P is for Participation

I was invited to write about “P is for Participation”. For many, including me, the word participation immediately clicks the button for the WHO International Classification of Functioning, Disability and Health (ICF), a classification system within which participation is one key cluster of health outcomes. As a WHO framework, the ICF obviously has prominence, and consequently has dominated a lot of thinking and discussion in both practice and research. And, like all things prominent, it has also received its fair share if debate and challenge – much of this led by occupational therapists. This would be the obvious place to start on a blog for participation.

But I really did not want to write about the WHO ICF, how it defines participation, or what the strengths and limitations of that are. That debate has been going on for nearly two decades. Almost everything that needs to be said has already been, extensively, said.

Which then posed a new question. If I am not writing this blog about participation through the WHO ICF lens, then about what shall I write it?

Inspired by other blog posts in the series, I decided to worry less about frameworks, theory, and evidence – and instead allow myself to think about participation much more broadly. In a way, that is the end key message from much of the debates and research around participation. While there are generic principles about what things can and cannot be classified as participation, it is multidimensional, and different people experience participation in life differently.

I decided to pair P for Participation with other ‘P-words’ that really speak to me… and that, to me, reflect the ideas of participation debated in the wider literature.

Passion – P is for Participating in something about which one is Passionate. To me, participation is often about feeling challenged and feeling that I am growing. I am a strong believer in the growth mindset, and research shows that we actually grow and develop faster and further when we do things that we are passionate about. We all have strengths, and things we are not so good at. For years I believed it important to work on my weaknesses, to bring them up to an acceptable level. Until I realised that it was much more fun and productive to work more on the things I was good at, to cultivate my strengths (and support others who excelled in the things that I was not so good at). Participating in things that we are good at helps to create a virtuous cycle powered by Passion. And that, in my view, is a key to sustained, long-term participation that enables true, lasting change. For me, personally, my passion has been, and remains, building research capacity for disciplines and topics where research participation has traditionally been scarce. To enable, for all, access to the advancement that only research and innovation can bring.

Pioneering – P is for Participating in Pioneering activities. When one believes in, and thrives on, the growth mindset, one often ends up participating at the forefront of new ideas, activities, and positive change. At such forefronts one often also finds a small, select group of others with similar passions. That is hugely exciting and rewarding, and regularly results in exceptionally deep experiences of Participation in something truly important.

For me, personally, I have enjoyed the huge privilege of participating, with an amazing group of people, equally passionate about enabling research for all, in creating truly exciting, fully inclusive, next-generation research structures – such as our NHIP Academy.

Progress – P is for Participation to achieve truly remarkable Progress. Every successful pioneering activity reaches a tipping point, where the adoption becomes so wide there is no going back. Allied health professions, including occupational therapists, in the UK, are now past that tipping point for participation in research. Scotland has still a little bit more work to do to bring the truly inclusive access for funding and career development programmes for all, but progress in England and Wales is now so far gone that cross-border pollination means this direction is, in my view, inevitable. Not just me but for all, Participation in leading and delivering research is here to stay!

Profession – P is for Participation in our Profession. So what will this shift mean for our Profession? What is our Profession making of it? As we are now past the tipping point, and research is genuinely accepted and valued as one of the core activities in which we make the world a better place for people, our Profession has become a huge Positive Power. For me, personally, it has been amazing to see how participation in research has grown and evolved over time, with a pace of change, and the depth and quality of conversations, on the clinical front line now such that everyone truly can be participating in research.

Permission – P is for Participation without seeking Permission. The vast majority of occupational therapists are women, and even those of us who are fairly loud, strong minded, and opinionated still often struggled with the internalised social norm that

‘good girls do the expected and don’t cause trouble’. Good women do not push boundaries, not without someone else’s permission anyway.But to Participate and Pioneer with Passion, in a way that results in true Progress, we cannot expect Permission for all our Participation. For me, personally, this has meant navigating some very narrow ridges and tight corners – being really clear on that Passion and end game, and brave enough to set my own course, and take some carefully thought through risks.

People – P is for the other key People Participating in your space. For ultimately, surely this is why we got into this Participation business in the first place?

Whatever the Passion you are following, and topic you are Pioneering, it is People at the heart of it.

For me, personally, this has been Parents of young children, and especially the young children themselves. Professor Helen Minnis recently, deliberately, provoked with the statement that “A quiet baby is easy to ignore”, in sharing a call for adults to take a more proactive role in speaking for children and promoting the Academy of Medical Sciences report on Prioritising early childhood to promote the nation’s health, wellbeing and prosperity.

Perfection – P is for Participation, in understanding that quality really matters while Perfection is the ultimate enemy of the good. For me, personally, high quality comes from aspiring for perfection in what we seek and how we go about our work, while adopting a Pragmatic, flexible approach that ensures delivery on the ground.

I was also quite tempted to add one more P is for… Peace. It seems highly relevant to Participation and to these P-words here. But perhaps that is for someone else to pick up on.

Written by
Dr Niina Kolehmainen
Reader in Allied Child Health, Newcastle University.
@niinamk