Using Action Research in Information Systems Design to Address Change: A South African Health Information Systems Case Study ELAINE BYRNE University of Pretoria
This paper advocates for the use of Action Research (AR) approaches in the designing of Information Systems (IS). Following a brief overview of the history of AR as a research methodology and it’s use in IS research a framework for describing the AR process is developed. This framework is then used to describe the AR process involved in the design and development of a paper based and orally communicated child health IS. A common criticism of AR in IS design is the focus on the output of the design and the lack of rigour in the description of AR projects. This paper addresses this gap by focusing on the process of the design and development of the IS in the case study, but also contributes to AR by outlining a number of concerns which should be addressed by the IS researcher if AR is to viewed as rigourous. The concerns which need to be addressed are the need: to make explicit the epistemology of the researcher(s) or practitioner(s) in any AR project; to adopt a participatory AR and longitudinal approach to avoid the conflict of ‘serving two masters’; to develop networks of action, and; to develop and disseminate generalisations and learnings from the research. Categories and Subject Descriptors: H.4.0 [Information Systems Applications]: General General Terms: Design Additional Key Words and Phrases: participatory action research, information system design, research methodology
1.
INTRODUCTION
In a world where changes in the IS field are taken place rapidly the focus of this conference on the definition, development and assessment of methodologies and systems for true interchangeability is particularly appropriate. Additionally, as the conference Call for Papers notes, this needs to occur alongside the development of the human and technical capacity, as well as the tools and methodologies, to manage these changes. This paper looks at an appropriate research approach that helps researchers engage with change. This approach is Action Research(AR). AR studies continue to be quite rare, though they are a much needed approach, in the IS field [Walsham and Sahay ming]. “Action research would appear to be particularly relevant in contexts where resources are scarce, when it can be argued that outside researchers should not only go away with data for their own papers and academic careers, but also aim to make a specific contribution in the research setting itself.”[Walsham and Sahay ming] Participatory AR has also the added value of collaborative research taking place and thus, the research capacity of all the participants in the project is developed. AR has developed and changed over time and there are many different frameworks, assumptions and goals that characterise the diverse forms of AR. However, one of the criticisms of using this approach is the lack of rigour employed. This paper addresses this criticism on two levels. Firstly, a case study is used to illustrate how AR can be used as a rigorous research methodology. Secondly, a number of concerns are raised which generally contribute to the perception of AR as a weak methodology and suggestions are given on how to address these concerns. Accordingly the next section of this paper looks briefly at the history of AR and its application in the IS field. Section 3 deals with the specifics of the case study using an AR framework which is developed based on AR literature. Some important concerns when using AR as a research approach are highlighted in Section 4 and are summarised in the concluding section. 2. 2.1
ACTION RESEARCH AND INFORMATION SYSTEMS History of Action Research
Early AR grew out of a desire of researchers to discover ways of dealing with important social problems and its history can be summarised in four stages [Baskerville and Wood-Harper 1998]. Author Addresses: Elaine Byrne, Department of Informatics, University of Pretoria, South Africa,
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• Origins (1940-1960): The origin of AR is accredited to Kurt Lewin’s (1951) call for researchers to be involved in the action process and to generate knowledge about a social system while simultaneously attempting to change it [Elden and Chisholm 1993]. Another group working independently in Britain was the Tavistock Clinic which developed a similar method has also been accredited with the origin of AR. [Baskerville and Wood-Harper 1998] • Disputes (1960-1975): The focus in this period was mainly on the problems and limitations of AR, namely the ethical dilemmas (e.g. Rapoport 1970) and the nature of research sponsorship (e.g. Clark 1972). Another problem which arose during this same period was the lack of distinction between consulting and AR. • Fragmentation (1975-1990): In this period there were two streams developed which emphasised the relationship between reflection and action, Argyris and Schon’s (1978) double loop organisational learning and Checkland’s (1981) AR and systems science. It is during this period that the use of AR in IS emerged as a distinct application area, for example, Mumford’s ETHICS methodology and Wood-Harper’s use of AR for studying IS development. • Diffusion (1990 onwards): This period specifically addressed IS and AR, where there was not one emerging approach to AR, but an increasing number of AR publications, with the focus being on the results of such studies rather than the philosophy. Some of the publications in this diffusion period include the special issue of Information Technology and People in 2001: the practical domains of IS AR [Baskerville and WoodHarper 1996]; a review of IS AR journal publications [Lau 1997]; the delineation of an inclusive AR paradigm for IS research [Baskerville and Wood-Harper 1998]; investigating IS with AR [Baskerville 1999], and; the importance of networks of action for sustainable health IS across developing countries [Braa et al. 2004]. The main changes which have taken place over this time frame are the increasing emphasis on participation and the call for greater rigour in the use of AR. 2.2
Participation
There has been the increasing awareness that participation is needed if AR is to solve problems in a sustainable and culturally acceptable way. Alongside this increased interest in participation was also the re-examination of the roles language, communication and power differences play [Elden and Chisholm 1993]. This relies on a different epistemology of inquiry from earlier approaches [Elden and Chisholm 1993] where participation has moved towards a “.. full partnership in creating and using new knowledge. . . . The important product here, in contrast to the classical model, is participants learning how to learn to develop their own, more effective practical theories.” [Elden and Chisholm 1993] This adds to the “.. aim of making change and learning a self-generating and self-maintaining process in the systems in which the action researchers work.” Brown (1993), however, makes the distinction between AR application in the Northern hemisphere and AR application in the Southern hemisphere. He notes that traditionally AR in the North attempts to improve organisational performance, and generate social science theory. In the South a more participatory approach has always been adopted which attempts to raise levels of consciousness, address basic social problems, and deal with empowerment [Elden and Chisholm 1993]. In general, participatory AR implies a closer relationship between the researcher and the subject and greater participation of ‘insiders’ than commonly found in traditional AR [Baskerville 1999]. Participatory action research means that all relevant stake-holders do what only researchers usually do. It can be seen primarily as a learning strategy for empowering participants and only secondarily as producing ‘research’ in the conventional sense. . . . The researcher is the linchpin so that what he or she learns contributes to accumulation of knowledge above and beyond a local, ‘context-bound’ situation. [Elden and Levin 1991]. 2.3
Scientific merits of Action Research
In IS AR has been closely linked to systems theory from its inception. Susman and Evered have strongly influenced later developments with the idea that human activities are systematic and that action researchers are intervening in social systems. They explore the scientific merits of AR in terms of post-positivist science and see AR based in phenomenology rather than positivism. This work includes the five phase cyclical process most prevalently used in AR, namely diagnosing, action planning, action taking, evaluating and specifying learning [Susman and Evered 1978]. Checkland’s extensive use of AR in the methodology of systems development drew considerable attention also from the IS field (1981). Though, as mentioned, AR is not commonly found in IS journals AR is often claimed to have a poor reputation in the IS field due to the lack of rigour in the AR process [Avison et al. 2001]. Avison et al. [Avison et al. 2001] suggest that greater emphasis should be given to the process of Proceedings of SAICSIT 2005
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AR rather than the output to make AR more rigorous. They specifically look at the control of AR projects. On the other hand, Checkland [Checkland 1991] believes that some kind of prescription is needed to make AR more rigorous and a more acceptable method. He argues that in general the literature on AR neglects the explicit intellectual framework by means of which the nature of research lessons will be defined. These concerns will be addressed in the following two sections. 3. 3.1
CASE STUDY: THE DESIGN OF A COMMUNITY-BASED IS IN UTHUKELA DISTRICT, SOUTH AFRICA Background
The community-based child health IS was implemented in oKhahlamba, which is one of five municipalities in the uThukela District lying in KwaZulu-Natal on the eastern coast of South Africa. The IS designed is largely paper and oral-based, though it does link into the computerised district health IS. The population of oKhahlamba Municipality is mainly rural, poor and relatively under-resourced. The uThukela District Child Survival Project (TDCSP) was selected by the National Department of Health as one of three learning sites for the development of a community component of child health in 1999. The design of the community-based child health IS was part of this larger child health project. TDCSP was a NGO that initially operated in the oKhahlamba Municipality from 1995 to 1999 and expanded to the rest of the District from 1999 to 2003. Through a partnership with the community and Department of Health, TDCSP’s mission, during the eight years of operation, was to create a well-being context through child health, maternal health and HIV/AIDS interventions which were co-designed and implemented in a holistic, integrated and sustainable manner. In developing a community-based IS, TDCSP relied heavily on its strategies of participation and capacity development. The author has been engaged with TDCSP since 1997 until the Project ended in 2003. The involvement commenced at the initial stage of proposal-writing for funding whilst the author was working at UNICEF. UNICEF supported the development of learning sites for community child-health interventions. After leaving UNICEF, the author was approached by TDCSP in 2001 to facilitate the development of the community-based IS, an aspect of the community child-health intervention that had not been developed at that point in time. In general, the author’s role at the community level in the development of a community-based child-health IS, and in support of TDCSP, has included various activities, such as facilitation of meetings and report writing, training on research collection and analysis, evaluator and field worker in data collection and part of the team during many dissemination sessions. 3.2
Action Research framework used
Addressing the call for the improvement of the rigour of AR approaches, Checkland’s framework [Checkland 1991] and Lau’s categories for AR [Lau 1997] have been used to describe the research approach used in this case study. In Figure 1 F is the basic premise of the research which was to increase the visibility of children through the inclusion of data on children in the IS and through using this data for decision making to improve the situation of children. M is the methodological framework adopted and included not specific methodologies from the outset, but specific principles of participation, capacity development, reflective practices and the cultivation of a learning environment through the sharing of theory and practice. Lau’s categories of problem diagnosis, action intervention and reflective learning are used to describe the process [Lau 1997]. • Problem diagnosis: This involved planning the research process and exploring the problem situation, methodologies to be used, fundamental principles for conducting research and theoretical ideas - combining A, M, F and the research theories with reflection. This process commenced with vision building and then conducting a participatory situational assessment and analysis. Once agreement was reached on the objectives and a greater understanding of the context was developed plans for conducting further research were made. • Action intervention: Based on the analysis of the diagnostic stage a number of specific interventions were made in the IS. • Reflective learning: Reflective learning occurred throughout the process from the initial problem diagnosis situation through to the analysis and implementation of action. One of the final reflective processes was the evaluation of the system. Theoretical and practical generalisations and learnings were developed and disseminated throughout the process. Clarification on the client-system infrastructure is dealt with as a separate phase as it is this agreement which determines the overall boundaries and framework of the research. The main activity in this stage was reaching agreement between the insiders and the outsiders in terms of the objectives of the research, roles and Proceedings of SAICSIT 2005
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Figure 1.
Action research approach
responsibilities, the resources needed and the principles of operation. The entry and exit of the researcher and the dissemination of the learning gained in the research needed to be also discussed at this stage ([Baskerville and Wood-Harper 1996]). The model presented here serves as an analytical tool of the process, but each stage or phase was not consecutively conducted nor is each step distinct. Often aspects of the project were being dealt simultaneously with aspects from another stage. For example, evaluation and reflection were continuous activities and fed into revisions of who to include in the process and as such is not the final phase of the process. Furthermore, we have not reached an end-point either for, if IS design is seen as a social process, there can never be an end point. The end of an AR project is arbitrary since human situations continue to evolve through time ([Checkland 1991]p.401). The project still needed an exit strategy and agreement on the time frame for operation. These discussions were dealt with at the onset in the ‘client-system infrastructure’ phase. 3.3
The Action Research process
Each of the phases mentioned above in the process of conducting the AR is now discussed. 3.3.1
Client-System Infrastructure
It was necessary, firstly, to establish a working group to conduct the research. Participants for the working team were selected based on the positions they held within the District, the networks they were currently part of, the skills and expertise they possessed, as well as their willingness to participate. The team mainly comprised representatives from TDCSP and the Department of Health, Community Health Workers and Facilitators, Community Development Officers and Community Field Facilitators. Over different periods of time university staff, community leaders and representatives, Department of Education and International Non-Governmental Organisations were also involved. The roles and responsibilities of all parties were not only agreed to and documented for clarification purposes, but also to avoid confusion or misunderstanding arising at a later date. This included discussions on the exit strategy. Though many participants had experience in monitoring and evaluation and had been involved, although to a lesser extent, with the community component of child-health interventions, brief discussions were held with all team members on the current status of child health and child health information in the District. These discussions were felt to be necessary so that a common starting point was established. 3.3.2
Diagnosing
The child health intervention within TDCSP, along with the District Health Management Team, adopted a future-focused approach to planning for child health. The implications of this approach for IS design and development were the focus on measuring children’s health in a holistic way and the shift to expressing children’s health status with respect to the attainment of a vision. This approach reflects what is required to be done to attain the vision and thus, hopefully, to stimulate action. Agreement on vision and objectives: When the TDCSP commenced the community child-health intervention, agreement on the vision and objectives of the intervention had been agreed to through Participatory Learning for Action (PLA) sessions with community Proceedings of SAICSIT 2005
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Identification of duty bearers and role players
participants (comprising men, women, youth, councillors, traditional leaders and Community Health Committee members) in two different wards in different Sub-Districts. The vision was: to achieve optimal health, growth, development and well-being of children within the family and community in the uThukela Health District. Situational analysis and identification of role players: The TDCSP conducted a participatory situational analysis and assessment at the commencement of the community child-health intervention in 1999. This involved a demographic overview of the oKhahlamba-eMtshezi District, a review of the health services in the pilot area and a summary of the health information gained from the facility-based health IS and the Community Health Workers. From the participatory situational analysis and assessment the main people responsible for child-health (the duty bearers) and other key people in the community (the role players) were identified1 . An example of the participatory methodology employed was the process of the identification of the main role players and duty bearers which is illustrated in the photograph in Figure 2. Participants were asked to place the child at the centre of the picture and the rest of the duty bearers and role players in circles of differing distances from the child. The closer the circle is to the child the more important is that role player or duty bearer. If action needed to be taken to improve the care of the children of the community it was felt that these people would need to be involved in the design of an IS. The following groups of people were identified and therefore, participated in the research: children, Community Health Workers, Clinic Health Committees, traditional leaders, councillors, social workers, early childhood practitioners, mothers (including teenagers), fathers, grandmothers and TDCSP staff. The participatory situational assessment further explored and described the community infrastructure in the District and reported on the results of Focus Group Discussions (FGDs) and PLA sessions on child-health and care-seeking practices. From the research, a glossary of local terms for childhood illnesses was developed [Gibson et al. 1999]. Gaps in the information about child health were investigated at a later stage, through FGDs, critical incidence analysis and further PLA sessions [Gibson et al. 2000]. Monitoring and evaluation workshop: Subsequently, a workshop was held in Bergville in February 2000 to explore the existing District Health IS in relation to the monitoring and evaluation of the vision for child health. Participants included mothers, fathers, Community Health Committee members, Local and District Government representatives, University staff, International and National Non-Governmental Organisations and TDCSP staff. One of the interesting aspects from this workshop was a discussion of the vision that had been previously determined. Agreement on the objectives for the attainment of this vision was necessary if we were to design an IS that could assist with 1A
duty bearer is a person who is legally obliged to fulfil certain rights, a claim-holder or rights-holder is the subject who is entitled to the right and a role player is a person who is engaged, whether obliged or not, in the process of realising that right. Proceedings of SAICSIT 2005
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the monitoring of the vision. It became evident that very few participants who attended this workshop could understand the ‘co-determined’ objectives which had been previously agreed to in another community meeting. The objectives were translated, both in terms of the terminology used and also to simple English and then to isiZulu. It became clear that the original objectives did not represent the views of this particular group of workshop participants. Once agreement had been reached on the objectives workshop participants were then asked to arrange themselves into groups and to discuss the following question: If we are achieving these objectives what can we SEE, HEAR and how can we MEASURE what is happening? Though it was noted that very few of the current indicators are community identified and that there was the need for community members to be involved in determining them, some of the indicators that emerged from this exercise were similar to indicators already existing in the formal District Health IS, such as the percentage of children immunised and breastfed. Other indicators were not so clearly measurable, such as abuse at the household level. Community members and other participants said that abuse could be measured through being able to ‘See and Hear’ less abuse. More work was needed to explore the ‘See and Hear’ aspects of an IS. This workshop and a review of the District Health IS in November 2001 provided the impetus to work on a community-based child health IS. Data collection and analysis The next stage was to discover the underlying meanings of community members in terms of the vision. As the agreed vision was around the attainment of ‘holistic health and well-being’ for their children, one of the initial challenges of the participatory process was to understand what meaning was attached to a child being in a ‘state of well-being’. With respect to the specific research conducted for the community-based child health IS a total of 10 interviews, 15 FGDs and one meeting took place between July and September 2002 in order to understand what the community’s’ information needs were, who should be involved in the design and use of the IS, and the format in which the information should be communicated. The duty bearers and role players who were identified in the situational assessment were included in the various groups of research participants. Due to the small number of children involved in previous discussions, an additional FGD with children was conducted in May 2004. Listening to different community members’ views which emerged through the data collected, facilitated a greater understanding around the meanings of the terms ‘well-being’ and ‘at-risk’ for a child, what factors and practices contribute to these situations, how the situations can be identified and measured and, based on what action can be taken, to whom the information should be provided. The discussions and interviews were facilitated by people who were familiar with the geographical area and who also had an understanding of the local norms and values, such as the Community Health Workers, Community Field Facilitators and orphan group ‘mothers’. In the initial stages, because of differentials in status and roles within the community, groups comprising, for example, mothers, children, councillors and facility staff, met separately to discuss what they wanted for children. These meetings were held in the local language and near the homes or work places of the individuals. At a later stage, representatives from the various groups met jointly to share the findings from the research and to discuss the way forward. One important element which arose out of these discussions was the need to move beyond the measurement of child-health status in terms of the physical being to a more holistic approach of measurement. It was seen as important to monitor the context in which a child is living (the process towards ‘well-being’ or ‘risk’) as well as the state of ‘well-being’ and ‘at-risk’ (end product), because if the focus is on the end product it may be too late to act to improve the situation of the child. The factors affecting the conditions for ‘well-being’ and ‘at-risk’ mentioned were not viewed as isolated, but as interwoven in a socially, politically and culturally complex situation. Part of the discussion in these initial meetings was also around determining a local term for indicators or ‘signpost’. There was agreement on the term izinkomba. In terms of measuring ‘at-risk’ and ‘well-being’ the discussions explored broad areas of measurement rather than developing precise formulations of indicators. This was because community members felt that they were not looking for a value to be placed on childhood vulnerability or risk, but rather there was the need to track changes in this status and to know when action needed to be taken when a child was falling into risk or danger. This is quite different from the predominant focus on quantitative indicators in health IS design, reflecting a positivist technological tradition in the medical informatics field. Chambers also challenges the pursuit of excessive accuracy of data when approximations are good enough. He notes that “What often matter are judgements of trends and of relative amounts, and insights into causality”[Chambers 1999]. He urges people to aim for ‘approximate precision’ as well as accepting ‘optimal ignorance’, or knowing only what you need to know. From the FGDs and interviews, various izinkomba for ‘well-being’ and ‘at-risk’ were suggested and these were subsequently grouped through group sessions into common areas or themes. Based on these findings, the process of refining the izinkomba took place. Working sessions with representatives from the District Health Management Proceedings of SAICSIT 2005
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Team, the Project and community members, as well as discussions with the Community Health Workers and Facilitators were conducted to refine the izinkomba. The data collection and analysis process was iterative, evolving and connected in a cyclical manner. The participatory modes of analysis, such as interviews, discussions, feedback from presentations and writings, as well as insights from theoretical work and other empirical work, contributed to the data collected and further analysis and interpretations. Once there was a clear picture of what the community wanted to measure, what was currently available and in what format, community-based data collection tools, for the collection of the remaining data, were discussed. From these discussions, the use of a community assessment tool was piloted as an approach to measure these types of izinkomba. Participants felt strongly that the assessment should be used as an empowering communication tool, rather than as a means of inspection. The capacity of the role players and duty bearers to act if they received the necessary information or knowledge was then addressed. An important requisite was getting access to the data, as the data was not flowing to people who could take action. Based on these discussions changes in the information flows were recommended, as well as changes in the format of the routine District data. A number of discussion forums were also enhanced. Overall the research identified that, while some data for ‘at-risk’ and ‘well-being’ was currently collected in the District Health IS, this data was not being delivered back to the people responsible for taking action at the household level. Another gap identified was the need to include in the District Health IS indicators of the context which shapes the status of children and the enhancement of forums for reflection and analysis of the data. 3.3.3
Action taking
The system implemented has built upon the traditions and culture in practice and therefore is primarily a paperbased and orally communicated IS. Using an observation form, the health worker assesses and registers the ‘risk’ or ‘well-being’ of the child at the monthly household visits. Based on the observations, the health worker discusses the situation with the caregiver present. Advice is given immediately, possible solutions identified, referrals made and assistance provided in the carrying out of household decisions if needed. Data on ‘risk’ and ‘well-being’ are collected during these visits by Community Health Workers. Community Health Workers and Facilitators come together monthly to collate their household data and reflect on it. The individual Community Health Worker data is compiled by the Community Field Facilitator and a process of ‘Assess, Analysis and Act’ is used to discuss the data and to share experiences between themselves. The aggregated data (at village level) is presented to the community at quarterly village health days. The Community Health Committee chairs the meeting, the Community Health Workers and Facilitators organise the meeting and parents, mainly mothers and grandmothers, school children and District staff attend the meeting. Feedback from the aggregated data is given through song, dance, poetry, role-play and bar graphs. The compiled community data (for all villages in the Municipality) is sent to the District Health Information Officer who should include the aggregated municipality data in monthly feedback reports to the health facilities and to the District programme staff. Ideally the community-based data submitted to the District Information Officer should also be shared with other programmes at District level and higher levels, as well as include a feedback loop of analysis and reflective questions for those who submitted the data. Additionally local government should be involved in the information flows. These two latter links have not been made to date due to the absence of a District Information Officer and the volatility of local government structures during the research process. In summary, four main changes were introduced in the District Health IS: • Participatory determination of indicators that the community needed to be included into the system. The new indicators included information on communication and relationships within the household, deaths within the family, employment and access to education and social services. These are indicators that could be used to describe the context in which the child grows up and need to be largely articulated from and collected within the community. • Adaptation of the existing Community Health Worker data collection forms to include these indicators. • Enhancement of different discussion forums for analysis of the data collected to stimulate reflection and use of the community-based data. • Integrating formats and flows of information in the health IS. These changes were implemented in the Municipality in June 2003 and agreement was reached later that year to expand the system to the rest of the District. 3.3.4
Reflective learning
The evaluation of TDCSP, which included an evaluation of all the interventions and hence also the Health IS, was conducted in November 2003. Given that the community-based IS has only recently been implemented it Proceedings of SAICSIT 2005
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was really too early to judge its impact on broader health system outputs, such as child-health. So in terms of evaluating the aims of the research - to be able to use the IS to describe the situation of children and act upon the information generated to improve the condition of children - it was too early to say whether this will happen. Identifiable benefits to date have largely been process-oriented, such as: the reduction in the number of data collection tools (from 5 forms to 2) and the subsequent decrease in time in collating the data; the training of 75 Community Health Workers, and involvement of those workers in the design process, and; the development of a culture of communities monitoring themselves and the status of their children. More broadly, the communitybased IS research has helped to emphasis the importance of information at community level within a District Health IS, making it clearer where information should flow based on who can take action, and highlighting the importance of feedback of information to the community-level partners in child-health. But reflection goes beyond an end of project evaluation and occurred throughout the AR process. Some of the reflective processes mentioned above include: • developing a future focused vision; • reflecting on the existing IS and recognition of lack of data on children and lack of community determined indicators; • exploring the measurement of the context and state of child for inclusion into a health IS; • the participatory and iterative analysis of data and meanings of health, and; • the enhancement of forums for reflective practice in the IS. Throughout the process, reports have been written and circulated amongst the researchers, community members, TDCSP, donors, academics, researchers and various levels and individuals within the Department of Health. A number of papers have been written and presented in different forums which highlight the practical and theoretical learnings from this project. This ‘rich picture’ of the process involved in the case study described above allows readers of the paper to interpret the case study themselves and take from it what they feel is valuable. However, there are also a number of issues which need to be addressed in conducting AR which the case study highlighted. These issues are based on the relative success of the approach adopted, as well as the challenges still to be addressed for the sustainability of the community-based IS and are applicable to any AR project, not just health IS. It is these issues which are the focus of the next section. 4.
DISCUSSION AND IMPLICATIONS FOR ACTION RESEARCH PROJECTS
If AR is to be taken as a rigorous research methodology in any field it is not sufficient to adopt a more rigorous approach to the description of the process undertaken in any project. There are also a number of issues which also need to be addressed. Though an attempt is not made here to provide an exhaustive list, a number of important issues of concern highlighted by this case study and through reviewing the literature on AR, need to be addressed. These are: • • • • 4.1
explicit reference to the epistemological basis; developing a network of action, rather than focusing on single units; adopting a participatory approach and a long term perspective, and; commitment to making generalisations from the project. Epistemology
Lau notes that “While the use of action research as a strategy of inquiry is undisputed, its epistemological basis as a research paradigm is open to question due to the different meanings that have been attributed to the concept over time.” [Lau 1997] There are various types of AR with different emphasises as noted above and so Lau concludes his discussion on the epistemology of AR with “.. it is necessary for the researcher to distinguish the type of action research used and its historical context from which the purpose, focus, theory and methods of the study are based.” [Lau 1997] Similarly, Elden and Chisholm in their review of emerging varieties of AR note that there is the need to be explicit about the purpose and value choices made. For them “Action research is change oriented and seeks to bring about change that has positive social value...” [Elden and Chisholm 1993]. Two important outcomes of the AR approach are firstly, to address a problem or a problem situation and secondly, to develop practical and theoretical generalisations and learnings. A participatory AR approach supports the argument that theory and practice must be interconnected if the human condition is to improve. It is impossible to improve the human condition solely by critiquing ideology or theories. It necessitates becoming involved in real life situations, but there is the need to make the political agenda explicit and to declare this position in advance. In this case study the premise behind this research is that vulnerability of children can be Proceedings of SAICSIT 2005
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tackled using two interconnected strategies. The first is through the creation of awareness of the situation of children and the second through mobilising the commitment and action of government and society to address this situation. These strategies can be supported by designing an IS for action - an IS that can be used to advocate and influence decisions and policies for the rights of these children. Participatory AR fits in with this critical social theoretical approach. 4.2
Develop networks of action
Situating action within networks rather than singular units, is not a new idea and has been addressed in IS especially in Scandinavian based AR. Chisholm and Elden [Chisholm and Elden 1993] mention that the importance of networks is a new emphasis in emerging AR and this emphasis stems for the recognition of the changes needed in complex social process, such as at community level. The argument for developing these networks is based on the fact that local intervention needs to be part of a larger network to be robust. Braa et al [Braa et al. 2004] use this argument and concepts from Actor Network Theory to analyse the network in their Health Information Systems Project (HISP) in a number of different countries and note that there is also the need to be aware of the networks which have the potential to dominate. They established networks within and between countries (between research institutions, health authorities, donors, NGOs and Ministry of Health). Through the utilisation of vertical and horizontal processes of appropriation and spread, the health IS was more sustainable. Braa et al. emphasis that “.. local action research interventions need to be conceptualized and approached as but one element in a larger network of action in order to ensure sustainability.”[Braa et al. 2004] Scaling (spreading) of the intervention is a prerequisite for sustainable AR. The scaling is not so much about increasing in size, as facilitating the necessary learning processes that enable the process to continue and develop [Braa et al. 2004]. In this case study, the sharing of experiences occurred between all role players in the community, as well as sharing beyond the community, to enhance those broader networks. However, the information flows from the community level have been hampered by the absence of a District Information Officer for the duration of the research. As such, the link between the community and the higher level decision makers has been broken. Furthermore, due to changes in local government and the decentralisation process of the health services, the challenge of developing a more multi-sectoral approach to the child-health IS is still faced. The development of broad networks of action is an area that is often neglected in an AR approach to IS design. 4.3
Participatory and longitudinal approach
“Whatever the case, the IS action researcher serves two different ‘masters’, namely the research client and the research community as a whole. The needs of these two masters are usually entirely different and sometimes conflict with each other.” [Kock and Lau 2001] Participatory AR should have little distinction between the two parties and, therefore, offers the potential of reducing the conflict of ‘serving two masters’. In participatory AR there is the need for a co-determined agreement on the research and problem solving process at the outset. In this case study, as with the case of HISP mentioned above, there was multi-levelled and multisectoral participation as opposed to the “relatively dichotomous separation of the practitioners from the researchers” [Braa et al. 2004] and a sliding in and out of positions of ‘insider’ and ‘outsider’. The position of researcher and practitioner should not be a given state, but a relative contextual concept. Depending on the degree of participation and the stage of the research, people should be able to move in and out of the research process. For example, when the author commenced with TDCSP, she was viewed by TDCSP as the outsider. However, over the years of her involvement with TDCSP this perception changed. For example, in the evaluation of TDCSP in 1999 she was the external assessor to the child-health intervention, whereas, in the final assessment of TDCSP in 2003, she was the internal assessor of the health IS intervention. Adopting a participatory approach necessitates a long term commitment and involvement in the project. This longitudinal approach is especially necessary in social situations where there are a number of overlapping problems rather than one given problem. “Checkland (1981) argues that an action researcher should perceive the aim of projects to improve problem situations, that is, situations where there may be a number of problems, rather than ‘solve’ a particular problem.” [Avison et al. 2001] This case study describes the small incremental steps in an AR process: developing a partnership; creating a vision; participatory diagnosing of the problem; action planning and implementation, and participatory evaluation. Each of these small incremental steps, took place in a flexible manner and were enacted as a team or partnership. 4.4
Generalisations from interpretive Action Research studies
One of the outcomes of an AR process is the learnings which should take place, both on a practical and theoretical level. In interpretive case studies, not just AR approaches, this can be a significant challenge [Lee and Baskerville Proceedings of SAICSIT 2005
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2003]; [Walsham 1995]. The challenge of generalisations concerns how results from a particular case study, whether in terms of methodologies adopted or theoretical insights generated, can be abstracted, and applied to, other settings. Unlike positivist studies which rely on statistical generalisations [Baskerville 1996], interpretive research poses different sets of challenges around generalisations, especially relating to what can be generalised, how and to what extent. One of the reasons as to why generalisations are not typically made from interpretive research is that generalisations are often narrowly, and arguably inappropriately, confined to a positivist view of research. Positivist studies generally adopt statistical-based approaches to develop mathematical relationships between independent and dependent variables, and extrapolate the results from the sample studied to the larger population within specified statistical confidence intervals [Baskerville 1996]. Interpretive research has been criticised from this perspective for its results being ‘non-generalisable’ to larger populations because its focus is ‘only’ on a single case study or ‘only’ one organisation [Baskerville and Lee 1999]. Empirical and theoretical generalisations from interpretive case studies are both necessary and possible, however, they require approaches different from those used in positivist studies. Examples of generalisations, from the above case study, include the manner in which participation was reconceptualised through this study and how this re-conceptualisation has more general learnings to other settings. Another generalisation relates to the development of a communication framework which extends Habermas’ criteria for the attainment of the ‘Ideal Speech Situation’ and can be used in other IS design contexts2 . Much valuable insight and experience is lost in IS design and development from the lack of developing and disseminating such learnings. 5.
CONCLUSION
There is a lot to be learnt from AR and “No other research approach has the power to add to the body of knowledge and deal with the practical concerns of people in such a positive manner.”[Avison et al. 2001] Though the case study above relates to a community-based health IS, the implications for AR from this case study are applicable to other AR studies. The main contributions are twofold. Firstly, there is the need to rigorously describe the process undertaken and not just focus on the output of any Ar project. Secondly, a number of more general implications are the need to: • be explicit, given the various forms of AR, about the epistemological stance of the research and who has the authority in the project when describing the processes undertaken; • develop networks of action, rather than focus on one site or unit, if the project is to be sustainable; • adopt a longitudinal and participatory approach to develop trusting relationships, to develop the capacity to participate and to build on exiting structures and institutions, and • avoid the loss of much valuable insight in IS design by developing generalisations on a theoretical and empirical level from interpretive IS research. If thorough descriptions of the AR process are given and the above implications addressed, then AR will be regarded as not only an acceptable scientific research approach, but a preferable approach in which to conduct AR in an ever-changing society. ACKNOWLEDGMENTS
I wish to thank all the people from uThukela District who assisted with the research. In particular thanks to the staff from the uThukela District Child Survival Project and the Department of Health, who assisted with the carrying out of the field research, the data analysis and the implementation of the IS. Financial support for the research was provided by a World Vision/USAID grant to uThukela District Child Survival Project and was partially supported by the research project, District Health Information Systems in South Africa, jointly funded by the National Research Councils of Norway and South Africa (2003-2005). I am grateful for the advice and support given to me by my PhD supervisors Dr. Uta Lehmann, University of the Western Cape and Prof. Sundeep Sahay, University of Oslo.
REFERENCES Avison, D., Baskerville, R., and Myers, M. 2001. Coontrolling action research projects. Information Technology and People 14, 1, 28–45. 2 Details
of these specific generalisations can be found in [Byrne and Sahay 2005].
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Baskerville, R. 1996. Deferring Generalizability: Four Classes of Generalization in Social Enquiry. Scandinavian Journal of Information Systems 8, 2 (November), 5–28. Baskerville, R. 1999. Investigating Information Systems with Action Research. Communications of the Association for Information Systems 2, 19 (October), 1–31. Baskerville, R. and Lee, A. S. 1999. Distinctions among Different Types of Generalizing in Information Systems Research. In New Information Technologies in Organizational Processes: Field Studies and Theoretical Reflections on the Future of Work, O. Ngwenyama, L. Introna, M. Myers, and J. DeGross, Eds. Kluwer Academic Publishers, New York, 49–65. Baskerville, R. and Wood-Harper, A. T. 1998. Diversity in Action Research Methods. European Journal of Information Systems 7, 90–107. Baskerville, R. and Wood-Harper, T. 1996. A critical perspective on action research as a method for informaiton system research. Journal of Information Technology 11, 235–246. Braa, J., Monteiro, E., and Sahay, S. 2004. Networks of actions: sustainable health information systems across developing countries. MIS Quarterly 28, 3, 337–362. Byrne, E. and Sahay, S. 2005. Generalisations from a qualitative South African information systems case study. In proceedings of IFIP (International Federation for Information Processing) 9.4 conference, Abuja, Nigeria. Chambers, R. 1999. Whose Reality Counts? Putting the first last. Intermediate Technology Publications. Checkland, P. 1991. From Framework through Experience to Learning: the essential nature of Action Research. In Information Systems Research: Contemporary Approaches and Emergent Traditions, H. E. Nissen, H. K. Klein, and R. Hirschheim, Eds. Elsevier Science Publishers B.V., North-Holland, 397–403. Chisholm, R. F. and Elden, M. 1993. Features of emerging action research. Human Relations 46, 2, 275–298. Elden, M. and Chisholm, R. F. 1993. Emerging Varieties in Action Research. Human Relations 46, 2, 121–141. Elden, M. and Levin, M. 1991. Cogenerative learning - bringing participation into action research. In Participatory Action Research, W. F. Whyte, Ed. Sage Publication, Chapter 9, 127–142. Gibson, C., Kerry, T., and Kerry, C. 1999. Child Health Situational Analysis for oKhahlamba-eMtshezi. Written on behalf of the UThukela District Child Survival Project. Gibson, C., Kerry, T., Mchunu, Z., Khumalo, Z., and Kerry, C. 2000. The household and community component of the Integrated Management of Childhood Illness (IMCI). Written on behalf of the UThukela District Child Survival Project. Phase II report - New research. Kock, N. and Lau, F. 2001. Information systems action research: serving two demanding masters. Information Technology and People 14, 1, 6–11. Lau, F. 1997. Information Systems and Qualitative Research. In A Review on the Use of Action Research in Information Systems Studies, A. Lee, J. Liebenau, and J. DeGross, Eds. Chapman and Hall, London, 31–68. Lee, A. S. and Baskerville, R. L. 2003. Generalizing Generalizability in Information Systems Research. Information Systems Research 14, 3 (September), 221–243. Susman, G. and Evered, R. 1978. An Assessment of The Scientific Merits of Action Research. Administrative Science Quarterly 23, 4, 582–603. Walsham, G. 1995. Interpretive case studies in IS research: nature and method. European Journal of Information Systems 4, 74–81. Walsham, G. and Sahay, S. forthcoming. Research on is in developing countries: Current lanscape and future prospects. Information technology for Development.
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