The Critical Realism Participatory Health Research (CRPHR) Starter Kit!
This kit has been developed to support researchers, partners, and practitioners engaging in Critical Realist Participatory Health Research (CRPHR) (Rao, 2025). Participatory Health Research (PHR) has been framed as an innovative, community-centred approach, but once absorbed into institutional health systems, it often (always?) loses its radical edge. Institutions have reworked participatory approaches into methods that fit existing structures rather than challenge them (co-opt much?).
CRPHR is your protective gear-fortifying PHR with the explanatory power of Critical Realism (CR) so it can resist co-optation and remain a force for real change.
Before You Begin: Do You Need a CRPHR Study?
CR is about fallibility - we are always seeking to understand reality more fully, knowing we may never fully grasp it. Under that philosophy, you’re not going to agree with everything in this kit, and you shouldn’t. CRPHR is not meant to be a static framework - it’s something to react to, to reflect on, and to engage with critically. The best way to do that? Send this to your friends, your colleagues, and your mentors. Talk about it. Debate it. We’re not trying to get you to do what we did, but to help you on your way to impactful research. Also, we learned the HARD way and we wished we had a resource like this when we started!
If you don’t know, you can’t ask questions. And if you can’t ask questions, how will you ever know?
Hopefully, you already have a community of practice or a network of support to help you think through this work. If you don’t, reach out. Maybe we can connect you. And above all else, you’ve always got a home in our Collaboratory.
You can read all of these materials on your own, but if you are designing anything in isolation, you are not doing CRPHR. CR is all about interdisciplinary and well, “participatory” is in the name. Moreover, when thinking about the “who” in the team, representation is not the same as being representative. No disease, community, or identity is a monolith. Having a single person represent an entire experience is neither fair nor ethical.
Our approach is inspired by Marcel Mauss' concept of The Gift - an understanding that participation in research is not transactional, but relational. We are always in and with community. Sustainability is central. This is not a one-and-done process - it is about building lasting relationships that begin before the study and continue long after, evolving in new ways.
This is not just another research method. CRPHR is a commitment. Ask yourself:
Do you have the time and resources to support meaningful partnerships?
Do you and your team have the structures in place to care for yourselves throughout the process?
Do you have the holistic capacity—emotionally, physically, and professionally—to undertake a participatory approach that requires deep engagement and reflexivity? (e.g. do you have the spoons and its okay if you don’t!)
All research is hard. But not all research needs to be participatory to be impactful. Sometimes, the most ethical and emancipatory choice is not to do a PHR study because, when done poorly, participatory research can cause more harm than good.
Unlike realist evaluation, which asks, “What works, for whom, and in what context?” CRPHR asks, “What are the underlying structures that shape inequities, and how do we transform them?”
This kit will walk you through the entire research lifecycle, from conceptualization to impact, ensuring your work is built to withstand the pressures of institutional systems and remain genuinely transformative.
1. Laying the Foundation: Pre-Work & Ethical Commitments
Start Here:
Power Assessment Reflexivity Tool for Navigating Equality in Research (PARTNER) → Helps research teams critically assess power dynamics and maintain equity.
Transparen-SCI Blog → Learn about research ethics, transparency, and accountability before starting your project.
Find Your WAG (Wellness, Aspiration, Growth) Tool → Helps research partners determine their meaningful engagement (especially helpful if they have never done research before). Blog post about it here.
How to do Young Adult CRPHR from the people that know it best, Young Adults → A good primer for how we managed the how of CRPHR. We also have it in video format if that’s more accessible!
Ethics: Keep Checking Back
Our ethics publication and POWER publication are forthcoming.
Essential Primers to Set Your Thinking:
Critical Realism Primer → Understanding CR as a metatheory for social justice research. (in press)
Patient-Oriented Research (POR) & Participatory Research (PR) Primer → Contextualizing these approaches in health research.
Equality Primer → Why “better than nothing” is not an ethical stance.
2. Designing Your Study: The Blueprint for Transformative Research
HEARTS Study Process Report → Key insights and lessons from a large-scale CRPHR study.
HEARTS Study Reflections → An unplugged, BTS, version of the CRPHR study.
Strategic Primer for Execution (Slide Deck Available) → A step-by-step guide to planning your participatory study.
Town Hall Presentation (Slide Deck Available) → Strategies for engaging diverse partners in study design.
3. Engaging Partners: Co-Creation & Relationship Building
Example Presentation from Young Adult Partners → Demonstrates participatory research in action.
Solidarity Statement (download to files)→ Establishes ethical commitments, incident reporting, and ombudsperson processes (we used this instead of a project charter or terms of reference).
Weekly Research Newsletter (download to files)→ A model for keeping geographically dispersed partners engaged.
4. Conducting the Research: Making It Happen
Justice-Oriented Financial Compensation Survey → Helps partners make informed decisions about research compensation.
5. Evaluating and Reflecting: Measuring Impact & Learning from the Process
Co-Created Study Evaluation Survey → Measures the effectiveness of participatory engagement.
PEIRS-22 Evaluation (Google Form Adaptation) → Evaluates research participation anonymously.
Measurement was really important that’s why we created The Measure of Meaning: Redefining Success in Patient-Oriented Research → We needed to redefine the game, the rules and what’s considered a success in CRPHR. (if you are not able to access this publication, let us know!)
6. Sharing Knowledge & Mobilizing Impact
Considerations for publication → Things to consider when thinking about the publication process. (more details about this on the blog)
From Publish or Perish to Publish with Purpose → rethinking authorship and publications in CRPHR
Co-created Knowledge Reciprocity (Rao, 2025) efforts - national magazine.
7. Sustaining the Research Ecosystem: Building Long-Term Impact
Collaboratory → A space for collaborative, justice-oriented research.
The VOICE Study → Young Adult researchers from the HEARTS study did a completely young adult led CRPHR study!
We hope this starter pack can help kickstart your transformative research. CRPHR provides a structured way to navigate participatory research without losing its radical intent to institutional constraints. Whether you are designing, conducting, or mobilizing your research, these resources will help you make informed, ethical, and impactful decisions.
For access to specific materials, feel free to reach out.
CRPHR is not a method. It’s a commitment to research that disrupts, transforms, and liberates.
