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Table 4 Description of inter-stakeholder dialogue, Stage 2 fieldwork - Direct Ranking PLA technique

From: Using Participatory Learning & Action (PLA) research techniques for inter-stakeholder dialogue in primary healthcare: an analysis of stakeholders’ experiences

Description of inter-stakeholder dialogue, Stage 2 fieldwork: Direct Ranking PLA technique
On the evening of 6th February 2013, eleven people who are stakeholders in the RESTORE research project about migrant health gather for the seventh time in a meeting room in the National University of Ireland, Galway. Having come from various workplaces, they are greeted with culturally-appropriate refreshments. Aged between 31 and 55, eight are female, three male. Of these, eight represent migrant communities from six different countries and cultures, and five of them have experience in community interpreting. Also present are a policy planner, a practice manager and a doctor. These stakeholders make up an ‘inter-stakeholder group’ as they represent various and diverse backgrounds and fields of stakeholder expertise; they all have a vested interest in participating in the research and all have unique knowledge to contribute. All are fluent in English which is the conversation language. Two researchers from the university, who are conversant with Participatory Learning & Action (PLA) research, are facilitating this PLA session, which is one among many in a two-year-long research process. In previous meetings, these stakeholders engaged in PLA techniques to assess a range of Guidances and Training Initiatives (G/TIs) related to improving communication between migrants and healthcare professionals. They identified strengths and weaknesses of each G/TI as they perceived them. They exchanged very diverse perspectives and views, learning from and with each other, and co-generated Commentary Charts to record their findings.
The atmosphere in this inter-stakeholder group is relaxed, open and trusting, which is essential because the task they face this evening is to use another PLA technique (Direct Ranking) to democratically select a single Guidance or Training Initiative for implementation in a local healthcare setting. First, they review their Commentary Charts and discuss and co-analyse them in relation to the research question asked: ‘Please rank the Guidances and Training Initiatives in terms of ‘most suitable’ to ‘least suitable’ for implementation at local level’. Having listened carefully to all perspectives, they use visual and tangible materials (images, photographs, Post-Its, markers, flipchart paper, paper clips) to complete a Direct Ranking chart which clearly shows their voting result. They check their outcome, and the researchers invite them to confirm their result by engaging in continued discussion, asking key questions such as ‘Is everyone comfortable with the decision you have reached as a group?’ ‘Is there anything of concern to anyone?” Is there anything surprising about your result?’ By the end of the three-hour PLA session, eleven very diverse stakeholders have generated a transparent democratic outcome, based on their co-generation and co-analysis of data. They now know which of the G/TIs they agree to proceed with on their ‘implementation journey’; in future PLA sessions, they will use other PLA techniques to work together, fine-tuning their chosen Guidance for use in the primary care practice where the doctor and practice manager work.