Resúmen El VIH es uno de los principales desafíos de la salud pública global. En Latinoamérica la prevalencia de contraer VIH para los hombres que tienen sexo con hombres (HSH) y las mujeres transgénero (MTG) es 30 veces más alta que la población en general. Colombia tiene la segunda tasa más alta de personas con VIH en la región. La PrEP es una terapia que ha dado resultados positivos en otros contextos latinoamericanos. Sin embargo, para que una intervención como la PrEP sea efectiva y factible en el contexto colombiano, es fundamental explorar como los determinantes sociales de la salud (DSS) podrían afectar la implementación de la PrEP en el país. No sabemos de otros estudios en el país que hallan explorado este tema. A través de un análisis secundario de datos cualitativos subsanamos esta brecha de la literatura y generamos conocimiento de primera línea sobre las desigualdades de salud que limita a los profesionales de la salud en la implementación de PrEP en poblaciones HSH y MTG en el país. Objetivos: El propósito de este estudio fue explorar como los DSS afectan la intención de los proveedores de salud de implementar PrEP como estrategia de prevención contra el VIH en Colombia. Métodos: Análisis de datos secundarios con un enfoque critico hermenéutico a las entrevistas realizadas a proveedores de salud. El análisis temático siguió un marco conceptual de los DSS. Resultados: Los hallazgos mostraron que el estigma, los comportamientos culturales, el conflicto armado, la falta de acceso a los servicios de salud y la alfabetización en salud afectan la adopción de la PrEP en el país. Conclusiones: Para el éxito en la implementación de PrEP en el país es necesario tener en cuenta el contexto social y político colombiano especialmente en áreas afectadas por la violencia y desigualdades históricas concentradas.

Abstract Globally, HIV is one of the major public health challenges of our time. In Latin America, the prevalence of HIV for men who have sex with men (MSM) and transgender women (TGW) is 30 times higher than for the general population. Colombia has the second highest rate of people with HIV in the region. PrEP therapy has been successfully implemented in other Latin American contexts. However, for an intervention such as PrEP to be effective and feasible in the Colombian context, it is necessary to explore how the social determinants of health (SDH) could potentially affect its implementation and uptake. To our knowledge, no other study in the country has explored this issue. Through a secondary analysis of qualitative data, we fill this gap of knowledge and generate evidence about the health inequities that could potentially limit the adoption of PrEP to prevent HIV in MSM and MTG populations. Objectives: To explore how the SDH affect the intention of health providers to implement PrEP as an HIV prevention strategy in Colombia. Methods: The study analyzed secondary data from interviews conducted with health providers in Colombia. A critical hermeneutic approach was used, and an SDH conceptual framework was followed for the thematic analysis. Results: The findings showed that stigma, cultural behaviours, armed conflict, lack of access to health services, and health literacy affect the adoption of PrEP in the country. Conclusions: For the successful implementation of PrEP in the country, it is necessary to consider the Colombian social and political context, especially in areas affected by violence and concentrated historical inequities.

Abstract Diabetes is a growing public health concern in Liberia, where an estimated 2.1% of the population live with the disease. The challenges with diabetes in Liberia are enormous. Diabetes places immense socioeconomic pressure on individuals and their families and burdens an already overstretched health care system still recovering from the destructive effects of the 14-year civil war. While efforts towards rebuilding the health care system in Liberia are ongoing, people with diabetes experience significant challenges accessing social, economic, and health-care resources to manage their illness. Purpose: The goal of this critical hermeneutic study was to explore what is it like to live with diabetes in Liberia. Methods: Through purposeful sampling, 10 adults with diabetes were recruited from a publicly funded hospital in Monrovia, Liberia. Data were collected using a photovoice method, wherein participants photographed their everyday experiences of living with diabetes. Results: We identified three themes that answered the question of what is it like to live with diabetes in Liberia: living with diabetes means living with 1) food insecurity, 2) trying to access a health care system that was not built to respond to diabetes, and 3) using faith to cope and foster hope. Conclusion: The experiences of people living with diabetes in Liberia are under-researched, pointing to a gap in knowledge. The findings from this study address this gap in the literature by providing a clearer picture of the impact of diabetes on individuals and families. We provide tangible recommendations to local governments and policy makers on interventions that may improve health outcomes and quality of life for people living with diabetes in Liberia.

Abstract Treatment for kidney failure, such as dialysis, can result in a tremendously high physical and psychosocial symptom burden on patients and their families. Kidney supportive care (KSC), including advance care planning, involves early identification and treatment of symptoms that improve the quality of life for people receiving dialysis. The delay or lack of engagement in KSC by dialysis nurses until the end of life may result in people dying without receiving optimal palliative care services. Purpose and Questions: Our overarching purpose is to develop a theory about the process of engagement in KSC by dialysis nurses, and this paper is about a sub-question: What are the personal, professional, organizational, and environmental factors that shape nurses’ attitudes/beliefs toward and knowledge of supportive care in dialysis? Methods: We followed Charmaz’s constructivist grounded theory method. Through initial purposeful and subsequent theoretical sampling, 23 nurses with work experience in outpatient hemodialysis, home hemodialysis, and peritoneal dialysis settings from across Canada were recruited to participate in two interviews, each using the Zoom© teleconferencing platform. Concurrent data collection and analysis were undertaken. Results: Findings at the focused coding stage comprise contextual factors impacting such engagement. The core category of Fragmenting Care is explained by four categories of contextual factors and their related concepts and sub-concepts: (1) structural (lack of dedicated time, language barrier, knowledge gap); (2) inter-relational (patient-related factors; nurse-related factors [discomfort with having the conversation, lack of self-confidence, multi-dimensional tensions-them versus us]); (3) cultural-dialysis (biomedical focus, ambiguous responsibility, inopportune conversations); and (4) systemic (lack of conceptual clarity). Implications: These collective factors have not been illuminated previously, and while challenging, they help to better understand and therefore address engagement in KSC by dialysis nurses. Conclusion: Effecting change to normalize KSC is a priority requiring solutions compatible with complex systems.

Abstract Problem-solving is one of the principles of the Unified Health System (SUS) in Brazil, with its ability to solve the health problems of the population at different levels of complexity. The Indigenous Health Care Subsystem (SASI-SUS) is part of this service, respecting the specificities of indigenous populations. The scope of this article is to analyze the perception of professionals and managers of an Indigenous Health Center (CASAI) regarding its ability to cope with the circumstances of the pandemic. It involved qualitative and descriptive research under the National Health Care Policy for Indigenous Peoples (PNASPI) and Paul Ricoeur’s hermeneutic theory. Interviews were conducted with participants in order to record the experiences in the work process of the actors who assist the indigenous people housed at CASAI. Four essential themes were identified in the interviews: cultural care; permanent education in health & health education; negotiation & improvisation; and reception & infrastructure. CASAI is an institution that is more than a support center or accommodation, being a crossover point between the different levels of care and knowledge production of the indigenous people, as well as a place for establishing a relationship, resulting in a problem-solving space.

Resumo A resolutividade é um dos princípios do Sistema Único de Saúde (SUS) no Brasil, com sua capacidade de resolver os problemas da população nos diferentes níveis de complexidade da saúde. O Subsistema de Atenção à Saúde Indígena (SASI-SUS) integra este sistema, respeitando as especificidades das populações indígenas. O objetivo deste artigo é analisar a percepção dos profissionais e gestores de uma Casa de Saúde Indígena (CASAI) a respeito da resolutividade no subsistema quanto às circunstâncias da pandemia. Pesquisa qualitativa, de caráter descritivo, à luz da Política Nacional de Atenção à Saúde dos Povos Indígenas (PNASPI) e da teoria hermenêutica de Paul Ricoeur. Foram realizadas entrevistas entre os participantes a fim de registrar as experiências no processo de trabalho dos atores que cuidam dos indígenas referenciados à Manaus, Amazonas. Foram identificadas, pelas entrevistas, quatro temáticas essenciais: cuidado cultural; educação permanente em saúde & educação em saúde; negociação & improviso e; acolhimento & infraestrutura. A CASAI é uma instituição que vai além de um centro de apoio ou alojamento, sendo ponto de articulação entre os diferentes níveis de atenção aos indígenas e local de produção de cuidados e de saberes, tal como da construção de suas relações, resultando em um espaço resolutivo.

Abstract Problem-solving is one of the principles of the Unified Health System (SUS) in Brazil, with its ability to solve the health problems of the population at different levels of complexity. The Indigenous Health Care Subsystem (SASI-SUS) is part of this service, respecting the specificities of indigenous populations. The scope of this article is to analyze the perception of professionals and managers of an Indigenous Health Center (CASAI) regarding its ability to cope with the circumstances of the pandemic. It involved qualitative and descriptive research under the National Health Care Policy for Indigenous Peoples (PNASPI) and Paul Ricoeur’s hermeneutic theory. Interviews were conducted with participants in order to record the experiences in the work process of the actors who assist the indigenous people housed at CASAI. Four essential themes were identified in the interviews: cultural care; permanent education in health & health education; negotiation & improvisation; and reception & infrastructure. CASAI is an institution that is more than a support center or accommodation, being a crossover point between the different levels of care and knowledge production of the indigenous people, as well as a place for establishing a relationship, resulting in a problem-solving space.

Resumo A resolutividade é um dos princípios do Sistema Único de Saúde (SUS) no Brasil, com sua capacidade de resolver os problemas da população nos diferentes níveis de complexidade da saúde. O Subsistema de Atenção à Saúde Indígena (SASI-SUS) integra este sistema, respeitando as especificidades das populações indígenas. O objetivo deste artigo é analisar a percepção dos profissionais e gestores de uma Casa de Saúde Indígena (CASAI) a respeito da resolutividade no subsistema quanto às circunstâncias da pandemia. Pesquisa qualitativa, de caráter descritivo, à luz da Política Nacional de Atenção à Saúde dos Povos Indígenas (PNASPI) e da teoria hermenêutica de Paul Ricoeur. Foram realizadas entrevistas entre os participantes a fim de registrar as experiências no processo de trabalho dos atores que cuidam dos indígenas referenciados à Manaus, Amazonas. Foram identificadas, pelas entrevistas, quatro temáticas essenciais: cuidado cultural; educação permanente em saúde & educação em saúde; negociação & improviso e; acolhimento & infraestrutura. A CASAI é uma instituição que vai além de um centro de apoio ou alojamento, sendo ponto de articulação entre os diferentes níveis de atenção aos indígenas e local de produção de cuidados e de saberes, tal como da construção de suas relações, resultando em um espaço resolutivo.

Abstract: In Canada, an unacceptable number of women live below the poverty threshold. Some subgroups of women, such as Indigenous, visible minorities, immigrants and refugees, older adults, and single mothers are more likely to live in poverty, as they face multiple systemic barriers preventing their financial stability. Further, socioeconomic status, employment, gender, and access to healthcare and social services negatively impact women’s well-being and health. Yet little is known about how these factors affect healthcare behaviours and experiences for women living on a low income. Our goal is to describe and understand how gender and income influence access to healthcare and social services for women living on a low income. Methods: Partnered with a not-for-profit organization, we explored the experiences of women living on a low income in Kingston, Canada. Using participatory, art-based research and hermeneutic phenomenological approaches, our data collection methods included photovoice, semi-structured interviews and culture circles. A purposive sample was recruited. Analysis was conducted following the social determinants of health framework by Loppie-Reading and Wien. Results: Participants perceived the healthcare and social services systems as unnecessarily complex, disrespectful, and dismissive-one where they are mere spectators without voice. They do not feel heard. They also identified problematic issues regarding living conditions, housing, and fresh food. Despite these experiences, participants are resilient and optimistic. Implications: Learning from participants has indicated priority issues and potential, pragmatic solutions to begin incremental improvements. Changing system design to enable self-selection of food items is one example. Conclusion: For an individual to feel others view them as unworthy of care, especially if those ‘others’ are the care providers, is ethically and morally distressing-and it certainly does not invite system-use. While our early findings reveal considerable system improvements are required, we are inspired by and can learn from the strength of the participants.

Abstract: In Canada, diabetes self-management education (DSME) programs are offered to enable individuals with diabetes to successfully implement and sustain lifestyle changes, with the goal of reducing risk of complications and morbidity. Researchers have demonstrated how older adults with diabetes often fail to achieve or maintain diabetes self-management (DSM) competencies, increasing complication risk. Further, little is known about the influence of the social determinants of health (SDH) on DSME, potentially producing additional inequalities for these adults; the WHO defines SDH as non-medical factors (e.g., education; food insecurity) that impact health outcomes. The study goal was to better understand how the SDH affect DSME for older adults living with diabetes. Methods: In our qualitative study we used participatory, art-based, and hermeneutic phenomenology research methodologies. Data collection included photovoice and semi-structured phone interviews. Fourteen older adults with diabetes participated (11 men, 3 women; aged 65 years or older). A SDH framework (Loppie-Reading and Wien) guided the thematic analysis. Results: The findings illuminate how participants live with the effects and pressures of the SDH. Proximal determinants of health revealed in participants’ stories included health behaviours (diabetes self-management practices), physical environments (rurality), socioeconomic status (income), and food insecurity (accessing healthy food). Intermediate determinants comprised health-care systems (accessing DSME in their community) and community resources and capacities (limited infrastructure due to rurality). Distal determinants involved the pandemic (isolation due to mobilization restrictions). Conclusion: Our study demonstrated how the SDH affect DSME and DSM for older adults. Participants were continuously rearranging their diabetes needs to accommodate other life priorities. Additionally, rural living is described as a barrier to DSM, as accessing diabetes education, food, medications, and gas is at a distance-a particular inconvenience during wintertime. Our findings will guide future design, planning and implementation of DSME programs for older adults in this rural setting.

Abstract: Qualitative researchers in the health sciences often engage with participants to collect information about their thoughts, feelings, and behaviours related to a particular research topic. When the topic under investigation involves a traumatic event or experience, listening to, or being exposed to those personal accounts, can carry a significant emotional cost for the mental health of the researcher who can develop secondary trauma. Yet there is limited exploration of the effects of participant trauma on qualitative researchers. This is the focus of the current paper. Objective: Our goal is to relate how we have approached, experienced, and worked with our partner organization and the goal of better understanding the experiences of frontline providers caring for residents with disabilities living in a community residential setting during a COVID-19 outbreak. Methods: Using reflection as a qualitative method, we describe our experiences as we undertake this important work. Results: As researchers, navigating sensitive, deeply felt experiences can be difficult. We share an interim offering of our processes and experiences garnering the insights and feelings of frontline providers who lived through the physical and emotional stress of a COVID-19 outbreak. It has required us to be nimble and resourceful, but most critically to be present. Several lessons emerge from this work such as preparing to address a difficult topic, creating a realistic work plan, and creating spaces for reflection in the research team in order to take care of our mental health. Conclusions: Every study is a story. Often the reader wants the final chapter - the conclusion. We aim to illuminate the path we are travelling, as for us it has been and is equally compelling.

Resumen: Los investigadores cualitativos en el área de la salud se conectan con los participantes para recolectar información sobre sus pensamientos, emociones y conductas relacionadas con una pregunta particular de investigación. Cuando el tópico de investigación está relacionado con eventos o experiencias traumáticas, el escuchar o estar expuesto a esos relatos una y otra vez puede tener un costo emocional importante para la salud mental del investigador. Sin embargo, existe una exploración limitada de los efectos del trauma del participante en los investigadores cualitativos. Este es el enfoque de este artículo. Objetivos: La meta de este trabajo es el de relatar cómo nos hemos acercado, experimentado y trabajado en un estudio que busca comprender las experiencias de los profesionales de primera línea que cuidaron a residentes con discapacidades en un hogar comunitario durante un brote the COVID-19. Métodos: Empleando la reflexión como método práctico de trabajo cualitativo, analizamos nuestras experiencias de investigación. Resultados: Como investigadores, navegar por experiencias sensibles y profundamente sentidas puede ser difícil. Compartiremos una oferta provisional de nuestros procesos y experiencias para recopilar los conocimientos y sentimientos de los proveedores de primera línea que vivieron el estrés físico y emocional de un brote de COVID-19 Ha requerido que seamos ágiles e ingeniosos, pero lo más importante es que estemos presentes. De este trabajo surgen varias lecciones como prepararse para abordar un tema difícil, crear un plan de trabajo realista y crear espacios de reflexión en el equipo de investigación para cuidar nuestra salud mental. Conclusiones: Cada estudio es una historia. A menudo, el lector quiere el capítulo final: la conclusión. Pretendemos iluminar el camino que estamos recorriendo, ya que para nosotros ha sido y es igualmente apremiante y necesario contar nuestras experiencias.

Abstract: Equitable access to health and social services is recognized as a fundamental right in Canada. Women living on a low income experience the harmful effects of structural inequalities when accessing health and social services. Some of those women belong to minority groups such as Indigenous, immigrants and refugees, LGTBQ2S, single mothers, older adults, and those living with chronic illnesses and disabilities. However, little we know about how gender and income as social determinants of health affect access to health and social services for women on a low income. Goals: Our purpose in this qualitative study was to explore how the SDH affect the experiences of Canadian women who live on a low income, with accessing health and social services. Methods: In keeping with a participatory research approach, we are partnering with a not-for-profit organization, and are using an art-based approach (photovoice), hermeneutic phenomenology, as well as one-to-one interviews to illuminate the experiences of women living on a low income. Results: Five women are participating. In our analysis to date we have found three themes: 1) I know what I'm feeling, I know what my body feels; 2) There’s a lack of empathy, lack of compassion; and 3) They didn't break me because I'm going to keep going. Conclusions: Although access to health and social services is considered a fundamental right for all Canadians; it is unfair and unjust how women in this study do not experience that right. This work aims to bring access issues to light and elevate the voices of women living on a low income to create sustainable solutions with them and other community members, including a more compassionate health system and inclusive society in Ontario, Canada.

Resumen: El acceso equitativo a los servicios de salud y sociales se reconoce como un derecho fundamental para la reducción de desigualdades en el Canadá. Las mujeres que viven en condiciones de pobreza y experimentan los efectos negativos de las desigualdades estructurales en el acceso a los servicios de salud y sociales son aquellas pertenecientes a grupos indígenas, inmigrantes y refugiadas, miembros de comunidades LGTBI2E, mujeres cabeza de familia, adultos mayores, aquellas que viven con enfermedades crónicas y con discapacidades. Sin embargo, poco se ha explorado como el género y los ingresos económicos como determinantes sociales de la salud afectan el acceso a los servicios sociales y de salud. Objetivos: Explorar cómo el género y los ingresos afectan las experiencias de las mujeres canadienses que viven con bajos ingresos al acceder a los servicios de salud y sociales. Métodos: Seguimos un enfoque de investigación participativa, investigación basada en las artes y la hermenéutica fenomenológica. Como métodos de recolección de datos usamos foto voz, entrevistas y grupos focales para ilustrar las experiencias de vida de las mujeres. Resultados: Participan cinco mujeres. En nuestro análisis encontramos tres temas particulares: 1) Sé lo que siento, sé lo que siente mi cuerpo; Falta empatía, falta compasión; y 3) No me quebraron, voy a seguir. Conclusiones: Aunque el acceso a los servicios sociales y de salud es considerado un derecho fundamental para todos los canadienses, es injusto que las mujeres de este estudio no experimenten ese derecho. La meta de este trabajo es sacar a la luz los problemas de acceso, elevar las voces de las mujeres que viven con bajos ingresos para luego crear soluciones sostenibles en conjunto con ellas y otros miembros de la comunidad y de esta forma crear un sistema de salud y social más compasivos e inclusivos en Ontario, Canadá.

Resumo Objetivo Discutir as relações de poder entre profissionais de saúde em ambientes de cuidado intensivo e sua interferência no processo de construção do conhecimento. Métodos Neste artigo filosófico, exploramos a influência das relações de poder na construção do conhecimento, a partir das perspectivas foucaultiana e crítica de Gramsci e Freire em relação às práticas de enfermagem e cuidados de saúde. Resultados Há quatro fontes de poder organizacional (tomada de decisão, critério, controle de recursos e controle de conhecimento/rede) que atuam em diferentes níveis das organizações de saúde. As unidades de terapia intensiva são um importante segmento do ambiente de saúde, e a complexidade no cotidiano dos profissionais desse setor pode dificultar as relações de poder no processo de construção do conhecimento. Por exemplo, quando profissionais externos à equipe da UTI, que detêm conhecimentos específicos, precisam ser contatados para auxiliar em casos, como durante o processo de doação e transplante de órgãos. Nesta situação, é necessário desconstruir o poder competitivo para construir o poder colaborativo. Conclusão Usando as perspectivas de Freire e Gramsci, argumentamos que a falta de conhecimento contribui para o poder competitivo, que pode ser superado se os indivíduos envolvidos participarem no processo de aprendizagem em direção ao poder colaborativo. Portanto, as estratégias ou ações para lidar com os desequilíbrios de poder interprofissional podem contribuir para a transformação e mudança mútua.

Abstract Objective To discuss the power relations among health care professionals in acute care settings and its interference in the process of knowledge building. Methods In this philosophical paper, we explored the influence of power relations on knowledge building using a Foucauldian and critical perspective of Gramsci and Freire related to nursing and health care practices. Results There are four sources of organizational power (decision-making, discretion, control of resources, and control of knowledge/network) that act at different levels of healthcare organizations. Intensive care units are an important segment of healthcare setting, and the complexity involved in the daily activities of professionals in this sector can lead to difficult power relations in the process of knowledge building. For instance, when professionals external to the ICU team that hold specific knowledge need to be contacted to help in cases, such as during organ donation and transplantation process. In this situation it is necessary to deconstruct the competitive power in order to build the collaborative power. Conclusion Using Freire’s and Gramsci’s perspectives we argued that lack of knowledge contributes to competitive power which can be overcome if involved individuals engage in the learning process towards a collaborative power approach. Therefore, strategies or action to address interprofessional power imbalances can contribute mutual transformation and change.

Resumen Objetivo Discutir las relaciones de poder entre profesionales de salud en ambientes de cuidado intensivo y su interferencia en el proceso de construcción del conocimiento. Métodos En este artículo filosófico, exploramos la influencia de las relaciones de poder en la construcción del conocimiento a partir de las perspectivas foucaultianas y la crítica de Gramsci y de Freire en relación con las prácticas de enfermería y los cuidados de salud. Resultados Hay cuatro fuentes de poder organizativo (toma de decisión, criterio, control de recursos y control de conocimiento/red) que actúan en distintos niveles de las organizaciones de salud. Las unidades de cuidados intensivos son un importante sector del ambiente de la salud, y la complejidad en la labor cotidiana de los profesionales de ese sector puede dificultar las relaciones de poder en el proceso de construcción del conocimiento. Por ejemplo, cuando profesionales externos al equipo de la UCI, que tienen conocimientos específicos, tienen que ser contactados para auxiliar en algunos casos, como durante el proceso de donación y trasplante de órganos. En esta situación se hace necesario deconstruir el poder competitivo para construir el poder colaborativo. Conclusión Usando las perspectivas de Freire y de Gramsci, argumentamos que la falta de conocimiento contribuye para el poder competitivo, que se puede superar si los individuos involucrados participan en el proceso de aprendizaje en dirección al poder colaborativo. Por lo tanto, las estrategias o las acciones para hacer frente a los desequilibrios de poder interprofesional pueden contribuir con la transformación y el cambio mutuo.

Resumen: El presente trabajo presenta los retos y desafíos generados por un proyecto de investigación acción participativa orientado a examinar el acceso a los servicios de salud y sociales para las mujeres que viven en condiciones de pobreza en Kingston, Ontario, Canadá. Objetivo: Describir nuestra experiencia implementando un trabajo participativo. Métodos: En este estudio usamos investigación acción participativa (IAP), investigación artística (foto voz), y metodologías interpretativas (hermenéutica fenomenológica). Resultados: Reportamos en este artículo nuestras experiencias con una organización sin animo de lucro en Kingston, así como también los desafíos y recompensas de este estudio. Igualmente, presentamos como hemos adaptado nuestro trabajo a las restricciones de COVID-19, mientras se sigue esforzando por mantener el impulso del estudio. Conclusión: Este proyecto nos ha dejado muchas enseñanzas como que requiere tiempo, adaptación y motivación para abordar una metodología participativa. Para lograr un cambio significativo y sostenido, debe habilitarse a través de una asociación, una que honre y beneficie a los más necesitados.

Abstract: This paper presents our experience following participatory methodologies to understand the experience of access to health and social services for women living on low-income in Kingston, Ontario, Canada. Goals: The study aims are to describe and understand our experiences implementing a PAR study. Methods: In this study, we use participatory (PAR), art-based research (photovoice), and interpretive (hermeneutic phenomenological) approaches. Results: In this paper, we report our processes and experiences to date doing PAR with a not-for-profit organization in Kingston, Canada, both the challenges and the rewards, but most importantly the necessity of it for this context. This work has included the need to be adaptable and creative in light of COVID-19 restrictions, particularly while still striving to maintain study momentum. Conclusion: We have learned that a PAR study needs time, commitment and motivation. For meaningful, sustained change it must be enabled through partnership - one that honors and benefits those most in need.

Resumen: El COVID-19 ha afectado como vivimos, aprendemos, trabajamos e investigamos. Objetivos: Reflexionar en los efectos de la pandemia en nuestro trabajo de investigación participativa con adultos mayores que viven con diabetes. Métodos: Este estudio sigue un marco de investigación acción participativa (IAP) y una metodología de pedagogía crítica. Resultados: En este artículo reportamos nuestra experiencia como investigadores en un proyecto participativo durante la pandemia. Reflexionamos en los cambios que hemos implementado con el fin de continuar el proyecto a pesar de las restricciones. Conclusiones: Concluimos con lecciones aprendidas y una nueva visión sobre cómo mantener la naturaleza colaborativa de lAP en instancias en las que es imposible trabajar en estrecha proximidad con los miembros de la comunidad y realizar investigaciones en un determinado contexto.

Abstract: The impact of the global COVID-19 pandemic cannot be overstated, affecting how we live, learn, work, and do research. Goals: Reflect on the impact of the global pandemic in a participatory research project with seniors living with diabetes. Method: This study follows a participatory action research and critical pedagogy approaches. Results: In this paper, we describe our experience as researchers working on a PAR project during the pandemic. We reflect on the challenges, the research modifications made in our efforts to move forward with distance-based participatory approaches, and the surprising (unimagined) benefits. Conclusions: We conclude with lessons learned and new visioning about how to maintain the collaborative nature of PAR in instances where it is impossible to work in close proximity with community members and conduct research in a co-located context.