Medida de la actividad antiviral

Section 3.1 has described action research as being carried out with people who take action to resolve their concerns and generate knowledge through this process. However, many writers such as Atwal (2002), Morton-Cooper (2000) and Holloway

92 and Wheeler (2002) acknowledge that there can be challenges using action

research. Action research studies are often multi-dimensional, as the method evolves during the process, and so are not easy to classify. This can also create problems with obtaining informed consent as research participants will not know everything that may happen or be expected of them at the start. Some studies have not been able to maintain the change after the project has finished as success is reliant on the skills of the researcher and how well the research participants work together and the circumstances of the setting. Action research can be lengthy because of the cyclical nature and so may use more time and resources than other research methods. However, Williamson (2012a) argues that other traditional

research approaches can be focused on abstract theory rather than practical issues, they often identify problems but do not act to address them and researchers are separate from their subjects. He describes action research as ‘a third paradigm because of the involvement of researchers and their collaboration with participants and their explicit remit of changing for the better aspects of the clinical and/or social worlds of participants’ (Williamson 2012b, p36-37).

The actions taken in the fieldwork for this research study needed to be in accordance with the occupational therapists’ roles and within the remit and expectations of the organisation which employed them as the work was deeply embedded within this. Stage one of the action research field work commenced prior to gaining ethical approval as it was a natural extension of the local occupational therapy service’s practice development. During this preliminary stage, the local occupational therapists were motivated to be involved in the research in a more in- depth way and to ascertain the perceptions of people with learning disabilities and others who had experienced their practice. Ethical approval was granted by the Joint South London and Maudsley and The Institute of Psychiatry NHS Research Ethics Committee on 21/12/2009 (see Appendix F). This ethics committee was selected as it was approved for studies that involved people who may not have capacity to consent to be involved in research. It had been anticipated that some of the potential participants with learning disabilities would be able to understand and be fully

informed about the research process and the implications of taking part and others would lack the capacity to consent even when support had been provided to make the information accessible. Personal consultees, as set out in the Mental Capacity Act 2005, were approached to ensure that adults with learning disabilities, who lacked the capacity to consent, could be offered the opportunity to participate in this

93 research study. The issues about interviewing participants with learning disabilities are further explored in Chapter five, Section 5.2.

This action research study was based in the lead researcher’s work place and the ethical approval included agreement by the local employer that the study could go ahead. However, the occupational therapists’ management structure changed during the action research fieldwork on two occasions and so the participation of the local occupational therapists needed to be renegotiated at these times to ensure that the service managers were in agreement that the research study was

compatible with the needs of the service delivery. All the local occupational therapy staff including those who were not qualified were invited to become OT co-

researchers so that their contribution would be influential in the study. Many of the studies considered in the literature review in Chapter two such as Creek (2003), and Tannous et al, (1999) for example only included experienced or expert qualified occupational therapists within their studies. However, as the intention of this research study was to consider occupational therapy practice development within the local service it was important that all staff should be included as each one of them had a valuable contribution to make and it would not have been ethical to exclude them. During the recruitment process of the OT co-researchers it was made clear that participation in the research study was optional and that they could

withdraw at any time (see information and consent forms Appendix D). A specific question in the OT co-researcher questionnaires asked them if they were happy to participate. Each aspect of the action research fieldwork such as attendance at the meetings, completion of questionnaires and selection of people that they had recently worked with as potential participants to be interviewed, were all optional. Declining involvement in one or more of these aspects did not exclude them from participating in the others. However, as all of the occupational therapy staff were recruited the action research fieldwork and the occupational therapy practice were not clearly separated. The decision of individual staff members to opt out would have been respected, although it probably would have been difficult for staff to decline as they may have been concerned about what their colleagues would have thought and may have felt excluded from professional support and learning. The lead researcher was observant about any concerns regarding engagement in the research study and ensured that the OT co-researcher meetings continued to be clearly demarcated as separate from usual practice meetings. The lead researcher negotiated the times and venues for the OT co-researcher meetings with the local occupational therapists and these could be re-scheduled if other priorities arose.

94 The lead researcher only accessed information regarding the specific occupational therapy practice of each of the OT co-researchers from what they were willing to share as part of the action research specific activities.

For most research studies, the lead researcher needs to be objective and demonstrate that he or she has not influenced or introduced bias to the study. However, in this action research study, the lead researcher was an insider-

researcher and so had a remit of sharing her reflections and having an influence on the direction of the study. The lead researcher must also balance the role of being part of the research with the responsibility to ensure that all the views of the co- researchers and the other participants were represented and the issues of bias and subjectivity were taken into account and limited as much as possible. This included ensuring that the views of the quieter or less articulate responders were not

marginalised by the more dominant voices.

All participant identifiable information was removed from all documents and replaced by code. All data, which included audio recordings, questionnaires, transcripts of interviews and group meetings and completed consent forms, were stored in a locked filing cabinet on NHS premises and/or filed on an encrypted NHS computer system. All data will be kept for the maximum of ten years from when it was

collected which is March 2020 and will then be destroyed. Some aspects of the data collected were shared by the lead researcher with the OT co-researchers so that they could participate in the data analysis process and discuss and reflect on the emerging themes and findings. How the data would be stored and used was explained on all the participant information sheets provided (see Appendices D, H and I) and explained in person to all participants who were interviewed prior to obtaining consent. All participants were made aware that they could withdraw from the study at any time. The OT co-researchers were aware of each other’s

contributions within the OT co-researcher meetings but responses to the

questionnaires were amalgamated by the lead researcher to ensure that individual contributions could not be identified by the other co-researchers. As the study took place within the lead researcher’s own service, the OT co-researchers as a group could potentially be identified. Therefore all care was made to remove any

contributions that could be identified as being from an individual OT co-researcher and the findings were shared with the OT co-researchers throughout the fieldwork so that any concerns could be addressed.

95 It was acknowledged that this lack of anonymity may have inhibited the OT co- researchers to respond openly if they had negative views to share. In order to address this, the information sheet (see Appendix D) had explained that any concerns that the OT co-researchers may have had could be raised with the team manager who was not part of the occupational therapy profession and as with any work issues, general concerns could be raised with the individual member of staff’s line manager or a formal complaint could be raised. The purpose of this research study was to consider how occupational therapy practice developed within the local service. As part of the study of occupational therapy practice there was a need to take into account differences of opinions between colleagues and to be aware of the hierarchy of structure within the service, where some members have managerial and supervisory responsibility for others. These factors exist within the local occupational therapy service and are part of the context of the investigation. Hypothetically, it would be expected that difficulties in sharing information may also have been a problem if there had been an external researcher. There may have been a reluctance to share practice concerns with a person who was not from the service as this may have been considered disloyal. There could have been less trust as to how this information would have been used as an external researcher may have been unaware of sensitive or potentially difficult issues. The OT co-researcher questionnaire responses, and if these had been influenced by the lack of anonymity, are briefly discussed in Chapter ten.

3.7 Summary

Action research was chosen as the methodology for this research study as it used a critical social science tradition to empower the local occupational therapists to collaboratively learn about and develop their own practice. The methods used in this research study were qualitative as they explored the local occupational therapy practice using small samples. The lead researcher participated with the local occupational therapists and data were collected from multiple perspectives in order to gain new knowledge of occupational therapy practice development and theory. Action research findings need to be considered in terms of being meaningful and authentic for the participants.

This research study was based in the context of the local community occupational therapy service for adults with learning disabilities and the claims for knowledge are

96 related to the development of the local occupational therapy practice. The research study also sought to contribute to the professional knowledge as to how

occupational therapy could best be practised and improved for this speciality. This research study was based on Zuber-Skerritt (2007)’s CRASP model and the focus was on the local occupational therapists working collaboratively with the lead researcher to develop their practice. Data were gathered from the discussions in group settings and also individual reflections using questionnaires. The action research fieldwork was completed with the local occupational therapists over three stages and the specific methods used at each stage were not all planned in advance but evolved as part of the collaborative enquiry. Data were analysed mainly by thematic analysis. The action research thesis was completed by the lead researcher and involved a meta- analysis of the findings of the action research and re-

engagement with the literature in order to develop practice based on research findings in order to meet the overall purpose of the study and to address the fieldwork objectives (stated at the end of Chapter one).

97

Chapter four: Stage one - the local occupational

therapists’ search for a standardised assessment to

support evidence-based practice in working with

adults with learning disabilities

Stage one commenced in 2007 when the local occupational therapy service was part of a primary care trust and managed by health professionals (see Section 1.2). The local occupational therapists were confident in their practice but understood that there was an expectation from their professional body (COT) to demonstrate

evidence based practice specifically in the use of standardised assessments (see Chapter one, Section 1.3 and Tables 1.1 and 1.2).

In stage one the lead researcher collaborated with the local occupational therapists to explore the current use of assessments by the local community health team working with adults with learning disabilities and to further develop and improve practice based on the evidence generated. Gray (2014) acknowledges that a group of people will have differing views and opinions and describes these different realities as “constructions”. The lead researcher’s role was, therefore, ‘to bring people with divergent views and perceptions together so that they can collectively formulate a joint construction’ (Gray 2014, p333).