action research is learning by doing

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Action Research: What it is, Stages & Examples

The best way to get things accomplished is to do it yourself. This statement is utilized in corporations, community projects, and national governments. These organizations are relying on action research to cope with their continuously changing and unstable environments as they function in a more interdependent world.

In practical educational contexts, this involves using systematic inquiry and reflective practice to address real-world challenges, improve teaching and learning, enhance student engagement, and drive positive changes within the educational system.

This post outlines the definition of action research, its stages, and some examples.

Content Index

What is action research?

Stages of action research, the steps to conducting action research, examples of action research, advantages and disadvantages of action research.

Action research is a strategy that tries to find realistic solutions to organizations’ difficulties and issues. It is similar to applied research.

Action research refers basically learning by doing. First, a problem is identified, then some actions are taken to address it, then how well the efforts worked are measured, and if the results are not satisfactory, the steps are applied again.

It can be put into three different groups:

• Positivist: This type of research is also called “classical action research.” It considers research a social experiment. This research is used to test theories in the actual world.
• Interpretive: This kind of research is called “contemporary action research.” It thinks that business reality is socially made, and when doing this research, it focuses on the details of local and organizational factors.
• Critical: This action research cycle takes a critical reflection approach to corporate systems and tries to enhance them.

All research is about learning new things. Collaborative action research contributes knowledge based on investigations in particular and frequently useful circumstances. It starts with identifying a problem. After that, the research process is followed by the below stages:

Stage 1: Plan

For an action research project to go well, the researcher needs to plan it well. After coming up with an educational research topic or question after a research study, the first step is to develop an action plan to guide the research process. The research design aims to address the study’s question. The research strategy outlines what to undertake, when, and how.

Stage 2: Act

The next step is implementing the plan and gathering data. At this point, the researcher must select how to collect and organize research data . The researcher also needs to examine all tools and equipment before collecting data to ensure they are relevant, valid, and comprehensive.

Stage 3: Observe

Data observation is vital to any investigation. The action researcher needs to review the project’s goals and expectations before data observation. This is the final step before drawing conclusions and taking action.

Different kinds of graphs, charts, and networks can be used to represent the data. It assists in making judgments or progressing to the next stage of observing.

Stage 4: Reflect

This step involves applying a prospective solution and observing the results. It’s essential to see if the possible solution found through research can really solve the problem being studied.

The researcher must explore alternative ideas when the action research project’s solutions fail to solve the problem.

Action research is a systematic approach researchers, educators, and practitioners use to identify and address problems or challenges within a specific context. It involves a cyclical process of planning, implementing, reflecting, and adjusting actions based on the data collected. Here are the general steps involved in conducting an action research process:

Identify the action research question or problem

Clearly define the issue or problem you want to address through your research. It should be specific, actionable, and relevant to your working context.

Review existing knowledge

Conduct a literature review to understand what research has already been done on the topic. This will help you gain insights, identify gaps, and inform your research design.

Plan the research

Develop a research plan outlining your study’s objectives, methods, data collection tools, and timeline. Determine the scope of your research and the participants or stakeholders involved.

Collect data

Implement your research plan by collecting relevant data. This can involve various methods such as surveys, interviews, observations, document analysis, or focus groups. Ensure that your data collection methods align with your research objectives and allow you to gather the necessary information.

Analyze the data

Once you have collected the data, analyze it using appropriate qualitative or quantitative techniques. Look for patterns, themes, or trends in the data that can help you understand the problem better.

Reflect on the findings

Reflect on the analyzed data and interpret the results in the context of your research question. Consider the implications and possible solutions that emerge from the data analysis. This reflection phase is crucial for generating insights and understanding the underlying factors contributing to the problem.

Develop an action plan

Based on your analysis and reflection, develop an action plan that outlines the steps you will take to address the identified problem. The plan should be specific, measurable, achievable, relevant, and time-bound (SMART goals). Consider involving relevant stakeholders in planning to ensure their buy-in and support.

Implement the action plan

Put your action plan into practice by implementing the identified strategies or interventions. This may involve making changes to existing practices, introducing new approaches, or testing alternative solutions. Document the implementation process and any modifications made along the way.

Evaluate and monitor progress

Continuously monitor and evaluate the impact of your actions. Collect additional data, assess the effectiveness of the interventions, and measure progress towards your goals. This evaluation will help you determine if your actions have the desired effects and inform any necessary adjustments.

Reflect and iterate

Reflect on the outcomes of your actions and the evaluation results. Consider what worked well, what did not, and why. Use this information to refine your approach, make necessary adjustments, and plan for the next cycle of action research if needed.

Remember that participatory action research is an iterative process, and multiple cycles may be required to achieve significant improvements or solutions to the identified problem. Each cycle builds on the insights gained from the previous one, fostering continuous learning and improvement.

Explore Insightfully Contextual Inquiry in Qualitative Research

Here are two real-life examples of action research.

Action research initiatives are frequently situation-specific. Still, other researchers can adapt the techniques. The example is from a researcher’s (Franklin, 1994) report about a project encouraging nature tourism in the Caribbean.

In 1991, this was launched to study how nature tourism may be implemented on the four Windward Islands in the Caribbean: St. Lucia, Grenada, Dominica, and St. Vincent.

For environmental protection, a government-led action study determined that the consultation process needs to involve numerous stakeholders, including commercial enterprises.

First, two researchers undertook the study and held search conferences on each island. The search conferences resulted in suggestions and action plans for local community nature tourism sub-projects.

Several islands formed advisory groups and launched national awareness and community projects. Regional project meetings were held to discuss experiences, self-evaluations, and strategies. Creating a documentary about a local initiative helped build community. And the study was a success, leading to a number of changes in the area.

Lau and Hayward (1997) employed action research to analyze Internet-based collaborative work groups.

Over two years, the researchers facilitated three action research problem -solving cycles with 15 teachers, project personnel, and 25 health practitioners from diverse areas. The goal was to see how Internet-based communications might affect their virtual workgroup.

First, expectations were defined, technology was provided, and a bespoke workgroup system was developed. Participants suggested shorter, more dispersed training sessions with project-specific instructions.

The second phase saw the system’s complete deployment. The final cycle witnessed system stability and virtual group formation. The key lesson was that the learning curve was poorly misjudged, with frustrations only marginally met by phone-based technical help. According to the researchers, the absence of high-quality online material about community healthcare was harmful.

Role clarity, connection building, knowledge sharing, resource assistance, and experiential learning are vital for virtual group growth. More study is required on how group support systems might assist groups in engaging with their external environment and boost group members’ learning. 

Action research has both good and bad points.

• It is very flexible, so researchers can change their analyses to fit their needs and make individual changes.
• It offers a quick and easy way to solve problems that have been going on for a long time instead of complicated, long-term solutions based on complex facts.
• If It is done right, it can be very powerful because it can lead to social change and give people the tools to make that change in ways that are important to their communities.

Disadvantages

• These studies have a hard time being generalized and are hard to repeat because they are so flexible. Because the researcher has the power to draw conclusions, they are often not thought to be theoretically sound.
• Setting up an action study in an ethical way can be hard. People may feel like they have to take part or take part in a certain way.
• It is prone to research errors like selection bias , social desirability bias, and other cognitive biases.

LEARN ABOUT: Self-Selection Bias

This post discusses how action research generates knowledge, its steps, and real-life examples. It is very applicable to the field of research and has a high level of relevance. We can only state that the purpose of this research is to comprehend an issue and find a solution to it.

At QuestionPro, we give researchers tools for collecting data, like our survey software, and a library of insights for any long-term study. Go to the Insight Hub if you want to see a demo or learn more about it.

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Frequently Asked Questions(FAQ’s)

Action research is a systematic approach to inquiry that involves identifying a problem or challenge in a practical context, implementing interventions or changes, collecting and analyzing data, and using the findings to inform decision-making and drive positive change.

Action research can be conducted by various individuals or groups, including teachers, administrators, researchers, and educational practitioners. It is often carried out by those directly involved in the educational setting where the research takes place.

The steps of action research typically include identifying a problem, reviewing relevant literature, designing interventions or changes, collecting and analyzing data, reflecting on findings, and implementing improvements based on the results.

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How Teachers Can Learn Through Action Research

A look at one school’s action research project provides a blueprint for using this model of collaborative teacher learning.

When teachers redesign learning experiences to make school more relevant to students’ lives, they can’t ignore assessment. For many teachers, the most vexing question about real-world learning experiences such as project-based learning is: How will we know what students know and can do by the end of this project?

Teachers at the Siena School in Silver Spring, Maryland, decided to figure out the assessment question by investigating their classroom practices. As a result of their action research, they now have a much deeper understanding of authentic assessment and a renewed appreciation for the power of learning together.

Their research process offers a replicable model for other schools interested in designing their own immersive professional learning. The process began with a real-world challenge and an open-ended question, involved a deep dive into research, and ended with a public showcase of findings.

Start With an Authentic Need to Know

Siena School serves about 130 students in grades 4–12 who have mild to moderate language-based learning differences, including dyslexia. Most students are one to three grade levels behind in reading.

Teachers have introduced a variety of instructional strategies, including project-based learning, to better meet students’ learning needs and also help them develop skills like collaboration and creativity. Instead of taking tests and quizzes, students demonstrate what they know in a PBL unit by making products or generating solutions.

“We were already teaching this way,” explained Simon Kanter, Siena’s director of technology. “We needed a way to measure, was authentic assessment actually effective? Does it provide meaningful feedback? Can teachers grade it fairly?”

Focus the Research Question

Across grade levels and departments, teachers considered what they wanted to learn about authentic assessment, which the late Grant Wiggins described as engaging, multisensory, feedback-oriented, and grounded in real-world tasks. That’s a contrast to traditional tests and quizzes, which tend to focus on recall rather than application and have little in common with how experts go about their work in disciplines like math or history.

The teachers generated a big research question: Is using authentic assessment an effective and engaging way to provide meaningful feedback for teachers and students about growth and proficiency in a variety of learning objectives, including 21st-century skills?

Take Time to Plan

Next, teachers planned authentic assessments that would generate data for their study. For example, middle school science students created prototypes of genetically modified seeds and pitched their designs to a panel of potential investors. They had to not only understand the science of germination but also apply their knowledge and defend their thinking.

In other classes, teachers planned everything from mock trials to environmental stewardship projects to assess student learning and skill development. A shared rubric helped the teachers plan high-quality assessments.

Make Sense of Data

During the data-gathering phase, students were surveyed after each project about the value of authentic assessments versus more traditional tools like tests and quizzes. Teachers also reflected after each assessment.

“We collated the data, looked for trends, and presented them back to the faculty,” Kanter said.

Among the takeaways:

• Authentic assessment generates more meaningful feedback and more opportunities for students to apply it.
• Students consider authentic assessment more engaging, with increased opportunities to be creative, make choices, and collaborate.
• Teachers are thinking more critically about creating assessments that allow for differentiation and that are applicable to students’ everyday lives.

To make their learning public, Siena hosted a colloquium on authentic assessment for other schools in the region. The school also submitted its research as part of an accreditation process with the Middle States Association.

Strategies to Share

For other schools interested in conducting action research, Kanter highlighted three key strategies.

• Focus on areas of growth, not deficiency:  “This would have been less successful if we had said, ‘Our math scores are down. We need a new program to get scores up,’ Kanter said. “That puts the onus on teachers. Data collection could seem punitive. Instead, we focused on the way we already teach and thought about, how can we get more accurate feedback about how students are doing?”
• Foster a culture of inquiry:  Encourage teachers to ask questions, conduct individual research, and share what they learn with colleagues. “Sometimes, one person attends a summer workshop and then shares the highlights in a short presentation. That might just be a conversation, or it might be the start of a school-wide initiative,” Kanter explained. In fact, that’s exactly how the focus on authentic assessment began.
• Build structures for teacher collaboration:  Using staff meetings for shared planning and problem-solving fosters a collaborative culture. That was already in place when Siena embarked on its action research, along with informal brainstorming to support students.

For both students and staff, the deep dive into authentic assessment yielded “dramatic impact on the classroom,” Kanter added. “That’s the great part of this.”

In the past, he said, most teachers gave traditional final exams. To alleviate students’ test anxiety, teachers would support them with time for content review and strategies for study skills and test-taking.

“This year looks and feels different,” Kanter said. A week before the end of fall term, students were working hard on final products, but they weren’t cramming for exams. Teachers had time to give individual feedback to help students improve their work. “The whole climate feels way better.”

Action Research

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Action research is an approach to research which aims at both taking action and creating knowledge or theory about that action as the action unfolds. It starts with everyday experience and is concerned with the development of living knowledge. Its characteristics are that it generates practical knowledge in the pursuit of worthwhile purposes; it is participative and democratic as its participants work together in the present tense in defining the questions they wish to explore, the methodology for that exploration, and its application through cycles of action and reflection. In this vein they are agents of change and coresearchers in knowledge generation and not merely passive subjects as in traditional research. In this vein, action research can be understood as a social science of the possible as the collective action is focused on creating a desired future in whatever context the action research is located.

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Coghlan, D. (2022). Action Research. In: Glăveanu, V.P. (eds) The Palgrave Encyclopedia of the Possible. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-90913-0_180

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Action research.

• Eileen S. Johnson Eileen S. Johnson Oakland University
• https://doi.org/10.1093/acrefore/9780190264093.013.696
• Published online: 29 May 2020

Action research has become a common practice among educational administrators. The term “action research” was first coined by Kurt Lewin in the 1930s, although teachers and school administrators have long engaged in the process described by and formally named by Lewin. Alternatively known as practitioner research, self-study, action science, site-based inquiry, emancipatory praxis, etc., action research is essentially a collaborative, democratic, and participatory approach to systematic inquiry into a problem of practice within a local context. Action research has become prevalent in many fields and disciplines, including education, health sciences, nursing, social work, and anthropology. This prevalence can be understood in the way action research lends itself to action-based inquiry, participation, collaboration, and the development of solutions to problems of everyday practice in local contexts. In particular, action research has become commonplace in educational administration preparation programs due to its alignment and natural fit with the nature of education and the decision making and action planning necessary within local school contexts. Although there is not one prescribed way to engage in action research, and there are multiple approaches to action research, it generally follows a systematic and cyclical pattern of reflection, planning, action, observation, and data collection, evaluation that then repeats in an iterative and ongoing manner. The goal of action research is not to add to a general body of knowledge but, rather, to inform local practice, engage in professional learning, build a community practice, solve a problem or understand a process or phenomenon within a particular context, or empower participants to generate self-knowledge.

• action research cycle
• educational practice
• historical trends
• philosophical assumptions
• variations of action research

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1 What is Action Research for Classroom Teachers?

ESSENTIAL QUESTIONS

• What is the nature of action research?
• How does action research develop in the classroom?
• What models of action research work best for your classroom?
• What are the epistemological, ontological, theoretical underpinnings of action research?

Educational research provides a vast landscape of knowledge on topics related to teaching and learning, curriculum and assessment, students’ cognitive and affective needs, cultural and socio-economic factors of schools, and many other factors considered viable to improving schools. Educational stakeholders rely on research to make informed decisions that ultimately affect the quality of schooling for their students. Accordingly, the purpose of educational research is to engage in disciplined inquiry to generate knowledge on topics significant to the students, teachers, administrators, schools, and other educational stakeholders. Just as the topics of educational research vary, so do the approaches to conducting educational research in the classroom. Your approach to research will be shaped by your context, your professional identity, and paradigm (set of beliefs and assumptions that guide your inquiry). These will all be key factors in how you generate knowledge related to your work as an educator.

Action research is an approach to educational research that is commonly used by educational practitioners and professionals to examine, and ultimately improve, their pedagogy and practice. In this way, action research represents an extension of the reflection and critical self-reflection that an educator employs on a daily basis in their classroom. When students are actively engaged in learning, the classroom can be dynamic and uncertain, demanding the constant attention of the educator. Considering these demands, educators are often only able to engage in reflection that is fleeting, and for the purpose of accommodation, modification, or formative assessment. Action research offers one path to more deliberate, substantial, and critical reflection that can be documented and analyzed to improve an educator’s practice.

Purpose of Action Research

As one of many approaches to educational research, it is important to distinguish the potential purposes of action research in the classroom. This book focuses on action research as a method to enable and support educators in pursuing effective pedagogical practices by transforming the quality of teaching decisions and actions, to subsequently enhance student engagement and learning. Being mindful of this purpose, the following aspects of action research are important to consider as you contemplate and engage with action research methodology in your classroom:

• Action research is a process for improving educational practice. Its methods involve action, evaluation, and reflection. It is a process to gather evidence to implement change in practices.
• Action research is participative and collaborative. It is undertaken by individuals with a common purpose.
• Action research is situation and context-based.
• Action research develops reflection practices based on the interpretations made by participants.
• Knowledge is created through action and application.
• Action research can be based in problem-solving, if the solution to the problem results in the improvement of practice.
• Action research is iterative; plans are created, implemented, revised, then implemented, lending itself to an ongoing process of reflection and revision.
• In action research, findings emerge as action develops and takes place; however, they are not conclusive or absolute, but ongoing (Koshy, 2010, pgs. 1-2).

In thinking about the purpose of action research, it is helpful to situate action research as a distinct paradigm of educational research. I like to think about action research as part of the larger concept of living knowledge. Living knowledge has been characterized as “a quest for life, to understand life and to create… knowledge which is valid for the people with whom I work and for myself” (Swantz, in Reason & Bradbury, 2001, pg. 1). Why should educators care about living knowledge as part of educational research? As mentioned above, action research is meant “to produce practical knowledge that is useful to people in the everyday conduct of their lives and to see that action research is about working towards practical outcomes” (Koshy, 2010, pg. 2). However, it is also about:

creating new forms of understanding, since action without reflection and understanding is blind, just as theory without action is meaningless. The participatory nature of action research makes it only possible with, for and by persons and communities, ideally involving all stakeholders both in the questioning and sense making that informs the research, and in the action, which is its focus. (Reason & Bradbury, 2001, pg. 2)

In an effort to further situate action research as living knowledge, Jean McNiff reminds us that “there is no such ‘thing’ as ‘action research’” (2013, pg. 24). In other words, action research is not static or finished, it defines itself as it proceeds. McNiff’s reminder characterizes action research as action-oriented, and a process that individuals go through to make their learning public to explain how it informs their practice. Action research does not derive its meaning from an abstract idea, or a self-contained discovery – action research’s meaning stems from the way educators negotiate the problems and successes of living and working in the classroom, school, and community.

While we can debate the idea of action research, there are people who are action researchers, and they use the idea of action research to develop principles and theories to guide their practice. Action research, then, refers to an organization of principles that guide action researchers as they act on shared beliefs, commitments, and expectations in their inquiry.

Reflection and the Process of Action Research

When an individual engages in reflection on their actions or experiences, it is typically for the purpose of better understanding those experiences, or the consequences of those actions to improve related action and experiences in the future. Reflection in this way develops knowledge around these actions and experiences to help us better regulate those actions in the future. The reflective process generates new knowledge regularly for classroom teachers and informs their classroom actions.

Unfortunately, the knowledge generated by educators through the reflective process is not always prioritized among the other sources of knowledge educators are expected to utilize in the classroom. Educators are expected to draw upon formal types of knowledge, such as textbooks, content standards, teaching standards, district curriculum and behavioral programs, etc., to gain new knowledge and make decisions in the classroom. While these forms of knowledge are important, the reflective knowledge that educators generate through their pedagogy is the amalgamation of these types of knowledge enacted in the classroom. Therefore, reflective knowledge is uniquely developed based on the action and implementation of an educator’s pedagogy in the classroom. Action research offers a way to formalize the knowledge generated by educators so that it can be utilized and disseminated throughout the teaching profession.

Research is concerned with the generation of knowledge, and typically creating knowledge related to a concept, idea, phenomenon, or topic. Action research generates knowledge around inquiry in practical educational contexts. Action research allows educators to learn through their actions with the purpose of developing personally or professionally. Due to its participatory nature, the process of action research is also distinct in educational research. There are many models for how the action research process takes shape. I will share a few of those here. Each model utilizes the following processes to some extent:

• Plan a change;
• Take action to enact the change;
• Observe the process and consequences of the change;
• Reflect on the process and consequences;
• Act, observe, & reflect again and so on.

Figure 1.1 Basic action research cycle

There are many other models that supplement the basic process of action research with other aspects of the research process to consider. For example, figure 1.2 illustrates a spiral model of action research proposed by Kemmis and McTaggart (2004). The spiral model emphasizes the cyclical process that moves beyond the initial plan for change. The spiral model also emphasizes revisiting the initial plan and revising based on the initial cycle of research:

Figure 1.2 Interpretation of action research spiral, Kemmis and McTaggart (2004, p. 595)

Other models of action research reorganize the process to emphasize the distinct ways knowledge takes shape in the reflection process. O’Leary’s (2004, p. 141) model, for example, recognizes that the research may take shape in the classroom as knowledge emerges from the teacher’s observations. O’Leary highlights the need for action research to be focused on situational understanding and implementation of action, initiated organically from real-time issues:

Figure 1.3 Interpretation of O’Leary’s cycles of research, O’Leary (2000, p. 141)

Lastly, Macintyre’s (2000, p. 1) model, offers a different characterization of the action research process. Macintyre emphasizes a messier process of research with the initial reflections and conclusions as the benchmarks for guiding the research process. Macintyre emphasizes the flexibility in planning, acting, and observing stages to allow the process to be naturalistic. Our interpretation of Macintyre process is below:

Figure 1.4 Interpretation of the action research cycle, Macintyre (2000, p. 1)

We believe it is important to prioritize the flexibility of the process, and encourage you to only use these models as basic guides for your process. Your process may look similar, or you may diverge from these models as you better understand your students, context, and data.

Definitions of Action Research and Examples

At this point, it may be helpful for readers to have a working definition of action research and some examples to illustrate the methodology in the classroom. Bassey (1998, p. 93) offers a very practical definition and describes “action research as an inquiry which is carried out in order to understand, to evaluate and then to change, in order to improve educational practice.” Cohen and Manion (1994, p. 192) situate action research differently, and describe action research as emergent, writing:

essentially an on-the-spot procedure designed to deal with a concrete problem located in an immediate situation. This means that ideally, the step-by-step process is constantly monitored over varying periods of time and by a variety of mechanisms (questionnaires, diaries, interviews and case studies, for example) so that the ensuing feedback may be translated into modifications, adjustment, directional changes, redefinitions, as necessary, so as to bring about lasting benefit to the ongoing process itself rather than to some future occasion.

Lastly, Koshy (2010, p. 9) describes action research as:

a constructive inquiry, during which the researcher constructs his or her knowledge of specific issues through planning, acting, evaluating, refining and learning from the experience. It is a continuous learning process in which the researcher learns and also shares the newly generated knowledge with those who may benefit from it.

These definitions highlight the distinct features of action research and emphasize the purposeful intent of action researchers to improve, refine, reform, and problem-solve issues in their educational context. To better understand the distinctness of action research, these are some examples of action research topics:

Examples of Action Research Topics

• Flexible seating in 4th grade classroom to increase effective collaborative learning.
• Structured homework protocols for increasing student achievement.
• Developing a system of formative feedback for 8th grade writing.
• Using music to stimulate creative writing.
• Weekly brown bag lunch sessions to improve responses to PD from staff.
• Using exercise balls as chairs for better classroom management.

Action Research in Theory

Action research-based inquiry in educational contexts and classrooms involves distinct participants – students, teachers, and other educational stakeholders within the system. All of these participants are engaged in activities to benefit the students, and subsequently society as a whole. Action research contributes to these activities and potentially enhances the participants’ roles in the education system. Participants’ roles are enhanced based on two underlying principles:

• communities, schools, and classrooms are sites of socially mediated actions, and action research provides a greater understanding of self and new knowledge of how to negotiate these socially mediated environments;
• communities, schools, and classrooms are part of social systems in which humans interact with many cultural tools, and action research provides a basis to construct and analyze these interactions.

In our quest for knowledge and understanding, we have consistently analyzed human experience over time and have distinguished between types of reality. Humans have constantly sought “facts” and “truth” about reality that can be empirically demonstrated or observed.

Social systems are based on beliefs, and generally, beliefs about what will benefit the greatest amount of people in that society. Beliefs, and more specifically the rationale or support for beliefs, are not always easy to demonstrate or observe as part of our reality. Take the example of an English Language Arts teacher who prioritizes argumentative writing in her class. She believes that argumentative writing demonstrates the mechanics of writing best among types of writing, while also providing students a skill they will need as citizens and professionals. While we can observe the students writing, and we can assess their ability to develop a written argument, it is difficult to observe the students’ understanding of argumentative writing and its purpose in their future. This relates to the teacher’s beliefs about argumentative writing; we cannot observe the real value of the teaching of argumentative writing. The teacher’s rationale and beliefs about teaching argumentative writing are bound to the social system and the skills their students will need to be active parts of that system. Therefore, our goal through action research is to demonstrate the best ways to teach argumentative writing to help all participants understand its value as part of a social system.

The knowledge that is conveyed in a classroom is bound to, and justified by, a social system. A postmodernist approach to understanding our world seeks knowledge within a social system, which is directly opposed to the empirical or positivist approach which demands evidence based on logic or science as rationale for beliefs. Action research does not rely on a positivist viewpoint to develop evidence and conclusions as part of the research process. Action research offers a postmodernist stance to epistemology (theory of knowledge) and supports developing questions and new inquiries during the research process. In this way action research is an emergent process that allows beliefs and decisions to be negotiated as reality and meaning are being constructed in the socially mediated space of the classroom.

Theorizing Action Research for the Classroom

All research, at its core, is for the purpose of generating new knowledge and contributing to the knowledge base of educational research. Action researchers in the classroom want to explore methods of improving their pedagogy and practice. The starting place of their inquiry stems from their pedagogy and practice, so by nature the knowledge created from their inquiry is often contextually specific to their classroom, school, or community. Therefore, we should examine the theoretical underpinnings of action research for the classroom. It is important to connect action research conceptually to experience; for example, Levin and Greenwood (2001, p. 105) make these connections:

• Action research is context bound and addresses real life problems.
• Action research is inquiry where participants and researchers cogenerate knowledge through collaborative communicative processes in which all participants’ contributions are taken seriously.
• The meanings constructed in the inquiry process lead to social action or these reflections and action lead to the construction of new meanings.
• The credibility/validity of action research knowledge is measured according to whether the actions that arise from it solve problems (workability) and increase participants’ control over their own situation.

Educators who engage in action research will generate new knowledge and beliefs based on their experiences in the classroom. Let us emphasize that these are all important to you and your work, as both an educator and researcher. It is these experiences, beliefs, and theories that are often discounted when more official forms of knowledge (e.g., textbooks, curriculum standards, districts standards) are prioritized. These beliefs and theories based on experiences should be valued and explored further, and this is one of the primary purposes of action research in the classroom. These beliefs and theories should be valued because they were meaningful aspects of knowledge constructed from teachers’ experiences. Developing meaning and knowledge in this way forms the basis of constructivist ideology, just as teachers often try to get their students to construct their own meanings and understandings when experiencing new ideas.  

Classroom Teachers Constructing their Own Knowledge

Most of you are probably at least minimally familiar with constructivism, or the process of constructing knowledge. However, what is constructivism precisely, for the purposes of action research? Many scholars have theorized constructivism and have identified two key attributes (Koshy, 2010; von Glasersfeld, 1987):

• Knowledge is not passively received, but actively developed through an individual’s cognition;
• Human cognition is adaptive and finds purpose in organizing the new experiences of the world, instead of settling for absolute or objective truth.

Considering these two attributes, constructivism is distinct from conventional knowledge formation because people can develop a theory of knowledge that orders and organizes the world based on their experiences, instead of an objective or neutral reality. When individuals construct knowledge, there are interactions between an individual and their environment where communication, negotiation and meaning-making are collectively developing knowledge. For most educators, constructivism may be a natural inclination of their pedagogy. Action researchers have a similar relationship to constructivism because they are actively engaged in a process of constructing knowledge. However, their constructions may be more formal and based on the data they collect in the research process. Action researchers also are engaged in the meaning making process, making interpretations from their data. These aspects of the action research process situate them in the constructivist ideology. Just like constructivist educators, action researchers’ constructions of knowledge will be affected by their individual and professional ideas and values, as well as the ecological context in which they work (Biesta & Tedder, 2006). The relations between constructivist inquiry and action research is important, as Lincoln (2001, p. 130) states:

much of the epistemological, ontological, and axiological belief systems are the same or similar, and methodologically, constructivists and action researchers work in similar ways, relying on qualitative methods in face-to-face work, while buttressing information, data and background with quantitative method work when necessary or useful.

While there are many links between action research and educators in the classroom, constructivism offers the most familiar and practical threads to bind the beliefs of educators and action researchers.  

Epistemology, Ontology, and Action Research

It is also important for educators to consider the philosophical stances related to action research to better situate it with their beliefs and reality. When researchers make decisions about the methodology they intend to use, they will consider their ontological and epistemological stances. It is vital that researchers clearly distinguish their philosophical stances and understand the implications of their stance in the research process, especially when collecting and analyzing their data. In what follows, we will discuss ontological and epistemological stances in relation to action research methodology.

Ontology, or the theory of being, is concerned with the claims or assumptions we make about ourselves within our social reality – what do we think exists, what does it look like, what entities are involved and how do these entities interact with each other (Blaikie, 2007). In relation to the discussion of constructivism, generally action researchers would consider their educational reality as socially constructed. Social construction of reality happens when individuals interact in a social system. Meaningful construction of concepts and representations of reality develop through an individual’s interpretations of others’ actions. These interpretations become agreed upon by members of a social system and become part of social fabric, reproduced as knowledge and beliefs to develop assumptions about reality. Researchers develop meaningful constructions based on their experiences and through communication. Educators as action researchers will be examining the socially constructed reality of schools. In the United States, many of our concepts, knowledge, and beliefs about schooling have been socially constructed over the last hundred years. For example, a group of teachers may look at why fewer female students enroll in upper-level science courses at their school. This question deals directly with the social construction of gender and specifically what careers females have been conditioned to pursue. We know this is a social construction in some school social systems because in other parts of the world, or even the United States, there are schools that have more females enrolled in upper level science courses than male students. Therefore, the educators conducting the research have to recognize the socially constructed reality of their school and consider this reality throughout the research process. Action researchers will use methods of data collection that support their ontological stance and clarify their theoretical stance throughout the research process.

Koshy (2010, p. 23-24) offers another example of addressing the ontological challenges in the classroom:

A teacher who was concerned with increasing her pupils’ motivation and enthusiasm for learning decided to introduce learning diaries which the children could take home. They were invited to record their reactions to the day’s lessons and what they had learnt. The teacher reported in her field diary that the learning diaries stimulated the children’s interest in her lessons, increased their capacity to learn, and generally improved their level of participation in lessons. The challenge for the teacher here is in the analysis and interpretation of the multiplicity of factors accompanying the use of diaries. The diaries were taken home so the entries may have been influenced by discussions with parents. Another possibility is that children felt the need to please their teacher. Another possible influence was that their increased motivation was as a result of the difference in style of teaching which included more discussions in the classroom based on the entries in the dairies.

Here you can see the challenge for the action researcher is working in a social context with multiple factors, values, and experiences that were outside of the teacher’s control. The teacher was only responsible for introducing the diaries as a new style of learning. The students’ engagement and interactions with this new style of learning were all based upon their socially constructed notions of learning inside and outside of the classroom. A researcher with a positivist ontological stance would not consider these factors, and instead might simply conclude that the dairies increased motivation and interest in the topic, as a result of introducing the diaries as a learning strategy.

Epistemology, or the theory of knowledge, signifies a philosophical view of what counts as knowledge – it justifies what is possible to be known and what criteria distinguishes knowledge from beliefs (Blaikie, 1993). Positivist researchers, for example, consider knowledge to be certain and discovered through scientific processes. Action researchers collect data that is more subjective and examine personal experience, insights, and beliefs.

Action researchers utilize interpretation as a means for knowledge creation. Action researchers have many epistemologies to choose from as means of situating the types of knowledge they will generate by interpreting the data from their research. For example, Koro-Ljungberg et al., (2009) identified several common epistemologies in their article that examined epistemological awareness in qualitative educational research, such as: objectivism, subjectivism, constructionism, contextualism, social epistemology, feminist epistemology, idealism, naturalized epistemology, externalism, relativism, skepticism, and pluralism. All of these epistemological stances have implications for the research process, especially data collection and analysis. Please see the table on pages 689-90, linked below for a sketch of these potential implications:

Again, Koshy (2010, p. 24) provides an excellent example to illustrate the epistemological challenges within action research:

A teacher of 11-year-old children decided to carry out an action research project which involved a change in style in teaching mathematics. Instead of giving children mathematical tasks displaying the subject as abstract principles, she made links with other subjects which she believed would encourage children to see mathematics as a discipline that could improve their understanding of the environment and historic events. At the conclusion of the project, the teacher reported that applicable mathematics generated greater enthusiasm and understanding of the subject.

The educator/researcher engaged in action research-based inquiry to improve an aspect of her pedagogy. She generated knowledge that indicated she had improved her students’ understanding of mathematics by integrating it with other subjects – specifically in the social and ecological context of her classroom, school, and community. She valued constructivism and students generating their own understanding of mathematics based on related topics in other subjects. Action researchers working in a social context do not generate certain knowledge, but knowledge that emerges and can be observed and researched again, building upon their knowledge each time.

Researcher Positionality in Action Research

In this first chapter, we have discussed a lot about the role of experiences in sparking the research process in the classroom. Your experiences as an educator will shape how you approach action research in your classroom. Your experiences as a person in general will also shape how you create knowledge from your research process. In particular, your experiences will shape how you make meaning from your findings. It is important to be clear about your experiences when developing your methodology too. This is referred to as researcher positionality. Maher and Tetreault (1993, p. 118) define positionality as:

Gender, race, class, and other aspects of our identities are markers of relational positions rather than essential qualities. Knowledge is valid when it includes an acknowledgment of the knower’s specific position in any context, because changing contextual and relational factors are crucial for defining identities and our knowledge in any given situation.

By presenting your positionality in the research process, you are signifying the type of socially constructed, and other types of, knowledge you will be using to make sense of the data. As Maher and Tetreault explain, this increases the trustworthiness of your conclusions about the data. This would not be possible with a positivist ontology. We will discuss positionality more in chapter 6, but we wanted to connect it to the overall theoretical underpinnings of action research.

Advantages of Engaging in Action Research in the Classroom

In the following chapters, we will discuss how action research takes shape in your classroom, and we wanted to briefly summarize the key advantages to action research methodology over other types of research methodology. As Koshy (2010, p. 25) notes, action research provides useful methodology for school and classroom research because:

Advantages of Action Research for the Classroom

• research can be set within a specific context or situation;
• researchers can be participants – they don’t have to be distant and detached from the situation;
• it involves continuous evaluation and modifications can be made easily as the project progresses;
• there are opportunities for theory to emerge from the research rather than always follow a previously formulated theory;
• the study can lead to open-ended outcomes;
• through action research, a researcher can bring a story to life.

Action Research Copyright © by J. Spencer Clark; Suzanne Porath; Julie Thiele; and Morgan Jobe is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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How Action Research Can Improve Your Teaching

Do you ever find yourself looking at a classroom problem with not a clue in the world about how to fix it? No doubt, teaching art is difficult. Sometimes the issues we face don’t have easy solutions.

One method that is worth looking into is action research. In action research, a teacher takes the time to analyze a problem and then cycles through specific steps to solve it. If you’re struggling with a problem in your classroom, this might be the perfect strategy to try!

What is action research?

Simply put, action research describes a research methodology used to diagnose and address problems. In a school setting, the teacher plays the role of the researcher, and the students represent the study participants. Action research is a meaningful way for a teacher to find out why students perform the way they do.

The term, “action research,” was coined in 1933 by Kurt Lewin to describe a scenario in which a researcher and participants collaborate to solve a specific problem. Donald Schön  developed this idea further with the term, “reflective practitioner,” to describe a researcher who thinks systematically about their practice.

Educators have taken both of these ideas into the classroom to better serve their students.

Here is a look at the basic structure of an action research cycle. You might notice it looks a lot like the Design Thinking Process.

• The teacher recognizes and wonders about a problem in the classroom.
• The teacher thinks about possible reasons students are having trouble.
• The teacher collects and analyzes data.
• The teacher comes up with solutions to try.
• The teacher analyzes the solution.

In this model, if the first solution is not effective, the cycle starts over again. The teacher recognizes what remains of the problem and repeats the steps to collect more evidence and brainstorm new and different solutions.

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Because the process is cyclical, the teacher can loop through the steps as many times as needed to find a solution. Perhaps the best part of action research is that teachers can see which solutions have made a real impact on their students. If you’re looking for an even more in-depth take on the topic, The Art of Classroom Inquiry: A Handbook for Teacher-Researchers  by Hubbard and Powers is a great place to start.

Action research can be as informal or formal as you need it to be. Data is collected through observation, questioning, and discussion with students. Student artwork, photographs of your classroom at work, video interviews, and surveys are all valid forms of data. Students can be involved throughout the whole process, helping to solve the problem within the classroom. With a formal study for a university, there will be requests for permission to use student data through the Institutional Research Board (IRB) process.

How can action research be implemented in your classroom?

I discovered action research while working on my higher degree. Using action research allowed me to find real solutions for real issues in my classroom and gave me my topic of study for my dissertation at the same time!

The problem I chose to address was how to engage students in an analog photography course in the digital age.

I broke my classes into two groups. I taught the district curriculum to one group and an altered curriculum to another. In the altered version, I included big ideas and themes that were important to students such as family, identity, and community.

To gather data, I observed, compared the quality of the photos, and conducted student interviews. I found students were much more engaged when I switched the projects from a technical study (i.e., demonstrating depth of field) to a more personal focus (breaking the teenage stereotype.)

What are the benefits of action research?

Using action research in my classroom allowed me to involve students in the curriculum process. They were actively more engaged within the classroom and felt ownership of their learning.

I was able to show them that teachers can be lifelong learners, and that inquiry is a powerful way to enact change within the classroom. The students cheered me on as I was writing and defended the results of my study. Plus, I was able to connect with them on a personal level, as we were all students. Furthermore, my teaching practice became more confident, and my understanding of art education theory deepened.

Conducting action research also allowed me to become a leader in my community. I was able to present a way to be a reflective practitioner within my classroom and model it for other teachers. I shared my new knowledge with the other art teachers in my district and invited them to try their own informal studies within their classrooms. We were able to shift our focus from one of compliance to one of inquiry and discovery, thus creating a more engaging learning environment for our students.

Action research provides a way to use your new knowledge immediately in your classroom. It allows you to think critically about why and how you run your art classroom. What could be better?

What kinds of issues are you facing in the classroom right now?

What kind of research study might you be interested in conducting?

Magazine articles and podcasts are opinions of professional education contributors and do not necessarily represent the position of the Art of Education University (AOEU) or its academic offerings. Contributors use terms in the way they are most often talked about in the scope of their educational experiences.

Alexandra Overby

Alexandra Overby, a high school art educator, is one of AOEU’s Adjunct Instructors. She immerses herself in topics of photography practice, visual ethnography, technology in the art room, and secondary curriculum.

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• Open access
• Published: 03 June 2024

Continue nursing education: an action research study on the implementation of a nursing training program using the Holton Learning Transfer System Inventory

• MingYan Shen 1 , 2 &
• ZhiXian Feng 1 , 2  

BMC Medical Education volume  24 , Article number:  610 ( 2024 ) Cite this article

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To address the gap in effective nursing training for quality management, this study aims to implement and assess a nursing training program based on the Holton Learning Transfer System Inventory, utilizing action research to enhance the practicality and effectiveness of training outcomes.

The study involved the formation of a dedicated training team, with program development informed by an extensive situation analysis and literature review. Key focus areas included motivation to transfer, learning environment, and transfer design. The program was implemented in a structured four-step process: plan, action, observation, reflection.

Over a 11-month period, 22 nurses completed 14 h of theoretical training and 18 h of practical training with a 100% attendance rate and 97.75% satisfaction rate. The nursing team successfully led and completed 22 quality improvement projects, attaining a practical level of application. Quality management implementation difficulties, literature review, current situation analysis, cause analysis, formulation of plans, implementation plans, and report writing showed significant improvement and statistical significance after training.

The study confirms the efficacy of action research guided by Holton’s model in significantly enhancing the capabilities of nursing staff in executing quality improvement projects, thereby improving the overall quality of nursing training. Future research should focus on refining the training program through long-term observation, developing a multidimensional evaluation index system, exploring training experiences qualitatively, and investigating the personality characteristics of nurses to enhance training transfer effects.

Peer Review reports

Introduction

The “Medical Quality Management Measures“ [ 1 ] and “Accreditation Standards for Tertiary Hospitals (2020 Edition)” [ 2 ] both emphasize the importance of using quality management tools in medical institutions to carry out effective quality management [ 3 ]. However, there is a notable gap in translating theoretical training into effective, practical application in clinical settings [ 4 ]. This gap is further highlighted in the context of healthcare quality management, as evidenced in studies [ 5 ] which demonstrate the universality of these challenges across healthcare systems worldwide.

Addressing this issue, contemporary literature calls for innovative and effective training methods that transition from passive knowledge acquisition to active skill application [ 6 ]. The Holton Learning Transfer System Inventory [ 7 ] provides a framework focusing on key factors such as motivation, learning environment, and transfer design [ 7 , 8 , 9 ]. This study aims to implement a nursing training program based on the Holton model, using an action research methodology to bridge the theoretical-practical gap in nursing education.

Quality management training for clinical nurses has predominantly been characterized by short-term theoretical lectures, a format that often fails to foster deep engagement and lasting awareness among nursing personnel [ 10 ]. The Quality Indicator Project in Taiwan’s nursing sector, operational for over a decade, demonstrates the effective use of collective intelligence and scientific methodologies to address these challenges [ 11 ]. The proposed study responds to the need for training programs that not only impart knowledge but also ensure the practical application of skills in real-world nursing settings, thereby contributing to transformative changes within the healthcare system [ 12 ].

In April 2021, the Nursing Education Department of our hospital launched a quality improvement project training program for nurses. The initiation of this study is underpinned by the evident disconnect between theoretical training and the practical challenges nurses face in implementing quality management initiatives, a gap also identified in the work [ 13 ]. By exploring the efficacy of the Holton Learning Transfer System Inventory, this study seeks to enhance the practical application of training and significantly contribute to the field of nursing education and quality management in healthcare.

Developing a nursing training program with the Holton Learning Transfer System Inventory

Establishing a research team and assigning roles.

There are 10 members in the group who serve as both researchers and participants, aiming to investigate training process issues and solutions. The roles within the group are as follows: the deputy dean in charge of nursing is responsible for program review and organizational support, integrating learning transfer principles in different settings [ 14 ]; the deputy director of the Nursing Education Department handles the design and implementation of the training program, utilizing double-loop learning for training transfer [ 15 ]; the deputy director of the Nursing Department oversees quality control and project evaluation, ensuring integration of evidence-based practices and technology [ 16 ] and the deputy director of the Quality Management Office provides methodological guidance. The remaining members consist of 4 faculty members possessing significant university teaching experience and practical expertise in quality control projects, and 2 additional members who are jointly responsible for educational affairs, data collection, and analysis. Additionally, to ensure comprehensive pedagogical guidance in this training, professors specializing in nursing pedagogy have been specifically invited to provide expertise on educational methodology.

Current situation survey

Based on the Holton Learning Transfer System Inventory (refer to Fig.  1 ), the appropriate levels of Motivation to Improve Work Through Learning (MTIWL), learning environment, and transfer design are crucial in facilitating changes in individual performance, thereby influencing organizational outcomes [ 17 , 18 ]. Motivation to Improve Work Through Learning (MTIWL) is closely linked to expectation theory, fairness theory, and goal-setting theory, significantly impacting the positive transfer of training [ 19 ]. Learning environment encompasses environmental factors that either hinder or promote the application of learned knowledge in actual work settings [ 20 ]. Transfer design, as a pivotal component, includes training program design and organizational planning.

To conduct the survey, the research team retrieved 26 quality improvement reports from the nursing quality information management system, which were generated by nursing units in 2020. A checklist was formulated, and a retrospective evaluation was conducted across eight aspects, namely, team participation, topic selection feasibility, method accuracy, indicator scientificity, program implementation rate, effect maintenance, and promotion and application. Methods employed in the evaluation process included report analysis, on-site tracking, personnel interviews, and data review within the quality information management system [ 21 ]. From the perspective of motivation [ 22 ], learning environment [ 23 ], and transfer design, a total of 14 influencing factors were identified. These factors serve as a reference for designing the training plan and encompass the following aspects: lack of awareness regarding importance, low willingness to participate in training, unclear understanding of individual career development, absence of incentive mechanisms, absence of a scientific training organization model, lack of a training quality management model, inadequate literature retrieval skills and support, insufficient availability of practical training materials and resources, incomplete mastery of post-training methods, lack of cultural construction plans, suboptimal communication methods and venues, weak internal organizational atmosphere, inadequate leadership support, and absence of platforms and mechanisms for promoting and applying learned knowledge.

Learning Transfer System Inventory

Development of the training program using the 4W1H approach

Drawing upon Holton’s Learning Transfer System Inventory and the hospital training transfer model diagram, a comprehensive training outline was formulated for the training program [ 24 , 25 ]. The following components were considered:

(1) Training Participants (Who): The training is open for voluntary registration to individuals with an undergraduate degree or above, specifically targeting head nurses, responsible team leaders, and core members of the hospital-level nursing quality control team. Former members who have participated in quality improvement projects such as Plan-Do-Check-Act Circle (PDCA) or Quality control circle (QCC) are also eligible.

(2) Training Objectives (Why): At the individual level, the objectives include enhancing the understanding of quality management concepts, improving the cognitive level and application abilities of project improvement methods, and acquiring the necessary skills for nursing quality improvement project. At the team level, the aim is to enhance effective communication among team members and elevate the overall quality of communication. Moreover, the training seeks to facilitate collaborative efforts in improving the existing nursing quality management system and processes. At the operational level, participants are expected to gain the competence to design, implement, and manage nursing quality improvement project initiatives. Following the training, participants will lead and successfully complete a nursing quality improvement project, which will undergo a rigorous audit.

(3) Training Duration (When): The training program spans a duration of 11 months.

(4) Training Content (What): The program consists of 14 h of theoretical courses and 18 h of practical training sessions, as detailed in Table  1 .

(5) Quality Management Approach (How): To ensure quality throughout the training process, two team members are assigned to monitor the entire training journey. This encompasses evaluating whether quality awareness education, quality management knowledge, and professional skills training are adequately covered. Additionally, attention is given to participants’ learning motivation, the emphasis placed on active participation in training methods, support from hospital management and relevant departments, as well as participants’ satisfaction and assessment results. Please refer to Fig.  2 for a visual representation.

In-house training model from Holton Learning Transfer

Implementation of the nursing project training program using the action research method

The first cycle (april 2021).

In the initial cycle, a total of 22 nurses were included as training participants after a self-registration process and qualification review. The criteria used to select these participants, elaborated in Section Development of the training program using the 4W1H approach, ‘Development of the Training Program,’ were meticulously crafted to capture a broad spectrum of experience, expertise, and functional roles within our hospital’s nursing staff. The primary focus was to investigate their learning motivation. The cycle comprised the following key activities:

(1) Training Objectives: The focus was on understanding the learning motivation of the participating nurses.

(2) Theoretical Training Sessions: A total of 7 theoretical training sessions, spanning 14 class hours, were completed. The contents covered various aspects, including an overview of nursing quality improvement projects, methods for selecting project topics, common tools used in nursing quality improvement projects, effective leadership strategies to promote project practices, literature retrieval and evaluation methods, formulation and promotion of project plans, and writing project reports. Detailed course information, including the title, content, and class hours, is listed in Table  1 . At the end of each training session, a course satisfaction survey was conducted.

(3) Assessment and Reporting: Following the completion of the 7 training sessions, a theoretical assessment on quality management knowledge was conducted. Additionally, nurses were organized to present their plans for special projects to be carried out during the training. Several issues were identified during this cycle:

Incomplete Literature Review Skills: Compared to other quality control tools, nursing quality improvement project places more emphasis on the scientific construction of project plans. The theoretical evaluation and interviews with nurses highlighted the incomplete and challenging nature of their literature review skills.

Insufficient Leadership: Among the participants, 6 individuals were not head nurses, which resulted in a lack of adequate leadership for their respective projects.

Learning environment and Support: The learning environment, as well as the support from hospital management and relevant departments, needed to be strengthened.

Second cycle (may-october 2021)

In response to the issues identified during the first cycle, our approach in the second cycle was both corrective and adaptive, focusing on immediate issues while also setting the stage for addressing any emerging challenges. The team members actively implemented improvements during the second cycle. The key actions taken were as follows:

(1) Establishing an Enabling Organizational Environment: The quality management department took the lead, and multiple departments collaborated in conducting the “Hospital Safety and Quality Red May” activity. This initiative aimed to enhance the overall quality improvement atmosphere within the hospital. Themed articles were also shared through the hospital’s WeChat public account.

(2) Salon-style Training Format: The training sessions were conducted in the form of salons, held in a meeting room specifically prepared for this purpose. The room was arranged with a round table, warm yellow lighting, green plants, and a coffee bar, creating a conducive environment for free, democratic, and equal communication among the participants. The salon topics included revising project topic selection, conducting current situation investigations, facilitating communication and guidance for literature reviews, formulating improvement plans, implementing those plans, and writing project reports. After the projects were presented, quality management experts provided comments and analysis, promoting the transformation of training outcomes from mere memory and understanding to higher-level abilities such as application, analysis, and creativity.

(3) Continuous Support Services: Various support services were provided to ensure ongoing assistance. This included assigning nursing postgraduates to aid in literature retrieval and evaluation. Project team members also provided on-site guidance and support, actively engaging in the project improvement process to facilitate training transfer.

(4) Emphasis on Spiritual Encouragement: The Vice President of Nursing Department actively participated in the salons and provided feedback on each occasion. Moreover, the President of the hospital consistently commended the training efforts during the weekly hospital meetings.

Issues identified in this cycle

(1) Inconsistent Ability to Write Project Documents: The proficiency in writing project documents for project improvement varied among participants, and there was a lack of standardized evaluation criteria. This issue had the potential to impact the quality of project dissemination.

(2) Lack of Clarity Regarding the Platform and Mechanism for Training Result Transfer: The platform and mechanisms for transferring training results were not clearly defined, posing a challenge in effectively sharing and disseminating the outcomes of the training.

The third cycle (November 2021-march 2022)

During the third cycle, the following initiatives were undertaken.

(1) Utilizing the “Reporting Standards for Quality Improvement Research (SQUIRE)”, as issued by the US Health Care Promotion Research, to provide guidance for students in writing nursing project improvement reports.

(2) Organizing a hospital-level nursing quality improvement project report meeting to acknowledge and commend outstanding projects.

(3) Compiling the “Compilation of Nursing Quality Improvement Projects” for dissemination and exchange among nurses both within and outside the hospital.

(4) Addressing the issue of inadequate management of indicator monitoring data, a hospital-level quality index management platform was developed. The main evaluation data from the 22 projects were entered into this platform, allowing for continuous monitoring and timely intervention.

Effect evaluation

To assess the efficacy of the training, a diverse set of evaluation metrics, encompassing both outcome and process measures [ 26 ]. These measures can be structured around the four-level training evaluation framework proposed by Donald Kirkpatrick [ 27 ].

Process evaluation

Evaluation method.

To assess the commitment and support within the organization, the process evaluation involved recording the proportion of nurses’ classroom participation time and the presence of leaders during each training session. Additionally, a satisfaction survey was conducted after the training to assess various aspects such as venue layout, time arrangement, training methods, lecturer professionalism, content practicality, and interaction. On-site recycling statistics were also collected for project evaluation purposes.

Evaluation results the results of the process evaluation are as follows

Nurse training participation rate: 100%.

Training satisfaction rate (average): 97.75%.

Proportion of nurses’ participation time in theoretical training sessions (average): 36.88%.

Proportion of nurses’ participation time in salon training sessions (average): 74.23%.

Attendance rate of school-level leaders: 100%.

Results evaluation

Assessment of theoretical knowledge of quality management.

To evaluate the effectiveness in enhancing the trainees’ theoretical knowledge of quality management, the research team conducted assessments before the training, after the first round of implementation, and after the third round of implementation. Assessments to evaluate the effectiveness of the training program were conducted immediately following the first round of implementation, and after the third round of implementation. This dual-timing approach was designed to evaluate both the immediate impact of the training and its sustained effects over time, addressing potential influences of memory decay on the study results. The assessment consisted of a 60-minute examination with different question types, including 30 multiple-choice questions (2 points each), 2 short-answer questions (10 points each), and 1 comprehensive analysis question (20 points). The maximum score achievable was 100 points.

The assessment results are as follows:

Before training (average): 75.05 points.

After the first round of implementation (average): 82.18 points.

After the third round of implementation (average): 90.82 points.

Assessment of difficulty in quality management project implementation

To assess the difficulty of implementing quality management projects, the trainees completed the “Quality Management Project Implementation Difficulty Assessment Form” before and after the training. They self-evaluated 10 aspects using a 5-point scale, with 5 indicating the most difficult and 1 indicating no difficulty. The evaluation results before and after implementation are presented in Table  2 .

Statistically significant differences were found in the following items: literature review, current situation analysis, cause analysis, plan formulation, implementation plan, and report writing. This indicates that the training significantly enhanced the nurses’ confidence and ability to tackle practical challenges.

Evaluation of transfer effect

To assess how effectively the training translated into practical applications. The implementation of the 22 quality improvement projects was evaluated using the application hierarchy analysis table. The specific results are presented in Table  3 .

In addition, the “Nursing Project Guidance Manual” and “Compilation of Nursing Project Improvement Projects” were compiled and distributed to the hospital’s management staff, nurses, and four collaborating hospitals, receiving positive feedback. The lecture titled “Improving Nurses’ Project Improvement Ability Based on the Training Transfer Theory Model” shared experiences with colleagues both within and outside the province in national and provincial teaching sessions in 2022. Furthermore, four papers were published on the subject.

The effectiveness of the training program based on the Holton Learning transfer System Inventory

The level of refined management in hospitals is closely tied to the quality management awareness and skills of frontline medical staff. Quality management training plays a crucial role in improving patient safety management and fostering a culture of quality and safety. Continuous quality improvement is an integral part of nursing management, ensuring that patients receive high-quality and safe nursing care. Compared to the focus of existing literature on the individual performance improvements following nursing training programs [ 28 , 29 , 30 ], our study expands the evaluation framework to include organizational performance metrics. Our research underscores a significantly higher level of organizational engagement as evidenced by the 100% attendance rate of school-level leaders. The publication of four papers related to this study highlights not only individual performance achievements but also significantly broadens the hospital organization’s impact on quality management, leading to meaningful organizational outcomes.

Moreover, our initiative to incorporate indicators of quality projects into a hospital-level evaluation index system post-training signifies a pivotal move towards integrating quality improvement practices into the very fabric of organizational operations. In training programs, it is essential not only to achieve near-transfer, but also to ensure that nurses continuously apply the acquired management skills to their clinical work, thereby enhancing quality, developing their professional value, and improving organizational performance. The Holton learning Transfer System Inventory provides valuable guidance on how to implement training programs and evaluate their training effect.

This study adopts the training transfer model as a framework to explore the mechanisms of “how training works” rather than simply assessing “whether training works [ 31 ].” By examining factors such as Motivation to Improve Work Through Learning (MTIWL), learning environment, and transfer design, the current situation is analyzed, underlying reasons are identified, and relevant literature is reviewed to develop and implement training programs based on the results of a needs survey. While individual transfer motivation originates from within the individual, it is influenced by the transfer atmosphere and design. By revising the nurse promotion system and performance management system and aligning them with career development, nurses’ motivation to participate and engage in active learning has significantly increased [ 32 ]. At the learning environment level, enhancing the training effect involves improving factors such as stimulation and response that correspond to the actual work environment [ 33 ]. This project has garnered attention and support from hospital-level leaders, particularly the nursing dean who regularly visits the training site to provide guidance, which serves as invaluable recognition. Timely publicity and recognition of exemplary project improvement initiatives have also increased awareness and understanding of project knowledge among doctors and nurses, fostering a stronger quality improvement atmosphere within the team.

Transfer design, the most critical component for systematic learning and mastery of quality management tools, is achieved through theoretical lectures, salon exchanges, and project-based training. These approaches allow nurses to gain hands-on experience in project improvement under the guidance of instructors. Throughout the project, nurses connect project management knowledge and skills with practical application, enabling personal growth and organizational development through problem-solving in real work scenarios. Finally, a comprehensive evaluation of the training program was conducted, including assessments of theoretical knowledge, perception of management challenges, and project quality. The results showed high satisfaction among nurses, with a satisfaction rate of 97.75%. The proportion of nurses’ participation time in theoretical and practical training classes was 36.88% and 74.23%, respectively. The average score for theoretical knowledge of quality management increased from 75.05 to 90.82. There was also a significant improvement in the evaluation of the implementation difficulties of quality management projects. Moreover, 22 nurses successfully led the completion of one project improvement project, with six projects focusing on preventing the COVID-19 pandemic, demonstrating valuable crisis response practices.

Action research helps to ensure the quality of organizational management of training

Well-organized training is the basis for ensuring the scientific and standardized development of nursing project improvement activities. According to the survey results of the current situation, there is a lot of room for improvement in the training quality; since it is the first time to apply the Holton training transfer model to the improvement training process of nurses in the hospital, in order to allow the nurses to have sufficient time to implement and evaluate the improvement project, the total training time Set at 11 months, a strong methodology is required to ensure training management during this period. Action research is a research method that closely combines research with solving practical problems in work. It is a research method aimed at solving practical problems through self-reflective exploration in realistic situations, emphasizing the participation of researchers and researchees. Practice, find problems in practice, and adjust the plan in a timely manner. According to the implementation of the first round, it was found that nurses had insufficient literature review skills, insufficient leadership, and lack of support from hospital management and related departments [ 32 ]. In the second round, the training courses were carried out in the form of salons. The project team members went deep into the project to improve on-site guidance, arranged graduate students to assist in document retrieval and evaluation, and promoted the transfer of training; the “Hospital Safety and Quality Red May” activity was carried out, and the vice president of nursing Regularly participate in the salon and make comments. The problems exposed after this round of implementation are the low quality of the project improvement project document, and the unclear platform and mechanism for the transfer of training results. In the third round, the “Reporting Standards for Quality Improvement Research (SQUIRE)” was used to standardize the writing of the report [ 33 ], and the “Compilation of Nursing Project Improvement Projects” was completed, and the main evaluation data of 22 projects were entered into the hospital-level quality index management platform for continuous monitoring and intervention. As of May 2022, the effect maintenance data of each project has reached the target value. It can not only produce useful improvement projects, but also help to promote the dissemination and penetration of quality awareness.

Future research directions

Drawing on the Holton training evaluation model, this study implemented nurse quality improvement project training using action research methodology, resulting in a successful exploration practice, and achieving positive transfer effects. To further advance this research area, the following future research directions are recommended:

Summarize the experiences gained from this action research training and continue to refine and enhance the training program. Through ongoing practice, reflection, and refinement in subsequent training sessions, long-term observation of the transfer effects can be conducted to establish an effective experiential model that can serve as a reference for future initiatives.

Develop a multidimensional evaluation index system for assessing transfer effects. A comprehensive framework that captures various dimensions of transfer, such as knowledge application, skill utilization, and behavior change, should be established. This will enable a more holistic and accurate assessment of the training program’s impact on the participants and the organization.

Conduct qualitative research to explore the training experiences of nurses. By gathering in-depth insights through interviews or focus group discussions, a deeper understanding of the nurses’ perceptions, challenges, and facilitators of training transfer can be obtained. This qualitative exploration will provide valuable information to further refine and tailor the training program to meet the specific needs and preferences of the nurses.

Investigate the personality characteristics of nurses who actively engage in training transfer and consider developing them as internal trainers. By identifying and cultivating nurses with a proactive attitude and a strong inclination towards knowledge application and skill development, the organization can enhance employee participation and initiative. These internal trainers can play a crucial role in motivating their colleagues and driving the transfer of training outcomes into daily practice.

By pursuing these future research directions, the field of healthcare and nursing care can continue to advance in optimizing training programs, enhancing transfer effects, and ultimately improving the quality of care and patient outcomes.

Limitations

The research was conducted with a cohort of 22 nurses and a 10-member research team from Grade 3, Class A hospitals in China Southeast. This specific composition and the relatively small sample size may affect the generalizability of our findings. The experiences and outcomes observed in this study might not fully encapsulate the diverse challenges and environments encountered by nursing professionals in varying healthcare settings. The significant improvements noted in the capabilities of the participating nursing staff underscore the potential impact of the training program. However, the study’s focus on a specific demographic—nurses from high-grade hospitals in a developed urban center—may limit the external validity of the findings.

Conclusions

This study affirms the efficacy of the Holton Learning Transfer System Inventory-based training program, coupled with action research, in significantly advancing nursing quality management practices. The strategic incorporation of motivation to improve work through learning, an enriched learning environment, and thoughtful transfer design significantly boosted the nurses’ engagement, knowledge acquisition, and practical application of quality management tools in their clinical work.

It highlights the importance of continuous learning, organizational support, and methodological flexibility in achieving sustainable improvements in healthcare quality and safety. Future endeavors should aim to expand the scope of this training model to diverse nursing contexts and evaluate its long-term impact on organizational performance and patient care outcomes.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to hospital policy but are available from the corresponding author on reasonable request.

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This study was funded by Department of Education of Zhejiang Province, Grant Number jg20220475.

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The following statements specify the individual contributions of each author to the manuscript titled “Continue Nursing Education: An Action Research Study on the Implementation of a Nursing Training Program Using the Holton Learning Transfer System Inventory”:ZhiXian Feng conceived and designed the analysis; led the research team and coordinated the project; critically reviewed and revised the manuscript for important intellectual content; oversaw the implementation of the training program; MingYan Shen conducted the research; collected and organized the data; analyzed and interpreted the data; contributed to the statistical analysis; wrote the initial draft of the manuscript; managed logistics and operational aspects of the study.

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Shen, M., Feng, Z. Continue nursing education: an action research study on the implementation of a nursing training program using the Holton Learning Transfer System Inventory. BMC Med Educ 24 , 610 (2024). https://doi.org/10.1186/s12909-024-05552-6

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For this issue, we used guidance from the Executive Function Mapping Project, led by Dr. Stephanie Jones of the Harvard Graduate School of Education. In its report,  self-regulation  is viewed as part of an umbrella term for “the broad phenomena of children’s developing regulation” and  executive function  as a set of “multi-component skills” within it. (For more on this report, visit  Executive Function Mapping Project: Untangling  the Terms and Skills Related to Executive Function and Self-Regulation in Early Childhood .)

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The first article, “ Intentionally Building Self-Regulation and Literacy Skills: The Power of Dramatization in Kindergarten ,” is written by Barbara Wilder-Smith, Deborah J. Leong, and Elena Bodrova. Knowing the push kindergarten teachers face to teach academic skills above all, the authors share a rationale for and vivid details about how children can develop self-regulation and literacy skills in a playful, impactful way—through dramatization.

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The next two articles focus more specifically on executive function skills and playful approaches to nurture them. In “ Building Executive Function Skills Through Games: The Power of Playful Learning ,” Cynthia A. Wiltshire and Molly Scott blend what is known from the science of learning and play to explain how early childhood educators can integrate play-based activities to promote executive function skills in their programs and/or schools.

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Finally, a team with backgrounds in early childhood education, behavior analysis, and speech-language pathology came together to conceive of “ The LEARN Framework: Supporting Self-Regulation in Diverse Early Childhood Settings .” Tahnee L. Wilder, Ashley Y. Grays, Fanica Young, Danica Moise, and Sharde Theodore write about the key principles of their framework, which is intended for early childhood educators as they support 3- to 5-year-olds’ self-regulation in culturally responsive learning environments.

Toward the goal of presenting research-to-practice content, this issue outlines the research base behind self-regulation and executive function, then shows what these concepts look like in real life and how early childhood professionals can nurture these areas of development. Whether you work in a teaching, leadership, or policy role, I hope you find many ideas in this issue for how to connect this research to your practice.

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Announcing the Newest Institutional Challenge Grantees: $2.6 Million for Partnerships Addressing Social Issues

Trustees of the William T. Grant Foundation, Spencer Foundation, Doris Duke Foundation, and Bezos Family Foundation have approved $2.6 million in funding for the winners of the 2024 Institutional Challenge Grant competition.

The winners of this year’s Institutional Challenge Grant are the University of Delaware, the University of Tennessee-Knoxville, Santa Clara University, and Washington University in St. Louis. These institutions will partner with local nonprofits or public agencies to:

• address inequalities in literacy opportunities and outcomes for K–3 students
• establish an implementation science program to better serve low-income and minoritized populations, focusing on Black and Latina pregnant teens
• support college preparation, persistence, and completion for Latinx students, and
• connect Black male youth with employment and enriched education opportunities.

The Institutional Challenge Grant encourages university-based research institutes, schools, and centers to grow existing research-practice partnerships with public agencies or nonprofit organizations in order to reduce inequality in youth outcomes. Each partnership receives a three-year award of $650,000.

“We are thrilled to receive so many high-quality applications,” said Adam Gamoran, president of the William T. Grant Foundation. “It’s a clear sign that researchers are recognizing the value of building research agendas in response to community priorities—and that universities are finding innovative ways to value and encourage community-engaged scholarship.”

“I look forward to using the presence of this grant to inform faculty across the campus about the importance of engaged scholarship and the importance it can hold in the annual review process as well as the promotion and tenure process”

As part of the program, grantee institutions must shift their policies and incentives to value collaborative work and strengthen institutional infrastructure to reward community-engaged research. At the University of Delaware, which will collaborate with the state’s Department of Education, the grant “will allow us to garner much more attention at the university for these kinds of initiatives and engaged scholarship,” said Gary Henry, Dean of the College of Education and Human Development and Professor in the School of Education and the Joseph R. Biden, Jr. School of Public Policy and Administration. “I look forward to using the presence of this grant to inform faculty across the campus about the importance of engaged scholarship and the importance it can hold in the annual review process as well as the promotion and tenure process.”

Mary McKay, Vice Provost for Interdisciplinary Initiatives at Washington University in St. Louis, who is partnering with Sean Joe, the Benjamin E. Youngdahl Professor of Social Development, and with the Boys and Girls Club of St. Louis, the Greater St. Louis Foundation, and the Fathers and Families Support Center, said that the collaboration is “a model for what we want to do as an institution, which is to create these vibrant, deep networks of partners that are in this with us in terms of our research and teaching. … We’re super excited to make this network a rich resource for other faculty doing related work around young people, their families, and the adults that raise them.”

Here what we’re doing is really bringing in the strength of both organizations … in order to create something better than what we could do individually

The partnerships also enhance the capacity of nonprofits or public agencies to use evidence in their decision-making. “Community health centers are typically tasked with providing access to care for under-resourced communities, and we recognize that part of that charge involves contributing to the scholarly literature [and] to the knowledge base about best practices to improve the health of a community. Here what we’re doing is really bringing in the strength of both organizations—UT with the research methodology and scientific rigor, and then our work in the trenches with under-resourced communities—in order to create something better than what we could do individually,” said Parinda Khatri, Chief Executive Officer at Cherokee Health Systems, which is partnering with the University of Tennessee-Knoxville.

For the Latino Education Advancement Foundation (LEAF), which, alongside the Foundation for Hispanic Education, is collaborating with Santa Clara University, “We want to do more of the systemic change work, knowing that these higher education systems need to change to serve this huge population of students who isn’t being served in our public education systems,” said Brittany Alvarez, LEAF’s Executive Director. The partnership “is going to deepen the areas of expertise that we have around collecting and utilizing research evidence for programmatic improvement, for best practice collection, and then sharing those best practices widely with all of the colleges and universities that we work with.”

All Institutional Challenge Grant recipients are eligible to apply for continuation funding of $350,000 to further their success in strengthening partners’ capacities to use research in their practice, enhancing institutional infrastructure to reward community-engaged research, and conducting rigorous research on reducing inequalities in youth outcomes.

Na’ilah Suad Nasir, president of the Spencer Foundation, said: “The Spencer Foundation invests in research that cultivates learning and transforms lives, and we believe that collaboration between scholars and policymakers, educators, communities, and families is key to driving equitable systems change. We are proud to support the Institutional Challenge Grant, designed to encourage such collaboration and improve the lives of young people.”

JooYeun Chang, program director for child well-being at the Doris Duke Foundation, stated: “We are thrilled to support these innovative partnerships through the Institutional Challenge Grant and to champion solutions that have the potential to reduce inequality in child and youth outcomes. These collaborations represent a vital step towards harnessing diverse expertise to effect sustainable, community-driven change.”

Jody Rosentswieg, director of strategic initiatives at the Bezos Family Foundation, said: “The Bezos Family Foundation is dedicated to ensuring frontline providers have access to research evidence they can use to improve the lives of young people. We are proud to support the Institutional Challenge Grant and these four grantees to elevate the value of research-practice partnerships across their institutions and partner with their communities to address inequality for young people.”

Related content

2024 webinar: institutional challenge grant, an overview of the program and how to apply, university reforms that reward engaged research: what does change look like.

Learning by Doing Together: Improving Education Policy in Puerto Rico through a Research-Practice Partnership

The Institutional Challenge Grant: An Overview of the Program and How to Apply

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• Improving the Use of Research Evidence

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• Published: 27 May 2024

Enhancing the delivery of comprehensive care for people living with HIV in Canada: insights from citizen panels and a national stakeholder dialogue

• Michael G. Wilson   ORCID: orcid.org/0000-0002-5383-2471 1 , 2 , 3 ,
• Cristina Mattison 4 ,
• Kerry Waddell 1 ,
• Jean Bacon 5 ,
• Marissa Becker 6 ,
• Christine Bibeau 7 ,
• John N. Lavis 1 , 2 , 3 , 8 ,
• Ron Rosenes 7   na1 &
• Claire E. Kendall 7 , 9  

Health Research Policy and Systems volume  22 , Article number:  62 ( 2024 ) Cite this article

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People living with human immunodeficiency virus (HIV) are living longer with health-related disability associated with ageing, including complex conditions. However, health systems in Canada have not adapted to meet these comprehensive care needs.

We convened three citizen panels and a national stakeholder dialogue. The panels were informed by a plain-language citizen brief that outlined data and evidence about the challenge/problem, elements of an approach for addressing it and implementation considerations. The national dialogue was informed by a more detailed version of the same brief that included a thematic analysis of the findings from the panels.

The 31 citizen panel participants emphasized the need for more prevention, testing and social supports, increased public education to address stigma and access to more timely data to inform system changes. The 21 system leaders emphasized the need to enhance person-centred care and for implementing learning and improvement across provinces, territories and Indigenous communities. Citizens and system leaders highlighted that policy actions need to acknowledge that HIV remains unique among conditions faced by Canadians.

Conclusions

Action will require a national learning collaborative to support spread and scale of successful prevention, care and support initiatives. Such a collaborative should be grounded in a rapid-learning and improvement approach that is anchored on the needs, perspectives and aspirations of people living with HIV; driven by timely data and evidence; supported by appropriate decision supports and aligned governance, financial and delivery arrangements; and enabled with a culture of and competencies for rapid learning and improvement.

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Introduction

Many provinces and territories in Canada have prioritized health-system reforms including integrated care for people living with complex conditions across health-system sectors and with social systems [ 1 , 2 , 3 , 4 ]. However, care for people living with human immunodeficiency virus (HIV) poses unique challenges, such as addressing stigma and discrimination, poverty, food security, homelessness, cognitive impairments and mental health and addictions that require tailored responses [ 5 , 6 , 7 ]. In addition, people living with HIV who take antiretroviral medications are living longer with HIV and with more chronic conditions [ 8 , 9 , 10 , 11 , 12 ].

Canadian federal and some provincial governments have supported achieving (and surpassing) the 90–90–90 targets set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) [ 13 ]. As of 2016, 86% of Canadians living with HIV were diagnosed; 81% of Canadians diagnosed with HIV were on treatment; and 91% of Canadians living with HIV on treatment had achieved viral suppression [ 13 , 14 , 15 , 16 ]. However, HIV incidence rates have not declined. Planned efforts to address these targets and incorporate prevention have been included in the Pan-Canadian Sexually Transmitted and Blood-Borne Infections (STBBI) Framework for Action, which is focussed on four pillars: (1) prevention, (2) testing, (3) linkage to care and treatment and (4) ongoing care and support [ 17 ]. To be successful, these efforts will need to focus on addressing the many complex and inter-related challenges that face people living with HIV [ 5 , 6 ]. For example, as compared with other chronic diseases, HIV-related stigma is a unique consideration and has been identified as one of the biggest challenges facing people living with HIV [ 7 ]. This stigmatization has been found to be associated with increased rates of depression, lower social support, anxiety, quality of life, physical health, emotional and mental distress and trauma and sexual risk, and significantly impacts people’s ability to engage with a fragmented health system [ 7 , 18 ].

Our goal was to spark action to address these challenges by convening deliberations across Canada with people living with, at risk of and affected by HIV, and with system leaders (policymakers, stakeholders and researchers) who could champion needed changes. To do this, we convened: (1) citizen panels with people living with, at risk of and affected by HIV to learn about their views of and experiences in relation to these challenges and their values and preferences for policy options to address the challenges and (2) a national stakeholder dialogue with HIV health system leaders to identify steps that can be taken to address the challenges. The approaches used for each are described in detail in the separate documents we have published, which include a citizen brief, panels summary, evidence brief and dialogue summary [ 19 , 20 , 21 , 22 ]. We provide a concise overview of our approach below. In this paper, we integrate the findings from both components to provide insights from citizens and system leaders about the important next steps identified for enhancing comprehensive care for people living with HIV in Canada.

The project was led by an interdisciplinary steering committee, which included people living with HIV as well as policymakers, clinicians and researchers with expertise in HIV-related policy, care and support. The committee guided the project from start to finish, including establishing the scope of the project, providing feedback on the citizen and evidence brief, identifying key informants to engage to provide feedback on the citizen and evidence brief, shaping the recruitment criteria for the citizen panels, identifying participants for the stakeholder dialogue and providing feedback on the analysis of the deliberations.

First, we convened three citizen panels in 2019 in Manitoba (March 22), Ontario (April 5) and Newfoundland and Labrador (April 22) that sought to engage participants from each Canadian province. Each panel was informed by a plain-language citizen brief that described what is known on the basis of data and evidence and insights from 25 key informants [ 19 , 21 ]. The deliberations focussed on describing the underlying problem related to enhancing comprehensive care for people living with HIV in Canada, three possible elements of an approach to addressing the problem, and implementation considerations for the elements. Panellists were recruited through the AskingCanadians™ panels, which include more than 600 000 Canadians that are affiliated with loyalty programs in Canada and are representative of all the Statistics Canada demographic categories. We sought to engage 14–16 panellists living with or affected by HIV for each panel who were diverse in terms of gender, age, sexual orientation, socioeconomic status, ethnocultural background and geographic residence (both in terms of provinces they live in and from urban, suburban and rural/remote settings). The deliberations were facilitated by one of two team members (MGW and CM) and followed the structure of the citizen brief. We summarized key insights from the panel using themes that the facilitators identified and refined from their detailed notes in each panel. Within panels, these themes were discussed and refined with panellists through mid-day summaries that were reviewed and discussed. In addition, our wrap-up deliberations for each were used to debrief with the panellists to ensure that we accurately documented and understood the experiences, values and preferences that were articulated during the deliberations. We also used this time to ensure that areas of common ground and divergence were accurately captured and framed in a way that reflected the deliberations. We continued to identify and refine themes through subsequent panels and used our detailed notes to capture areas of consistency across panels, as well as insights that were unique to a particular panel. After all of the panels were convened, we selectively revisited recordings to ensure accuracy of notes, themes identified and illustrative quotes.

In May 2019, we convened a stakeholder dialogue that was informed by pre-circulated evidence brief [ 22 ] (a more detailed version of the citizen brief), which included key findings from the panels. We identified participants in collaboration with the project steering committee on the basis of their ability to: (1) bring unique views, experiences and tacit knowledge to bear on the challenge and learn from the research evidence and from others’ views, experiences and tacit knowledge and (2) champion actions that will address the challenge creatively. The dialogue concluded with a focus on potential next steps that could be taken. Deliberations were facilitated by one of us (MGW) with detailed notes and observations taken by the facilitator and one secretariat (KW), which were used to prepare an analysis of key insights from the deliberations [ 20 ]. This included a draft summary of key themes that we provided to all dialogue participants to reflect on before the dialogue was completed. The stakeholder dialogue was convened “off the record” and adhered to the Chatham House Rule (participants are free to use the information received, but neither the identity nor the affiliation of the speaker(s), nor that of any other participant, may be revealed) and therefore deliberations were not recorded.

Key insights from citizen and stakeholder engagement

The citizen panels convened 31 ethnoculturally and socio-economically diverse people living with or affected by HIV from all provinces except Saskatchewan (demographic information provided in the panel summary) [ 19 ]. Demographic information of panellists is provided in Table  1 . The stakeholder dialogue convened 21 participants, which included people living with HIV and Indigenous people. While most participants held several positions, the principal roles included five federal- and provincial-level policymakers and/or leaders of a health region, five leaders of community-based HIV organizations, five leaders of stakeholder groups (including professional organizations, national and provincial-level groups and citizen-based groups) and six researchers (most of whom were also clinicians).

Insights about challenges related to the problem

Panellists identified eight challenges, which are summarized in Table  2 and include: (1) lack of comprehensive supports for HIV prevention, (2) limited access to point-of-care testing, (3) stigma is pervasive and layered, (4) lack of public awareness and education to address stigma, (5) privacy and confidentiality in testing and care are not respected, (6) limited access to social-systems supports, (7) the problem is magnified for the most vulnerable and (8) lack of timely data and use of evidence in policy decisions.

Dialogue participants agreed with these challenges, and expanded the list to include:

social and structural challenges including stigma and discrimination are fundamental to address, but continue to lack traction and commitment to change;

lack of emphasis on prevention and making available a broad menu of testing options that meet the needs of different communities;

lack of coordination across care pathways and throughout the lifespan;

limited access to timely data and the many different forms of evidence needed to inform policy and programmatic decision-making; and

mechanisms and resources not being in place to support learning across provinces, territories and Indigenous communities.

Insights about elements of a potentially comprehensive approach to address the problem

Citizen panellists and dialogue participants deliberated about three pre-circulated elements of a potentially comprehensive approach to address the problem: (1) strengthening comprehensive HIV care within the health system; (2) providing supports across social systems to address all of the challenges faced by people living with HIV; and (3) adopting a rapid-learning and improvement approach to incrementally strengthen health and social systems. These elements and evidence about them are detailed in the publicly available evidence brief [ 22 ]. Values and preferences from citizens and insights from system leaders are summarized in Table  3 .

Overall, citizens emphasized the need to provide equitable access to integrated comprehensive care to enable people to achieve optimal outcomes regardless of where they live and the challenges they face. Moreover, citizens consistently identified supports across social systems to address the full range of challenges faced by people living with HIV as being the most fundamental, yet potentially most difficult to achieve. In addition, it was identified that actions towards strengthening social systems should be prioritized over others as it will help address challenges (e.g. housing, poverty and stigma) that put people at risk for HIV and make getting diagnosed and engaged in care challenging. Lastly, despite initially struggling with the concept of rapid-learning health systems, there was consensus about the importance of making small yet rapid changes to improve HIV care and supports over time as it was viewed as more achievable than trying to reinvent entire health and social systems.

System leaders in the stakeholder dialogue participants emphasized the need for a combined health and social-system approach to strengthening care for those with HIV. Participants specifically called for a greater role for team-based care that prioritizes mental health and addictions services, and for care that is culturally competent, safe and responsive.

They also identified four themes requiring action: (1) acknowledging that HIV continues to be unique and needs to be accounted for in the pursuit of any next steps; (2) ensuring person-centred and adaptive approaches for strengthening comprehensive HIV care in health systems and providing supports across social systems; (3) underpinning all actions taken with enhanced efforts to address stigma and normalize HIV prevention, testing, care and support; and (4) focussing on achieving the Triple Aim of excellent patient experience, improved patient outcomes and keeping per capita costs manageable.

Implementation considerations

Dialogue participants also identified several implementation considerations that are likely to affect efforts to champion the necessary changes. These potential barriers included: (1) funds traditionally being siloed across government programs in health and social systems, which limits the ability flow funds to support integrated whole-person care; (2) power imbalances between different organizations and stakeholders (e.g. hospitals and credentialed professionals as compared with community and non-credentialed providers), which may make integration difficult; (3) challenges in navigating different priorities and languages used across health and social systems and the sectors within them; and (4) potential perceived delays and/or lack of action due to embedding HIV targets under the broader Pan-Canadian STBBI framework.

Next steps identified by system leaders

Stakeholders were willing to invest in several next steps, including to:

focus on improving delivery of prevention, care and support and to achieve the 90–90–90 targets, adding a fourth 90 focussed on improving quality of life, and the goals in STBBI framework (while recognizing the unique and often more complex needs of those in the remaining 10% of each of the targets);

continue to strengthen primary-care-based models emphasizing person-centred care (and include the full complement of primary-care-based providers, such as physicians, nurses and pharmacists);

identify groups of individuals with shared challenges that can be collectively supported, and shared strengths that can be built upon; and

create wrap-around social services and primary care, and inject primary-care elements into social-systems settings (e.g. housing, supervised-injection sites and prisons).

Our findings highlight that policy actions across provincial and territorial health systems need to acknowledge that HIV remains unique among conditions faced by Canadians, adopt person-centred approaches to care and address HIV-related stigma. This will require grappling with many long-standing challenges for provincial and territorial health-system reforms in Canada, particularly the lack of integration between health and social care which is typically driven by funding silos, power imbalances and limited coordination which makes intersectoral care difficult to achieve. However, the STBBI framework could be used as a common galvanizing mechanism for provinces and territories for addressing these challenges. Moreover, the framework could provide common ground for establishing greater collaboration across provincial and territorial governments, such as through a learning collaborative that can support an HIV rapid-learning model.

Such a collaborative should be grounded in a rapid-learning and improvement approach [ 23 , 24 ] that is anchored on the needs, perspectives and aspirations of people living with HIV; driven by timely evidence support; supported by appropriate decision supports and aligned governance, financial and delivery arrangements; and enabled with a culture of and competencies for rapid learning and improvement. This work could be grounded in the recommendations from the Global Commission on Evidence to Address Societal Challenges (GCESC), which is focussed on supporting actions to: (1) formalize and strengthen domestic evidence-support systems; (2) enhance and leverage the global evidence architecture; and (3) engage citizens, citizen leaders and citizen-serving non-governmental organizations (NGOs) in putting evidence at the centre of everyday life. In the recent update to the GCESC, rapid learning and improvement cycles were described as involving three stages [ 24 ]. The first stage focusses on making sense of a challenge or opportunity and the population(s) and then prioritizing what needs to be done. This requires continual efforts to identify where there are system gaps and what is driving them, where there are inequities and what challenges are prioritized to address. Next, the focus turns to co-designing new services and service models by identifying evidence-informed solutions that already exist, and how solutions can be adapted/designed with input from system users and communities (in this case, ensuring meaningful involvement of people living with HIV). The last stage of the cycle focusses on implementing, adapting and using system-level monitoring and evaluation (i.e. to determine what works, for whom and what adaptation are needed to support spread and scale). An HIV-focussed learning collaborative was viewed as being able to champion the type of work needed to operationalize this type of rapid-learning and improvement cycle.

Such an approach could be grounded as part of efforts to strengthen evidence-supports systems more broadly [ 24 ]. Such systems need to include: (1) structures and processes for those who can use evidence to inform decisions (i.e. on the “evidence demand” side, which can involve incorporating evidence use into routine advisory and decision-making processes, building and sustaining an evidence culture and strengthening capacity for evidence use); (2) mechanisms to enable coordination at the interface between evidence demand and the suppliers of evidence (e.g. by identifying evidence needs of decision-makers, packaging evidence from multiple sources in a way that is useful decision-making processes); and (3) evidence-support units on the evidence-supply side that have the expertise to understand the domestic context, evidence standards and preferred communication formats of decision-makers, and that are structured in a way that make them timely and demand-driven in their supply of evidence (e.g. by contextualizing existing domestic and global evidence in a way that ensures equity considerations are identified and considered) [ 24 ].

In considering these broader structures for using rapid-learning and improvement cycles and for strengthening evidence-support systems that have emerged since the deliberations were convened, there were many innovative and promising initiatives with potential for scale-up and spread in other communities, provinces and territories that were discussed during the deliberations which continue to be relevant. For example, many viewed the Ontario Health Teams as an opportunity to advance the implementation of person-centred approaches to care for people living with HIV. Similarly, a rapid-learning model is gaining traction in other provinces such as British Columbia through Michael Smith Health Research BC. Primary-care reform and addressing health human resource challenges continues to be a focal point for health-system reforms across the country and the actions described in this study can inform and be embedded within those efforts. The coronavirus disease 2019 (COVID-19) pandemic was also a catalyst for doing many things different and re-shaping priorities. In relation to this study, the focus on rapidly adjusting to address the needs of those most affected by COVID-19 can be taken as an opportunity to strengthen systems for the most marginalized and in ways that harness the ability to adjust rapidly, evaluate and continue to adjust.

Limitations

A potential limitation of our approach is that we engaged a smaller number of citizens in the panels. We made this choice to prioritize in-depth deliberations with a purposively selected sample of citizens, which in our experience has yielded rich insights. Moreover, we were unable to engage participants from every province. Given that key themes across the three panels were consistent, we are confident that our sample size was appropriate and representative, but may not have adequately represented the needs of black, Indigenous and people of colour. In addition, these findings were used to anchor the deliberations with health and social-system leaders in the stakeholder dialogue. Doing so ensured that our approach was grounded in the experiences, values and preferences of those living with HIV and that the deliberations with health- and social-system leaders were informed both by these insights and the best-available evidence. A final limitation to consider is that while we generated key insights from the deliberations using an iterative approach that is grounded in qualitative methods, we did not conduct a full qualitative analysis that included coding of transcripts. For the citizen panels, we used an iterative approach to identify key themes within and between panels and used recordings to corroborate our detailed notes. Detailed qualitative analysis was, however, not possible for the stakeholder dialogue given that it adopted the Chatham House Rule, which precludes recording of the deliberations.

Action will require a national learning collaborative to support spread and scale of successful prevention, care and support initiatives. Moreover, this type of approach will help operationalize, in at least one sector, the recommendations from the GCESC that emphasizes the need for more coordinated evidence-support systems [ 24 , 25 ], and doing so in a way that enables rapid-learning and improvement cycles to support spread and scale of promising new system-level innovations.

Availability of data and materials

This manuscript presents results from a series of citizen panels and a national stakeholder dialogue in Canada. All of the reports that this manuscript presents results from are publicly available here: https://www.mcmasterforum.org/find-evidence/products/project/enhancing-the-delivery-of-comprehensive-care-for-people-living-with-hiv-in-canada .

Abbreviations

Human immunodeficiency virus

Sexually transmitted and blood-borne infections

Joint United Nations Programme on HIV/AIDS

Global Commission on Evidence to Address Societal Challenges

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Acknowledgements

Not applicable

This project was funded by the: (1) Canadian Institutes of Health Research through a patient-oriented research collaboration grant (PEG-157060) and a team grant titled Advancing primary healthcare for persons living HIV with HI in Canada (TT5-128270); and (2) government of Ontario through grants to the Ontario HIV Treatment Network and to the McMaster Health Forum; and (3) Ontario SPOR SUPPORT Unit. The executive director of the Ontario HIV Treatment Network reviewed and approved the manuscript, but the project was overseen by MGW and CEK.

Author information

Deceased: Ron Rosenes.

Authors and Affiliations

McMaster Health Forum, McMaster University, 1280 Main Street West, MML-417, Hamilton, ON, L8S 4L6, Canada

Michael G. Wilson, Kerry Waddell & John N. Lavis

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada

Michael G. Wilson & John N. Lavis

Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada

Women’s and Children’s Health, Karolinska Institut, Stockholm, Sweden

Cristina Mattison

Ontario HIV Treatment Network, Toronto, Canada

Departments of Medicine, Medical Microbiology, and Community Health Sciences, University of Manitoba, Winnipeg, Canada

Marissa Becker

C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada

Christine Bibeau, Ron Rosenes & Claire E. Kendall

Department of Political Science, McMaster University, Hamilton, Canada

John N. Lavis

Department of Family Medicine, University of Ottawa, Ottawa, Canada

Claire E. Kendall

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MGW conceived of the project, oversaw all components and wrote the manuscript. CM drafted the citizen and evidence briefs with MGW that informed the citizen panels and stakeholder dialogue, co-facilitated the citizen panels, led the analysis of the citizen panels and reviewed and approved the manuscript. KW wrote the dialogue summary. JB contributed to establishing the scope of the project and reviewed all project materials. MB contributed to establishing the scope of the project and reviewed all project materials. CB contributed to establishing the scope of the project and reviewed all project materials. JNL contributed to establishing the scope of the project and reviewed all project materials. RR contributed to establishing the scope of the project and reviewed all project materials. CEK oversaw the project with MGW and was a major contributor to drafting the manuscript. All authors were part of the interdisciplinary project steering committee, and reviewed and approved the manuscript.

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Correspondence to Michael G. Wilson .

Ethics declarations

Ethics approval and consent to participate.

The Hamilton Integrated Research Ethics Board (HiREB) provided approval for the citizen panels (HiREB project # 13-369). All participants in the citizen panels provided informed consent. No ethics approval was obtained for the stakeholder dialogue as the Hamilton Integrated Ethics Board has indicated that ethics approval is not required for the meeting as it is not recorded. Ethics approval has been acquired for our ongoing evaluation of stakeholder dialogues (HiREB project # 09-336), but those results are not presented here.

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Not applicable.

Competing interests

JB is the Executive Director and JNL is the Chair of the Board of Directors of the Ontario HIV Treatment Network, which is one of the funders of the project. The rest of the authors declare that they have no professional or commercial interests relevant to the project.

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Wilson, M.G., Mattison, C., Waddell, K. et al. Enhancing the delivery of comprehensive care for people living with HIV in Canada: insights from citizen panels and a national stakeholder dialogue. Health Res Policy Sys 22 , 62 (2024). https://doi.org/10.1186/s12961-024-01147-1

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Received : 13 April 2022

Accepted : 08 May 2024

Published : 27 May 2024

DOI : https://doi.org/10.1186/s12961-024-01147-1

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