Table 1 Describes key benefits and challenges of pragmatic action research identified by the authors and current literature [10, 25, 27, 37, 39]

Provides a systematic approach to facilitates flexible development, evaluation and publication of multimodal, multidisciplinary interventions and systematic improvements to routine clinical practice

Research paradigm impacts on outcomes and should be considered as an intervention

Outcomes measures need to be available within the scope of routine clinical practice

Problem centric, practical, pluralistic epistemological approach placing an emphasis on the question and consequences of research rather than the research paradigm

Limited ability to demonstrate ‘cause and effect’

Allows and encourages research to be conducted within routine clinical practice

Limited clinician skills, understanding and application of action research, pragmatically focused trials, and/or multi-phase mixed methods research

Engages patients and clinicians to identify barriers and develop solutions and participate as co-researchers

Harnesses skills of everyday practitioners in the absence of an additional training, resources, or environmental modifications

Complex nature of the design

Difficult to define multiple phases as part of the one program

Maximises participation rate, allows participant recruitment with minimal or no selection bias, and does not emphasise the requirement for strictly controlled, limited variables, placebos or blinding

Require skilful connection of multiple phases or strands and the ability to transition between/across worldviews

Develops and supports multiple perspectives of reality and diversity of views rather than simplistic acceptance or rejection of a single hypothesis

Changes within the research team and environment need to be considered

Considerate towards investigating complex interventions that may be impacted by confounders

Flexibly addresses interconnected research questions across a breadth of enquiry

Post-positivist attitudes focusing on the interaction between highly selected specific variables (reductionism), cause and effect (determinism), detailed variable measurement, numerical analysis and reporting (quantitative techniques)

Allows development and incremental expansion and adaptation of interventional strategies in response to feedback, resource and environment changes throughout the study period

Prioritises relevant economic, objective, and subjective outcomes measures available for measurement in real world applications that are relevant to participants, funding bodies, healthcare providers, and the community

Knowledge is uncertain and outcomes are not assumed

Facilitates exploration of root causes of expected and unexpected findings

Open ended approach requires regular communication of updates and changes to clinicians and ethical bodies

Allows triangulation of results to corroborate findings

Promotes sustainability through engagement of multidisciplinary team members

May be difficult to meet publishing requirements/formats in quantitatively focused journals

Prioritises translation validity and applicability of outcomes to routine clinical practice

Highlighting utility of variety of research paradigms and worldviews within and across projects rather than a ‘one size fits all’ approach

Allow reporting and publication across the course of an extended project