The Training for Health Renewal Program (THRP) is a multi-year CIDA-funded partnership between the Health Science Faculties at the University of Saskatchewan and the Ministry of Health of Mozambique. Participatory Teaching, Learning and Research: Core Facilitator Training was a curriculum offered to participant Trainers in THRP between August 1999 and November 2000, at the University of Saskakatchewan. The participants were seven Mozambican health care workers who have since returned to Mozambique to work as core facilitators of improved community health practice in Massinga, Mozambique. In January, 2001, I traveled to Mozambique to contribute to the overall THRP program evaluation through the completion of a needs assessment. The assessment examined the current practice experience of the Trainers, used that experience to assist the Trainers in identifying professional development needs, and examined the use of the Story-Dialogue method as used in this particular context. The participants were six of the original seven Trainers. Data were collected using one-on-one interviews, the Story-Dialogue method, a focus group debriefing session, and journaling. The current practice experience of the Trainers involved both challenges and successes. Challenges included bridging several gaps related to having studied in Canada in order to practice in Mozambique, working with local communities, working with colleagues and students, and a lack of support. Successes described included those found when working with local communities and working as a team. The Trainers identified a rich breadth of professional development needs. Content needs included learning related to planning, formalizing their practice of critical reflection, recognizing their own assets and limitations, and dealing with organization issues affecting their professional development. As well, the Trainers identified course-specific areas of interest. Methods for achieving development included relationship building, use of distance education and participatory methods, and formalizing access to continuing education. Finally, the Story-Dialogue method was found to be particularly useful in this context. The Trainers found the method fostered both personal and organizational change and was inclusive. Challenges of the method included the risk of disclosure, the need to formalize follow-up, and the potential need to adapt the method depending on the community using it.

The Training for Health Renewal Program (THRP) is a multi-year CIDA-funded partnership between the Health Science Faculties at the University of Saskatchewan and the Ministry of Health of Mozambique. Participatory Teaching, Learning and Research: Core Facilitator Training was a curriculum offered to participant Trainers in THRP between August 1999 and November 2000, at the University of Saskakatchewan. The participants were seven Mozambican health care workers who have since returned to Mozambique to work as core facilitators of improved community health practice in Massinga, Mozambique. In January, 2001, I traveled to Mozambique to contribute to the overall THRP program evaluation through the completion of a needs assessment. The assessment examined the current practice experience of the Trainers, used that experience to assist the Trainers in identifying professional development needs, and examined the use of the Story-Dialogue method as used in this particular context. The participants were six of the original seven Trainers. Data were collected using one-on-one interviews, the Story-Dialogue method, a focus group debriefing session, and journaling. The current practice experience of the Trainers involved both challenges and successes. Challenges included bridging several gaps related to having studied in Canada in order to practice in Mozambique, working with local communities, working with colleagues and students, and a lack of support. Successes described included those found when working with local communities and working as a team. The Trainers identified a rich breadth of professional development needs. Content needs included learning related to planning, formalizing their practice of critical reflection, recognizing their own assets and limitations, and dealing with organization issues affecting their professional development. As well, the Trainers identified course-specific areas of interest. Methods for achieving development included relationship building, use of distance education and participatory methods, and formalizing access to continuing education. Finally, the Story-Dialogue method was found to be particularly useful in this context. The Trainers found the method fostered both personal and organizational change and was inclusive. Challenges of the method included the risk of disclosure, the need to formalize follow-up, and the potential need to adapt the method depending on the community using it.

This dissertation covers the subject of how abstract concepts and complex situations can be concretized through research together with practitioners. The dissertation is based on four empirical studies. The researcher role, the practitioner participation and the methods for data collection and analysis have varied. In study I the concept ‘Närsjukvård’ was explored to understand how practitioners, managers and politicians in hospitals, primary health care and municipalities interpreted the concept. The researcher acted as consultant who collected data by interviews and questionnaires. Practitioners’ participation was limited. ‘Närsjukvård’ was interpreted as accessibility to hospital beds, accessibility to primary health care, collaboration between care providers and continuity and developed home care. Study II aimed to explore how people experienced leg ulcer care. The researcher acted as a consultant who performed the interviews and  analysed the data. Although the informants experienced their encounters with the nurses as satisfying, the study illuminated low participation in the care and low practitioner involvement in issues about daily living with the leg ulcer. The findings were brought back to the informants and the practitioners. The project did not proceed towards development and change. In study III the aim was to explore the Swedish concept ‘trygghet’ by using stories from daily life. Four older women were interviewed and the Story Dialogue method was used together with assistant nurses and registered nurses who participated in data collection and analysis. Two themes emerged: Sense of Security and factors strengthening the Sense of Security. Together with the assistant nurses, areas for improvements were identified. Study IV aimed to explore the discharge planning situation in order to     generate ideas for development. Members from a discharge planning network participated in the whole research process. Conditions for a successful coordinated discharge planning situation were a system including: the participation of the patient, the competence of the staff and the support from the organisation. The group arranged a workshop about communication and interdisciplinary   collaboration. The findings resulted in a form with self-evaluation questions. In conclusion, this thesis illustrates that it is possible to clarify abstract concepts and complex situations together with practitioners. To do this successfully, sense making activities and to start from practitioners’ experiences and their own context are key factors. The studies illuminate that building trust, relationship and sense of participation are essential in health and social care in general and specifically in the participatory action research process.