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

From: Developing and evaluating interventions that are applicable and relevant to inpatients and those who care for them; a multiphase, pragmatic action research approach

Benefits Challenges
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