research funding, ethics review, and community-engaged scholarship. We identified, selected, and appraised a large-variety sample of primary studies describing PR partnerships, and in each stage, two team members independently reviewed and coded the literature. We used key realist review concepts (middle-range theory, demi-regularity, and context-mechanism-outcome configurations [CMO]) to analyze and synthesize the data, using the PR partnership as the main unit of analysis.


RESULTS
From 7,167 abstracts and 591 full-text papers, we distilled for synthesis a final sample of twenty-three PR partnerships described in 276 publications. The link between process and outcome in these partnerships was best explained using the middle-range theory of partnership synergy, which demonstrates how PR can (1) ensure culturally and logistically appropriate research, (2) enhance recruitment capacity, (3) generate professional capacity and competence in stakeholder groups, (4) result in productive conflicts followed by useful negotiation, (5) increase the quality of outputs and outcomes over time, (6) increase the sustainability of project goals beyond funded time frames and during gaps in external funding, and (7) create system changes and new unanticipated projects and activities. Negative examples illustrated why these outcomes were not a guaranteed product of PR partnerships but were contingent on key aspects of context.


CONCLUSIONS
We used a realist approach to embrace the heterogeneity and complexity of the PR literature. This theory-driven synthesis identified mechanisms by which PR may add value to the research process. Using the middle-range theory of partnership synergy, our review confirmed findings from previous PR reviews, documented and explained some negative outcomes, and generated new insights into the benefits of PR regarding conflicts and negotiation between stakeholders, program sustainability and advancement, unanticipated project activity, and the generation of systemic change.
Participatory Research at McGill, McGill University. justin.jagosh@mail.mcgill.ca
Justin
J
Jagosh
Ann C
AC
Macaulay
Pierre
P
Pluye
Jon
J
Salsberg
Paula L
PL
Bush
Jim
J
Henderson
Erin
E
Sirett
Geoff
G
Wong
Margaret
M
Cargo
Carol P
CP
Herbert
Sarena D
SD
Seifer
Lawrence W
LW
Green
Trisha
T
Greenhalgh
D057191:Capacity Building; D055812:Community-Based Participatory Research; D003299:Cooperative Behavior; D006302:Health Services Research; D006801:Humans; D010560:Personnel Selection; D015397:Program Evaluation