Journal of Cross-Cultural Gerontology

, Volume 28, Issue 1, pp 1–25 | Cite as

Using Participatory Approaches with Older People in a Residential Home in Guyana: Challenges and Tensions

  • Gillian Hewitt
  • Alizon K. Draper
  • Suraiya Ismail


Participatory approaches are a popular and entrenched strategy in community development, yet a number of unresolved issues and tensions persist regarding the definition, rationales, outcomes and ethics of participation. Despite its popularity there are relatively few examples of participatory projects with older people or in institutional settings so their potential with this group is poorly understood. This case study presents some of the practical and ethical challenges that arose over the course of a participatory project that aimed to analyse and improve quality of life in a residential home for older people in Guyana. Through a qualitative process evaluation it examines the degree of participation achieved, the determinants of the participatory process, the benefits the approach brought and the ethical dilemmas encountered. Although the degree of participation achieved was limited, beneficial outcomes were observed, notably the selection of appropriate and desirable interventions and the effect on the residents themselves, who valued their part in the project. The participatory process was unpredictable and complex, however, and key determinants of it included the organizational dynamics of the home and the skills, actions and attitudes of the researcher. Adopting a participatory approach brought valuable benefits in a residential home, but others adopting the approach should ensure they critically consider at the outset the ethical and practical dilemmas the setting and approach may produce and have realistic expectations of participation.


Guyana Participation Process evaluation Residential homes 



We extend our thanks to the residents, staff and committee members of the home and to the GAPSW, Ms. Carlyn Fraser and the project fieldworker, Ms. Eartha Grant.


  1. Abelson, J., Forest, P.-G., Eyles, J., Smith, P., Martin, E., & Gauvin, F.-P. (2003). Deliberations about deliberative methods: issues in the design and evaluation of public participation processes. Social Science and Medicine, 57, 239–251.CrossRefGoogle Scholar
  2. Arnstein, S. (1969). A ladder of citizen participation. Journal of the American Institute of Planners, 35, 216–224.CrossRefGoogle Scholar
  3. Aubel, J., Touré, I., & Diagne, M. (2004). Senegalese grandmothers promote improved maternal and child nutrition practices: the guardians of tradition are not averse to change. Social Science & Medicine, 59, 945–959.CrossRefGoogle Scholar
  4. Baldwin, N., Harris, J., & Kelly, D. (1993). Institutionalisation: why blame the institution? Ageing and Society, 13, 69–81.CrossRefGoogle Scholar
  5. Blair, T., & Minkler, M. (2009). Participatory action research with older adults: key principles in practice. The Gerontologist, 49, 651–662.CrossRefGoogle Scholar
  6. Bourke, L. (2009). Reflections on doing participatory research in health: participation, method and power. International Journal of Social Research Methodology, 12, 457–474.CrossRefGoogle Scholar
  7. Brathwaite, F.S. (1989). Social life among females aged 75 and over in Barbados. In Mid-life and older women in Latin America and the Caribbean (pp. 253–264). Washington: Pan American Health Organization and American Association of Retired Persons.Google Scholar
  8. Brett, E. A. (2003). Participation and accountability in development management. Journal of Development Studies, 40, 1–29.CrossRefGoogle Scholar
  9. Bureau of Statistics. (2007). The co-operative republic of guyana population and housing census 2002. National Census Report. Guyana: Bureau of Statistics.Google Scholar
  10. Chambers, R. (1997). Whose reality counts? London: ITDG Publishing.Google Scholar
  11. Cornwall, A. (2002). Locating citizen participation. IDS Bulletin, 33, 49–58.CrossRefGoogle Scholar
  12. Cornwall, A. (2008). Unpacking ‘participation’: models, meanings and practices. Community Development Journal, 43, 269–283.CrossRefGoogle Scholar
  13. Cornwall, A., & Jewkes, R. (1995). What is participatory research? Social Science & Medicine, 41, 1667–1676.CrossRefGoogle Scholar
  14. Dickson, G. (1997) Participatory action research and health promotion: the grandmothers’ story. Saskatoon: University of Saskatchewan. Available at: (Accessed 2nd April 2012).
  15. Dickson, G. (2000). Aboriginal grandmothers’ experience with health promotion and participatory action research. Qualitative Health Research, 10, 188–213.CrossRefGoogle Scholar
  16. Doyle, M., & Timonen, V. (2010). Lessons from a community-based participatory research project: older people’s and researchers’ reflections. Research on Aging, 32, 244–263.CrossRefGoogle Scholar
  17. Draper, A. K., Hewitt, G., & Rifkin, S. (2010). Chasing the dragon: developing indicators for the assessment of community participation in health programmes. Social Science & Medicine, 71, 1102–1109.CrossRefGoogle Scholar
  18. Eldemire-Shearer, D. (2008). Ageing: the response yesterday, today and tomorrow. The West Indian Medical Journal, 57, 577–588.Google Scholar
  19. ESRC. (2005). Research ethics framework. Swindon: Economic and Social Research Council.Google Scholar
  20. Fiorino, D. J. (1990). Citizen participation and environmental risk: a survey of institutional mechanisms. Science, Technology and Human Values, 15, 226–243.CrossRefGoogle Scholar
  21. Goffman, E. (1991a). On the characteristics of total institutions. In E. G. Asylums (Ed.), Essays on the social situation of mental patients and other inmates (pp. 13–115). London: Penguin.Google Scholar
  22. Goffman, E. (1991b). The underlife of a public institution: a study of ways of making out in a mental hospital. In E. G. Asylums (Ed.), Essays on the social situation of mental patients and other inmates (pp. 157–280). London: Penguin.Google Scholar
  23. Government of Guyana. (2000) National Development Strategy (2001–2010). Available at: (Accessed 29th March 2012)
  24. Guijt, I. (1998). Participatory monitoring and impact assessment of sustainable agricultural initiatives. (SARL Discussion Paper No.1). London: International Institute for Environment and Development.Google Scholar
  25. HelpAge International. (2002). Participatory research with older people: a sourcebook. London: HelpAge International.Google Scholar
  26. Heslop, A. (1996). Report of a participatory needs assessment with muthande society for the aged in clermont township, Durban, South Africa. London: HelpAge International.Google Scholar
  27. Hewitt, G. (2005). Improving the health, nutrition and quality of life of elderly Guyanese living in residential homes. (PhD thesis) London: University of Westminster.Google Scholar
  28. Hewitt, G., Draper, A., Ismail, S., & Patterson, S. (2007). Improving food provision in a Guyanese home for the elderly: a participatory approach. Public Health Nutrition, 10, 552–558.CrossRefGoogle Scholar
  29. Higgs, P. (1998). Risk, governmentality and the reconceptualization of citizenship. In G. Scambler & P. Higgs (Eds.), Modernity, medicine and health (pp. 176–197). London: Routledge.Google Scholar
  30. Hodkinson, H. (1972). Evaluation of a mental test score for assessment of mental impairment in the elderly. Age and Ageing, 1, 233–238.CrossRefGoogle Scholar
  31. Hoeyer, K., Dahlager, L., & Lynöe, N. (2005). Conflicting notions of research ethics. The mutually challenging traditions of social scientists and medical researchers. Social Science & Medicine, 61, 1741–1749.CrossRefGoogle Scholar
  32. Hudelson, P. M. (1994). Qualitative research for health programmes. Geneva: World Health Organization.Google Scholar
  33. Kari, N., & Michels, P. (1991). The Lazarus Project: the politics of empowerment. American Journal of Occupational Therapy, 45, 719–7725.CrossRefGoogle Scholar
  34. Kelley, L. S. (2005). Growing old in St. Lucia: expectations and experiences in a Caribbean village. Journal of Cross-Cultural Gerontology, 20, 67–78.CrossRefGoogle Scholar
  35. Khanlou, N., & Peter, E. (2005). Participatory action research: considerations for ethical review. Social Science & Medicine, 60, 2333–2340.CrossRefGoogle Scholar
  36. Laliberte Rudman, D. (2006). Shaping the active, autonomous and responsible modern retiree: an analysis of discursive technologies and their links with neo-liberal political rationality. Ageing & Society, 26, 181–201.CrossRefGoogle Scholar
  37. Langley, A., Denis, J.-L., & Lamothe, L. (2003). Process research in healthcare: towards three-dimensional learning. Policy and Politics, 31, 195–206.Google Scholar
  38. Laverack, G., & Wallerstein, N. (2001). Measuring community empowerment: a fresh look at organizational domains. Health Promotion International, 16, 179–185.CrossRefGoogle Scholar
  39. Lavoie-Tremblay, M. (2004). Creating a healthy workplace: a participatory organizational intervention. Journal of Nursing Administration, 34, 469–474.CrossRefGoogle Scholar
  40. Lindeman, M. A., Black, K., Smith, R., Gough, J., Bryce, A., Gilsenan, B., Hill, K., & Stewart, A. (2003). Changing practice in residential aged care using participatory methods. Education and Health, 16, 22–31.CrossRefGoogle Scholar
  41. Mahoney, M. E., Potter, J.-L. L., & Marsh, R. S. (2007). Community participation in HIA: discords in teleology and terminology. Critical Public Health, 17, 229–241.CrossRefGoogle Scholar
  42. Mays, N., & Pope, C. (1995). Qualitative research: rigour and qualitative research. British Medical Journal, 311, 109–112.CrossRefGoogle Scholar
  43. Michener, V. J. (1998). The participatory approach: contradiction and co-option in Burkina Faso. World Development, 26, 2105–2118.CrossRefGoogle Scholar
  44. Morgan, L. M. (2001). Community participation in health: perpetual allure, persistent challenge. Health Policy and Planning, 16, 221–230.CrossRefGoogle Scholar
  45. Mosse, D. (1995). Social analysis in participatory rural development. PLA Notes, 24, 27–33.Google Scholar
  46. Myers, R. (2012). Guyana’s National Report on Ageing: a review and evaluation of the Brasilia Declaration, (Accessed 13 September 2012).
  47. Naylor, P.-J., Wharf-Higgins, J., Blair, L., Green, L., & O’Connor, B. (2002). Evaluating the participatory process in a community-based heart health project. Social Science & Medicine, 55, 1173–1187.CrossRefGoogle Scholar
  48. Nyanguru, A. (1987). Residential care for the destitute elderly: a comparative study of two institutions in Zimbabwe. Journal of Cross-Cultural Gerontology, 2, 345–357.CrossRefGoogle Scholar
  49. Patton, M. Q. (1987). How to use qualitative methods in evaluation. Newbury Park: Sage Publications.Google Scholar
  50. Pretty, J. N., Guijt, I., Thompson, J., & Scoones, I. (1995). Participatory learning and action: a trainer’s guide. London: IIED.Google Scholar
  51. Purdey, A. F., Bahadur Adhikari, G., Robinson, S. A., & Cox, P. W. (1994). Participatory health development in rural Nepal: clarifying the process of community empowerment. Health Education Quarterly, 21, 329–343.CrossRefGoogle Scholar
  52. Rifkin, S. B., Muller, F., & Bichmann, W. (1988). Primary health care: on measuring participation. Social Science & Medicine, 26, 931–940.CrossRefGoogle Scholar
  53. Rifkin, S. B., Lewando-Hunt, G., & Draper, A. K. (2000). Participatory approaches in health promotion and health planning: a literature review. London: Health Development Agency.Google Scholar
  54. Ritchie, M. (2000). Social capacity, sustainable development, and older people: lessons from community-based care in Southeast Asia. Development in Practice, 10, 638–649.CrossRefGoogle Scholar
  55. Ritchie, J., & Spencer, L. (1994). Qualitative data analysis for applied policy research. In A. Bryman & R. G. Burgess (Eds.), Analyzing qualitative data (pp. 173–194). London: Routledge.CrossRefGoogle Scholar
  56. Rowlands, J. (1997). Questioning empowerment: working with women in Honduras. Oxford: Oxfam.Google Scholar
  57. Shrestha, S. (2003). A conceptual model for empowerment of the female community health volunteers in Nepal. Education and Health, 16, 318–327.CrossRefGoogle Scholar
  58. Shura, R., Siders, R. A., & Dannefer, D. (2011). Culture change in long-term care: participatory action research and the role of the resident. The Gerontologist, 51, 212–225.CrossRefGoogle Scholar
  59. Theis, J., & Grady, H. M. (1991). Participatory rapid appraisal for community development. London: International Institute for Environment and Development.Google Scholar
  60. Townsend, P. (1962). The last refuge: a survey of residential institutions and homes for the aged in England and Wales. (Abridged edition). London: Routledge and Kegan Paul.Google Scholar
  61. Truman, C., & Raine, P. (2001). Involving users in evaluation: the social relations of user participation in health research. Critical Public Health, 11, 215–229.CrossRefGoogle Scholar
  62. UNPD. (2002). Population division of the Department of Economic and Social Affairs of the United Nations Secretariat. World Population Prospects: The 2002 Revision. (Accessed 27 October 2004).
  63. UNPD. (2010). Population division of the Department of Economic and Social Affairs of the United Nations Secretariat. World Population Prospects: The 2010 Revision. (Accessed 13 September 2012).
  64. van der Velde, J., Williamson, D. L., & Ogilvie, L. D. (2009). Participatory action research: practical strategies for actively engaging and maintaining participation in immigrant and refugee communities. Qualitative Health Research, 19, 1293–1302.CrossRefGoogle Scholar
  65. Waddington, D. (1994). Participant Observation. In C. Carsell & G. Symon (Eds.), Qualitative methods in organizational research. London: Sage Publications.Google Scholar
  66. Wallerstein, N. (2006). What is the evidence on effectiveness of empowerment to improve health? Copenhagen: WHO Regional Office for Europe.Google Scholar
  67. Yin, R. K. (1999). Enhancing the quality of case studies in health services research. Health Services Research, 34, 1209–1224.Google Scholar
  68. Yoo, S., Butler, J., Elias, T. I., & Goodman, R. M. (2009). The 6-step model for community empowerment: revisited in public housing communities for low-income senior citizens. Health Promotion Practice, 10, 262–275.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Gillian Hewitt
    • 1
  • Alizon K. Draper
    • 1
  • Suraiya Ismail
    • 1
  1. 1.School of Life SciencesUniversity of WestminsterLondonUK

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