Quality Improvement with a focus on target group involvement
PQD is an integrated set of tools designed to help improve work practices. It relies heavily on the local knowledge of stakeholders and helps them use it, reflect on it and extend it. PQD includes a selection of participatory and evidence-based methods and processes that are tailored, feasible and useful for HIV prevention projects.
The methods and processes originate in different fields of health and social science theory and practice, and the toolkit has been used in general health promotion as well as in HIV prevention.
PQD stands for Participatory Quality Development. You can use PQD as a Quality Improvement tool for prevention and health promotion projects.
The PQD Toolkit is an integrated set of theory, eleven practical methods and a set of case studies. PQD aims to involve stakeholders meaningfully in improving Health Promotion and HIV Prevention and support projects/programmes, create practice-based evidence and improve the effectiveness of interventions.
How will PQD help improve quality?
PQD uses local knowledge to improve the relevance of projects/programmes and provide feedback on the effectiveness of interventions.
PQD methods can be used to improve the quality of interventions at all stages of the cycle – from needs assessment to planning, implementation and evaluation.
PQD methods can help gather data that supports evidence-based practice and in turn build practice-based evidence.
Although the PQD methods can be used to enhance the quality of a project/programme, they do not necessarily offer specific quality benchmarks. Stakeholder collaboration and participation can, however, be an indication of the quality of a project/programme.
PQD can be used with other Quality Action tools, for example the Succeed tool, which will provide a structure to guide quality improvement of your project/programme.
Background and evidence of effectiveness:
PQD is an approach used by Deutsche AIDS-Hilfe (DAH), initiated with WZB (the Social Science Research Centre, Berlin) and supported by BZgA, the German Federal Centre for Health Education. The feasibility of PQD has been tested in German HIV and Health Promotion organisations.
The methods and processes of PQD are based on evidence from the fields of health and social science, theory and practice. The four-phase PQD cycle is adapted from the Public Health Action Cycle.
PQD stems from the internationally recognised Action Research model (or community-based participatory research), which demonstrates the effectiveness of interventions through generating practice-based evidence.
What are the benefits of PQD?
PQD is a flexible and adaptable quality improvement tool that offers a choice of methods for all stages of the project/programme cycle.
PQD provides practical, step-by-step methods that are tailored, feasible, useful, participatory and evidence-based.
PQD helps you gather the local knowledge of target groups to help identify problems and provide insights into implementing interventions that are relevant and appropriate to the local situation.
When you use PQD methods, you can document local knowledge and theories and produce practice-based evidence.
PQD is a means to strategically increase participation of key stakeholders.
When you involve stakeholders, you create the opportunity for more informed and expansive thinking. Stakeholders then have greater ownership of interventions and their capacity to identify with the project/programme is strengthened. This can lead to better outcomes for the interventions.
When can PQD be used?
Quality improvement is a long-term commitment and different methods from the toolkit may be used at all stages of planning, implementation and evaluation.
You can use PQD in combination with other Quality Action tools.
You can use PQD in a variety of prevention and health promotion interventions such as information campaigns, outreach, group work, social support, self-help groups, community development as well as community-based health services and clinics.
You can use PQD if your projects/programmes are engaged directly with your target groups, or if you want to move in that direction.
You can use PQD to include the observations of the target group alongside the perspectives of service providers and other experts because they each possess local knowledge. By using the local knowledge (i.e. expertise) of key stakeholders, your project/programme will be more fully informed about the needs and environments of your target groups.
Based on this local knowledge, you may develop a local theory or understanding of the characteristics of the health problem and its context and causes, so as to devise appropriate interventions.
Local knowledge and local theories exist but are often implicit (unspoken). You can make these more explicit and clarify them through the participatory data collection, planning and evaluation methods in PQD, which are:
• Tailored to the specific local conditions such as the composition of the target group and the approach and capacity of your organisation.
• Feasible so that the time you put into the appbrcation is proportionate to the results you get from it.
• Useful so that you can act to improve the situation.
• Evidence-based (practice-based evidence)so that you can check if your intervention methods are appropriate to the local context.
Collaboration
Building and sustaining collaboration between stakeholders is a core principle of PQD, informed by the view that no individual stakeholder has a full picture of the local problem.
You can facilitate collaboration between different stakeholders in your project/programme, to help ensure the diverse views of stakeholders are heard, common interests identified and solutions mediated.
The stakeholders usually include the project team, members of the key groups or individuals, intermediaries in close contact key populations, funding bodies and others identified as key to the success of the project/programme.
You and your team can identify the key stakeholders for your project/programme by assessing whom you want/have to collaborate with for this intervention and how they should be involved. See Collaboration on the PQD website for further information.
You and your team can use PQD methods and other Quality Action tools to clarify structures and agree procedures and levels of authority in the decision-making process for the project/programme. For example, you can use the Circles of influence method to clarify who contributes to the decision-making process and at what level they are best involved.
Participation
PQD focuses on the strong and meaningful participation of key populations at any stage of the intervention (needs assessment, planning, implementation, evaluation).
Participation means more than being involved in the project/programme. It also facilitates ownership by target groups and service providers who possess the local knowledge required for the success of the interventions.
Participation depends on both the abilities and experience of all of the stakeholders and the various contextual factors of the intervention.
Strong and meaningful participation requires involvement in the decision-making process.
People are more likely to participate in your project/programme when they see the benefits of their involvement and that their contributions are valued and respected.
Participation requires planning to ensure that the key people are involved and that the collaborations are sustainable. This can be quite a time-consuming process and you will need to ensure that you and your team have the resources to support it. The benefits of participation for the project/programme outweigh this.
You can use some PQD methods to assess the level of participation best suited to your project/programme and your target group under current conditions. Other PQD methods focus on increasing the level of participation.
The staged levels of participation are as illustrated below:
PQD: Applying in practice
What is the structure of PQD?
While the other tools provide a very clear structure to guide you through their application, PQD provides a variety of participatory methods for use at any stage of the intervention.
You can select the most appropriate methods and apply them to suit the problems, skills and interests of the stakeholders and the phase of the intervention.
The PQD cycle describes the four phases of interventions: needs assessment, project planning, implementation and evaluation/analysis, as you can see in the diagram below.
Needs Assessment refers to what the people need in order to improve their health and well-being.
When you use PQD methods for needs assessment, you will generate specific information about your key populations from the key stakeholders. Participation of stakeholders in needs assessment means that information is not only collected about the target group, but also from and with the target group.
In addition to gathering local knowledge using PQD methods, you can also use other data to help with needs assessment, such as epidemiological data, research, official reports etc.
Project planning with PQD methods means involving the target group and other stakeholders in setting the goals, objectives and strategies of the project/programme, in response to the results of the needs assessment.
Meaningful participation of stakeholders improves project planning by clarifying what is desirable at societal level (vision); the values, principles, ideas, methods and expectations of the organisation (mission); and the objectives of the intervention.
Evaluation with PQD methods means the participation of stakeholders in all stages of the evaluation process.
What stakeholders want/require from an evaluation can differ. If you involve the stakeholders from the beginning you can focus on the approach you need to the evaluation which best suits everyone’s (appropriate) needs.
How can PQD be used?
You can organise training workshops on the principles and methods of PQD to enable the project teams to facilitate meaningful and purposeful participation using the methods.
You will need to make a decision which stage(s) of the quality improvement cycle to work on and then select the most appropriate methods for that purpose. If you are not sure which part of the cycle to focus on or which aspect of your project/programme needs improvement, one of the assessment-based Quality Action tools, such as Succeed, can help you make that decision.
Ideally, your project will aim to improve all parts of the cycle and you will select one or more appropriate methods for each.
PQD Toolkit – Link to PQD on Quality Action website for Toolkit: All Tools at a Glance
The toolkit consists of eleven methods to improve interventions through participation. The methods are accessible on the right hand side of this page.
The toolkit describes each method in detail with sections as follows:
Brief Description
• Prerequisites Applications
• Process Overview
• Resources Required (Time, Personnel, Materials, Other Costs)
• Detailed Working Steps
• Further Advice
• Further Reading and Links
While you can choose the methods which are most suitable for your project/programme, the toolkit highlights methods which are of particular use during each of the four phases of the cycle.
PQD also contains a collection of case studies that illustrate the use of specific methods in a range of health promotion and prevention projects.
Some methods require a high level of participation from the service providers and target group and others require a lower level of participation. This allows you to choose the method most appropriate to your project/programme.
You can also use PQD methods for facilitating or increasing stakeholder participation in the application of other Quality Action tools.
What resources are required?
Preparation:
It is essential that you are familiar with the PQD Toolkit. This will help you select and apply different methods to a variety of situations and at the different stages of the process.
You need to consider whether the meetings you organise to apply PQD are better facilitated by a neutral (external) person to allow for diverse views to be expressed and respected.
Decide what time is available and when meetings will be held. It is advisable to tell people in advance to keep the time for applying PQD completely free and that phones and computer access will be reserved for the breaks.
People:
The number of participants involved depends on the PQD method you select and your decisions about participation. See Levels of Participation above.
You will need people with experience and skills in facilitation and leadership to build and maintain mutual trust and respect between the various stakeholders in the project/programme.
Some methods require research expertise. You will at a minimum need people to take notes during meetings and make the documentation available to participants afterwards.
You can consider ways in which to support the on-going participation of key stakeholders, such as facilitating environments of mutual respect to ensure positive experiences of their involvement.
Time:
Some methods require a high degree of commitment from stakeholders and others require relatively low levels. The application of PQD methods can range from hours to days to weeks, depending on the aims and methods you choose. The PQD toolkit states the time required in the step-by-step guides to each method.
The greater the levels of stakeholder participation, the more time may be required to support it.
You will need to be prepared to contribute a significant amount of time to ensure sustainable, strong and meaningful participation at all stages of the cycle.
Facilities:
Creating an open and supportive environment for reflection is essential. Time-tabling, allowing for sufficient breaks, food, comfortable surroundings with good light and ventilation, can all be considered when choosing the best venue for meetings.
Finances:
The application of the tool itself need not require additional resources. It may be possible to use meeting rooms that are free of charge, for example. Food and travel expenses may or may not be an issue, depending upon geographical spread of participants and the ethos of the organisation.
You may consider providing financial assistance to support participation of those who are not employed by the project/programme, such as travel or childcare expenses.
What are the challenges of using PQD?
PQD requires leaders and facilitators who are skilled and share the principles of collaboration and participation.
There may be differences in power relationships and responsibilities between stakeholders (for example between funders and recipients; drug users or sex workers and government officials). You will need careful planning and facilitation to ensure all viewpoints are heard and respected.
PQD requires considerable time and a commitment to collaboration and participation which can be difficult to sustain given the diversity of interests involved.
PQD may require that you train people in using the methods so as to sustain collaboration and ensure participants engage with the process effectively.
You will need to ensure that you have the right people involved and consider how to identify them and how to motivate them to be involved.
