How to evaluate participatory action research for health promotion interventions: the pragmatic Emke framework

Participatory Action Research (PAR) is a promising approach to increase the effectiveness and impact of health promotion interventions. Evaluating the process of developing and implementing co-created interventions can provide important insights in barriers, facilitators and potential impact of a PAR approach. To date, a framework guiding the process evaluation of developing and implementing actions using a PAR approach is lacking. This study aimed to develop a pragmatic framework to guide the process evaluation of a PAR approach for the development and implementation of health promotion actions, as part of the Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) study. The framework we developed, called the Emke framework, is primarily based on the RE-AIM framework (1999) as the RE-AIM framework has previously been successfully used to evaluate the process of conducting PAR to develop and implement actions. Additionally, the Emke framework is based on the framework of Saunders et al. (2005) which is commonly used in the process evaluation of health promotion interventions. Elements that would complement the Emke framework specifically focussing on the evaluation of PAR, were added from the Dutch PAR quality framework by Jurrius (2013) listing important requirements of conducting PAR approach with youth and the position paper by Wright et al. (2013) that describes eleven essential characteristics of high-quality PAR in health research. The Emke framework consists of seven elements related to the process evaluation of (1) conducting PAR and (2) the implementation of co-created actions, which are both iterative processes. These elements include: preconditions, recruitment, participants, adoption, iterative implementation, perceived effects, and sustainability. All elements are applicable to both the process evaluation of conducting PAR and implementation co-created actions, yet their application differs. This is the first framework specifically designed to guide the process evaluation of PAR projects. Systematic process evaluations of PAR projects will gain a better understanding of barriers, facilitators and potential impact of PAR projects. We hope that the Emke framework will prove useful to researchers in future PAR projects. - This study shows the development of a process evaluation framework to evaluate a Participatory Action Research (PAR) approach, currently such a framework is lacking. - The framework, called the ‘Emke framework’, consists of seven elements that are related to both the evaluation of the process of conducting PAR and to the evaluation of the implementation of actions that are developed together with the population of interest. - With the Emke framework we can help other researchers gain a better understanding of the barriers, facilitators and potential impact of their PAR project.