Succeeding in Organizational Participatory Research (OPR): 21 Challenges and Solutions
Jiahao Deng, M.Sc., Paula L. Bush, P.hD.
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Succeeding in Organizational Participatory Research (OPR): 21 Challenges and Proposed Solutions
6 categories of challenges
New to OPR? Start here
How to navigate this document
The work process
Equity and power imbalances
The working group
AcknowledgementS
Definitions
Resources
Working group relationships
Adaptations to the needs of partners
The research
References
Help us make this guide better
How to cite this document
Last update: Jun 2025
Definitions of terms used in this Guide
Some of the terms used in this resource are defined below. Readers who would like more background information about OPR can consult the Organization Participatory Research Practice Guide.
Participatory research
Organizational participatory research
Organizational partners
Working group
Terms of references
Audit and feedback
Extra benefits
Equity and Power Imbalances
Handling power imbalances between academic and organizational partners
Handling power imbalances between decision-maker and other organizational partners
Handling power imbalances between patient and staff partners
Handling power imbalances between patient and staff partners
From the health professionals' perspective: 1) Staff partners perceive that patient partners put too much pressure on them.6,8
2) Staff partners are uncomfortable with the involvement of patient partners in the OPR.6,10
From the service end user's perspective: 1) Patient partners perceive staff partners as paternalistic and unwilling to listen to their input.10
Handling power imbalances between patient and staff partners
Draft Terms of Reference for the partnership with equal input from all partners, at the onset of the OPR. Address the importance of equity among partners and how the partnership will preserve it in the Terms of Reference.1 Hold separate working group meetings for patient and staff partners to allow for more open and direct dialogue.6
Have academic partners step in as a neutral third party to help clarify misunderstandings.6
Hold specific meetings for self-reflection and to provide an opportunity for patient and staff partners to express empathy and have their voices heard.6
Handling power imbalances between decision-maker and other organizational partners
Staff and decision-maker partner interactions may be impacted by their positions in the hierarchy of their organization.6,11
Staff partners are concerned their opinions could have negative repercussions for them at work.12,13
Patient partners do not believe decision-maker partners value their input.14
Handling power imbalances between decision-maker and other organizational partners
Draft Terms of Reference for the partnership with equal input from all partners at the onset of the OPR. Ensure the Terms of Reference outline the importance of equity among partners and how to promote it throughout the OPR.1
Hold separate working group meetings for patient, staff, and decision-maker partners to allow for more open and direct dialogue.6 Recruit cooperative decision-makers who are conscious of power imbalances within the organization as well as its structural, cultural, and practical realities.
Implement an audit and feedback process.9
Handling power imbalances between academic and organizational partners
Partners perceive or experience power imbalances between one another.11
Handling power imbalances between academic and organizational partners
Ensure regular open and honest communication during working group meetings.
Example
Use given names rather than formal titles such as Doctor. Adopt a casual dress code for working group meetings rather than formal attire or uniforms.11
The Working Group
Recruiting research partners
Leadership structure
Recruiting organizational partners
OPR initiators are unsure which and how many organizational partners should join the working group.15 Working group partners face difficulty encouraging organizational partners to join the working group.15
Additional Reading: Sections 1.1 and 1.2 of the OPR Practice Guide emphasize the importance of building an OPR working group.
Recruiting organizational partners
Rely on the objectives of the OPR to guide the specifics of the working group’s profile.16 Ideally, representatives of those who may need to make decisions based on the results, implement the results or be affected by the results should be recruited.1
Recruit at least two representatives for each type of organizational partner deemed necessary for the working group.
Example
Prioritize individuals who are eager to contribute to the OPR and have good teamworking skills.1
Example
Ensuring productive OPR leadership
The working group partners are unsure how to select the appropriate leadership structure and the partner(s) who will take on leadership roles.16 The working group faces difficulty keeping the inherent organizational hierarchy from seeping into the working group and hindering optimal functioning.6,11
Additional Reading: Section 1.4 of the OPR Practice Guide discusses how to organize the management of an OPR , including delegating management and leadership responsibilities within the working group.
Ensuring productive OPR leadership
Address the leader selection process early in the OPR and include the agreed selection criteria in the Terms of Reference. Ensure that all working group partners contribute to choosing the leadership structure and individual leaders.
Recognize that any partner can take on a leadership role within the working group.
Modify the leadership structure as the OPR progresses.
Example
Consider co-leadership between a staff or decision maker partner and a patient or academic partner, or consider conferring the leadership of the OPR to an external party.16
The Work Process
Managing time
Ensuring equal and open discourse
Navigating uncomfortable topics of conversation
Managing time
The working group experiences difficulties managing the pace of the OPR and achieving objectives within the planned timeframe.17,18
The working group faces difficulties addressing all issues to all partners’ satisfaction during meetings.19,20
Additional Reading: Sections 1.5 and 1.6 of the OPR Practice Guide provides insights into keeping meetings structured, focused, and efficient.
Managing time
Recognize that the extra benefits of the OPR process are worth investing the extra time required.4,5 Hold specific meetings to discuss and manage partner expectations.
Indicate the time allotted for each point, in meeting agendas, and elect a timekeeper at the beginning of each meeting.
Hold additional meetings when more time is needed to address various issues.19 Form smaller working groups to address issues that require extra time.
Ensuring equal and open discourse
Some partners don’t fully contribute during working group meetings because they are shy or feel intimidated.
Ensuring equal and open discourse
Strive for a balance between open, continual communication and maintaining boundaries.20 Begin trust building among partners as soon as possible.8 Ensure organizational and individual values/expectations are understood from the onset. Encourage partners to show empathy.6 Outline values and expectations in the Terms of Reference. Implement an audit and feedback process.9
Example
Example
Navigating uncomfortable topics of conversation
Partners lack training in some topics related to the OPR project.6,17 Partners are uncomfortable discussing some topics.17
Navigating uncomfortable topics of conversation
Example
Provide training to address partners’ needs.1
Avoid jargon and ensure partners feel free to express when they don’t understand.22 Facilitate continual dialogue to increase partners’ comfort to share experiences problems-solve together.17 Encourage genuine listening17 and empathy.6 Encourage partners not to take the discussion or feedback too personally.6 Allow for patients to attend meetings with a caregiver or proxy.23
The Research
Disseminating OPR results
Aligning the visions, goals and activities of the OPR and of the partners
Making unpopular decision
Aligning the visions, goals and activities of the OPR and of the partners
Partners have difficulty aligning their goals given their diverse backgrounds.14 Partners have difficulty aligning short term realities of OPR with long-term organizational goals.14
Aligning the visions, goals and activities of the OPR and of the partners
Clarify all partners’ short- and long-term goals and manage expectations upfront. Ensure all partners provide input for all objectives of the OPR.
Develop consensus on objectives and ensure sure they are understood by all partners.
Example
Making research decision
Partners experience polarizing decisions around, for example, data ownership and results dissemination.
Additional Reading: See section 2.1 of the OPR Practice Guide for more information about developing short-term and long-term shared objectives through a common understanding of each research objective, the potential extra benefits of OPR, as well as about making executive decisions during the research process. See the First Nations OCAP Principles for information and resources about data Ownership, control, access and possession
Making research decision
Discuss the limitations, benefits, and impacts of all possible decisions.8,16 Allow for all partners to access interpreted data regardless of who owns it.1
Use a shared leadership structure for decision-making19 (see Ensuring productive OPR leadership-solutions for detail).
Disseminating OPR results
Partners have differing perspectives regarding which results to share and with whom.8 For example: research partners want to share results at academic conferences, but decisionmaker partners are concerned with how this might affect the image of the organization.
The working group faces challenges disseminating results that are not as hypothesized.
Disseminating OPR results
Share preliminary results only within the working group.8 Employ knowledge translation framework to tailor dissemination of results to various target audiences.23
Share and explain the results that were unexpected together with any extra benefits that were experienced or observed due to the OPR process.
Adaptations to the Needs of Partners
Ensuring partner well-being
Accounting for multi-lingualism
Coordinating partner schedules
Managing multiple roles of partners
Accounting for multi-culturalism
Determining partner roles and responsibilities
Ensuring partners' well-being
Partners require accommodations for particular needs (e.g., a disability).16,22
Ensuring partners' well-being
Create an environment with as many health accommodations as possible.16,21 Use assistive technology to promote co-writing and facilitate involvement.21
Allow for partners with special needs to attend meetings with a caregiver or proxy.23
Schedule breaks during meetings for partners to address their personal needs.
Example
Allow for partners to pair up when doing public speaking or any other task they may view as difficult or uncomfortable.24 Implement technology to facilitate online attendance for those who are unable to attend in person, and offer training to familiarize partners with the technology.25
Coordinating partner schedules
The working group faces scheduling difficulties due to unforeseen changes in partners’ schedules or priorities.15,19,20
Additional Reading: Section 3.1 in the OPR Practice Guide outlines the importance of being open, accommodating and adaptable to partner’s needs and evolving professional/personal realities.
Coordinating partner schedules
Account for the personal and professional lives of OPR partners.15
Example
Share meeting minutes, with all partners, promptly.
Example
Accounting for multilingualism
Partners may face language barriers.
Additional Reading: Section 3.2 of the OPR Practice Guide speaks to language and literacy needs
Accounting for multilingualism
Recruit partners who are fluent in the necessary languages.26 Use translation technology. Provide documentation in the necessary languages.
Use visual aids and multimedia materials to enhance communication.26
Accounting for multiculturalism
Some partners are from different organizations with cultural differences and have diverging perspectives or strongly disagree with one another.16 Partners have varying cultural realities that contribute to different expectations regarding the project’s timeline, and risk management and decision-making styles.14
Fully preventing political discourse can lead to a loss of dialogue, but a lack of boundaries can cause tension.22
Accounting for multiculturalism
Consider cultural differences, such as organizational or religious norms, values, or priorities. Recruit partners with intercultural and intracultural training.27 Respect different viewpoints and keep an open mind. Ensure partners to freely share their views and listen to dissenting opinions. Focus discussions on the objectives of the OPR. Avoid sharing extreme perspectives or opinions. Set boundaries (e.g., in the Terms of Reference) and update them as needed.22
Managing multiple roles of partners
Individual partners and the working group as a whole find it difficult to manage competing priorities,28 limited availability for working group meetings,29 or conflicts of interest15 that arise from the various roles partners hold both inside and outside of the OPR.
Managing multiple roles of partners
Example
Recognize partners’ freedom to choose how they want to contribute.1
Recognize partners’ freedom to choose at which stages of the OPR the want to contribute.17
Example
Aim to maximize partners’ contributions at the stage where they feel the most valuable. Require all partners to disclose their conflicts of interest from the onset and determine how to manage through all stages of the OPR.31
Example
Determining partner roles and responsibilities
The working group faces challenges aligning partners’ roles and responsibilities with the interests, expertise and needs.16 Partners are uncertain as to which role best suits them.
Additional Reading: Section 3.4 of the OPR Practice Guide states that the OPR process needs to adapt to partner skills and strengths.
Determining partner roles and responsibilities
Allocate roles and responsibilities according to the unique expertise and experience of each partner.8
Example
Account for patient partners’ medical realities when determining roles. Ensure all partners understand what all roles of the OPR entail.8
Example
Working Group Relationships
Acknowledging partner contributions
Engaging and retaining partners
Dealing with partner turnover
Dealing with insufficient resources
Engaging and retaining partners
Some partners reduce their involvement or withdraw from the working group, especially for very long project.16,17,32 Partners have different expectations for the OPR, or their expectations change over the course of the project.
Engaging and retaining partners
Be strategic when recruiting partners.14(see Recruiting organizational partners - solutions).
Example
Ensure expectations about the OPR objectives, timeline, and partner roles and responsibilities are clear from the onset and revisit them throughout the OPR project.
Dealing with partner turnover
The working group experiences revolving or fluctuating involvement of partners.6,16,33
Dealing with partner turnover
Discuss and decide the type and extent of each partner’s involvement and recognize that this may change throughout the OPR project.8 Encourage partner involvement at the stage(s) they feel best suits their needs, expertise, and interests (see Managing multiple roles of partners - Solution).
Recruit two representatives for each type of working group partner (e.g., two health professionals, two managers).
Maintain a logbook of meeting minutes that is accessible to all partners.
Identify and provide the support and resources partners need to fully engage.6
Dealing with insufficient resources
Decisionmaker partners may be unable or unwilling to contribute additional financial and human resources from their organization.16 Academic partners may be unable to secure additional funding.
Dealing with insufficient resources
Manage the budget collectively. Decide upfront how to use the budget and include the budget details in the Terms of Reference.
Begin with a small OPR project to build engagement and momentum for a larger project once more funding is secured.
Discuss progress regularly such that all partners understand the resources that are available to complete the remaining activities of the OPR.
Agree to a logical endpoint for the OPR project should it become apparent that it cannot be completed as originally planned.
Leave buffer room in the budget to account for activities that may cost more than anticipated.
Example
Acknowledging partner contributions
Some partners may not feel properly acknowledged.
Partners may have difficulty agreeing on how to acknowledge their various contributions.
Additional Reading: Chapter 4 of the OPR Practice Guide speaks to the importance of acknowledgements and provides additional tips on how to properly thank stakeholders as well as maintain the integrity of intellectual property/authorship.
Acknowledging partner contributions
Recognize to the contributions of all working group partners and any other stakeholders throughout the OPR project. Acknowledge partners in the organization’s newsletter, annual reports, circulating pamphlets.8
Establish a shared understanding of authorship, acknowledgements, and contributions, when considering publication and intellectual property,34 and follow authorship criteria and guidelines.8
Ensure all partners understand the meaning and importance of authorship order.
Example
Select a Creative Commons copyright license to protect OPR products (e.g., infographic of results) from misuse (see Additional Resources). Discuss whether a patent or copyright number is needed for the OPR product(s).
Additional Resources
Evaluation tools for audit and feedback processes
The First Nations Principles of OCAP
Guideline for patient-partnership recruitment
Recommendations for authorship
Intellectual property guidelines
Copyright and patenting of research product
REFERENCES
1. Bush, P. L., Tremblay, M.-C. & the OPR recommendation working group (2018). Organizational Participatory Research Practice Guide. Registration of Copyright for the English version (#1144569), Canadian Intellectual Property Office, Industry Canada. Retrieved from https://soutiensrapmetho.ca/mieuxservir/
2. Green, Lawrence & George, M. Anne & Daniel, M. & Frankish, Charles & Herbert, Carol & Bowie, W.R. & O'Neill, M.. (1995). Study of Participatory Research in Health Promotion. Book Study of Participatory Research in Health Promotion. 43-50.
3. Waterman, Heather & Tillen, D & de koning, Korrie. (2001). Action Research: A Systematic Review and Guidance for Assessment. Health technology assessment (Winchester, England). 5. iii-157. 10.3310/hta5230.
4. Bush, P.L., Pluye, P., Loignon, C. et al. Organizational participatory research: a systematic mixed studies review exposing its extra benefits and the key factors associated with them. Implementation Sci 12, 119 (2017). https://doi.org/10.1186/s13012-017-0648-y
5. Bush, P.L., Pluye, P., Loignon, C. et al. A systematic mixed studies review on Organizational Participatory Research: towards operational guidance. BMC Health Serv Res 18, 992 (2018). https://doi.org/10.1186/s12913-018-3775-5
6. Larsen, T., Karlsen, J. E., & Sagvaag, H. (2022). Keys to unlocking service provider engagement in constrained co-production partnerships. Action Research, 20(2), 180-198. https://doi.org/10.1177/1476750320925862
7. CIHR. A Guide to Researcher and Knowledge-User Collaboration in Health Research. Section 6 Ethics and Partnership Agreements (2015).
8. Hurley, Susan & DeSanto-Madeya, Susan & Fortney, Christine & Izumi, Seiko & Phongtankuel, Veerawat & Carpenter, Joan. (2021). Building Strong Clinician-Researcher Collaborations for Successful Hospice and Palliative Care Research. Journal of Hospice & Palliative Nursing. Publish Ahead of Print. 10.1097/NJH.0000000000000818.
9. Ivers, N, Jamtvedt, G, Flottorp, S, Young, JM, Odgaard‐Jensen, J, French, SD, O’Brien, MA, Johansen, M, Grimshaw, J. & Oxman, A. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst. Rev. (2012) doi:10.1002/14651858.CD000259.pub3.
10. Pomey M-P, Bush PL, Demers-Payette O, et al. Developing recommendations for the diagnosis and treatment of Lyme disease: the role of the patient’s perspective in a controversial environment. International Journal of Technology Assessment in Health Care. 2021;37(1):e11. doi:10.1017/S0266462320002123
11. Fusi-Schmidhauser, T., Riglietti, A., Froggatt, K., & Preston, N. (2018). Palliative Care Provision for Patients with Advanced Chronic Obstructive Pulmonary Disease: A Systematic Integrative Literature Review. COPD: Journal of Chronic Obstructive Pulmonary Disease, 15(6), 600–611. https://doi.org/10.1080/15412555.2019.1566893
12. Smith, S. E. (1995). Dancing with conflict: public health nurses in participatory action-research (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/16699
13. Bush, P. L. et al. Organizational Participatory Research in North America. in Participatory Health Research: Voices from Around the World (eds. Wright, M. T. & Kongats, K.) 179–204 (Springer International Publishing, Cham, 2018). doi:10.1007/978-3-319-92177-8_12.
14. Abayneh, S., Lempp, H., Kohrt, B.A. et al. Using participatory action research to pilot a model of service user and caregiver involvement in mental health system strengthening in Ethiopian primary healthcare: a case study. Int J Ment Health Syst 16, 33 (2022). https://doi.org/10.1186/s13033-022-00545-8
15. Lorente, M., Hogg, G., & Ker, J. (2006). The challenges of initiating a multi-professional clinical skills project. Journal of Interprofessional Care, 20(3), 290–301. https://doi.org/10.1080/13561820600649755
Last update: Jun 2025
REFERENCES
16. Alexander JA, Christianson JB, Hearld LR, Hurley R, Scanlon DP. Challenges of Capacity Building in Multisector Community Health Alliances. Health Education & Behavior. 2010;37(5):645-664. doi:10.1177/1090198110363883
17. Nyman, A., Rutberg, S., Lilja, M., & Isaksson, G. (2022). The Process of Using Participatory Action Research when Trying out an ICT Solution in Home-Based Rehabilitation. International Journal of Qualitative Methods, 21. https://doi.org/10.1177/16094069221084791
18. Grimshaw, J.M., Eccles, M.P., Lavis, J.N. et al. Knowledge translation of research findings. Implementation Sci 7, 50 (2012). https://doi.org/10.1186/1748-5908-7-50
19. Woods, Andrew & Cashin, Andrew & Horstmanshof, Louise. (2022). The social construction of nurse educator professional identities: Exploring the impact of a community of practice through participatory action research. Journal of Advanced Nursing. 78. 10.1111/jan.15200.
20. Buckley, C., Hartigan, I., Coffey, A., Cornally, N., O’Connell, S., O’Loughlin, C., Timmons, S., & Lehane, E. (2022). Evaluating the use of participatory action research to implement evidence-based guidance on dementia palliative care in long-term care settings: A creative hermeneutic analysis. International Journal of Older People Nursing, 17, e12460. https://doi.org/10.1111/opn.12460
21. Isaacs, W. (2018). Dialogic leadership. https://thesystemsthinker.com/dialogic-leadership/.
22. Wicks, P. G., & Reason, P. (2009). Initiating action research: Challenges and paradoxes of opening communicative space. Action Research, 7(3), 243-262. https://doi.org/10.1177/1476750309336715
23. Tsatsi, Itumeleng & Plastow, Nicola. (2021). Optimizing a Halfway House to Meet Mental Health Care Users’ Occupational Needs: Optimisation d'une maison de transition pour répondre aux besoins occupationnels des usagers des soins de santé mentale. Canadian Journal of Occupational Therapy. 88. 000841742110448. 10.1177/00084174211044896.
24. Meinders, Marjan & Donnelly, Anne & Bloem, Bas. (2022). Including People with Parkinson’s Disease in Clinical Study Design and Execution: A Call to Action. Journal of Parkinson’s Disease. 12. 1359-1363. 10.3233/JPD-223190.
25. Cuthbert, Colleen & Nixon, Nancy & Vickers, Michael & Samimi, Setareh & Rawson, Krista & Ramjeesingh, Ravi & Karim, Safiya & Stein, Barry & Laxdal, Garry & Dundas, Lorilee & Huband, Diane & Daze, Emily & Farrer, Christie & Cheung, Winson. (2022). Top 10 research priorities for early-stage colorectal cancer: a Canadian patient-oriented priority-setting partnership. CMAJ Open. 10. E278-E287. 10.9778/cmajo.20210046.
26. Wallerstein N, Duran B. Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity. Am J Public Health. 2010 Apr 1;100 Suppl 1(Suppl 1):S40-6. doi: 10.2105/AJPH.2009.184036. Epub 2010 Feb 10. PMID: 20147663; PMCID: PMC2837458.
27. Council of Europe. Building intercultural competence. https://www.coe.int/en/web/interculturalcities/intercultural-competence#:~:text=Intercultural%20competence%20is%20the%20ability,intercultural%20way%20in%20diverse%20societies.
28. Bryant, Wendy & Vacher, Geraldine & Beresford, Peter & Mckay, Elizabeth. (2010). The modernisation of mental health day services: participatory action research exploring social networking. Mental Health Review Journal. 15. 11-21. 10.5042/mhrj.2010.0655.
29. Ngoma, Caroline (2022) "Mutual Learning during Post-implementation. A study of designing a maternal and child health application in rural Tanzania," Scandinavian Journal of Information Systems: Vol. 34: Iss. 1, Article 6. Available at: https://aisel.aisnet.org/sjis/vol34/iss1/6
30. Wideman, T. H., Bostick, G., Miller, J., Thomas, A., Bussières, A., Walton, D., … Shay, B. (2022). The development of a stakeholder-endorsed national strategic plan for advancing pain education across Canadian physiotherapy programs. Canadian Journal of Pain, 6(1), 21–32. https://doi.org/10.1080/24740527.2022.2056006
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REFERENCES
31. Bryn, W.-J. Les conflits d’intérêts dans le monde de la recherche : comment s’outiller pour les bien identifier, évaluer et gérer? (n.d.).
32. Santos, S. S. C. et al. Elaboração de prontuário do residente em uma instituição de longa permanência para idosos. Acta Paul. Enferm. 23, 725–731 (2010).
33. Gerrish, , Clayton, , Nolan, , Parker, and Morgan, (1999), Promoting evidence-based practice: managing change in the assessment of pressure damage risk. Journal of Nursing Management, 7: 355-362. https://doi.org/10.1046/j.1365-2834.1999.00135.x
34. Page K. Ethics and the co-production of knowledge. Public Health Res Pract. 2022 Jun 15;32(2):3222213. doi: 10.17061/phrp3222213.
35. Loban E, Scott C, Lewis V, Haggerty J. Measuring partnership synergy and functioning: Multi-stakeholder collaboration in primary health care. PLoS One. 2021 May 28;16(5):e0252299. doi: 10.1371/journal.pone.0252299.
36. Hamzeh J, Pluye P, Bush PL, Ruchon C, Vedel I, Hudon C. Towards an assessment for organizational participatory research health partnerships: A systematic mixed studies review with framework synthesis. Eval Program Plann. 2019 Apr;73:116-128. doi: 10.1016/j.evalprogplan.2018.12.003. Epub 2018 Dec 11.
37. Brown QL, Elmi A, Bone L, Stillman F, Mbah O, Bowie JV, Wenzel J, Gray A, Ford JG, Slade JL, Dobs A. Community Engagement to Address Cancer Health Disparities: A Process EVALUATION using the Partnership Self-Assessment Tool. Prog Community Health Partnersh. 2019;13(1):97-104. doi: 10.1353/cpr.2019.0012.
38. Mrklas, K.J., Boyd, J.M., Shergill, S. et al. Tools for assessing health research partnership outcomes and impacts: a systematic review. Health Res Policy Sys 21, 3 (2023). https://doi.org/10.1186/s12961-022-00937-9
39. Centre d’excellence sur le partenariat avec les patients et le public. Guide de recrutement des patients partenaires. https://ceppp.ca/ressources/guide-de-recrutement-des-patients-partenaires/.
Last update: Jun 2025
Audit and feedback
In OPR, an audit and feedback process can be used to provide opportunities for partners to voice concerns and observations and to feel heard. The working group can implement audit and feedback to evaluate their partnership building process. For example:
Audit: the working group members assess their partnership and compare their processes to existing standards, guidelines, or recommendations.
Feedback: the working group members collectively reflect on the results leading to changes in individual and group behaviours.
A thank you to those who helped develop the content on which this manual is based:
Christian Tonnesen Moustafa Laymouna
Aravind Rajendran A thank you to those who contributed to the French translation: Armelle Choquart André Nguyen
A thank you to those who provided feedback on the content:Jack Moncado Annie-Danielle Grenier
Cynthia Henrickson
Rania Jribi
Marie-Ève Lamontagne
Sonia Lussier
Yessica-Haydee Gomez
Myra Drolet
Partners should feel free to propose ways of improving the organization or the study at any time.8
1) Guide de recrutement des patients partenaires.392) Patient Partnership Guidelines: McGill Practice-Based Research Network.
Partners may need to be compensated for extra meeting hours.19,20
See "Additional Resources" for a guide for recruiting patient partners (in French).
Maintain a safe and open environment to encourage partners to express values/expectations that may have changed.
Traditional, or formal, leadership structure: Specific partners take charge of the entire OPR or parts of it.15
- Pros: Quicker decision-making process because few are involved in decisions; Reduced potential for communication difficulties.15
- Cons: Leaders may be prone to burnout because there is more on their shoulders; Power imbalances among partners may develop.14
Collateral, or shared, leadership structure: Partners share responsibilities.14
- Pros: multiple perspectives; help to break through organizational hierarchies that may seep into the working group.14
- Cons: Slower decision-making process given the need to reach consensus.14
Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work from the International Committee of Medical Journal Editor.
Recognize that additional time to complete tasks may be necessary, at times.
Clinician partners may feel they are more useful in a consultation role.
This resource is for anyone interested in Organizational Participatory Research (henceforth referred to as OPR for short). It describes challenges research partners may face and offers solutions to address them. Both challenges and solutions were found in scientific journal articles on OPRs. This resource com plements the Organization Participatory Research Practice Guide by Bush et al.1 It is recommended to read the guide before consulting this resource. Many of the challenges and solutions presented end with a reference to the exact section of the Organization Participatory Research Practice Guide to facilitate cross-reference. Please read Definitions before starting.
Avoid assigning the notetaker role to someone who has Parkinson’s without providing the support they need to fulfill such a role.24
Some may feel that their experience lends itself better to for example, commenting on data collection tool. Some may feel they are better in helping in developing the dissemination strategies.
A partner may need to give themselves an injection and prefer to do this in private. A partner who has a disability may need extra time to use the facilities.
Organizational participatory research
Organizational Participatory Research (OPR) refers to participatory research that aims to effect change within the partnering organization (e.g., a community health clinic, a hospital, or a hospital ward).3,4 In OPR, the non-academic partners are interested parties of the organization and may include, for example, frontline health workers, patients, or administrators. Their insider knowledge increases the relevance of the research and the likelihood that the change (e.g., new practice or policy) will be implemented and sustained. Note that, in this resource, we use the term "partner" to underscore the importance of the research partnership. Various terms, such as "co-researcher", can be found in the scientific literature.
Remain open, transparent, genuine, direct,22 and honest.17 Include time in meetings for partners to express how they feel relative to one another (e.g., subordinate),6 to share fears and other personal feelings,21 and to set boundaries.
and highlighted words are also interactive. Hover your mouse to floating items and click to see their content. Symbols:
Floating items
Example
Consider recruiting patient partners from patient advocacy organizations as they may be more able to commit to long-term involvement.25
This resource is for anyone interested in Organizational Participatory Research (henceforth referred to as OPR for short). It describes challenges research partners may face and offers solutions to address them. Both challenges and solutions were found in scientific journal articles on OPRs. This resource complements the Organization Participatory Research Practice Guide by Bush, Tremblay, et al.1 It is recommended to read the guide before consulting this resource. Many of the challenges and solutions presented end with a reference to the exact section of the Organization Participatory Research Practice Guide. Please read Definitions before starting.
Training about relevant health and research topics. Training about how to work in a multi-stakeholder partnership (e.g., cultural safety).
If the OPR is a graduate student project, discuss and the importance of the student being the 1st author.
Continuous collective reflection on topics such as real and perceived power dynamics and sources of inequity.11 Audit and feedback.9
Participatory research
Participatory research is an approach to research characterised by a partnership between academics and non-academics who represent various groups with a vested interest in the study. The non-academic partners, also referred to as "interested parties", are involved throughout the research. They make decisions with the academic partners regarding the research question, methods, and dissemination or application of the results.2 Participatory research blends research and action to effect change that is relevant to the non-academic partners.
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Organizational partners
Organizational partners are the interested parties of the organization involved in the OPR. They can be divided into 3 sub-groups as follows:
- Decision-maker: managers, policy makers, and senior practitioners within the organization.
- Staff: health and social service professionals and administrative personnel.
- Patient: People who use health and social care services offered by the organization.
Terms of reference
The Terms of Reference (ToR) is a partnership agreement amongst all partners of the working group that outlines the study (e.g., objectives, timelines), and the roles and responsibilities of all partners. Throughout an OPR, this agreement can be updated to reflect new realities. The ToR is not a legally binding contract. It is recommended for the working group to develop their ToR together so that everyone is on the same page regarding all aspects of the project (e.g., anticipated challenges, logistics of when/how meetings will take place, expectations, goals).5 Co-constructing the Terms of Reference may also address power imbalances from the onset.
Academic partners contribute research methods knowledge or manage access to peer reviewed literature. Healthcare provider partners contribute clinical knowledge.8
Decision maker partners facilitate change management within the organization.
Patient partners to provide knowledge related to navigating the healthcare and social services system.
Extra benefits
Extra benefits are unexpected positive outcomes of an OPR that are unrelated to the study’s objectives.4,5 For example, for an OPR with a research objective to implement an organizational change, extra benefits brought by the OPR process could be building up a sustainable partnership, or leadership or workforce development.
Schedule regular, recurring meetings from the onset, e.g., the 1st Monday of each month. Allow for partners to take part in meetings remotely.
1) Multi-Stakeholder partnership questionnaire.35
2) Organizational participatory research health partnerships assessment model.36 3) Partnership self-assessment tool (questionnaire).37 4) Systematic review of tools for assessing health research partnership outcomes and impacts.38
Working Group
OPR is conducted by a working group that includes organizational and academic partners on the research team. The working group meets regularly to plan and carry out the study. It is within the working group meetings that key research decisions are discussed and agreed upon.
Avoid central roles for those who have many conflicts of interest. Alter partner roles, as needed, if new conflicts of interest arise during the OPR. Disclose conflicts of interest in all communications about the OPR.
From the First Nations Information Governance Centre, standards on Ownership, Control, Access and Possession of Data.
If partners decide that nurses, patients and social workers are needed, recruit two of each to the working group.
1) Creative common license.
2) Ligne directrice.
3) Canadian patent application.
A thank you to those who helped develop the content on which this manual is based:
Christian Tonnesen Moustafa Laymouna
Aravind Rajendran A thank you to those who contributed to the French translation: Armelle Choquart André Nguyen
A thank you to those who provided feedback on the content:Jack Moncado Annie-Danielle Grenier
Cynthia Henrickson
Rania Jribi
Marie-Ève Lamontagne
Sonia Lussier
Yessica-Haydee Gomez
Myra Drolet
Succeeding in Organizational Participatory Research (OPR): 21 Challenges and Solutions © 2025 by Jiahao Deng, Paula L. Bush is licensed under CC BY-NC-ND 4.0. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/
1) Canadian intellectual property enforcement guidelines information.
2) Lignes directrices sur la propriété intellectuelle.
OPR CHALLENGES
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Succeeding in Organizational Participatory Research (OPR): 21 Challenges and Solutions
Jiahao Deng, M.Sc., Paula L. Bush, P.hD.
New to OPR? Start here
How to navigate this document
Version Française
Acknowledgements
Content on this site is licensed under a Creative Commons Attribution 4.0 International license.
Succeeding in Organizational Participatory Research (OPR): 21 Challenges and Proposed Solutions
6 categories of challenges
New to OPR? Start here
How to navigate this document
The work process
Equity and power imbalances
The working group
AcknowledgementS
Definitions
Resources
Working group relationships
Adaptations to the needs of partners
The research
References
Help us make this guide better
How to cite this document
Last update: Jun 2025
Definitions of terms used in this Guide
Some of the terms used in this resource are defined below. Readers who would like more background information about OPR can consult the Organization Participatory Research Practice Guide.
Participatory research
Organizational participatory research
Organizational partners
Working group
Terms of references
Audit and feedback
Extra benefits
Equity and Power Imbalances
Handling power imbalances between academic and organizational partners
Handling power imbalances between decision-maker and other organizational partners
Handling power imbalances between patient and staff partners
Handling power imbalances between patient and staff partners
From the health professionals' perspective: 1) Staff partners perceive that patient partners put too much pressure on them.6,8 2) Staff partners are uncomfortable with the involvement of patient partners in the OPR.6,10
From the service end user's perspective: 1) Patient partners perceive staff partners as paternalistic and unwilling to listen to their input.10
Handling power imbalances between patient and staff partners
Draft Terms of Reference for the partnership with equal input from all partners, at the onset of the OPR. Address the importance of equity among partners and how the partnership will preserve it in the Terms of Reference.1 Hold separate working group meetings for patient and staff partners to allow for more open and direct dialogue.6
Have academic partners step in as a neutral third party to help clarify misunderstandings.6 Hold specific meetings for self-reflection and to provide an opportunity for patient and staff partners to express empathy and have their voices heard.6
Handling power imbalances between decision-maker and other organizational partners
Staff and decision-maker partner interactions may be impacted by their positions in the hierarchy of their organization.6,11 Staff partners are concerned their opinions could have negative repercussions for them at work.12,13
Patient partners do not believe decision-maker partners value their input.14
Handling power imbalances between decision-maker and other organizational partners
Draft Terms of Reference for the partnership with equal input from all partners at the onset of the OPR. Ensure the Terms of Reference outline the importance of equity among partners and how to promote it throughout the OPR.1
Hold separate working group meetings for patient, staff, and decision-maker partners to allow for more open and direct dialogue.6 Recruit cooperative decision-makers who are conscious of power imbalances within the organization as well as its structural, cultural, and practical realities. Implement an audit and feedback process.9
Handling power imbalances between academic and organizational partners
Partners perceive or experience power imbalances between one another.11
Handling power imbalances between academic and organizational partners
Ensure regular open and honest communication during working group meetings.
Example
Use given names rather than formal titles such as Doctor. Adopt a casual dress code for working group meetings rather than formal attire or uniforms.11
The Working Group
Recruiting research partners
Leadership structure
Recruiting organizational partners
OPR initiators are unsure which and how many organizational partners should join the working group.15 Working group partners face difficulty encouraging organizational partners to join the working group.15
Additional Reading: Sections 1.1 and 1.2 of the OPR Practice Guide emphasize the importance of building an OPR working group.
Recruiting organizational partners
Rely on the objectives of the OPR to guide the specifics of the working group’s profile.16 Ideally, representatives of those who may need to make decisions based on the results, implement the results or be affected by the results should be recruited.1 Recruit at least two representatives for each type of organizational partner deemed necessary for the working group.
Example
Prioritize individuals who are eager to contribute to the OPR and have good teamworking skills.1
Example
Ensuring productive OPR leadership
The working group partners are unsure how to select the appropriate leadership structure and the partner(s) who will take on leadership roles.16 The working group faces difficulty keeping the inherent organizational hierarchy from seeping into the working group and hindering optimal functioning.6,11
Additional Reading: Section 1.4 of the OPR Practice Guide discusses how to organize the management of an OPR , including delegating management and leadership responsibilities within the working group.
Ensuring productive OPR leadership
Address the leader selection process early in the OPR and include the agreed selection criteria in the Terms of Reference. Ensure that all working group partners contribute to choosing the leadership structure and individual leaders. Recognize that any partner can take on a leadership role within the working group. Modify the leadership structure as the OPR progresses.
Example
Consider co-leadership between a staff or decision maker partner and a patient or academic partner, or consider conferring the leadership of the OPR to an external party.16
The Work Process
Managing time
Ensuring equal and open discourse
Navigating uncomfortable topics of conversation
Managing time
The working group experiences difficulties managing the pace of the OPR and achieving objectives within the planned timeframe.17,18
The working group faces difficulties addressing all issues to all partners’ satisfaction during meetings.19,20
Additional Reading: Sections 1.5 and 1.6 of the OPR Practice Guide provides insights into keeping meetings structured, focused, and efficient.
Managing time
Recognize that the extra benefits of the OPR process are worth investing the extra time required.4,5 Hold specific meetings to discuss and manage partner expectations. Indicate the time allotted for each point, in meeting agendas, and elect a timekeeper at the beginning of each meeting. Hold additional meetings when more time is needed to address various issues.19 Form smaller working groups to address issues that require extra time.
Ensuring equal and open discourse
Some partners don’t fully contribute during working group meetings because they are shy or feel intimidated.
Ensuring equal and open discourse
Strive for a balance between open, continual communication and maintaining boundaries.20 Begin trust building among partners as soon as possible.8 Ensure organizational and individual values/expectations are understood from the onset. Encourage partners to show empathy.6 Outline values and expectations in the Terms of Reference. Implement an audit and feedback process.9
Example
Example
Navigating uncomfortable topics of conversation
Partners lack training in some topics related to the OPR project.6,17 Partners are uncomfortable discussing some topics.17
Navigating uncomfortable topics of conversation
Example
Provide training to address partners’ needs.1
Avoid jargon and ensure partners feel free to express when they don’t understand.22 Facilitate continual dialogue to increase partners’ comfort to share experiences problems-solve together.17 Encourage genuine listening17 and empathy.6 Encourage partners not to take the discussion or feedback too personally.6 Allow for patients to attend meetings with a caregiver or proxy.23
The Research
Disseminating OPR results
Aligning the visions, goals and activities of the OPR and of the partners
Making unpopular decision
Aligning the visions, goals and activities of the OPR and of the partners
Partners have difficulty aligning their goals given their diverse backgrounds.14 Partners have difficulty aligning short term realities of OPR with long-term organizational goals.14
Aligning the visions, goals and activities of the OPR and of the partners
Clarify all partners’ short- and long-term goals and manage expectations upfront. Ensure all partners provide input for all objectives of the OPR. Develop consensus on objectives and ensure sure they are understood by all partners.
Example
Making research decision
Partners experience polarizing decisions around, for example, data ownership and results dissemination.
Additional Reading: See section 2.1 of the OPR Practice Guide for more information about developing short-term and long-term shared objectives through a common understanding of each research objective, the potential extra benefits of OPR, as well as about making executive decisions during the research process. See the First Nations OCAP Principles for information and resources about data Ownership, control, access and possession
Making research decision
Discuss the limitations, benefits, and impacts of all possible decisions.8,16 Allow for all partners to access interpreted data regardless of who owns it.1 Use a shared leadership structure for decision-making19 (see Ensuring productive OPR leadership-solutions for detail).
Disseminating OPR results
Partners have differing perspectives regarding which results to share and with whom.8 For example: research partners want to share results at academic conferences, but decisionmaker partners are concerned with how this might affect the image of the organization.
The working group faces challenges disseminating results that are not as hypothesized.
Disseminating OPR results
Share preliminary results only within the working group.8 Employ knowledge translation framework to tailor dissemination of results to various target audiences.23 Share and explain the results that were unexpected together with any extra benefits that were experienced or observed due to the OPR process.
Adaptations to the Needs of Partners
Ensuring partner well-being
Accounting for multi-lingualism
Coordinating partner schedules
Managing multiple roles of partners
Accounting for multi-culturalism
Determining partner roles and responsibilities
Ensuring partners' well-being
Partners require accommodations for particular needs (e.g., a disability).16,22
Ensuring partners' well-being
Create an environment with as many health accommodations as possible.16,21 Use assistive technology to promote co-writing and facilitate involvement.21 Allow for partners with special needs to attend meetings with a caregiver or proxy.23
Schedule breaks during meetings for partners to address their personal needs.
Example
Allow for partners to pair up when doing public speaking or any other task they may view as difficult or uncomfortable.24 Implement technology to facilitate online attendance for those who are unable to attend in person, and offer training to familiarize partners with the technology.25
Coordinating partner schedules
The working group faces scheduling difficulties due to unforeseen changes in partners’ schedules or priorities.15,19,20
Additional Reading: Section 3.1 in the OPR Practice Guide outlines the importance of being open, accommodating and adaptable to partner’s needs and evolving professional/personal realities.
Coordinating partner schedules
Account for the personal and professional lives of OPR partners.15
Example
Share meeting minutes, with all partners, promptly.
Example
Accounting for multilingualism
Partners may face language barriers.
Additional Reading: Section 3.2 of the OPR Practice Guide speaks to language and literacy needs
Accounting for multilingualism
Recruit partners who are fluent in the necessary languages.26 Use translation technology. Provide documentation in the necessary languages. Use visual aids and multimedia materials to enhance communication.26
Accounting for multiculturalism
Some partners are from different organizations with cultural differences and have diverging perspectives or strongly disagree with one another.16 Partners have varying cultural realities that contribute to different expectations regarding the project’s timeline, and risk management and decision-making styles.14 Fully preventing political discourse can lead to a loss of dialogue, but a lack of boundaries can cause tension.22
Accounting for multiculturalism
Consider cultural differences, such as organizational or religious norms, values, or priorities. Recruit partners with intercultural and intracultural training.27 Respect different viewpoints and keep an open mind. Ensure partners to freely share their views and listen to dissenting opinions. Focus discussions on the objectives of the OPR. Avoid sharing extreme perspectives or opinions. Set boundaries (e.g., in the Terms of Reference) and update them as needed.22
Managing multiple roles of partners
Individual partners and the working group as a whole find it difficult to manage competing priorities,28 limited availability for working group meetings,29 or conflicts of interest15 that arise from the various roles partners hold both inside and outside of the OPR.
Managing multiple roles of partners
Example
Recognize partners’ freedom to choose how they want to contribute.1
Recognize partners’ freedom to choose at which stages of the OPR the want to contribute.17
Example
Aim to maximize partners’ contributions at the stage where they feel the most valuable. Require all partners to disclose their conflicts of interest from the onset and determine how to manage through all stages of the OPR.31
Example
Determining partner roles and responsibilities
The working group faces challenges aligning partners’ roles and responsibilities with the interests, expertise and needs.16 Partners are uncertain as to which role best suits them.
Additional Reading: Section 3.4 of the OPR Practice Guide states that the OPR process needs to adapt to partner skills and strengths.
Determining partner roles and responsibilities
Allocate roles and responsibilities according to the unique expertise and experience of each partner.8
Example
Account for patient partners’ medical realities when determining roles. Ensure all partners understand what all roles of the OPR entail.8
Example
Working Group Relationships
Acknowledging partner contributions
Engaging and retaining partners
Dealing with partner turnover
Dealing with insufficient resources
Engaging and retaining partners
Some partners reduce their involvement or withdraw from the working group, especially for very long project.16,17,32 Partners have different expectations for the OPR, or their expectations change over the course of the project.
Engaging and retaining partners
Be strategic when recruiting partners.14(see Recruiting organizational partners - solutions).
Example
Ensure expectations about the OPR objectives, timeline, and partner roles and responsibilities are clear from the onset and revisit them throughout the OPR project.
Dealing with partner turnover
The working group experiences revolving or fluctuating involvement of partners.6,16,33
Dealing with partner turnover
Discuss and decide the type and extent of each partner’s involvement and recognize that this may change throughout the OPR project.8 Encourage partner involvement at the stage(s) they feel best suits their needs, expertise, and interests (see Managing multiple roles of partners - Solution). Recruit two representatives for each type of working group partner (e.g., two health professionals, two managers). Maintain a logbook of meeting minutes that is accessible to all partners. Identify and provide the support and resources partners need to fully engage.6
Dealing with insufficient resources
Decisionmaker partners may be unable or unwilling to contribute additional financial and human resources from their organization.16 Academic partners may be unable to secure additional funding.
Dealing with insufficient resources
Manage the budget collectively. Decide upfront how to use the budget and include the budget details in the Terms of Reference. Begin with a small OPR project to build engagement and momentum for a larger project once more funding is secured. Discuss progress regularly such that all partners understand the resources that are available to complete the remaining activities of the OPR. Agree to a logical endpoint for the OPR project should it become apparent that it cannot be completed as originally planned.
Leave buffer room in the budget to account for activities that may cost more than anticipated.
Example
Acknowledging partner contributions
Some partners may not feel properly acknowledged. Partners may have difficulty agreeing on how to acknowledge their various contributions.
Additional Reading: Chapter 4 of the OPR Practice Guide speaks to the importance of acknowledgements and provides additional tips on how to properly thank stakeholders as well as maintain the integrity of intellectual property/authorship.
Acknowledging partner contributions
Recognize to the contributions of all working group partners and any other stakeholders throughout the OPR project. Acknowledge partners in the organization’s newsletter, annual reports, circulating pamphlets.8 Establish a shared understanding of authorship, acknowledgements, and contributions, when considering publication and intellectual property,34 and follow authorship criteria and guidelines.8
Ensure all partners understand the meaning and importance of authorship order.
Example
Select a Creative Commons copyright license to protect OPR products (e.g., infographic of results) from misuse (see Additional Resources). Discuss whether a patent or copyright number is needed for the OPR product(s).
Additional Resources
Evaluation tools for audit and feedback processes
The First Nations Principles of OCAP
Guideline for patient-partnership recruitment
Recommendations for authorship
Intellectual property guidelines
Copyright and patenting of research product
REFERENCES
1. Bush, P. L., Tremblay, M.-C. & the OPR recommendation working group (2018). Organizational Participatory Research Practice Guide. Registration of Copyright for the English version (#1144569), Canadian Intellectual Property Office, Industry Canada. Retrieved from https://soutiensrapmetho.ca/mieuxservir/ 2. Green, Lawrence & George, M. Anne & Daniel, M. & Frankish, Charles & Herbert, Carol & Bowie, W.R. & O'Neill, M.. (1995). Study of Participatory Research in Health Promotion. Book Study of Participatory Research in Health Promotion. 43-50. 3. Waterman, Heather & Tillen, D & de koning, Korrie. (2001). Action Research: A Systematic Review and Guidance for Assessment. Health technology assessment (Winchester, England). 5. iii-157. 10.3310/hta5230. 4. Bush, P.L., Pluye, P., Loignon, C. et al. Organizational participatory research: a systematic mixed studies review exposing its extra benefits and the key factors associated with them. Implementation Sci 12, 119 (2017). https://doi.org/10.1186/s13012-017-0648-y 5. Bush, P.L., Pluye, P., Loignon, C. et al. A systematic mixed studies review on Organizational Participatory Research: towards operational guidance. BMC Health Serv Res 18, 992 (2018). https://doi.org/10.1186/s12913-018-3775-5 6. Larsen, T., Karlsen, J. E., & Sagvaag, H. (2022). Keys to unlocking service provider engagement in constrained co-production partnerships. Action Research, 20(2), 180-198. https://doi.org/10.1177/1476750320925862 7. CIHR. A Guide to Researcher and Knowledge-User Collaboration in Health Research. Section 6 Ethics and Partnership Agreements (2015). 8. Hurley, Susan & DeSanto-Madeya, Susan & Fortney, Christine & Izumi, Seiko & Phongtankuel, Veerawat & Carpenter, Joan. (2021). Building Strong Clinician-Researcher Collaborations for Successful Hospice and Palliative Care Research. Journal of Hospice & Palliative Nursing. Publish Ahead of Print. 10.1097/NJH.0000000000000818. 9. Ivers, N, Jamtvedt, G, Flottorp, S, Young, JM, Odgaard‐Jensen, J, French, SD, O’Brien, MA, Johansen, M, Grimshaw, J. & Oxman, A. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst. Rev. (2012) doi:10.1002/14651858.CD000259.pub3. 10. Pomey M-P, Bush PL, Demers-Payette O, et al. Developing recommendations for the diagnosis and treatment of Lyme disease: the role of the patient’s perspective in a controversial environment. International Journal of Technology Assessment in Health Care. 2021;37(1):e11. doi:10.1017/S0266462320002123 11. Fusi-Schmidhauser, T., Riglietti, A., Froggatt, K., & Preston, N. (2018). Palliative Care Provision for Patients with Advanced Chronic Obstructive Pulmonary Disease: A Systematic Integrative Literature Review. COPD: Journal of Chronic Obstructive Pulmonary Disease, 15(6), 600–611. https://doi.org/10.1080/15412555.2019.1566893 12. Smith, S. E. (1995). Dancing with conflict: public health nurses in participatory action-research (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/16699 13. Bush, P. L. et al. Organizational Participatory Research in North America. in Participatory Health Research: Voices from Around the World (eds. Wright, M. T. & Kongats, K.) 179–204 (Springer International Publishing, Cham, 2018). doi:10.1007/978-3-319-92177-8_12. 14. Abayneh, S., Lempp, H., Kohrt, B.A. et al. Using participatory action research to pilot a model of service user and caregiver involvement in mental health system strengthening in Ethiopian primary healthcare: a case study. Int J Ment Health Syst 16, 33 (2022). https://doi.org/10.1186/s13033-022-00545-8 15. Lorente, M., Hogg, G., & Ker, J. (2006). The challenges of initiating a multi-professional clinical skills project. Journal of Interprofessional Care, 20(3), 290–301. https://doi.org/10.1080/13561820600649755
Last update: Jun 2025
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16. Alexander JA, Christianson JB, Hearld LR, Hurley R, Scanlon DP. Challenges of Capacity Building in Multisector Community Health Alliances. Health Education & Behavior. 2010;37(5):645-664. doi:10.1177/1090198110363883 17. Nyman, A., Rutberg, S., Lilja, M., & Isaksson, G. (2022). The Process of Using Participatory Action Research when Trying out an ICT Solution in Home-Based Rehabilitation. International Journal of Qualitative Methods, 21. https://doi.org/10.1177/16094069221084791 18. Grimshaw, J.M., Eccles, M.P., Lavis, J.N. et al. Knowledge translation of research findings. Implementation Sci 7, 50 (2012). https://doi.org/10.1186/1748-5908-7-50 19. Woods, Andrew & Cashin, Andrew & Horstmanshof, Louise. (2022). The social construction of nurse educator professional identities: Exploring the impact of a community of practice through participatory action research. Journal of Advanced Nursing. 78. 10.1111/jan.15200. 20. Buckley, C., Hartigan, I., Coffey, A., Cornally, N., O’Connell, S., O’Loughlin, C., Timmons, S., & Lehane, E. (2022). Evaluating the use of participatory action research to implement evidence-based guidance on dementia palliative care in long-term care settings: A creative hermeneutic analysis. International Journal of Older People Nursing, 17, e12460. https://doi.org/10.1111/opn.12460 21. Isaacs, W. (2018). Dialogic leadership. https://thesystemsthinker.com/dialogic-leadership/. 22. Wicks, P. G., & Reason, P. (2009). Initiating action research: Challenges and paradoxes of opening communicative space. Action Research, 7(3), 243-262. https://doi.org/10.1177/1476750309336715 23. Tsatsi, Itumeleng & Plastow, Nicola. (2021). Optimizing a Halfway House to Meet Mental Health Care Users’ Occupational Needs: Optimisation d'une maison de transition pour répondre aux besoins occupationnels des usagers des soins de santé mentale. Canadian Journal of Occupational Therapy. 88. 000841742110448. 10.1177/00084174211044896. 24. Meinders, Marjan & Donnelly, Anne & Bloem, Bas. (2022). Including People with Parkinson’s Disease in Clinical Study Design and Execution: A Call to Action. Journal of Parkinson’s Disease. 12. 1359-1363. 10.3233/JPD-223190. 25. Cuthbert, Colleen & Nixon, Nancy & Vickers, Michael & Samimi, Setareh & Rawson, Krista & Ramjeesingh, Ravi & Karim, Safiya & Stein, Barry & Laxdal, Garry & Dundas, Lorilee & Huband, Diane & Daze, Emily & Farrer, Christie & Cheung, Winson. (2022). Top 10 research priorities for early-stage colorectal cancer: a Canadian patient-oriented priority-setting partnership. CMAJ Open. 10. E278-E287. 10.9778/cmajo.20210046. 26. Wallerstein N, Duran B. Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity. Am J Public Health. 2010 Apr 1;100 Suppl 1(Suppl 1):S40-6. doi: 10.2105/AJPH.2009.184036. Epub 2010 Feb 10. PMID: 20147663; PMCID: PMC2837458. 27. Council of Europe. Building intercultural competence. https://www.coe.int/en/web/interculturalcities/intercultural-competence#:~:text=Intercultural%20competence%20is%20the%20ability,intercultural%20way%20in%20diverse%20societies. 28. Bryant, Wendy & Vacher, Geraldine & Beresford, Peter & Mckay, Elizabeth. (2010). The modernisation of mental health day services: participatory action research exploring social networking. Mental Health Review Journal. 15. 11-21. 10.5042/mhrj.2010.0655. 29. Ngoma, Caroline (2022) "Mutual Learning during Post-implementation. A study of designing a maternal and child health application in rural Tanzania," Scandinavian Journal of Information Systems: Vol. 34: Iss. 1, Article 6. Available at: https://aisel.aisnet.org/sjis/vol34/iss1/6 30. Wideman, T. H., Bostick, G., Miller, J., Thomas, A., Bussières, A., Walton, D., … Shay, B. (2022). The development of a stakeholder-endorsed national strategic plan for advancing pain education across Canadian physiotherapy programs. Canadian Journal of Pain, 6(1), 21–32. https://doi.org/10.1080/24740527.2022.2056006
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31. Bryn, W.-J. Les conflits d’intérêts dans le monde de la recherche : comment s’outiller pour les bien identifier, évaluer et gérer? (n.d.). 32. Santos, S. S. C. et al. Elaboração de prontuário do residente em uma instituição de longa permanência para idosos. Acta Paul. Enferm. 23, 725–731 (2010). 33. Gerrish, , Clayton, , Nolan, , Parker, and Morgan, (1999), Promoting evidence-based practice: managing change in the assessment of pressure damage risk. Journal of Nursing Management, 7: 355-362. https://doi.org/10.1046/j.1365-2834.1999.00135.x 34. Page K. Ethics and the co-production of knowledge. Public Health Res Pract. 2022 Jun 15;32(2):3222213. doi: 10.17061/phrp3222213. 35. Loban E, Scott C, Lewis V, Haggerty J. Measuring partnership synergy and functioning: Multi-stakeholder collaboration in primary health care. PLoS One. 2021 May 28;16(5):e0252299. doi: 10.1371/journal.pone.0252299. 36. Hamzeh J, Pluye P, Bush PL, Ruchon C, Vedel I, Hudon C. Towards an assessment for organizational participatory research health partnerships: A systematic mixed studies review with framework synthesis. Eval Program Plann. 2019 Apr;73:116-128. doi: 10.1016/j.evalprogplan.2018.12.003. Epub 2018 Dec 11. 37. Brown QL, Elmi A, Bone L, Stillman F, Mbah O, Bowie JV, Wenzel J, Gray A, Ford JG, Slade JL, Dobs A. Community Engagement to Address Cancer Health Disparities: A Process EVALUATION using the Partnership Self-Assessment Tool. Prog Community Health Partnersh. 2019;13(1):97-104. doi: 10.1353/cpr.2019.0012. 38. Mrklas, K.J., Boyd, J.M., Shergill, S. et al. Tools for assessing health research partnership outcomes and impacts: a systematic review. Health Res Policy Sys 21, 3 (2023). https://doi.org/10.1186/s12961-022-00937-9 39. Centre d’excellence sur le partenariat avec les patients et le public. Guide de recrutement des patients partenaires. https://ceppp.ca/ressources/guide-de-recrutement-des-patients-partenaires/.
Last update: Jun 2025
Audit and feedback
In OPR, an audit and feedback process can be used to provide opportunities for partners to voice concerns and observations and to feel heard. The working group can implement audit and feedback to evaluate their partnership building process. For example: Audit: the working group members assess their partnership and compare their processes to existing standards, guidelines, or recommendations. Feedback: the working group members collectively reflect on the results leading to changes in individual and group behaviours.
A thank you to those who helped develop the content on which this manual is based: Christian Tonnesen Moustafa Laymouna Aravind Rajendran A thank you to those who contributed to the French translation: Armelle Choquart André Nguyen
A thank you to those who provided feedback on the content:Jack Moncado Annie-Danielle Grenier Cynthia Henrickson Rania Jribi Marie-Ève Lamontagne Sonia Lussier Yessica-Haydee Gomez Myra Drolet
Partners should feel free to propose ways of improving the organization or the study at any time.8
1) Guide de recrutement des patients partenaires.392) Patient Partnership Guidelines: McGill Practice-Based Research Network.
Partners may need to be compensated for extra meeting hours.19,20
See "Additional Resources" for a guide for recruiting patient partners (in French).
Maintain a safe and open environment to encourage partners to express values/expectations that may have changed.
Traditional, or formal, leadership structure: Specific partners take charge of the entire OPR or parts of it.15
- Pros: Quicker decision-making process because few are involved in decisions; Reduced potential for communication difficulties.15
- Cons: Leaders may be prone to burnout because there is more on their shoulders; Power imbalances among partners may develop.14
Collateral, or shared, leadership structure: Partners share responsibilities.14Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work from the International Committee of Medical Journal Editor.
Recognize that additional time to complete tasks may be necessary, at times.
Clinician partners may feel they are more useful in a consultation role.
This resource is for anyone interested in Organizational Participatory Research (henceforth referred to as OPR for short). It describes challenges research partners may face and offers solutions to address them. Both challenges and solutions were found in scientific journal articles on OPRs. This resource com plements the Organization Participatory Research Practice Guide by Bush et al.1 It is recommended to read the guide before consulting this resource. Many of the challenges and solutions presented end with a reference to the exact section of the Organization Participatory Research Practice Guide to facilitate cross-reference. Please read Definitions before starting.
Avoid assigning the notetaker role to someone who has Parkinson’s without providing the support they need to fulfill such a role.24
Some may feel that their experience lends itself better to for example, commenting on data collection tool. Some may feel they are better in helping in developing the dissemination strategies.
A partner may need to give themselves an injection and prefer to do this in private. A partner who has a disability may need extra time to use the facilities.
Organizational participatory research
Organizational Participatory Research (OPR) refers to participatory research that aims to effect change within the partnering organization (e.g., a community health clinic, a hospital, or a hospital ward).3,4 In OPR, the non-academic partners are interested parties of the organization and may include, for example, frontline health workers, patients, or administrators. Their insider knowledge increases the relevance of the research and the likelihood that the change (e.g., new practice or policy) will be implemented and sustained. Note that, in this resource, we use the term "partner" to underscore the importance of the research partnership. Various terms, such as "co-researcher", can be found in the scientific literature.
Remain open, transparent, genuine, direct,22 and honest.17 Include time in meetings for partners to express how they feel relative to one another (e.g., subordinate),6 to share fears and other personal feelings,21 and to set boundaries.
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Consider recruiting patient partners from patient advocacy organizations as they may be more able to commit to long-term involvement.25
This resource is for anyone interested in Organizational Participatory Research (henceforth referred to as OPR for short). It describes challenges research partners may face and offers solutions to address them. Both challenges and solutions were found in scientific journal articles on OPRs. This resource complements the Organization Participatory Research Practice Guide by Bush, Tremblay, et al.1 It is recommended to read the guide before consulting this resource. Many of the challenges and solutions presented end with a reference to the exact section of the Organization Participatory Research Practice Guide. Please read Definitions before starting.
Training about relevant health and research topics. Training about how to work in a multi-stakeholder partnership (e.g., cultural safety).
If the OPR is a graduate student project, discuss and the importance of the student being the 1st author.
Continuous collective reflection on topics such as real and perceived power dynamics and sources of inequity.11 Audit and feedback.9
Participatory research
Participatory research is an approach to research characterised by a partnership between academics and non-academics who represent various groups with a vested interest in the study. The non-academic partners, also referred to as "interested parties", are involved throughout the research. They make decisions with the academic partners regarding the research question, methods, and dissemination or application of the results.2 Participatory research blends research and action to effect change that is relevant to the non-academic partners.
and highlighted words are interactive. Hover your mouse to floating items and click to see their content. Symbols:
Floating items
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Organizational partners
Organizational partners are the interested parties of the organization involved in the OPR. They can be divided into 3 sub-groups as follows:
Terms of reference
The Terms of Reference (ToR) is a partnership agreement amongst all partners of the working group that outlines the study (e.g., objectives, timelines), and the roles and responsibilities of all partners. Throughout an OPR, this agreement can be updated to reflect new realities. The ToR is not a legally binding contract. It is recommended for the working group to develop their ToR together so that everyone is on the same page regarding all aspects of the project (e.g., anticipated challenges, logistics of when/how meetings will take place, expectations, goals).5 Co-constructing the Terms of Reference may also address power imbalances from the onset.
Academic partners contribute research methods knowledge or manage access to peer reviewed literature. Healthcare provider partners contribute clinical knowledge.8 Decision maker partners facilitate change management within the organization. Patient partners to provide knowledge related to navigating the healthcare and social services system.
Extra benefits
Extra benefits are unexpected positive outcomes of an OPR that are unrelated to the study’s objectives.4,5 For example, for an OPR with a research objective to implement an organizational change, extra benefits brought by the OPR process could be building up a sustainable partnership, or leadership or workforce development.
Schedule regular, recurring meetings from the onset, e.g., the 1st Monday of each month. Allow for partners to take part in meetings remotely.
1) Multi-Stakeholder partnership questionnaire.35 2) Organizational participatory research health partnerships assessment model.36 3) Partnership self-assessment tool (questionnaire).37 4) Systematic review of tools for assessing health research partnership outcomes and impacts.38
Working Group
OPR is conducted by a working group that includes organizational and academic partners on the research team. The working group meets regularly to plan and carry out the study. It is within the working group meetings that key research decisions are discussed and agreed upon.
Avoid central roles for those who have many conflicts of interest. Alter partner roles, as needed, if new conflicts of interest arise during the OPR. Disclose conflicts of interest in all communications about the OPR.
From the First Nations Information Governance Centre, standards on Ownership, Control, Access and Possession of Data.
If partners decide that nurses, patients and social workers are needed, recruit two of each to the working group.
1) Creative common license. 2) Ligne directrice. 3) Canadian patent application.
A thank you to those who helped develop the content on which this manual is based: Christian Tonnesen Moustafa Laymouna Aravind Rajendran A thank you to those who contributed to the French translation: Armelle Choquart André Nguyen
A thank you to those who provided feedback on the content:Jack Moncado Annie-Danielle Grenier Cynthia Henrickson Rania Jribi Marie-Ève Lamontagne Sonia Lussier Yessica-Haydee Gomez Myra Drolet
Succeeding in Organizational Participatory Research (OPR): 21 Challenges and Solutions © 2025 by Jiahao Deng, Paula L. Bush is licensed under CC BY-NC-ND 4.0. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/
1) Canadian intellectual property enforcement guidelines information. 2) Lignes directrices sur la propriété intellectuelle.