Guiding Principles for Quality, Equity and Sustainability in ImplementationResearch: Multicountry Learnings from ParticipatoryAction Research

Objective: This article analyzes the application of participatory action research (PAR) principles in implementation research to strengthen health systems, proposing an expanded framework of guiding principles to ensure quality, ethical standards, and ongoing learning. Methodology: Qualitative study based on 20 interviews with co-researchers from national and sub-national levels in Liberia and Nigeria, complemented by reflexive analysis of PAR implementation in neglected tropical disease programs. Results: Five additional principles to existing PAR frameworks were identified: (1) recognize communities as units of identity and define stakeholder participation for equitable engagement; (2) enable flexible action planning that builds on existing structures; (3) address health systems and research power differentials; (4) embed relational practices that lead to new political forms of participation; and (5) develop structures for ongoing learning at multiple levels of the system. Conclusions: PAR can strengthen health systems by connecting and co-creating potentially sustainable solutions to implementation challenges. Additional research is needed to explore how these five principles can support the attainment of quality and ethical standards within implementation research (Ozano et al., 2020).