Clients or colleagues? Reflections on the process of participatory action research with young injecting drug users

Few published reports have explored the potential for participatory action research (PAR) with injecting drug users (IDUs) that extends their role beyond consultation, facilitating recruitment or conducting peer-driven interventions. We reflect on the process of conducting a participatory needs assessment of young IDUs who do not access drug health services using qualitative methods. This report draws on formal feedback obtained from the research teams, which comprised both peer and health workers, and informal observations made by the university researchers, to describe the benefits and challenges inherent in implementing this approach. Results indicate that the privileged access of peer workers to hidden IDUs and sensitive information improved the quality of the data. The PAR approach was also instrumental in changing the negative attitudes of health workers towards IDU and peer involvement in service delivery, an important first step towards meaningful consumer participation. However, the success of peer involvement is dependent on the extent to which health workers are willing to accept IDUs as colleagues rather than clients. We suggest that the capacity of peer workers to undertake these roles needs to be judged according to performance-based criteria that regards their injecting drug use experience as a legitimate form of expertise.