Factores de riesgo cardiovascular

Given that inquiry in the participatory paradigm blurs the boundaries between the researcher and the researched, it is important to outline the role that different individuals and groups played in the study.

I was the lead investigator for the study although, as indicated above, the participatory approach meant that others were also involved in the research endeavour. Trust staff contributed to the research in a variety of ways and this is described more below. Five other researchers from City University were also involved in data collection and analysis at various points in the study. My role as lead investigator included the following:

• Co-ordinating the work of other researchers involved • Collecting and analysing data

• Feeding back findings to the directorate

• Initiating and co-ordinating development workshops • Reflecting on progress

• Prompting ‘next steps’ from participants • Supporting change work agreed

Because of the genuinely busy working lives of Trust staff, I had the main

responsibility for carrying out the research and leading changes. In practice, this often meant making decisions and then seeking the approval of key participants to carry out that decision. Attempts to include participants in the inquiry processes were mainly focused on communication about project progress and findings, negotiating the involvement of Trust staff representing all relevant professional groups and then supporting their involvement by, for example, scheduling meetings at less busy times, gaining management support for staff involvement in the

project, providing a variety of means for staff to contribute to the project and providing relevant training in research methods and data collection when this was required.

Although the need for change was initiated by participant reflections on the study findings, many of the ideas for what changes could be tried came from me. These ideas were based on what I had learned about the IPCC role and the organisational context, and my experience in development work in other Trusts. Often I also

power in the Trust (I was employed instead by the university) but my field notes reflect that participants often listened actively to my suggestions and usually adopted them. It is possible that my credibility as a nurse with development experience meant that people viewed my suggestions as valid. It is also likely that my in-depth knowledge of that particular context, based on data gathered also helped. Interpersonal skills may also have played a key role here, and interview and focus group transcripts reflect that my role was a facilitative one, rather than an authoritative role. As the study progressed, the length of time I was at the Trust may also have helped establish my credibility.

4.6.1 Involvement of the IPCCs

A sensitive and flexible approach was particularly needed to ensure the democratic participation of the IPCCs. They and their managers were the key people with whom study findings were shared and decisions made as to what changes could be made and/or what data were to be collected and/or shared on the basis of emerging findings. Collaborative mechanisms included formal meetings, informal contacts and the sharing of written work when it was produced. Throughout the study, I met regularly (about every two weeks) with the IPCCs. Sometimes it was just the five of us. At other times, their manager was also included. These meetings were used as an opportunity to keep each other informed about study progress and raise any issues that had emerged, either to do with the study or to do with wider changes that may be affecting the IPCCs’ working role or their role in the study.

Efforts were made to take their busy work lives into account by, for example, scheduling meetings at times that suited them but there was an extent to which their involvement in the study added to their already large workloads. This sometimes had an impact on the quality of their involvement. For example, the IPCCs were asked to complete a form on each of the patients they had contact with (see patient profile below). When they were at their busiest, particularly if one of them was sick or on annual leave and the others were covering their work, the completion of these forms was not a priority. This meant that some forms were not filled in and this then compromised the validity of the data analysed. Although, perhaps understandably, the IPCCs were not always able to complete data collection, overall the IPCCs were fully involved in both the inquiry and the practice

development aspects of the study. Other issues regarding the IPCCs’ involvement in the study are discussed in the section below on ethical considerations.

4.6.2 Steering group

A steering group oversaw the project during its initial exploration phase (see p. 4 for details of the study’s three phases). The role of the group was as the main forum for the receipt of emerging findings and to decide on next lines of inquiry and practice developments needed. Members were encouraged to share findings with their own professional groups and use them as the basis for further discussion. Senior representatives of IPCCs’ interprofessional colleagues were members of the study’s steering group that ran for the first year of the project. They were selected for their seniority and ability to provide an overview. Members included the clinical director, the two operations managers, the head of nursing, the senior nurse, a social services team leader, the Trust director of therapy services and all four IPCCs. The Trust’s R&D manager was also a member of the steering group. The IPCCs rarely attended steering group meetings and it became necessary to meet with them outside of meetings to ensure that they were also aware of

emerging findings and that they contributed to the direction of inquiry and practice development. Steering group members who attended were relatively senior in their position and this may have meant that initial investigations directed by the group were informed by their experiences, rather than those of ‘grass-roots’ practitioners who worked directly with the IPCCs. However, grass-roots practitioners were interviewed early on in the study and these findings were fed back to the steering group and used as the basis for further inquiry.

At the close of the initial exploration phase, the steering group stopped meeting and interprofessional development workshops (see p. 9 for details) became the main fora in which findings were shared and decisions were taken. This change allowed for wider participation at all levels in directing the course of the inquiry.