Participatory Action Research Approach

This chapter again outlines the research question, aim and objectives, then the research setting, recruitment process, ethical and methodological considerations. It identifies how the data is generated and analysed using the Koch and Kralik’s PAR approach. Two distinct phases are described separately in PAR. Phase one is storytelling (one to one interviews), feedback and construction of a storyline. Phase two is researching alongside participants in a group, guided by the principles of PAR and following the cyclical processes of ‘looking, thinking, and acting’ as an iterative process (Koch & Kralik 2006). It is important to state that this version of PAR:

Takes place in collaboration with participants

Participants determine the agenda

Participants drive the research

Participants decide on actions

I will also offer ways in which this inquiry can be considered as trustworthy and rigorous.

Research question, aims and objectives

The research question in this inquiry is: How do Guyanese women living in the UK learn to live with Type 2 Diabetes?

The aim of the study is to explore with Guyanese women living in the UK their experience of living with diabetes. The objectives of the study are to:

1.give voice to the stories of Guyanese women;

2.explore their experiences living with diabetes in the context of their Guyanese background;

3.facilitate a participatory action research group and in collaboration with participant women explore self-care diabetes trajectories

4.consider ways ‘we’ (women and researchers) can initiate changes at an individual level and/or within the Guyanese community living in the UK.

The methodology selected for this inquiry is based on Koch and Kralik’s (2006) PAR, a democratic, collaborative and participatory research approach involving facilitators/researchers and participants equitably. It is different to other approaches because it is a change process based on reflection and action where the researcher’s role is to facilitate and systematically monitor change or reforms decided by the participants.

The inquiry commenced in January 2010 and 18 months were spent in the field where relationships were formed and sustained. The inquiry is due to be completed in May 2014.

This inquiry obtained approval from the University of Surrey Ethics Committee and was conducted within the University’s ethical framework. (See Appendix 3 for copy of letter). This requires the researcher to recognise and respect participants’ rights and dignity, do them no harm and to work with honesty, integrity and confidentiality.

I complied with the Ethics Committee’s requirements for data storage with no identifying details and maintained confidentiality throughout the inquiry. The information, records and transcripts were kept in a locked cabinet and all data collected were password protected on the computer that only I or the supervisors could access. Participants had access throughout the study to the recordings and transcripts and any changes required marked as edited. On completion of the inquiry the information will be destroyed other than tapes/discs kept for ten years in the CRNME, the University of Surrey archives.

No identifying details of the participants were recorded and pseudonyms were used for transcribed interviews and reporting findings. Participants were given written information about the inquiry and completed consent and confidentiality forms prior to commencing the interview process. (See Appendix 4.) The importance of not sharing the content of the conversation outside of the group was emphasised at group sessions.

The inquiry did not involve life threatening situations, emotional discomfort or distress. Participants were informed of their right to withdraw at any point or refuse to answer any of the questions. They were advised to seek counselling or GP support if during the interview or the group session they felt distressed or bad memories occurred. In the capacity of a researcher and not as a counsellor I would refer them to the appropriate services should the need arise.

Their rights were protected as follows:

You have the right to ask questions of the researcher

You have the right to refuse to participate in this inquiry

You have the right to refuse to answer any question, should you chose, and need not give any reasons for your refusal

I gave due consideration to the principle of disengagement and prepared participants for the termination of the inquiry but the group has continued to meet and share their experiences of living with diabetes.

This inquiry took place within the London area because a high concentration of Guyanese live in and around the suburbs of London. The participants fulfilled the following inclusive criteria:

First generation Guyanese women aged between 60 to 75 years who came to the UK aged 16 to 25 from the 1950s to 1970s

Who have had Type 2 Diabetes for at least one year

Who are interested and willing to talk about their lives in Guyana and England

Willing to explore their experience of living with Type 2 Diabetes

Live in and around the suburbs of London

Exclusion criteria

First generation Guyanese migrant women who came later to England in the 1980s

Second generation Guyanese women

Eight participants were recruited from social groups, school reunions and UK Guyanese Organisations listed on the Guyana High Commission UK website. Guyanese women were also recruited via events. A poster (see Appendix 5.) was also circulated amongst the Guyanese community and organisations in the London area.

Four core members were recruited for the first part of the inquiry which is the apprenticeship phase of the PAR approach (Koch & Kralik 2006). A further four participants were recruited via the core group using similar networks for the second phase. This type of recruitment is a form of snowballing that Browne (2005) asserts is a useful technique often used in hidden populations who are difficult to access due to low numbers or sensitivity of the topic. Information was sent the participants by letter (see Appendix 6.) with an individual follow-up to arrange mutually convenient times to meet at their homes.

Eight women with an average age of 69 volunteered. The majority had been diagnosed with Type 2 Diabetes for several years, only one had a diagnosis in the last four years. All were retired and from middle class backgrounds. They lived in and around London. One to one storytelling interviews were facilitated in their homes, with the PAR groups hosted on a rotational basis in each participant’s house and in my house.

Perceived benefits of researching with participants

The PAR process involves sharing, listening and reconstructing stories, working collaboratively towards being heard and having a voice for the first time (Koch & Kralik 2006). A key aim of this inquiry was personal development for the researcher and the participants leading to reform or action.

The process provides participants with the means to take systematic action to resolve problems they have identified, build on their strengths, set the discussion agenda, prioritise issues pertinent to the group’s needs and decide on the actions. Sharing a story in a safe, comfortable environment tends to empower and bond people and storytelling is often therapeutic (Frank 1997).

Data generation Phase 1 – Storytelling

As previously mentioned in this chapter my adaptation of Koch and Kralik’s (2006) methodology consisted of two distinct phases: phase one is storytelling and phase two is researching alongside participants in a group. Another form of data emerged from the reflective journal, discussion with my supervisors and my learning as I developed self-awareness and confidence in using the PAR approach.

Preparation for the interviews

Storytelling allowed me to invite participants to talk about their experiences and to take ownership of their own stories. The biographical work or storytelling celebrates a particular mode of self-expression and individualised versions of experience. According to Koch and Kralik (2006), telling one’s story is helpful for reflection, prompting further self-understanding and often initiates improved self-management.

The interview process was planned so that the participants and I felt organised and at ease. Pre-interview phone contact was made to establish a meaningful dialogue. On the day, the participant was contacted to confirm the interview; I ensured that the recording device worked correctly, and I was prepared and punctual for each interview.

I commenced one to one interviews with eight women who consented to participate in the inquiry. At the beginning of the interviews I introduced myself and followed the ethical procedures by ensuring the consent form was signed, (Appendix 7.) and reminded the participants of their rights that they could withdraw from the study at any time.

As interviews progressed I learned to ask fewer questions. For my first interview, which was supervised, I reflected and shared my views with Professor Tina Koch who was present during the PAR apprenticeship phase. I learnt to ask the first question as: ‘Tell me your story about when you were first diagnosed with diabetes’. I found that the women would open up and tell me their story so the standby prompts were rarely used. (See Appendix 8. for standby prompts)

Listening to the stories allowed me to understand the changes the participants had to make in their daily lives (Frank 1997). I was particularly interested in the storytelling phase of Koch and Kralik’s (2006) approach that consisted of look (look coded in red), what is being reflected on (think coded in orange) and what action is proposed (act coded in green). I considered look, think and act important to understand the way people self-manage their diabetes.

Transcribing the digitally recorded interviews verbatim took at least ten hours for every recording but gave enhanced familiarity with the data. To get an overview of what was being said I listened to the entire recording. Then I transcribed all the information even if what was said was not always coherent. The transcripts were then word processed and notes made for the participant clarification and feedback. I was aware the women used terms and place names that only a Guyanese researcher would recognise for example ‘cassava’ or ‘plantain’ and there were specific places in Guyana that they named that only someone familiar with the country or culture would recognise so a glossary of these words, foods and terms is provided (see pages 8, 9.). Interviews ranged from one to two hours. An explanation of how long and short stories were developed following Koch and Kralik’s protocol is in the following section.

The women were asked to read through their stories to comment on them as an accurate interpretation. My transcribing improved as the inquiry progressed but for the first interviews I made a number of changes to information that appeared to be incoherent.

I realised that I might be asked for health or lifestyle advice but decided that it would be best not to offer advice; rather I sought a diabetes specialist nurse who could answer their questions as a group. Notes were taken about advice requested or questions asked, and with the participant’s permission, I offered to seek answers for them.

I became fully engaged with Koch and Kralik’s (2006) storytelling as a vehicle for human encounter and communication. Frank describes what storytelling about illness means to an individual: “Telling stories of illness is the attempt, instigated by the body’s disease, to give voice to an experience that medicine cannot describe. This voice is embodied in a specific person but it is equally social, taking its speech from the postmodern times we live in” (Frank 1997:18).

During the interviews I was able to listen to the women’s stories, maintain eye contact and show a keen interest in what was said. By recognising the need not to judge or to offer any sort of advice, trusting relationships developed that fostered an environment in which they could talk freely about their condition. Prompts were only offered after long periods of silence or to explore an issue further. I appreciated the need to feel listened to and have the time and space to talk. Listening to their stories allowed me to follow the participants’ daily lives and understand the major changes they had had to make. Maintaining frequent contact with the participants over a period of 18 months by phone and home visits also afforded me the opportunity to examine how they dealt with the daily issues of growing older in the UK.

Journal as data

Reflection in PAR is crucial for both the researcher and the participants as they rethink their position, discover new ways of being, acting and doing, and deal with the issues that they face. It is through critical dialogue within group sessions that they agree, disagree, argue and debate the experience of new ways of thinking, acting and behaving.

For the researcher keeping a journal is important as it represents reflexivity, aids reflection and encourages the researcher to think about her reactions to the participants and record feelings (Waterman 2013). I kept a research journal throughout the period of the inquiry. These journal data constitute what was going on whilst researching as I developed self-awareness. Therefore a record of the content and the interactions that have taken place including reactions to various events exists, and credibility is enhanced in this process (Koch 1993).

Schon’s (1983) model of reflection underpinned how I reflected during the inquiry. Schon (1983) focuses on reflection-in-action, reflecting while doing, thinking at the same time about feelings, testing out new ideas by drawing on previous knowledge and understanding. Reflection-on-action occurs after the event which encourages some form of response leading to action following reflection-in-action. When I reflected on the interview questions, I noticed that direct and indirect questions were asked. I recognised that open questions starting with ‘what’ or ‘how’ gave long expansive answers, so used phrases like ‘tell me’ or ‘side effects’ to focus responses. I tried to avoid closed questions or seek factual information as I realised better quality data were received when the participant opened up. As interviews progressed my skills improved and I made notes in my reflective journal charting how I could further improve. When reviewing the transcripts again I believe the women felt safe to tell me not only their stories of living with diabetes but about life in Guyana, personal relationships and their experiences of migrating to the UK.

My field notes and my research journal were analysed concurrently. ‘Look, think and act’ was used as the interpretative framework to guide analysis (Koch 2006). Look, think and act also shaped the concurrent analysis in the researcher’s reflective journal. Further journal accounts will be woven into subsequent chapters.

Data Analysis Phase 1: Developing the story line

The story in Phase 1 was transcribed verbatim as told by the participant and data were analysed using Koch and Kralik’s ‘look, think and act’ framework. The entire transcript was read through several times to get an overview and gain familiarity with the narrator’s tone as this gave context and meaning to what was being said. I noted the choices participants made, the chronology (or not), what was included and that which could have been excluded.

In summation, the process of PAR is generally thought of as spirals of self-reflective cycles (Koch & Kralik 2006). In this, the researcher asks ‘what is happening in this story, what has the participant chosen to talk about and what is important here?’ The story is analysed concurrently and observations provided to participants as feedback. These steps are rarely linear so the researcher invites participants to reflect on the feedback and continue the story in subsequent sessions as the ‘thinking’ phase. By focusing on their lives participants make their experiences accessible for reflection, discussion and reconstruction. The learning process can be observed in what people do, how they interact, what they mean and value and the language used. As the story continues, participants may or may not decide on actions to take. The researcher monitors actions created as the action phase of the cycle. The story telling continues ‘in cycles’ until the researcher and the researched are satisfied with the ‘end’ product. The outcomes can offer personal growth and development for both the researcher and the participants (Koch & Kralik 2006).

I realised that the storytelling rarely followed a neat sequence of events. An episode of 60-120 recorded minutes creates about 20 pages of single spaced text, and the first draft varies between 1500-3000 words. One transcript was 7500 words but the long story came to 2250 words and its short version just 600 words.

I followed Koch and Kralik’s (2006) guidance in analysing the data which is based on two levels of clustering. For the first level of clustering, I closely read the transcripts and used word-processing ‘cut and paste’ to sequence events or time lines. Aspects of identity, relationships, social context, events, opinions, feelings, experiences, similar content and similar phrases were clustered under temporary headings. I paid attention to the significance of repetition, clustering when the participant had repeated certain events, people/relationships, or particular words or phrases, perhaps this emphasised particular importance. Maybe the participant was beginning to find her voice and the novelty of being heard instigated a revelation worth repeating. I paid attention to word selection, particularly the verbs which relate to ‘looking, thinking and acting’. When clustering I noted what was important to the participant, her strengths in the emerging storyline and the storytelling tense (Koch & Kralik 2006).

At the second level of clustering, text was coloured into look, think and act colour codes. I then clustered this around strengths, self-identity, relationships, social context, events, opinions, perspectives, feelings, experiences, similar content and phrases, deleted repetitions, noted images and metaphors. I grouped these into paragraphs and condensed text. I asked: what is the most significant thing happening in each paragraph? In this way, I determined significant statements. I then rewrote the paragraphs with the most significant statement at the helm. Using a significant statement as the first sentence of the paragraph, I then reordered the paragraphs into a storyline. This storyline was further condensed by gathering the first lines of each paragraph (significant statements) and joining them together to make a short story version. Depending on the situation, I could then select whether to return the long or short version of the story to the participant. I selected to give the longer story line. (See Appendix 9. for an example of the analysis of a story)

Commonalities or constructs

The interview, analysis process and storyline writing were repeated for each transcript in Phase 1 from which I compiled a list of significant statements from each story. I then wrote up the commonalities based on these significant statements in my own words as ‘findings’ (See Appendix 10.).

The developing storyline was given to the participants for co-construction and feedback as a central part of maintaining their involvement in the PAR collaborative process making the final story a co-construction between the facilitator/researcher and the participant. As additional information emerged from the group sessions individual storytelling continued until the participant was satisfied with their story. Constant validation of the story enhanced methodological rigour (Koch & Kralik 2006).

Data generation Phase 2 - Group sessions

In phase two, the data were digitally recorded and transcribed with feedback given to participants prior to each session as a summary of the previous meeting.

After I had completed the one to one interviews I invited all participants to join a PAR group discussion. More details of the participants are given on page 92 – Table 2. Two women, Shirley and Jane declined to participate in the larger PAR group so I researched alongside a group of six rather than eight. Shirley is involved in a range of activities linked with her local church and Jane attended a local neighbourhood forum and other local committees. Contact was maintained outside of the group sessions with Shirley during the earlier part of the inquiry and with Jane during the life of the groups. There were 14 group sessions over a period of 18 months.

The women agreed to host the sessions in their homes rather than meeting in a more formal setting like a community hall or centre. They communicated that their individual homes would be more relaxed, warm and inviting with facilities to make tea or coffee and we agreed that the host of the session would provide lunch. The PAR group sessions therefore rotated to each of the participants’ homes including the researcher’s home. In preparation I ensured that the environment was appropriate and that I was familiar with any equipment being used.

Initially lunch and beverages prepared by the host were available for the duration of the sessions. The meals were a rather elaborate affair with a huge variety of dishes mainly from Guyana that were consumed by all. At later group sessions, each of the women contributed one dish to the event therefore it became a shared experience. This introduced more variety and the recognition that they should only be consuming specific quantities of food, part of their learning was to eat smaller and healthier portions.

Prior to us setting the agenda for the PAR group a number of issues were considered. We discussed at the first group session if the women would like to set an agenda. In addition, two further questions were raised at this meeting. This included their views regarding this group and how they would like to take this forward? These were very broad questions but ones that required consideration of their expectations of the group.

The structure of these sessions is based on the Koch and Kralik’s (2006) model of setting up PAR groups. The women were reminded of the aim and objectives of the inquiry and discussed mine and their expectations. During the first phase of the inquiry, actions that resulted from this first group were discussed with those who later joined. It was generally accepted by the group that actions could change over a period of time as they learned to understand each other and the way in which the diabetes has impacted on their lives.

Following lunch, the session lasted for one to two hours. The setting of ‘norms’ or ground rules was agreed by all members (Tuckman 1965). The rules agreed were:

To set an agenda for each session

To introduce each participant at the beginning by name. (This helped me with voice recognition)

To avoid making any distracting noises (including mobiles) during the session

To allow one person to speak in turn rather than all members speaking at the same time

To ensure lunch lasted between one to two hours

This enabled all members to give their full concentration and attention to the session. A small table was selected so each individual could be heard and feel involved in the group. Familiarising myself with the recording equipment was another important factor that was considered in order to avoid any hiccups occurring during the session (Bloor & Wood 2006). The digital tape recorder was placed on the table in the centre of the group to ensure clarity. A sound check was undertaken to ensure all the voices were recorded clearly and coherently. Recording then commenced before anyone started talking in order to capture the content of the session. Afterwards I recorded my reflections.

A day convenient for all to arrive around lunch time was chosen. I was aware that some had not travelled for a long time so I checked they had the correct address and travel details for the session.

Expectations congruent with principles

Group norms were collaboratively agreed by the group. These are important because they govern behaviour in a group. Parks and Sanna (1999) suggest that norms can be explicit and carefully recorded or implicit but acknowledged by the group. A group without established and agreed norms would end up being chaotic because boundaries have not been set. The norms were: the women agreed to have a meal first and then to have the sessions afterwards for an hour. Each woman would then have the opportunity to speak in turn. This was a democratic process with the women determining what sort of group they wanted to have. The purpose of the group was reiterated to share experiences and to decide on future personal and group actions. We agreed that I would be the facilitator and reminded each other that we should show respect for what people had to say and that individuals should avoid speaking at the same time as the conversation could become incoherent. The women claimed that they understood the ethical considerations and confidentiality issues that might arise. The ground rules were discussed again when more members were added to the group.

A key to facilitating PAR groups is to be genuine and authentic (Stringer 1999; Koch & Kralik 2006). The researcher is expected to give of herself when facilitating the group and use the participants’ own words. The aim is to seek clarification and respond through reflection enabling participants to consider several courses of action. My listening, seeing and writing skills as a facilitator researcher developed as a consequence. Constructions of experience are dynamic and new understandings emerge as we make sense of our complex social world (Montero 2000). The looking phase means the group observes the setting or the situation and gathers information about each other.

The facilitator in the PAR process has a key role to play in enabling the women to take control of the group and to only intervene if the women are digressing or deviating from the research topic. The aim was to maintain the focus of the group. The other key aspects to this role as suggested by Koch (2006) were:

Act as a catalyst to bring about change

Maintain flexibility in the PAR process

Negotiate with the group about the role of the facilitator

Be an inquirer, a clarifier and a space maker

Stimulate people to change by addressing issues that concern them now

Use participants own words to record and listen

Seek clarification and check what has been said

Respond through reflection

Help the participants to analyse their situation

Enable people to consider several courses of action

Consider the possible consequences and results of each action

Assist in implementing the plan by raising issues and possible weaknesses in what was being suggested

The facilitator acts to assist participants to articulate the looking phase and to think/ reflect in line with the following criteria:

Maintain the focus of the group

Stimulate change by addressing issues that concern them (Koch & Kralik 2006; Stringer 2007)

I was also guided by Stringer’s (1999) guidelines on the role of the facilitator. A researcher, within the traditional paradigms, is an ‘expert’ doing research, whereas PAR has evolved to a point where the researcher is a ‘resource’ person and referred to as a facilitator. The PAR facilitator acts to assist participants to view their strengths, define concerns clearly, and support them in finding solutions. Guided by Stringer (1999), the facilitator can achieve this with the following guidelines:

Stimulate, rather than impose change. Encourage participants to change through addressing issues that concern them now;

Focus on the way things are done, rather than in the traditional method of focusing on results achieved;

Ensure that the process starts where people are, rather than where someone else thinks they are, or where someone thinks they ought to be;

Assist participants to analyse their present situation, consider what they find and then plan for which parts they would like to keep and what they would like to change.

It is not the role of the facilitator to tell the participants what they should change or keep, but rather to respect and acknowledge their ideas (Stringer 1999). It is enabling the participants to view several options and the potential outcomes or consequences. When the participants have selected an option, it is the facilitator's role to assist implementation by identifying the pros and cons and helping to locate the necessary resources. It is recognised that the ultimate responsibility for the success of the process centres on the participants’ feeling of ‘ownership’ and motivation for investing time and energy in changing the status quo.

Whilst the storytelling phase was new to me I am an experienced facilitator. I have also identified that it is important to be flexible with the research process. Working in this collaborative way assisted me in building relationships with the participants to make changes in their lives. I believe that I can demonstrate proficient management of intensive data generation and analysis, in-depth interviews and group participation.

I used PAR engagement strategies to foster on-going involvement by keeping in regular contact. One member declined telephone contact after three calls but asked for her interview to be included in the research. At PAR group sessions participants did not always want the session recorded for the entire period, for instance when sharing food. As co-researchers, I respected their right to decide what they wanted and only recorded data when they were in agreement. I observed their strengths rather than their problems or issues and facilitated the movement of the group towards achievement and action on a personal and group level.

I was comfortable with the uncertainty inherent in the process as I was never sure who would attend. The women were given reminders but not all of them attended every session. Consequently I contacted them to find out their reasons for not attending and was prepared for the unexpected, managing each situation as it arose.

In reviewing the literature on group dynamics and power relations, research groups are different to social groups where people congregate, exchange views and ideas and possibly have a shared or common goal. To form a group, there has to be a certain degree of connection which is meaningful to the individuals. Normally there is a shared purpose or goal that turns a mere aggregate of individuals into a bona fide group (Forsyth 2010).

Research groups bring individuals together for a specific purpose such as health care focus groups with participants who are expected to answer a specific question. In this type of group the facilitator makes a concerted effort to keep the participants on track that leads the group towards answering the set question. Hansen (2006) describes how focus groups have been used successfully in health related research by creating a safe environment for sharing experiences within a group setting.

PAR groups are uniquely different because they are exploratory and participants decide on the topic/experiences to be discussed over many sessions. Koch and Kralik (2006) suggest that when a PAR group meets the first session is exploratory; people are invited to talk about their experiences. PAR group participants take the lead and set the agenda of what will be discussed. Facilitation is important so participants do not continue talking about the same things or covering the same ground. The facilitator encourages them to build on their strengths and consider the action leading to reform which requires time for them to achieve a group action decision.

Group dynamics are the actions, processes and changes in social groups (Donelson 2010). For this inquiry group dynamics and power relations were important because they contributed to my understanding of what dynamics were taking place within the 14 PAR group sessions over an 18 month period. Participants had come together bringing their fears, insecurities, experiences and knowledge but being unaware that they may have identical issues that they face in their daily lives when living with Type 2 Diabetes. Several theories have contributed to my understanding of how group dynamics operate within this PAR group setting. (Lewin 1946; 1947) and Tuckman (1965; 1972; 1996; 2003), both agree that groups go through a series of phases or stages if they persist for lengthy periods. Lewin (1946) considered group dynamics and action research arguing that people may come to a group with different dispositions but if they share a common goal they are more likely to act together to achieve it. Lewin’s approach described powerful forces that occur in groups and emphasised that the power relationship between the researcher and those researched should not be ignored.

Tuckman’s (1965) classical group dynamic model initially identified four stages of group development but following subsequent reiteration of his model, he added an adjourning stage in 1975. Tuckman’s model gives a good explanation of how groups develop and make decisions through these various stages as relationships become firmly established over a period of time. The five stages of this model are forming, storming, norming, performing and adjourning.

Forming – reliance on the leader for guidance and direction

Storming – team members vie for position in the group, power struggles and conflicts exist and compromises are required

Norming – consensus is reached, decisions are made, facilitator plays a key role as team becomes committed, unified and settled

Performing – team has a shared vision, disagreements occur but members are able to resolve them. Leader delegates more but members may ask for support

Adjourning – break up of group as the task is completed and purpose is fulfilled. Sense of insecurity may occur as change takes place within the group

(Tuckman 1975)

Groups do not always go through Tuckman’s five stages in a linear fashion. They move in and out of the stages over time. These behaviour observations are considered in Chapter 7. It is important to recognise who holds the power and control within a group according to Arnstein (1969) where one member can dominate proceedings and exert influence over others even if they try to resist. A distinction should be made between citizen power, engagement and tokenism in a group situation (Arnstein 1969).

The Hawthorne effect too can occur when individuals in a group setting know that they are being observed as a group and so may behave differently. Forsyth (2006) cites the work of Mayo who developed this concept from productivity research conducted at the Hawthorne Plant of Western Electric Company. The researchers concluded that the participants worked harder because they were being observed.

In my PAR inquiry, the researcher and the participants are equal members of the group however changes in behaviour may be attributed to the Hawthorne effect created by my presence as facilitator. But stimulating action is precisely what this PAR inquiry sets out to achieve. These behaviour observations will need to be given consideration and will be discussed in Chapter 7.

Data Analysis Phase 2: PAR group process

At the first session the women were encouraged to contribute their thoughts regarding the group norms presented earlier. As the facilitator, I felt it was important to promote positive feelings and a sense of equality and collaborative relationship in order to maintain harmony and avoid conflict, whilst providing strategies to manage any conflict that arose (Koch & Kralik 2006).

Each group member was asked to state their name and respond to group questions to make it collaborative. I asked them to identify what they wanted from this group, whether they would like to set an agenda, had any particular views regarding the group and where they would like to take the group.

Each participant was given the opportunity to talk about their experiences of living with Type 2 Diabetes and to use this forum to discuss their common strengths in managing as well as living with the condition. Rather than provide each participant with a copy of each other’s story, they mutually agreed to verbally share their stories at this session as they consider this would be good way to introduce themselves to each other.

During this session, I needed to demonstrate my facilitative rather than control skills. I was relaxed and at ease with the process, reminded them of the purpose of the session, gave an overview of the inquiry and responded to any questions asked. I displayed sensitivity and created a context rich in interpersonal interaction so participants could engage and reflect on their stories (Schon 1983). The focus of the first session changed as they explored other issues important to them. Written feedback was shared with the group members after each session. I became aware that each group session raised different issues so that actions were revealed only through careful observation. Completed actions were agreed by the group leading to reform/action.

The PAR groups were analysed using Koch and Kralik’s (2006) analysis framework as previously mentioned in the earlier section of this chapter. The Guyanese women make sense of their world via the construction of their experiences of living with Type 2 Diabetes by accepting that they will come to the inquiry with their own knowledge(s) as highlighted by Berger and Luckmann (1991) in Chapter 4. I enhanced their experiences of living with chronic illness through their story telling, reflection and collaborative interactions with each other and the researcher.

Feedback cycles

I recorded each session. When each PAR group discussion was over, I transcribed the entire conversation and then summarised the issues and personal/group appropriate actions that the women wanted to take forward. This summary sheet was then mailed out to the women so they had a record of what was discussed. This was followed up with a telephone call to each woman to clarify if they wished to add anything further or to flag up any other personal issues that concerned them. A further copy of the summary sheet of the previous session was handed out at each subsequent group session so that the women were kept informed of all the proceedings. For example, the women contacted me if they had received information regarding their diabetes, new medication that they had read about in the Balance magazine for individuals with diabetes, specific diets, television programmes on diabetes and checklists identifying the type of services they should receive. They also telephoned me to clarify an action that they had agreed to take or to share something important that had taken place in their lives. Reflective notes were taken after each session.

Stories and analyses occurred concurrently, which enabled identification of emerging understanding from early data to guide the subsequent group discussion. Feedback to the participants was ongoing. In short, thinking refers to exploring, analysing, interpreting and explaining events, storylines and interpretations. I noted the group’s explanations as it was thinking and followed the analysis protocol. In terms of rigour, critical evaluation of the data generation process (or storyline), the main conversations from the previous group sessions were presented and confirmed at each gathering or conversation.

Rigour and evaluation in PAR research

During the PAR process, researchers record and analyse their reflections and these constitute a data source as discussed previously. A brief overview of rigour and evaluation is given in Chapter 4 however, in this section a more in depth account is discussed.

In this inquiry, the PAR process is the same as the process evaluation with a focus on what happens whilst researching. Providing feedback before the next session is crucial for engaging with PAR and necessary for on-going evaluation. Participants must take ownership of their story so they are asked to check that it is theirs and revisions made as they suggested. The storyline is then given to the participant for further co-construction with feedback offered on the strengths observed in the story- line to enhance methodological rigour. The final story becomes a co-construction between the facilitator/researcher and the participant (Koch & Kralik 2006).

Potentially the questions and prompts devised could lead the interviews; however my facilitation style was to step back. The participants influenced the research process and highlighted their personal experiences without being asked. They had found someone willing to listen to them. There were instances when we engaged in very deep, meaningful dialogue and I was uncertain how to proceed. Fortunately my supervisor was present at two of the apprenticeship phase interviews which meant I could observe and learn how an experienced researcher proceeds in such complex situations. For example, with one participant I was uncertain how to bring in her life experiences in Guyana, until my supervisor showed me the type of questions which encouraged the participant to expand on what she was saying.

A story can change, as new information is shared in subsequent interviews and data reconsidered from the group interaction. Noting the women’s strengths as I saw them and using this data to reinforce the inquiry’s process was part of the evaluation. How I shaped the story as a result of the questions being asked needed to be considered to check whose voice was being heard in the story, was it mine, the participants’ or both?

Process or formative evaluation refers to the provision of short loop diagnostic feedback about the quality and implementation of, immediate responses to, and activities generated by, action research (Dick 1999). PAR groups shape process evaluation as feedback cycles concurrent to the research. Cycles of PAR with concurrent feedback means that data generated is immediately validated. In PAR groups, short loop feedback will ensure that problems and issues identified during the research process are communicated quickly so that the refinements and improvements can be planned and implemented. Systematic recording and analysis of actions, feedback and responses provide process evaluation data. PAR and process evaluation share evaluation criteria.

During the PAR process I examined what happened whilst researching, using my recorded reflections as a data source for analysis. The level of transparency achieved will determine whether the reader can follow the decisions which were made by the researcher during the process. I suggest that, based on reported reflections, the reader will decide if they trust the research process.

The aim of collaborative inquiry is to construct meaningful practical knowledge from the experiences of the participants. The group process enriches insights into the experiences of others, from which the group engages in making meaning of these experiences (Donelson 2010). Collaborative, reflective discussions are helpful in generating deeper insights and understandings.

Rigour in PAR is evaluated by the willingness of participants to act (Dick 1999; Koch & Kralik 2006). Successful evaluation criteria are demonstrated when participants express a strong sense of self development and evolution in their practices (lives), when they demonstrate an increased understanding of their situation, and the group initiates action towards reform. The core validity claim is focused on the workability of the actual social change activity. I am interested in the participants’ practical accomplishment in making sense of their lives and its relation to social action.

In this chapter I have given a full description of the PAR process that includes the research setting, gaining ethics approval, how participants were recruited, data generation, analysis and reflection. This inquiry has two distinct phases of storytelling interviews and PAR group sessions. Storytelling and group sessions embrace a collaborative and democratic approach to research that involves the facilitators/researchers and the participants in the research process. It recognises the unique strength that each individual brings to the inquiry. The aim is to enable Guyanese women’s voices to be heard when telling their stories about living with Type 2 Diabetes. I have demonstrated how rigour was maintained throughout the process for the outcomes of this inquiry to have credibility and transparency under scrutiny.

In the next chapter, I examine the storytelling phase of the inquiry by privileging the participants’ eight stories shared with me including my post-interview reflections. From these, I outline the constructs that emerge for critical exploration in Chapter 8.

Chapter 6

One to One Interviews and Storytelling
In the previous chapter I discussed the PAR process and reiterated my rationale for the selection of this approach to answer the research question: How do Guyanese women living in the UK learn to live with Type 2 Diabetes? I discuss my role as a researcher and facilitator as I embrace the collaborative and democratic approach to PAR. The way that the interviews were conducted and the importance of individual and group relationship building are discussed in depth.

The aim of this chapter is to listen to the voices of the women as individuals and for their stories to be heard in their own voice. My inquiry was guided by the PAR methodology that consists of two distinct phases (Koch & Kralik 2006). Phase one is storytelling (one to one interviews), feedback, and construction of a long story, finding commonalities and constructs which will be covered in this chapter. This storytelling phase took place while I was in the field for 18 months. In terms of rigour, the women’s voices are incorporated into the text with a claim that a multi voiced text is believable. Stories will be presented in their entirety and I do not privilege certain aspects over others. Reflections are incorporated into the text making the research process transparent. Phase two is the PAR group discussion which was researching alongside participants in a group. The PAR group process will be discussed in Chapter 7.

Introducing the women

Eight women volunteered to take part in the study and were given fictional names: to preserve confidentiality: Vera, Marjorie, Pam, Bea, Jane, Shirley, Agnes and Jillian. Each will be introduced before sharing their story. These retired women are aged from mid-sixties to mid-seventies and the majority have lived an active life in the London suburbs for many years. The average age of the women is 69. Most were in a higher socio-economic class when they lived in Guyana.

The women in the inquiry classified themselves as middle class because of their previous lifestyles in Guyana which were framed around large houses with servants and families who engaged in career jobs in business, politics and ambassadorial positions. For many of them their circumstances changed when they migrated to England, but the women still perceived their status as middle class. However some of their positions could have been perceived as being the lower social strata of the UK based on their cited occupations. The Registrar General Social Class (2001) six fold model assigned individuals to a particular occupational group and placed workers at various levels in this model with professionals at the top and unskilled manual workers at the bottom. Savage et al. (2013) developed a newer seven staged model based on the Great British Class Survey. They devised a way of measuring class by the different types of capital that people possess. Savage et al. (2013) based this measurement of class on the work of Bourdieu’s (1984) three types of capital: economic (wealth and income), cultural (ability to engage with leisure, music and so on) and social (contacts and connections which people draw on). In their analysis of class and stratification, Savage et al. (2013) position middle class as having a high level of capital. The women in this inquiry did not ascribe to either of these measurements of class. Instead they used self-identification as a subjective definition of middle class.

In fact they are unlike other BME Groups living in London (Nandi & Platt 2010). Four were of mixed parentage, two African, one Chinese and one Indian. These women were also well educated and two had held substantial positions in the workforce. Only one person was still married, three widowed, two were divorced and two never married. The most interesting observation in Table 2 is the dates they were diagnosed. Only two women were diagnosed recently whereas the others were diagnosed many years ago, Vera being the longest. With one exception they have all lived with Type 2 Diabetes for several years. Given the length of time post-diagnosis, we could expect their diabetes self-management to be well orchestrated. We will listen to their stories about living with diabetes in the section to follow.