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Implementation research design: integrating participatory action research into randomized controlled trials

Luci K Leykum12*, Jacqueline A Pugh12, Holly J Lanham4, Joel Harmon3 and Reuben R McDaniel4

Author Affiliations

1 VERDICT, a VA HSR&D REAP at the South Texas Veterans Health Care System, San Antonio, Texas, USA

2 Department of Medicine, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA

3 School of Business, Fairleigh Dickinson University, Madison, New Jersey, USA

4 Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, Austin, Texas, USA

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Implementation Science 2009, 4:69  doi:10.1186/1748-5908-4-69

Published: 23 October 2009



A gap continues to exist between what is known to be effective and what is actually delivered in the usual course of medical care. The goal of implementation research is to reduce this gap. However, a tension exists between the need to obtain generalizeable knowledge through implementation trials, and the inherent differences between healthcare organizations that make standard interventional approaches less likely to succeed. The purpose of this paper is to explore the integration of participatory action research and randomized controlled trial (RCT) study designs to suggest a new approach for studying interventions in healthcare settings.


We summarize key elements of participatory action research, with particular attention to its collaborative, reflective approach. Elements of participatory action research and RCT study designs are discussed and contrasted, with a complex adaptive systems approach used to frame their integration.


The integration of participatory action research and RCT design results in a new approach that reflects not only the complex nature of healthcare organizations, but also the need to obtain generalizeable knowledge regarding the implementation process.