Engaging our communities: What is participatory appraisal?

A different approach to patient and public involvement

We have been using participatory appraisal techniques to design better health and care services for the past few years, including in the Northstowe Healthy New Town project (see Designing a healthy future with citizens at the heart)[i][ii]. We are working with local healthcare organisations to build it into their patient and public involvement (PPI) strategies, with a focus on co-development of services around the needs of local populations. You may not have heard about it, but you may already be practicing some elements of participatory appraisal within your own service design process.

What is participatory appraisal?

Participatory appraisal is a community-based approach to research that values people as experts in their own lives, builds community knowledge and encourages grassroots action. [iii][iv] It provides a better way to activate and co-design new health and care services with the public. Participatory appraisal was developed in Africa and Asia and is now used across the globe. It uses a flexible, accessible approach that draws on a range of visual tools which means that anyone can join in, regardless of background. A facilitating organisation listens and learns, with public engagement being carried out in a place where people already spend their time in their local area. It’s the method of drawing out the experiences, knowledge and ideas of local experts that makes participatory appraisal unique.

How does it work?

You can use participatory appraisal in many ways. It can be used to map local priorities and understand issues. It can be harnessed for ongoing research, learning and development and it can also be effective as part of empowering and enabling people to analyse and tackle their problems themselves. It is a community approach, which means that it doesn’t rely on specific events but instead reaches out to as many individuals in the community as possible. Using facilitators who live in and understand the area, it taps into networks that organisations aren’t usually able to reach. It asks the question, ‘who is not involved that should be?’ in order to includes those often don’t participate in consultation.

Why should you use it?

The strengths of participatory appraisal are numerous. They include:

• PA focusses on visual and flexible methods of communication including arts and drama, making it accessible to people of all ages and cultures, and it doesn’t require literacy.
• It mixes group work and individual input, reducing barriers to involvement
• Community ownership replaces closed ownership of information, giving greater transparency both of the process and ideas
• It values local knowledge and information and places local people as experts, empowering them to be catalysts in the community. Members trained in PA facilitation techniques develop lifelong skills
• Knowledge produced by local community researchers has been proven to be highly reliable and can help identify and tackle underlying issues

When should you use participatory appraisal?

You should use this approach when you are willing to let the community take control, when you want to base your actions on local knowledge and when you want to reach out to very diverse members of a community. It can deliver empowered participants, better relationships between participant groups, reliable and valid mapping of local knowledge and priorities, action and energy, as well as being a good tool to make decisions.

Examples of ways participatory appraisal can be used include:

• Mapping exercises – Participants map their own locality. This locates specific groups of people, resources, areas of self-interest or areas for community change.
• Timelines and trend analysis – Ongoing work to identify changes over time, including in the local economy, resources, population or issues of health and education.

It shouldn’t really be used as a one-off activity, but rather as a process of engagement that should lead to action; as a way to enable exploration of issues and experiences, and to develop community insights.

References

• [i] East of England Citizen’s Senate https://www.eoecitizenssenate.org/
• [ii] https://www.youtube.com/watch?v=IRh4hQcYTf0
• [iii] Northstowe Project Hopes – Helen Oliver EAHSN https://www.youtube.com/watch?v=IRh4hQcYTf0
• [iv] https://involve.org.uk/resource
• Community Empowerment Collective Review of Participatory Appraisal http://cec.vcn.bc.ca/cmp/modules/par-tech.htm
• Alaszewski, A and Crones, M (1996) Health needs and deprivation on Bransholme final report of a rapid appraisal study of primary health care. Hull: The University of Hull: Institute of Health Studies
• Chambers, R. (1992) Rural Appraisal: Rapid, Relaxed and Participatory. Discussion Paper 311: Brighton: Institute of Development Studies
• Chambers, R. (1994) The Origins and Practice of Participatory Rural Appraisal. World Development Vol. 22 pp953-969