John Oetzel

Tuhinga whakarāpopoto () Poor, unaffordable and overcrowded housing among Māori in Aotearoa New Zealand is one of the converging societal trends to impact significantly on older Māori ageing in place and in age-friendly environments. Some kaupapa Māori (Māori approach) organisations have sought to develop kaumātua (elders) villages to address these challenges. From the study of one such village, a toolkit of successful practices was developed. The purpose of this article is to describe the research design and methods for a project that will use this toolkit to develop community determined villages in three additional communities. The research approach involves process evaluation using photovoice, interviews, wānanga (consultation meetings) seminars and meeting’s notes, along with summative evaluation using surveys. The research process is grounded in a culture-centred and co-design approach with a vision underpinned by tikanga Māori (Māori custom) and te ao Māori (Māori world) that ...

Objective The aim of this study was to examine ways that older Māori (New Zealand’s Indigenous people) enhanced their ability to be peer educators and how this role impacted on their sense of purpose and well-being in later life. Method Kaupapa Māori and community-based participatory research principles guided the peer intervention involving 26 Māori kaumātua (older people 55 years and older) as peer educators (tuakana) for 121 other kaumātua (teina) facing transitions in later life. Each pair held up to 3 conversations; independent coders rated tuakana communication skills. We used mixed methods in a pre- and post-test, clustered staggered design. Participants completed baseline and post-intervention assessments of health and well-being consistent with Māori worldviews. 5 focus groups involving 22 teina and 1 with 5 tuakana were held. Results Tuakana communication skills were rated as high by teina and independent coders. Qualitative analysis supported the importance of Māori commu...

Critically reflecting on researcher–community partnerships is a key component in implementing chronic condition interventions in Indigenous communities. This paper draws on the results and learnings from a process evaluation that measures how well two research–community partnerships have followed the He Pikinga Waiora (HPW) Implementation Framework while co-designing chronic condition interventions in primary care. The HPW framework is centred on Indigenous self-determination and knowledge surrounded by community engagement, cultural centredness, systems thinking and integrated knowledge translation. The evaluation included in-depth interviews and online surveys with 10 team members. The findings demonstrate that the HPW framework was followed well, with strengths particularly in community engagement and relationship building. Areas for improvement included systems thinking and integrated knowledge translation to support sustainability of the interventions. The need for partnerships...

Low utilization of palliative care services by Māori remains despite increases in services designed to meet Māori needs. The purpose of this study is to explore palliative care information brochures in the context of Māori principles of well-being and communication protocols, and health literacy. We examined 99 brochures from palliative care services in New Zealand and held two focus groups with 12 Māori elders (kaumātua) and extended family (whanau) members. Taking a cultural-discursive approach incorporating Māori worldviews, we analysed textual and conceptual features of the brochures. The findings centred on cultural connection and disconnection within the brochures and serve as a critique of the prominent messages currently presented in these brochures. The findings raise questions about the capacity of agencies to convey culturally resonant messages to kaumātua and their whānau. We identify implications of palliative care brochures for health literacy of provider organizations...

New Zealand has an increasing multicultural and ageing population with greater increases in the population of Māori (indigenous people) than of Pākehā (European descent) projected. These changing demographics, along with the Treaty of Waitangi which frames relationships, services and politics in healthcare and elsewhere, result in a need for culturally effective and appropriate palliative care services.1 One key element for this level of service is the quality of communication among patients/carers and palliative care workers (PCW). Effective communication is challenging during the end-of-life journey, and the challenge is potentially exacerbated when PCW come from a different culture than their patients as has been found in New Zealand.1 Understanding how and why these challenges occur can be examined by exploring perspectives about ideal communication behaviours during palliative care. If there are differences in the ideal, both parties can communicate effectively from their own perspective and still ‘bypass’ each other. Thus, the purpose of our study was to identify differences in the ideal communication behaviours among kaumātua (elders 55 and older), their whānau (extended family) and PCW. This study was led by a Māori community health organisation that provides health and well-being services to kaumātua and involved a collaboration of health researchers/doctors, PCW and community members using a kaupapa Māori research approach.2 A kaupapa Māori approach provides a culturally rich methodology as it normalises Māori worldviews and practices through recognition of Māori language and culture. We interviewed 21 kaumātua with experience in end-of-life care with a partner or whānau member. Data collection involved soliciting stories about their experiences with end-of-life care. We conducted five focus groups with 39 whānau members from 14 distinct whānau groups all with experience in end-oflife care. Data collection involved using provocative statements to start a conversation and encourage the sharing of individual and whānau experiences. We also conducted three focus groups for the PCW – one group of six from a hospital palliative care team (all Pākehā), another group were eight members of a hospice team (seven Pākehā and one Pacific Islander) and a final group of seven Māori members from the community health organisation. Semistructured questions focussed on ideal interactive and cultural aspects during palliative care. Thematic analysis of the transcripts was completed by two researchers (one Māori and one Pākehā) to have a cultural insider and outsider perspective. Further details on the methods can be found elsewhere.3 Results identified some commonalities about ideal communication and yet three key differences emerged, particularly around cultural issues. Table 1 provides exemplar quotes for these themes. First, non-Māori PCW and kaumātua focussed on avoiding prejudice and cultural mistakes (e.g. placing a bedpan on a table where food is eaten) during palliative care rather than using tikanga (cultural practices such as waiata (songs) and karakia (prayers)) to support well-being. In contrast, whānau and Māori PCW suggested the significance of respecting and enabling tikanga to enhance the quality of care and facilitate wellbeing not simply avoiding mistakes. Second, kaumātua emphasised the need for whānaungatanga (relationship building) during end-of-life care to ensure a positive relationship was developed and honoured during the administration of palliative care. In contrast, whānau and PCW offered relationships that should be built before needing care as well as during care. They suggested that these foundations would enable whānau and kaumātua to understand their rights and the Differences in ideal communication behaviours during end-of-life care for Māori carers/patients and palliative care workers

The purpose of this study is to explore the cultural practices and communication tensions perceived among Māori kaumātua (elders) and their whānaunga (extended family) during the end-of-life journey. Further, the study aims to explore the manner in which the tensions are managed. The study was framed by relational dialectics theory and included interviews with 21 kaumātua and focus groups with 39 whānau members. The study identified three cultural practices (dying at home, prayer, and song) that helped to build connection among the family members and also helped to connect the dying person to the spiritual world. Further, four communication tensions were noted: (a) autonomy and connection; (b) conflict and connection; (c) isolation and connection; and (d) balancing the needs of self and other. To manage these tensions, the following strategies were used: (a) coordination conversations; (b) inclusion in decision-making conversations; (c) emotional support within the whānau; and (d) passing on lessons to the next generation.

PurposePrior research demonstrates the importance of face in conflict situations. However, the direct relationship of face concerns to facework behaviors has limited empirical support. Therefore, the purpose of this study is to investigate the relationships among self‐, other‐, and mutual‐face concern and 11 facework strategies within Chinese, Japanese, German, and USA national cultures in recalled conflict situations.Design/methodology/approachThe study was conducted by administering a survey to 768 participants from China, Japan, Germany, and the USA who recalled a conflict situation. Participants completed a self‐report questionnaire about their attitudes and conflict behaviors during a recalled conflict. Regression analysis and comparisons of correlations were utilized to examine relationships between face concerns and facework across the four cultures.FindingsThe major findings are: other‐face is associated with remain calm, apologize, private discussion, giving in and pretend ...

ABSTRACT This study linked emotion to the theoretical assumptions of the face-negotiation theory and probed the critical role of anger, compassion, and guilt in understanding the complex pathways of their relationships with self-construal, face concerns, and conflict styles in U.S. and Chinese cultures. Results showed that anger was associated positively with independent self-construal, self-face concern, and the competing style, and compassion was associated positively with interdependent self-construal, other-face concern, and the integrating, compromising, and obliging styles. Guilt was related positively with interdependent self-construal and the obliging style in the United States, and with interdependent self-construal and the avoiding style in China. Overall, emotion mediated the effects of self-construal and face concerns on conflict styles in both cultures, but cultural differences also emerged.

This study sought to test the underlying assumption of the face-negotiation theory that face is an explanatory mechanism for culture’s influence on conflict behavior. A questionnaire was administered to 768 participants in 4 national cultures (China, Germany, Japan, and the United States) asking them to describe interpersonal conflict. The major findings of this study are as follows: (a) cultural individualism-collectivism had direct and indirect effects on conflict styles, (b) independent self-construal related positively with self-face and interdependent self-construal related positively with other-face, (c) self-face related positively with dominating conflict styles and other-face related positively with avoiding and integrating styles, and (d) face accounted for all of the total variance explained (100% of 19% total explained) in dominating, most of the total variance explained in integrating (70% of 20% total explained), and some of the total variance explained in avoiding (38...

Background Community-Based Participatory Research (CBPR) is often used to address health inequities due to structural racism. However, much of the existing literature emphasizes relationships and synergy rather than structural components of CBPR. This study introduces and tests new theoretical mechanisms of the CBPR Conceptual Model to address this limitation. Methods Three-stage online cross-sectional survey administered from 2016 to 2018 with 165 community-engaged research projects identified through federal databases or training grants. Participants (N = 453) were principal investigators and project team members (both academic and community partners) who provided project-level details and perceived contexts, processes, and outcomes. Data were analyzed through structural equation modeling and fuzzy-set qualitative comparison analysis. Results Commitment to Collective Empowerment was a key mediating variable between context and intervention activities. Synergy and Community Engagem...

Public health has endorsed the use of community-based participatory research (CBPR) to address health inequities involving diverse and marginalized communities. However, few studies have examined how group diversity among members of CBPR partnerships influenced how well the partnerships achieve their goals of addressing health inequities through equitable collaboration. We conducted secondary, convergent, mixed methods analysis to (1) evaluate the association between group diversity and participatory decision-making within CBPR partnerships, and (2) identify the perceived characteristics, benefits, and challenges of group diversity within CBPR partnerships. Using data from a crosssite study of federally funded CBPR partnerships, we analyzed and integrated data from surveys of 163 partnerships (n = 448 partners) and seven in-depth case study interviews (n = 55 partners). Quantitatively, none of the measured characteristics of group diversity was associated with participatory decisionmaking within the partnerships. Qualitatively, we found that partnerships mainly benefited from membership differences in functional characteristics (e.g., skillset) but faced challenges from membership differences in sociocultural characteristics (e.g., gender and race). The integrated findings suggest the need to further understand how emergent group characteristics and how practices that engage in group diversity contribute to collective functioning of the partnerships. Attention to this area can help promote health equity achievements of CBPR partnerships.

This chapter explores some of the challenges in evaluating PHR. Firstly, it examines the reasons for evaluating participatory health research (PHR), placing that need in the context of different paradigms of public health research and the ongoing debates about methodology and different models of evaluation. Four key issues/challenges are identified. Secondly, this chapter introduces the community-based participatory research (CBPR) conceptual model as a framework that helps to address these key issues. Thirdly, this chapter includes several cases to illustrate ways of PHR evaluation: from New Zealand, the USA (including communities of immigrants/refugees), and Nicaragua. Finally, this chapter ends with a discussion on ways in which PHR researchers can proactively evaluate their research, so lessons can be learnt and case studies can be developed to showcase alternative ways of documenting process, impact, and outcomes. This discussion highlights how the conceptual model addresses some of the key issues surrounding the evaluation of PHR.

This article describes a mixed methods study of community-based participatory research (CBPR) partnership practices and the links between these practices and changes in health status and disparities outcomes. Directed by a CBPR conceptual model and grounded in indigenous-transformative theory, our nation-wide, cross-site study showcases the value of a mixed methods approach for better understanding the complexity of CBPR partnerships across diverse community and research contexts. The article then provides examples of how an iterative, integrated approach to our mixed methods analysis yielded enriched understandings of two key constructs of the model: trust and governance. Implications and lessons learned while using mixed methods to study CBPR are provided.

One of the major challenges facing those working with people living with HIV (PLWH) is the increased potential for burnout, which results in increased turnover and reduces quality of care provided for PLWH. The goal of this study was to examine the relationship among HIV health-care providers' burnout (emotional exhaustion and depersonalization) and organizational culture including teamwork, involvement in decision-making, and critical appraisal. Health-care providers for PLWH (N = 47) in federally funded clinics in a southwestern state completed a cross-sectional survey questionnaire about their perceptions of organizational culture and burnout. The results of multiple regression analysis indicated that positive organizational culture (i.e., teamwork) was negatively related to emotional burnout (p < .005, R(2) = .18). Further negative organizational culture (i.e., critical appraisal) was positively related to depersonalization (p < .005, R(2) = .18). These findings suggest that effective organizational communication interventions might protect HIV health-care providers from burnout.

The purpose of this study was to investigate the influence of 3 subjective cultural variables--self-construals (independence and interdependence), ethnic identity (bicultural, assimilation, traditional, and marginal), and cultural health attributions (equity and behavioral-environmental attributions)--on source, message, and channel preferences for receiving breast health information by Hispanic women age 35 or older. Subjective cultural variables collectively accounted for 2% to 28% of the variance in communication preferences. In addition, several associations were discovered: (a) having an interdependent self-construal was associated positively with preferences for significant other as a source, family sources, fear messages, media channels, and face-to-face channels; (b) having a bicultural identity was associated positively with preferences for family sources and media channels, but negatively with a desire for no information; and (c) having a marginal identity and equity attributions were associated positively with preferences for fear messages and a desire for no information, but negatively with preferences for expert sources. These findings are discussed in the context of tailoring breast health information to Hispanic women using computer technology and entertainment-education.

Despite international efforts, national and ethnic disparities in utilization of breast cancer (BC) screenings prevail. In the United States, Hispanic women have one of the lowest BC screening rates. The purpose of our study was to examine how Hispanic women in New Mexico described their breast care behavior (BCB; BC screening practices, motivation to act, and breast care information behavior). Analysis of focus groups revealed five types of approaches to BCB. These findings have global implications for health care practitioners in directing attention toward the complexity of BC preventive behavior. Implications for other ethnic groups are discussed.

Purpose. The purpose of this study is to establish the psychometric properties of 22 measures from a community-based participatory research (CBPR) conceptual model. Design. The design of this study was an online, cross-sectional survey of academic and community partners involved in a CPBR project. Setting. CPBR projects (294) in the United States with federal funding in 2009. Subjects. Of the 404 academic and community partners invited, 312 (77.2%) participated. Of the 200 principal investigators/project directors invited, 138 (69.0%) participated. Measures. Twenty-two measures of CBPR context, group dynamics, methods, and health-related outcomes were examined. Analysis. Confirmatory factor analysis to establish factorial validity and Pearson correlations to establish convergent and divergent validity were used. Results. Confirmatory factor analysis demonstrated strong factorial validity for the 22 constructs. Pearson correlations (p < .001) supported the convergent and divergent...

Background Health inequities experienced by kaumātua (older Māori) in Aotearoa, New Zealand, are well documented. Examples of translating and adapting research into practice that identifies ways to help address such inequities are less evident. The study used the He Pikinga Waiora (HPW) implementation framework and the Consolidated Framework for Implementation Research (CFIR) to explore promising co-design and implementation practices in translating an evidence-based peer-education programme for older Māori to new communities. Methods The study was grounded in an Indigenous methodology (Kaupapa Māori) and a participatory research approach. Data were collected from research documentation, community meeting and briefing notes, and interviews with community researchers. Results The data analysis resulted in several key promising practices: Kaumātua mana motuhake (kaumātua independence and autonomy) where community researchers centred the needs of kaumātua in co-designing the programme ...

We explored the relationship of community-engaged research final approval type (tribal government, health board, or public health office (TG/HB); agency staff or advisory board; or individual or no community approval) with governance processes, productivity, and perceived outcomes. We identified 294 federally funded community-engaged research projects in 2009 from the National Institutes of Health's Research Portfolio Online Reporting Tools, Centers for Disease Control and Prevention's Prevention Research Centers, and Native American Research Centers for Health databases. Two hundred (68.0%) investigators completed a survey about governance processes and productivity measures; 312 partners (77.2% of 404 invited) and 138 investigators (69.0% of 200 invited) completed a survey about perceived outcomes. Projects with TG/HB approval had increased likelihood of community control of resources (odds ratios [ORs] ≥ 4.80). Projects with other approvals had decreased likelihood of dev...

This essay synthesizes the research on intimate partner violence (IPV) in American Indian and/or Alaska Native communities using a social ecological framework. The review of literature demonstrates that American Indian and/or Alaska Native women are at an elevated risk for IPV compared to non-American Indian women and thus this essay describes multi-level interventions that are culturally appropriate for American Indian and/or Alaska Native communities. The interventions address a variety of determinants including gender, age, socioeconomic status, alcohol, European colonization, and infrastructure.

This essay synthesizes the research on intimate partner violence (IPV) in American Indian and/or Alaska Native communities using a social ecological framework. The review of literature demonstrates that American Indian and/ or Alaska Native women are at an elevated risk for IPV compared to non-American Indian women and thus this essay describes multi-level interventions that are culturally appropriate for American Indian and/or Alaska Native communities. The interventions address a variety of determinants including gender, age, socioeconomic status, alcohol, European colonization, and infrastructure. The annual economic victim-related costs of intimate partner violence (IPV) in the U.S. have been estimated at $67 billion (Miller, Cohen, & Wiersema, 1996). These costs are associated with the severe and negative health and social consequences of violence to victims of IPV. These consequences include lower physical health (Brokaw et al., 2002; Hathaway et al., 2000; McNutt, Carlson, Pe...

In recent decades, there has been remarkable growth in scholarship examining the usefulness of community-engaged research (CEnR) and community-based participatory research (CBPR) for eliminating health inequities.This article seeks to synthesize the extant literature of systematic reviews, scoping reviews, and other related reviews regarding the context, processes, and research designs and interventions underlying CEnR that optimize its effectiveness. Through a scoping review, we have utilized an empirically derived framework of CBPR to map this literature and identify key findings and priorities for future research. Our study found 100 reviews of CEnR that largely support the CBPR conceptual framework.

BACKGROUND As federal research funding focuses more on academic/community collaborations to address health inequities; it is important to understand characteristics of these partnerships and how they work to achieve health equity outcomes. OBJECTIVES This study built on previous National Institutes of Health-funded research to: (a) describe partnership characteristics and processes of federally funded, community-based participatory research (CBPR) or community-engaged research (CEnR) projects; (b) explore characteristics of these projects by stage of funding; and (c) build on previous understanding of partnership promising practices. METHODS Between fall 2016 and spring 2017, we completed a cross-sectional analysis and principal component analysis of online survey data from key informants of federally funded CBPR and CEnR projects. Respondents for 179 projects (53% response rate) described project characteristics (e.g., type of partner, stage of partnership, and population) and the use of promising practices (e.g., stewardship, advisory board roles, training topics) by stage of partnership. RESULTS Projects involved community, healthcare, and government partners, with 49% of respondents reporting their project was in the early stage of funding. More projects focused on Black/African-American populations, while principal investigators were mostly White. The more established a partnership (e.g., with multiple projects), the more likely it employed the promising practices of stewardship (i.e., community safeguards for approval), community advisory boards, and training on values and power. CONCLUSIONS Community engagement is a developmental process with differences between early-stage and established CBPR partnerships. Engaging in active reflection and adopting promising partnering practices are important for CBPR partnerships working to improve health equity. The data provided in this study provide key indicators for reflection.

Background: Māori kaumātua (elders) face stark health and social inequities compared to non-Māori New Zealanders. The tuakana-teina (older sibling-younger sibling) peer education programme is a strengths-based approach to enhance well-being and social connectedness. The purpose of this study is to present the baseline data from this programme and identify correlates of well-being outcomes.Method: Participants included 128 kaumātua who completed a self-report survey about health-related quality of life, spirituality, social connection and loneliness, life satisfaction, cultural identity and connection, elder abuse, health service utilisation and demographics.Findings: Multiple regression models illustrated the following correlates of outcomes: (a) self-rated health: needing more help with daily tasks (β = −0.36) and housing problems (β = –0.17); (b) health-related quality of life: needing more help with daily tasks (β = –0.31), housing problems (β = –0.21), and perceived autonomy (β ...

The Ryan White HIV/AIDS Program (RWHAP) has been effective in serving people living with HIV (PLWH). Our goal was to examine the impact of the implementation of the Affordable Care Act (ACA) on the program's role in HIV care and its clients. We utilized critical review to synthesize the literature on the anticipated effects of the ACA, and assess the evidence regarding the early effects of the ACA on the program and on PLWH who receive RWHAP services. To date, research on the impact of ACA on RWHAP has been fragmented. Despite the expected benefits of the ACA to PLWH, access and linkage to care, reducing inequity in HIV risk and access to care, and coping with comorbidities remain pressing challenges. There are additional gaps following ACA implementation related to immigrant care. RWHAP's proven success in addressing these challenges, and the political threats to ACA, highlight the need for maintaining the program to meet HIV care needs. More evidence on the role and impact...

The literature regarding implementation science of evidence-based health interventions in Māori communities is limited, and there is a push for new and innovative delivery methods of health interventions in New Zealand. The purpose of the study was to identify the facilitators and barriers in implementing a health intervention designed by others and was framed by the Consolidated Framework for Implementation Research (CFIR). This study explored general perceptions of the implementation process and also included a case study, the Kaumātua Mana Motuhake (older people's autonomy and self-actualization) project; a codesigned peer education intervention for older Māori. Semistructured interviews (N = 17) were conducted via face-to-face, phone, or Zoom with health and social service professionals with experience working with Māori communities. Thematic analysis was used to analyze the data. The facilitators included community engagement, program structure, program adaptability and cre...

Background Aotearoa/New Zealand has a population that is ageing and there are challenges to health and social outcomes related to related to key life transitions (e.g., retirement, change in health conditions, loss of spouse). Further, there are significant inequities between Māori (Indigenous people) and non-Māori in ageing outcomes. The purpose of this study was to test the impacts and cost effectiveness of a tuakana/teina (peer education) intervention on kaumātua (elders) receiving the intervention. This study was framed by a strengths-based approach based on the key cultural concept of mana motuhake (autonomy and self-actualisation). Methods This study was grounded in principles of Kaupapa Māori and community-based participatory research to bring together a diverse group of stakeholders to co-develop and co-evaluate the intervention. The intervention had tuakana (peer educators) having conversations with up to six teina (recipients) and providing information related to health an...

© 2020 Australian Health Promotion Association Issue addressed: One of the biggest concerns for human health in the 21st century is the ever-increasing rate of obesity and its associated budgetary implications for publicly funded health care service provisioning. This study at the outset explores the multifaceted nature of food-related consumption choices and outcomes of obesity, and later offers suggestions to improve the existing interventional strategies to curtail the epidemic. Methods: A total of 24 participants were recruited through poster invitations placed around the greater metropolitan area of Auckland, New Zealand. Participants shared their health care intervention program experiences through in-depth, semi-structured interviews. Data were analysed in keeping with traditions of constructivist grounded theory. Findings: Analysis revealed various concurrent individually acting and ecologically mediated processes which led to obesogenic outcomes as a result of social actors’ (participants) engagement in acts of (food-related) consumption practices. Conclusions: This study helps to illustrate the underlying, multifaceted processes that lead to obese individuals feeling defeated or disempowered and categorically willing, yet unable to bring about healthy changes in their lives. We hope this study will prompt health care practitioners to take a holistic approach while conceiving and deploying health care intervention programs. So what?: Current health care interventional programs are not achieving optimum solutions for those in need. All future programs need to acknowledge the roles played by an individual, as well as ecological factors, while deploying client-centric intervention solutions. Perhaps these programs are in need of a team-based approach to offer a truly “wrap-around” service provisioning strategy, rather than the traditional one-on-one consultative approaches in use at current times.

A key challenge in evaluating the impact of community-based participatory research (CBPR) is identifying what mechanisms and pathways are critical for health equity outcomes. Our purpose is to provide an empirical test of the CBPR conceptual model to address this challenge. A three-stage quantitative survey was completed: (1) 294 US CBPR projects with US federal funding were identified; (2) 200 principal investigators completed a questionnaire about project-level details; and (3) 450 community or academic partners and principal investigators completed a questionnaire about perceived contextual, process, and outcome variables. Seven in-depth qualitative case studies were conducted to explore elements of the model not captured in the survey; one is presented due to space limitations. We demonstrated support for multiple mechanisms illustrated by the conceptual model using a latent structural equation model. Significant pathways were identified, showing the positive association of cont...

Internationally, the interest in involving patients and the public in designing and delivering health interventions and researching their effectiveness is increasing. Several systematic reviews of participation in health research have recently been completed, which note a number of challenges in documenting the impact of participation. Challenges include working across stakeholders with different understandings of participation and levels of experience in reviewing; comparing heterogeneous populations and contexts; configuring findings from often thin descriptions of participation in academic papers; and dealing with different definitions of impact. This paper aims to advance methods for systematically reviewing the impact of participation in health research, drawing on recent systematic review guidance. Practical examples for dealing with issues at each stage of a review are provided based on recent experience. Recommendations for improving primary research on participation in heal...