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F O C U S
Reflection Look, think and act cycles in participatory action
research
Tina Koch RGN, PhD Honorary Professor
The School of Health Science at the University of Wales Swansea
Susan Mann RN, MSocSc, BN, PhD Director, Clinical Leadership
Royal Adelaide Hospital, Adelaide
Debbie Kralik Post Doctoral Fellow (ARC)
University of South Australia
Antonia M. van Loon RN, PhD Senior Research Fellow
RDNS Research Unit, Royal District Nursing Service Foundation of SA Inc.,
Adjunct Faculty, Flinders University, Adelaide, South Australia
Abstract In this paper, four researchers describe reflection as a component of a participatory action research cycle. We draw on our experiences and learning
while undertaking three research inquiries. In the first inquiry we listen and
respond to the voices of Australian Aboriginal people who live with diabetes and
we share an alternate story, where fear is turned into courage, as told by these
Elders. The second inquiry involves email communications with women and men
who live with a chronic illness and gives a facilitator’s reflections. And the third
study is a capacity building process with women who have experienced child
sexual abuse. These women have used/misused alcohol, licit/illicit substances, or
gambling, which has contributed to their homelessness. Confronted by many of
life’s obstacles, we gain a glimmer of hope as women describe the way in which
they use the participatory process to make sense of their lives.
It is argued that reflection occupies a central place is participatory action
research cycles of ‘look, think and act’. ‘Look, think and act’ processes are
appealing precisely because they are meaningful to research participants in their
everyday lives. When these processes are internalised as modus operandi, they can
be sustained throughout one’s life as a strategy for building capacity or ‘moving
on’. ‘Moving on’ or transition is the theoretical focus that holds these inquiries
together.
261
Journal of Research in Nursing
© 2005
SAGE PUBLICATIONS
London, Thousand Oaks and
New Delhi
VOL 10(3) 261–278
ISSN 1744-9871
jr n
Keywords participatory action research, reflection, Australian Aboriginal Elders, chronic illness, homeless women, transition.
The aim of this paper is to describe reflection as a component of a partici-
patory action research cycle. We will draw on our experiences and learn-
ing while undertaking three research inquiries. In the first inquiry we
listen and respond to the voices of Australian Aboriginal people who live
with diabetes. The second inquiry involves email communications with
women and men who live with a chronic illness. And the third is a
capacity-building process with women who have experienced child sexual
abuse. These women have used/misused alcohol, licit/illicit substances or
gambling, which has contributed to their homelessness.
The working principles of Participatory Action Research (PAR) guiding
these inquiries included relationships, communication and inclusive par-
ticipation (Stringer and Genat, 2004). These principles are based on the
assumption that people are self-determining authors of their own actions,
who can and do learn to reflect on their world and their experiences
within it. Everyone involved in the research projects contributed to the
collaborative thinking, decision-making and idea-generating that
occurred, which was underpinned by notions of reciprocity and respect
for each person and their self-agency.
The three inquiries have in common Stringer’s (1999) application of
participatory action research cycles: look, think and act. Looking means
gathering information, defining and describing the situation. Thinking
refers to exploring, analysing, interpreting and explaining. Thinking is
stimulated as participants ask: ‘What is happening here?’ and ‘Why are
things as they are?’ Finally, in the action component, participants are
asked what is important to them in their daily lives and to consider ways
that they may be able to act to make changes in their lives.
PAR shapes our research programme
Our chronic illness research programme has been in progress since 1996
and has been shaped by a collaborative research approach and guided by
primary healthcare principles: social justice, equity, health promotion and
researching with clients and community. Each inquiry starts with particip-
ants’ storied accounts. As people narrate their stories and hear the
responses from others, they start to hear their life anew (Frank, 1995;
Koch, 1998; Holstein and Gubrium, 2000; Aranda, 2001, Brody, 2003).
When possible, participants are co-researchers, and we collaboratively
decide on action and what can be done to ‘make’ or shape the future.
Outside the field of chronic illness experience we have applied our
Journal of Research in Nursing 10(3)
262
theoretical understanding of transition in a capacity building programme
with homeless women who have been sexually abused during childhood.
Storytelling and reclaiming self-identity is part of that work (Kleinman,
1988; Gergen, 1991; Kelly and Field, 1996; Nettleton and Watson, 1998;
Brody, 2003).
Look, think and act: researching with Australian Aboriginal Elders
‘Diabetes is killing our community’. These were the words that brought
the project manager, the research team and Aboriginal Elders together in
this study. The Port Lincoln Community on the Eyre Peninsula in South
Australia has registered about 600 Indigenous Australian people, of whom
200 are reputedly diagnosed with diabetes. The diabetes death rate is
204% higher for Aboriginal people on the Eyre Peninsula in comparison
with Aboriginal populations in South Australia overall (Nguyen et al.,
1996). Despite the persistent and disproportionate burden of Aboriginal
ill-health caused by diabetes, the usual medical management approaches
have not yielded the necessary improvements for Aboriginal people.
Recent reviews have called for more locally responsive participatory pro-
grammes that empower Aboriginal people in the improvement of diabetes
management (KPMG Management Consulting, 1997; Diabetes Australia,
1998; Kimberley Aboriginal Medical Services Council WA, 1998). This
project was funded by National Health and Medical Research Council and
the proposal made its journey through several ethics committees and a Port
Lincoln Aboriginal Governance Committee. Approval was granted.
The management of diabetes often involves education for the diag-
nosed person and is underpinned by self-monitoring of metabolic
control. Non-adherence with the suggested therapeutic regime is often
cited as the most important problem in diabetes management. Rather than
follow the medical management route, and leaving behind the controlling
language of compliance and non-adherence, we believed that greater
involvement of Aboriginal families in diabetes management programmes
that deal with issues of concern to them would lead to improved health
outcomes. As researchers we argued that a more appropriate therapeutic
action could be developed collaboratively by Aboriginal families, their
health workers and other diabetes educators and clinicians. The value of
using empowering approaches to diabetes management has been substan-
tiated by previous research with non-Aboriginal people with Type 2 Dia-
betes (Koch et al., 1999; Koch et al., 2000; Kralik et al., 2000).
Empowerment in these instances was achieved by skilfully facilitating
people towards an exploration of their circumstances, the contexts of their
lives as well as their experiences with diabetes.
Koch et al. Reflection
263
The aim of this 12-month inquiry was two-fold — to use participatory
action research (PAR) to improve diabetes self-management with Aborigi-
nal families as well as develop the skills of Aboriginal Health Workers in
PAR. The Elders who participated in the project were all residents of Port
Lincoln. All belonged to the Council of Aboriginal Elders of South Aus-
tralia Port Lincoln Forum Incorporated.
Looking Facilitated by Mann, participants were encouraged to talk about their
experiences of living with diabetes in response to the questions: How has
diabetes affected your lifestyle? Can you give an example of an incident or
episode that really changed your life? How do you feel about what is hap-
pening to you? What sorts of things (people or services) help you to
manage successfully? Thereafter, the 12 participating Elders set the agenda
for discussion. Ten sessions or 40 contact hours provided the opportunity
to build trust. People were able to give storied accounts of their experi-
ences. Passing on information and educating others through storytelling is
well understood within Aboriginal communities. One important realisa-
tion that emerged from this project is that storytelling is a powerful way
to make positive changes in people’s lives.
Thinking The group identified four themes that impact on the successful self-man-
agement of Type 2 Diabetes. These themes were: nutrition, better under-
standing diabetes, the education of young people and providing support
for family and wider community members. Wrapped around these
themes was the need to create a supportive environment where learning
can occur. Such learning has the potential to encourage strong and mean-
ingful community action. While understanding of diabetes varied greatly
with the group it was primarily seen as an illness over which individuals
had little control. Initially diabetes was seen as debilitating and stopped
people doing the activities they wanted to do.
As the group continued to share their experiences, however, the link
between nutrition, exercise and medication became more apparent to
everyone. One member of the group found a way to live meaningfully by
adjusting her lifestyle and becoming involved on committees. The Elders
sharing their knowledge in this way resulted in their ability to recognise
that their general feeling of overall wellness could be enhanced with greater
understanding of the links between their diet, their physical activity and
their medication. The Elders also demonstrated generosity and commitment
to education of the young people by their willingness to share their time
and experiences, especially their experience with alcohol. While they
understood that drinking alcohol often had a detrimental effect to their suc-
Journal of Research in Nursing 10(3)
264
cessful management of diabetes, they understood that young people had a
great need to belong and that alcohol was one way of feeling included in a
group.
Acting The Elders developed a culture within the group that reflected a safe
learning environment for all involved. This supportive environment
enabled the participants in the group to discuss their fears of either being
diagnosed themselves, or having one of their family diagnosed, with dia-
betes. Initially, they were anxious about what such a diagnosis would
mean for themselves and/or their family members. This was expressed in
a dominant story of fear where fear was the controlling factor in their
experience of living with diabetes. As fear increased, participants talked
about withdrawing from family and friends. Some of the participants
blamed God or family.
During the discussions with the group, participants described what it
was like to be living a dominant story of anxiety and fear regarding living
with Type 2 Diabetes. This included a fear of doctors, which could lead to
anxiety attacks, high blood pressure and increased stress. Living life in this
way found the participants trapped within a way of life that resulted in
negativity, depression and failure to take responsibility for their own
health. Fear became the way the group initially described their experi-
ences under the identified themes of nutrition, understanding, education
of young people and support for family and community. Fear therefore
became an obstacle to management.
Fear hampered the management of diabetes because of the group’s lack
of understanding regarding the ‘chronic nature’ of diabetes. Even when
there are many resources available in terms of pamphlets and brochures,
participants identified a lack of awareness and education regarding the
symptoms of Type 2 Diabetes. Anxiety and fear prevented them either
understanding information or seeking education regarding diabetes. Their
fear of medical doctors hampered any thought or desire to gain informa-
tion or education. As a result they did not know what diabetes was, they
did not understand the link between family history and diabetes and they
did not understand the impact of physical activity on sugar levels. Believ-
ing they would ‘get over it’ they did not attempt to engage in any form of
physical activity. Anxiety was increased when available information was
conflicting or confusing regarding management of diabetes and the
impact of diabetes on lifestyle. Such confusion made keeping up with
current knowledge regarding diabetes difficult.
However, in the discussion that followed, the Elders recognised that
they had tackled fear and the way in which they had done this became the
topic of conversation. The Elders discussed ways that they could learn
Koch et al. Reflection
265
from each other and how their experience could benefit other members
of the community. ‘Acting’ in this context is taking community action.
From fear to courage: creating an alternate community story
As the group progressed and people expressed their fears about diabetes
and recognised how fear had dominated and interfered with their man-
agement of diabetes, there began to emerge a story of courage that was
full of life, creativity, resilience and strength. It is this story of courage
that demonstrated how people lived their life in a meaningful way.
Courage was recognised in both the person diagnosed with diabetes,
and the people caring for or living with a person with diabetes. For the
person diagnosed with diabetes, courage was evident by their ability to
name fear and accept the diagnosis. This ability was aided through prayer,
and the support of family and friends. The Elders agreed that only when
you took responsibility for your own health could you move forward.
Confidence was increased through the understanding that they were
‘not alone’ in their experience. Elders recognised and acknowledged their
own strengths and felt an enhanced ability to take control of their lives.
They gained in their knowledge and understanding of the impact of
diabetes on their lives by the knowledge generated in their group. As their
understanding increased, Elders gained a greater control and understand-
ing of their choices regarding their health. Their knowledge was affirmed,
valued and respected.
Significantly, this group worked towards an Elders Story Day and the
production of a booklet telling the stories of their experiences. This
outcome was designed to give voice to their experiences in a public
forum. This day represented the culmination of their learning and
involvement in this project. The booklet, Look, Think, Act: Indigenous
Stories about Living with Diabetes outlined the events as they took place
during 2003. The booklet focuses on the voices of the Elders as they talk
about their life experiences with a particular focus on their management
of Type 2 Diabetes. They shared their personal experiences of either
having diabetes or caring for a partner and/or family member with dia-
betes or wanting to support friends with diabetes. They also discuss their
hopes for the future, their hopes for the young and their plans for rescu-
ing their community from the onslaught of diabetes. Further the group
commenced road shows around the Port Lincoln Community. They found
that talking about their experience was liberating and they believed this
health promotion work was central to their community’s development.
Journal of Research in Nursing 10(3)
266
Email conversations with men and women who have chronic illness
Kralik has been the facilitator of a longitudinal study that has generated
data via an online collaborative inquiry group. In this section she shares
some of her reflections whilst researching
Longitudinal research with men and women learning to live with
chronic illness is in progress where the aim is to explicate transition, that
is, the way in which people can ‘move on’ and incorporate the con-
sequences of illness into their lives (Kralik, 2002). Conversations between
men and women (in separate gender groups) have taken place daily since
July 2003 (and will conclude early 2005) using a facilitated, private elec-
tronic mail (email) discussion list (Kralik et al., in press).
The decision to utilise email as a method for generating longitudinal
research data developed from our understanding of the consequences of
illness that people living with chronic conditions confront in their lives.
Fatigue, pain, social withdrawal and decreased mobility pose challenges
to these people that may limit their involvement in research that utilised
data generation via group or one-to-one interviews. Engaging in daily
email communications has created building blocks of text that reveal rich
life stories which, when analysed, will further explicate the experience of
incorporating a long-term illness into daily life.
The Internet or World Wide Web (WWW) enables people with suit-
ably connected computers to communicate with each other. We recog-
nised the potential of using email over the Internet to enable discussion
between research participants (Kralik et al., in press). It has also been a
useful approach for both data generation and data management because
we have been able to read, reply, print, forward or file extended messages
that have been electronically transmitted (Mann and Stewart, 2000). The
use of email has enabled data generation and analysis to occur concur-
rently, and has provided the means for us to research alongside people
living with chronic illness to describe the process of transition through
illness (Kralik, 2002). We have developed a website that includes more
detailed information about the background to the research
(http://www.unisa.edu.au/nur/arc_project/).
A learning circle
The group communication processes have developed into a ‘learning
circle’ which has fed into the cycle of action learning operationalised as
‘look, think and act’. Learning circles are virtual communities that have no
fixed locations or time zones and have been effective and practical
method of learning and social change (Hiebert, 1996). Community
Koch et al. Reflection
267
organisations, trade unions, churches and social justice groups have used
learning circles to empower their members to make choices and take
action. The distinctions between a learning circle and a discussion group
are that learning circles are more focused than a discussion group, they
are based on common resources and intended to have action outcomes.
Storytelling is privileged to a great extent in this type of online
community discussion. The story told online, however, is only part of the
story. A storyline continues to evolve in the life of the participant as a
direct result of reflecting on either the sent or received information. The
virtual and real life situations become inseparable.
A learning circle involves groups of people who discuss issues of
importance to them and society. They learn at their own pace, reflecting
on their own experiences and understandings, without a lecturer or an
expert ‘running the show’. A researcher facilitates the group conversations
by asking questions, prompting reflection and providing alternate ways of
thinking. Participants set the agenda for discussion by identifying the
issues that are important to them. Learning how to live with long-term
illness is not just preparation for life, it is a way of life for group
members. Exchanging ideas and experiences enhances learning because it
is inherently a social process of constructing shared understandings. The
facilitated groups provide structure and process to the learning circle for
creating a shared way of understanding.
The ‘action’ has not always been as obvious due to constraints such as
pain and mobility; however, the sense-making of experiences is privi-
leged (sense-making is often the act). Clearly, when we make sense of our
experiences through the reflection processes of looking and thinking,
possibilities for action become ignited. Developing these online
communities has been about creating a shared way of thinking about our
world and ourselves.
Reflection in action
The cycles of reflection and action are integral to this collaborative
inquiry. In this research, reflection has flowed naturally within the discus-
sions. The use of email has provided the participants with the time to
reflect and make sense of their experiences prior to communicating to the
group and hence enabled rich data to emerge. Bray et al. (2000)
described three forms of reflection: descriptive, evaluative and practical.
Descriptive reflection relates to events and responses to the discussions
experienced by the group. In this group, descriptive reflection has
occurred continuously. Evaluative reflection critiques actions, thoughts
and feelings, as related to the inquiry process. The group engaged in eval-
uative reflection when discussing their responses to each other, how they
Journal of Research in Nursing 10(3)
268
felt about the inquiry process, and how they felt about being a part of the
group. Practical reflection occurs when a summary of the communica-
tions is given as feedback to the group and in project team meetings when
direction for continuation of the project has been made.
Storytelling has been central to the group discussions, particularly
because communication by email has removed the dimension of body
language, tone of voice and facial expression that face-to-face conversa-
tion provides. Bray et al. (2000) noted that storytelling is particularly
valuable when working with diverse groups. The participants in the
online groups range in age from between 25 to 68 years, have diverse
medical diagnoses and reside in diverse geographical areas (urban, rural
and remote). Storytelling has been effective as the starting point for the
making of meaning in the experiences of the participants.
The aim of collaborative inquiry is to construct meaningful, practical
knowledge from the experiences of the participants. The group process
enables enriched insights into the experiences of others, from which the
group engages in making meaning of these experiences. Collaborative,
reflective discussions are helpful in generating deeper insights and under-
standings. This inquiry has generated data that have been transformed
into knowledge by using reflections on the similarities and differences
between participants’ experiences.
Self-reflection as data
Self-reflection is a requirement of this PAR process but it can be difficult
for researchers to make known their assumptions, presuppositions and
choices. Disclosure often means sharing one’s own experiences with the
group. We research in the awareness that our history and the various
communities to which we belong influence our interpretations. Keeping
journals and analysing the way in which our horizon is operating is
important whilst researching. During this longitudinal research, Kralik
uses prompts to aid reflection:
• Do the words I use betray my attitudes to topics?
• What unintended outcomes do I bring about through my own facilita-
tion style?
• Have I self-authorised the facilitation role that I have taken on?
• Is control in these conversations important and why?
• Do I confuse ‘facilitation’ with ‘control’?
• How do I know that I am not projecting my own importance onto this
group?
• Can I consciously replace control with trust?
• Can I be present and in connection with others?
Koch et al. Reflection
269
• Can I be vulnerable and have a ‘don’t know’ mind, and thereby be
open to new learning?
• Can I invite ambiguity and uncertainty to enter the conversations?
Asking these questions during the research process will focus attention on
interpretation and facilitate the researcher’s own reflection. These ques-
tions continue to prompt thought on contexts and how they affect
judgements and interpretations. The participants in the email groups
have challenged us as researchers to reflect upon our definitions of both
participation and facilitation. It has become evident that facilitation in a
longitudinal project such as this is a challenging and skillful role. The
groups have become self-aware through reflection without being driven,
probed or ‘controlled’ by a researcher. However, we are conversing with
the participants over a long period of time and constant self-reflection can
be exhausting and/or boring, so lighter times are also needed. We have
learned to trust the cyclic nature of using ‘look, think and act’ within the
learning circle and, consequently, we have identified shifts in understand-
ings that have occurred over time in communications on the same topic.
Learning to live with chronic illness needs time, and we have learned to
respect that need for time so that, through reflection, action may occur.
Capacity building with women who have experienced child sexual abuse and addiction
This two-year capacity building project, which commenced in August
2003, used the ‘Look, Think, Act’ model of Participatory Action Research
(PAR) described by Stringer (1999) to work with women survivors of
child sexual abuse (CSA). These experiences have led these women to
misuse alcohol, or illicit drugs/substances, or gambling, which has
directly contributed to their state of homelessness. Thirteen women con-
nected to an inner-city supported accommodation service were voluntar-
ily recruited into the project, thus their willing participation in a group
that had the potential for personal growth was likely. However, the
women stated that they were uncomfortable and felt unsafe in a large
group. Therefore, two groups were formed to facilitate a climate that
would promote trust, reciprocity and the opportunity for each woman to
be heard. The groups were facilitated by the author, a nurse researcher,
supported by a social worker from the partnering organisation. It was
anticipated that unpacking an abused past could surface painful memories
that would require counselling support from a trusted worker whom the
women knew.
Interaction and data generation commenced with an in-depth one-to-
one interview with each woman. She was provided with the space and
Journal of Research in Nursing 10(3)
270
time to tell ‘her story’ of how the sexual abuse experience/s have
impacted her life, and how and why she came to use/misuse
alcohol/drugs/gambling. These individual stories were analysed and the
plot lines of strength and resilience were presented as the starting point
for PAR group work. Interviews and group meetings used a narrative
approach that was audio-taped, transcribed, analysed and given back to
the women after each fortnightly PAR group for validation, reflection and
considered action. PAR groups continued fortnightly cycles for 16
months.
Feedback was presented using verbatim extracts grouped around them-
atic issues and written up using the ‘Look, Think and Act’ process to
guide reflection. Exemplars from the fortnight’s discussion were provided
and questions were posited so each woman could systematically name her
thoughts and feelings around the issues presented, thus making sense of
her own situation and preferred options in relation to that issue, and
reflect on which way she might like to move. If possible, she should
decide what she could action to achieve her desired outcomes. Addition-
ally, findings were summarised and provided to two reference groups of
service providers (n = 25) for reflection on their organisational practice
and possible actions to improve services, and build capacity and respon-
siveness to this client group. However this paper focuses on facilitating
reflection in the two CSA survivors’ groups.
Facilitating a trustworthy space for safe reflection
Many adult CSA survivors actively repress memories of the events, so they
can live and function from day-to-day. They avoid discussion of their
experiences because it involves disgusting, humiliating and embarrassing
details that are painful to recall (Mazza et al., 2001). Their early betrayal
and violation make them necessarily suspicious and protective. They have
difficulty trusting people; therefore, facilitating group work requires pro-
vision of a respectful and safe space and facilitation that is honest, authen-
tic and non-judgemental. The facilitator must demonstrate compassion
and genuine empathy or the group will not develop the trust required for
effective PAR group work.
Facilitating reflection in/on/for action from the ‘Look–Think Two Step’
The process used to facilitate action was an amalgam of the work of
Stringer (1999), Koch (1998) and Schön (1983) This was simplified
for ease of use to ‘looking’ meaning giving a name to the issue, and
‘thinking’ involving clarification of the details of the issue. The women
Koch et al. Reflection
271
recognised that the capacity to reflect more clearly was facilitated by
guided group work, where they could safely externalise the problem by
naming it, and giving it a voice in the group thus obtaining varying per-
spectives on the issue. What each woman took from the session, or what
changes she instigated in her life, was up to her. There were often quite
different interpretations for each person.
Looking In essence the issue/problem/situation was discussed so that the woman
could make sense of what was happening, increase her understanding and
commence thinking about ways to reshape or re-story her situation. In the
safety of the group, the story was unpacked for the woman’s meaning first.
This could be considered to be what Schön (1983) termed ‘reflection-in-
action’, which takes place when the woman is engaged with her situation
and looking and thinking about what is going on, which may produce the
tacit knowledge she uses to take further action. The women had a great deal
of tacit knowledge about people and survival. Their need to survive their
traumatic past has led to highly attuned observation and non-verbal com-
munication skills. Consequently, this group is very able to work out when a
health professional is working for/with them as a whole person, or simply
focused on their problems. Surfacing such tacit knowledge was very useful,
because it reinforced the alternate story of survival, resistance, strength and
agency, and that storyline became the framework for reshaping a new story.
Thinking Reflection within the PAR process is a dynamic movement forward or
backward. When a move fails to do what is intended and produces con-
sequences considered to be undesirable, the woman is encouraged to
think about why it did not work. Such sense-making conversations
surface understandings that can be critiqued, reshaped and embodied, a
process that Schön (1983: 50) terms ‘reflection-on-action’.
The group provided a safe space for conversations that could be termed
‘reflection-for-action’ where women considered options, contemplated
probable consequences and outcomes of various possible actions and pri-
oritised their future actions. The outcome was often that the situation
took on new meaning, and doing nothing was the chosen action. This
was perceived to be an excellent outcome because the woman was choos-
ing to create space to scope out the terrain of the problem before nomi-
nating her chosen action. This was an important alteration from past
patterns of responding, which tended to be reactive responses to intense
emotions such as fear, anger, guilt and shame.
It was Dewey (1933) who posited reflection as a process that enabled
connections to be formed between various aspects of one’s experience.
Journal of Research in Nursing 10(3)
272
Group reflection facilitated emancipatory knowledge when the women
recognised connections between their abuse experience recognising they
were not alone in these experiences. Other women had similar thoughts,
feelings and emotions that were the legacy of past abuse and this led to a
common understanding that helped each woman to feel free to express
herself within the group. Interpretative knowledge was facilitated by
working together to reflect on their lives, constructing common mean-
ings, making sense of experiences, exploring possible explanations for
their current life positions and thinking through close and hopeful altern-
ative ways of living in the future.
When the women received the previous week’s feedback, they reflected
on the problems discussed. The facilitator thematically clustered common
aspects of problems and posed questions that might assist reflective think-
ing. The narrative conversations shed light on problematic situations that
were troubling and uncertain, and enabled each participant to reshape her
actions accordingly. The problem was first named, which could take some
time because the women often became confused over the present situ-
ation and it took time and patience to establish linkages between current
emotions, thoughts, feelings and situations and past experiences. Bearing
in mind they had actively suppressed memories, their reflection skills
were not a part of their repertoire of life-skills. Concurrent with naming
the things to which they wished to attend was framing the context in
which they would attend them (Schön, 1983: 40). The problem was set
according to current observations and reflections of experiences. The
group compared responses to the framed problem and the women were
able to reflect-in-action, coming up with new ways to reframe the initial
problem. The group process stimulated reflection, so the women could
continue to reframe, experiment, transform knowledge schema and create
new insights. With each fortnight a repertoire of life praxis grew and this
built capacity to cope and choose new ways of responding to the intru-
sions of past sexual abuse on current living and being.
The potential of reflection toward action
The narrative process of group work helped women to find solidarity as
they worked through their past experiences. There were clusters of
common themes that were unpacked in conversation, so new ways of man-
aging the intrusiveness of past trauma could be considered. Particularly
intrusive were issues around self-image and self-worth, and emotional
experiences such as anger, guilt, shame, fear, anxiety, etc. Horowitz (1976:
115) points out that the mind has a ‘tendency to seek similarities and inte-
grations’. Consequently, any current experience that provoked such emo-
tional responses within the woman could send her back to former stress
Koch et al. Reflection
273
responses that she may have chosen to obliterate by using alcohol, drugs,
gambling, etc. Over the space of 12 months, many of the women could see
these connections and understand where their responses came from.
In reflecting about past coping strategies, childhood fantasies and
memories, we worked through their life stories, always foregrounding
and privileging any alternate story of strength and resistance. The fre-
quency of the meetings allowed the women to process the issues in man-
ageable bits. They would choose what to action based on their reflections.
At all times the woman maintained agency about her presence and
conversations within the group. Sometimes a woman would absent
herself for a time, because she felt the group was causing too many emo-
tional intrusions in her life. Invariably she would use this time to reflect
on the therapeutic worth of the group for her current situation. When she
was ready, she would return. More than 75% of the group chose to
return, and are continuing to meet on conclusion of data generation.
The women used their existing repertoire of life-skills and knowledge,
reflecting on similarities and differences, to form new understandings and
test new propositions within the group, probing their current situation
from multiple perspectives. Identification of similarities in concepts was
described by Schön (1983: 183) as developing a ‘generative metaphor’
that was highlighted in written feedback and became the basis for reflec-
tion and the next cycle. These metaphors were used to link ideas, so
common ground became obvious, and a sense of solidarity emerged as
women could see that they could learn from one another. When they saw
that reflection-for-action could lead to significant proactive responses that
provided their desired outcomes, they began to see the value in Looking,
Thinking, Actioning and began to incorporate it as a life skill to solve
problems. As with most skills, the more they practised, the better they
became at it. Thus the PAR research process demonstrates that it provides
emancipatory knowledge to participants, improving their life situations,
which is the aim of all participatory action research.
Discussion
The inquiries discussed in this paper show the way in which ‘look, ‘think’
and ‘act’ works. In the ‘looking’ phase, participants are brought together
and given time to become acquainted with each other. Guidelines are
developed in consultation with the group. These guidelines for group
behaviour always allow each individual to have a voice. Attentive listening
and confidentiality are stressed. In the early sessions, it is important to
explore personal expectations and fears. Participants are often in tune with
non-verbal behaviour and can assess genuineness of the facilitators and
others in the group. Participants are invited to tell their own story.
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In the ‘thinking’ phase of the group, disclosure may be a sign that trust
has been created; however, it has been noted that trust usually takes several
sessions. It took longer for vulnerable client groups, such as the survivors
of child sexual abuse who had inherent difficulty in trusting strangers.
There are some revealing characteristics to indicate that the group is effect-
ive even when early signs are of anxiety, defensiveness and resistance and a
struggle for control. It is recognised that conflict is part of the group
process and when this is unaddressed it results in defensive behaviour,
hostility, indirectness and lack of trust. Effective conflict resolution is likely
to result in group cohesion. The aim of ethical confrontation is to develop
a genuinely more cohesive and open relationship and needs to be delivered
sensitively. It is important to recognise that a person must be given an
opportunity to reflect before responding to questions raised by others.
In the inquiry with homeless women, the back and forward movement
within one’s head of ‘looking’ and ‘thinking’ could quickly become the
confusion that triggered panic attacks, anxiety and inability to sleep. The
women had multiple health and social problems which could rapidly over-
whelm them with fear, anger, guilt, shame, grief, sadness, hopelessness and
anxiety. These emotions create confusion, and women speak of ‘losing their
mind’ or ‘going crazy’ (Quas et al., 2003). Women respond to such painful
experiences with reactions learned over years of disruption and abuse. As
group discussion progressed, it became clear that reacting through taking
drugs, alcohol and/or gambling was seen as an immediate response to pain
and fear. The fear-driven responses of thinking and reacting (without
reflecting) enabled them to survive and provided instant relief. Through
expert facilitation, the women learned to purposefully reflect-on-action and
reflect-for-action. It stopped them becoming locked in the dizzying confu-
sion we termed the ‘Look–Think Two Step’. Thus using Participatory Action
Research has the potential to be risky if it is not carefully facilitated.
In the ‘acting’ phase of the group, there is usually a commitment of
participants to explore issues and there is increased involvement shown
by supportive interactions within the group. Greater responsibility for
individual and group outcomes is accepted. Learning is noticeable by real-
istic expectations of group experience. Participants begin to understand
that change is often slow and subtle. Participants decide what to do with
what they have learned and think for themselves. Often the group’s
closure includes consolidation of learning and reviewing of experience.
When participants are asked what they believe is the most important
outcome of the group, support and recognition they receive from others
are given as the most significant occurrences. The group sustainability
after participatory action research groups cease to meet is enhanced when
closure is handled sensitively. Often the group continues to meet or con-
verse once the facilitator has ‘left the field’.
Koch et al. Reflection
275
Conclusion
Reflection occupies a central place in cycles of ‘look, think and act’.
Writing, reflecting, analysing, providing feedback to participants and
rewriting are particular facilitator skills. Keeping a researcher/facilitator’s
journal and its critical analysis are vital aspects of participatory action
research practice. Facilitators are encouraged to monitor the research
process, show the way in which their interpretative horizon is operating
and show transparency about the collaborative construction of the find-
ings. We will argue that look, think and act cycles are appealing precisely
because they can be interpreted by research participants in their everyday
lives. We have alluded to the risks and the need for expert facilitation
when an inquiry takes an uncharted water course. However, the appeal of
this process is attributed to its simplicity. When the process is internalised
as a modus operandi, it can be sustained throughout one’s life as a strat-
egy for building capacity or ‘moving on’. ‘Moving on’, or transition, is
the theoretical focus that holds these inquiries together.
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Key points
• Participatory action research is recommended when working
with participants towards capacity building and/or community
development.
• It is proposed that ‘look, think and act’ is a useful way for con-
ceptualising participatory action research.
• Look, think and act participatory action cycles are appealing
precisely because they can be interpreted by research particip-
ants in their everyday lives.
• Reflection occupies a central place in participatory cycles of
look, think and act.
• Writing, reflecting, analysing, providing feedback to particip-
ants and rewriting require expert facilitating skills.
• Keeping a researcher/facilitator’s journal and its critical analysis
are vital aspects of participatory action research practice.
• The appeal of this PAR process is attributed to its simplicity.
When the process is internalised as a modus operandi, it can be
sustained throughout one’s life as a strategy for building capac-
ity or ‘moving on’.
• ‘Moving on’ or transition is the theoretical focus that holds
these inquiries together.
Acknowledgements
Research study one: Participatory Action Research to Improve Diabetes
Self-Management for Aboriginal Families (2003). Funded by National
Health and Medical Research Council. Dr Susan Mann, research facilitator,
and the research team wishes to thank the Port Lincoln Aboriginal
Community, the Elders Ambassador Group and SACRU for their involve-
ment. Appreciation is also extended to Aboriginal Health Workers, Tony
Burgoyne and Jeremy Colby, from the Port Lincoln Aboriginal Health
Service. A full report of this study is available on www.rdns.net.au.
Research study two: Describing Transition with People who Live with
Chronic Illness. Funded by The Australian Research Council (Discovery
grant) 2003–2006 through the University of South Australia. Dr Kralik is
facilitator of this inquiry in progress. Chief Investigators are Professor
Tina Koch and Dr Kay Price.
Research study three: A Participatory Action Program to Promote Capacity
Building for Women Who Have Been Sexually Abused and Who Abuse
Alcohol. Research facilitator is Dr Anne van Loon. Funding is from the
Alcohol Education & Rehabilitation Foundation Ltd — August 2003 to
August 2005 and the inquiry is conducted in partnership with Catherine
House Inc, Centacare and Royal District Nursing Service of SA Research
Unit. At the completion of the study a report will be available on
www.rdns.net.au.
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