3. Materiales y métodos
3.2 Medida de la actividad antioxidante
The plan for this research study was to identify the practice based knowledge that already existed in the local service and engage with the local occupational therapists as autonomous practitioners who were motivated to change and improve what they do. Practice was explored in collaboration with the occupational therapists by primarily using an inductive methodology to gather data so that theory can then be ‘generated and built through analysis of, and interaction with, the empirical data’ (Grix 2004, p113). For this research study, the occupational therapists in the local service initially identified the thematic concern of the lack of evidence to support their practice. They took the responsibility to evaluate their practice as a group and then from multiple perspectives to consider if their practice was meeting the COT Practice Principles (COT 2003, see Table 1.1). This was completed in repeated cycles of planning, implementing actions, evaluating and critically reflecting on this process. The local occupational therapy practice context met the characteristics of the definition of action research agreed at the first symposium on action research held in Brisbane 1989 (Zuber-Skerritt and Fletcher 2007). These were that:
The local occupational therapists developed their own practice, by interlinking their actions and reflections.
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Questions were raised by the local occupational therapists regarding their practice and data were gathered and analysed with them.
The local occupational therapists participated in the decision making in a democratic way as autonomous and reflective practitioners.
The local occupational therapists collaborated and were critically reflective within their team.
The local occupational therapists were reflective practitioners as they learnt by this process of planning, doing and reflecting.
Many authors have described different action research typologies. Williamson (2012a) outlined major strands of action research but stated that these overlap with each other and are not clearly distinct. The strands included: ‘human inquiry, cooperative inquiry and action science/inquiry which are concerned with ‘human experience and engagement’ (Williamson 2012a, p15), and participatory action research which is community based where the researchers and participants are equal and work together to change their own lives. Carr and Kemmis (1986)
proposed that there are three typologies: technical, practical and emancipatory. Hart and Bond (1995) developed an action research typology based on four broad
traditions: the experimental approach which is a scientific approach to social
problems; organisational productivity and quality; professionalising which is informed by professional practice; and the empowering approach which is ‘an explicit anti- oppressive stance to working with vulnerable groups’ (Hart and Bond 1995, p 44).
Carr and Kemmis (1986)’ action research typologies include emancipatory which is equivalent to Hart and Bond’s empowering typology. Hart and Bond’s typology was developed to attempt to simplify the complexity of action research but the authors acknowledged that this was not able to encompass the full ‘fluidity and dynamism of action research’ (Hart and Bond 1995, p 44). These typologies overlap in practice as the action research cycles evolve.
The dominant stance for this research study was envisaged to be professionalising as defined by Hart and Bond (1995) as the local occupational therapists were working together with the lead researcher to change their practice. However, it was important that people with learning disabilities would not be excluded from this research study as they were the essential reason for the local occupational therapy practice. Redmond (2005) and Gilbert (2004) both argue that adults with learning disabilities should be fully involved in research rather than just being participants.
66 took the lead in designing the study, gathering and analysing data. Gilbert (2004) reviewed the literature with ‘the aim of demonstrating the richness, ingenuity and
potential of research involving people with learning disabilities’ (Gilbert 2004, p299).
However, he found that there were gaps in the literature particularly for people with severe learning disabilities and suggested that ‘the challenges include: the attitudes
of professionals, the diversity and complexity of lay groups, knowledge, power relationships, resources (both personal and financial), and values’ (Gilbert 2004,
p298). He distinguished between ‘participatory’ research where people with learning disabilities participate with the support of people without learning disabilities, and ‘emancipatory’ research where people with learning disabilities were in control of the process that aimed for social change. Gilbert (2004) recommended that research with people with learning disabilities should aim to be emancipatory but suggested that ‘participatory research can be viewed as a transitional phase towards
emancipatory research’ (Gilbert 2004, p300).
In their practice, the local occupational therapists provide a short period of
assessment and intervention for each individual person with learning disabilities with whom they work. Therefore, it would be unlikely that researchers with learning disabilities would choose to research occupational therapy in isolation as there would be other more long-term topics of interest that may affect their lives. This may be why the recent occupational therapy literature that explores views of people with learning disabilities was not focused on occupational therapy practice (see Section 2.4.2). However, obtaining the perceptions of people, who have experienced occupational therapy was identified as a gap in the literature and was considered essential by the local occupational therapists in order to be able to improve the service provided for this group. Gilbert (2004) suggested that people with learning disabilities should be seen as ‘experts’ who should be consulted about research that affects them as ‘the involvement of people with learning disabilities in the research process strengthens the quality and relevance of the research’ (Gilbert 2004, p301). Therefore, although this research study only recruited the occupational therapy staff as co-researchers, people with learning disabilities were considered a crucial voice and so were recruited as participants for their expertise at key points in the action research fieldwork.
Williamson (2012a) suggests that action research is methodologically diverse but has often been linked to critical theorists who sought social change. Post-positivism or critical realism ‘can be understood as a research paradigm placed between both
67 positivism and interpretivism’ (Grix 2004, p 84) in which the gap between the
positivist’s ‘how’ and the interpretivist’s ‘why’ is bridged. Williamson (2012a) proposed that the action researcher needs to choose the strand of action research that meets the needs of the local setting. Grix (2004) outlined characteristics of critical realism which appeared to apply to this research study. These included the need to observe and understand but also to explain and interpret in order to have a fuller understanding of the occupational therapy practice. Chapter two has explored Schön (1991)‘s epistemology of reflective practice and how services for adults with learning disabilities were influenced by the critical theorist who questioned the authority of professionals and normalisation which supported the rights of people with learning disabilities. Therefore, the action research model chosen for this study was one that was influenced by the Frankfurt School of Critical Theory and other philosophies with its focus on participation, empowerment and change and the understanding that there are multiple ways of knowing.
The action research model for this research study was based on the CRASP model of action research (Zuber-Skerrit’s 1996) as it was developed for professionals who were working towards making organisational change and so was compatible with the professionalising and participatory typology. The CRASP model is a
‘collaborative, critical and self-critical inquiry by practitioners….into a major problem or issue of concern in their own service’ (Zuber-Skerritt 1996, p 84). The title of the model uses the first letters of the five key distinct parts of organisational change which are:
‘Critical (and self-critical) collaborative enquiry by Reflective practitioners being
Accountable and making the results of their enquiry public Self–evaluating their practice and engaged in
Participatory problem-solving and continuing professional development’ (Zuber-Skerritt 1996, p85).
The model starts from the assumption that professionals are autonomous and so, when practising within an organisation or system, they need to review any policy, theory, evidence or other expectation in relation to their own professional values and constructs of effectiveness. This requires both individual and collaborative reflection to consider how practice can develop taking into account the service demands. Action research contributes to knowledge about practice and theory. ‘Knowledge in practice relates to practitioners improvement and transformation of their workforce practices into ones that are new, unique and different from past practices in the
68 particular system’ (Zuber-Skerritt and Fletcher 2007 p419). The theoretical
knowledge is developed by critical and self-critical reflection of the whole action research process. See Figure 3.1 for a representation of the CRASP model.
Figure 3.1: The CRASP model of action research for management and
organisation development (Zuber-Skerritt 1996, p86)
The CRASP model (Zuber-Skerritt 1996) was developed from action research studies involving educationalists and managers working to change their organisation systems and contribute towards their professional development. The model
acknowledged that the action researchers needed to be accountable to agencies external to their local team, for example: they needed to ensure that they were complying with national and organisation policies. The CRASP model was adopted for this research study as it appeared to be able to take into account the multiple factors that were considered to influence occupational therapy practice as represented in Figure 1.1. Accountability External values and evidence Research into Practice Cycles of learning through experience and action research Professionalism and organisational development Improved practice, reports and papers
Critical Attitude
Professional values aims and
personal constructs of effectiveness Self- evaluation Reflection
69 Zuber-Skerritt (1996) suggested that, in order to change practice, professionals need to critically reflect on their values and how they perceive their effectiveness. This is achieved through cycles of learning in action research which include self- reflection and invited criticism from stakeholders. The result of the action research is intended to develop the practitioners’ critical attitude and to change their practice in response to this. The findings of the research are made public so that they can be used as a tool to influence developments in the practitioners’ profession and
organisation. There is an emphasis on revealing value systems, norms and conflicts which may be the underlying reason for the problem that is being researched. The model reflected the occupational therapists’ experience that change in the health and social care setting in which they worked was ‘evolving and on-going’ (Zuber- Skerritt 1996, p96). The action research was planned in line with this model to be in stages or spirals of: planning, observing, reflecting, and then revising the plan. The local occupational therapists needed to work collaboratively, develop a shared vision and be empowered and motivated to change.