Rebuilding international networks through participatory action-oriented training after COVID-19: insights from an action research study

Abstract

Objectives

Participatory action-oriented training (PAOT) programs are pivotal in developing facilitators for workplace environment improvement. However, the coronavirus disease 2019 (COVID-19) pandemic disrupted long-standing international training programs, requiring substantial reconstruction. This study examined the reconstruction of an international PAOT facilitator training program in the post-COVID-19 context to clarify the requirements for effective facilitator training and associated learning outcomes.

Methods

An action research design consisting of two iterative cycles of action and reflection was employed. Organizers (n=10), participants (n=79), and researchers (n=9) were involved, with partial overlap between organizers and researchers. Data sources included participants’ written reports from the second training, reflection meetings, steering committee documents, and supplementary training materials. Data were analyzed using a qualitative descriptive analytic approach with triangulation across sources. Reflections on the first post-pandemic training informed the redesign and implementation of the second training.

Results

Key challenges identified after the first training included limited participant interaction, insufficient experiential learning in the introductory phase, and weakened international training networks. These reflections led to the reconstruction of a participatory, experience-based PAOT model grounded in iterative action research cycles. Participants in the revised program reported enhanced experiential learning, a clearer understanding of facilitation roles, broadened occupational health perspectives, and strengthened international and intergenerational learning networks.

Conclusions

Systematic reflection and experiential redesign can effectively reconstruct facilitator training in disrupted contexts. The findings clarify key requirements for effective facilitator development and demonstrate the value of action research in developing context-responsive training programs.

Introduction

In recent decades, work environments have become increasingly complex due to globalization, the diversification of employment arrangements, and rapid socioeconomic changes¹⁾. Amidst these transformations, occupational safety and health (OSH) risks have persisted, particularly in small-scale enterprises and informal sectors, where resources for systematic OSH management are limited^1,2). In support, organizations such as the International Labour Organization (ILO) and the World Health Organization have emphasized the importance of creating safe, secure, and healthy working environments as a prerequisite for sustainable development, as articulated in Sustainable Development Goal 8.8^3,4).

To address these challenges, participatory approaches to workplace environment improvement have been widely promoted, particularly in Asia^2,5). This began with the Work Improvement in Small Enterprises⁶⁾ program, which was developed by an ILO project team and implemented in small enterprises from the 1980s onward⁷⁾. Several participatory programs have been introduced, including Work Improvement in Neighbourhood Development⁸⁾ and Work Improvement in Small Construction Sites⁹⁾. They encourage employers and workers to identify feasible improvement measures based on good practices in their workplaces^2,10). A defining feature of these participatory programs is their emphasis on “learning by doing,” or experiential learning, dialogue among stakeholders, and stepwise improvement, rather than on externally driven interventions focused primarily on regulatory compliance^11,12).

In the 2000s, Participatory Action-Oriented Training (PAOT) originated as a method for training facilitators who then played a critical role in implementing these participatory programs at the national and local levels. Through international participatory networks centered in the Asian region, PAOT has been implemented continuously for approximately two decades, mainly in Vietnam^12,13). Facilitators support workplace dialogue, promote workers’ active participation, and connect participants’ ideas to concrete actions while respecting the social and organizational contexts of communities and workplaces^13,14). However, despite the long-standing implementation of PAOT programs, systematic knowledge of how facilitators learn, change, and reconstruct their roles through training remains limited¹⁴⁾. Furthermore, limited information exists about how effective facilitator development processes can be designed, particularly under conditions of disruption and reconstruction.

The global spread of the coronavirus disease 2019 (COVID-19) pandemic disrupted these foundations, leading to the suspension of face-to-face international training for nearly 5 years as a result of travel restrictions and infection-prevention measures. This interruption fundamentally altered several core conditions required for the implementation of PAOT, including the loss of previously utilized field sites, diminished opportunities for experiential learning, and the weakening of international networks among facilitators and core trainers. Unlike many training programs that rapidly transitioned to online formats during the pandemic, PAOT could not be fully adapted to virtual environment because of its strong reliance on experiential learning, workplace observation, group-based facilitation, and direct interaction among participants¹²⁾. Consequently, facilitator training required not merely the resumption of previous activities but a comprehensive reconstruction of both its content and its pedagogical approaches. This unprecedented disruption also exposed a critical gap in the existing literature: the lack of empirical evidence on how participatory, network-based training systems can be effectively rebuilt and sustained following large-scale global crises.

Beyond logistical challenges, the prolonged suspension of international PAOT activities also significantly affected the developmental processes through which facilitators acquire experiential and tacit competencies. The interruption weakened the continuity of experiential learning, curtailed opportunities for workplace-based practice, and disrupted informal mentoring relationships through which facilitation skills had traditionally been transmitted across generations.

Moreover, the erosion of international networks reduced opportunities for reflective dialogue and peer learning, both of which are central to participatory and action-oriented training. These structural disruptions made it clear that simply resuming the program in its previous format would be insufficient to restore its educational and collaborative functions. Instead, the situation required a deliberate reconstruction of both the training design and the mechanisms supporting international collaboration.

Against this background, the present study adopted an action research approach to redesign and implement facilitator training in the post-COVID-19 era. Action research aims to generate practical knowledge through iterative cycles of action and reflection while simultaneously promoting change in real-world settings^15,16). By analyzing qualitative data derived from participants’ reflections and organizers’ comments across two consecutive training programs, this study sought to clarify how facilitator training was reconstructed in the post-pandemic context as well as how participants’ learning and perceptions evolved during the process. By addressing both the redesign training of content and the rebuilding of international networks, this study contributes to an underexplored dimension of OSH capacity building in the post-COVID-19 era.

The overall purpose of this study was to explore the requirements for effective facilitator training for participatory workplace environment improvement using an action research framework, with a particular focus on post-COVID-19 reconstruction and learning processes.

Methods

Study design

This study employed an action research design characterized by iterative cycles of action and reflection conducted collaboratively by researchers and practitioners to improve practice while generating knowledge¹⁵⁾. In this study, the researchers were not external observers but were actively involved as interventionists in planning, implementing, reviewing, and revising the facilitator training programs¹⁶⁾.

The study consisted of two action cycles. The first action cycle involved the implementation of the first post-pandemic PAOT program (hereafter referred to as “the first training”) and the collection of participant feedback. Reflection on this cycle included a systematic review of participants’ comments and six meetings conducted by the organizers to identify challenges and areas for improvement. Based on these reflections, the training program was redesigned and implemented as “the second training” in the second action cycle, followed by an evaluation of its outcomes. An overview of the two action cycles and the iterative process of action and reflection is presented in Figure 1.

Fig. 1.

Overview of action research process for reconstructing international PAOT

Context of the training programs

In this study, the PAOT facilitator training program consisted of an international training program aimed at developing facilitators who promote participatory workplace environment improvement in Asia. Before the COVID-19 pandemic, this program had been implemented continuously for approximately two decades as a face-to-face international training initiative through collaboration among stakeholders from multiple countries. Each training program was conducted as a 6-day, face-to-face program. Through these training activities, the program contributed to the development of facilitators working in various Asian countries, as well as that of core trainers who played key roles in training the next generation of facilitators in their local context.

This formed a cyclical process of facilitator development, enabling the PAOT program to function as a platform for building and sustaining an international facilitator network.

The resumption of training activities post-COVID-19 revealed several constraints that affected the program’s implementation. Previously used training field sites were no longer available, and changes in human resources — such as the aging, death, and retirement of core trainers — had weakened the international facilitator and core trainer networks. Furthermore, the organizational framework used to conduct international training appeared to be equally constrained and needed to be reconstructed.

Hence, the first post-pandemic training program, conducted in August 2024, was implemented at a new training field and combined lecture-based introductory sessions with practice-oriented workshops. Based on participants’ feedback collected during this event and the organizing team’s systematic reflections, the structure of the program — particularly the introductory phase — was reviewed and redesigned. Although practice-oriented workshops were included, the introductory phase remained predominantly lecture-centered, resulting in limited early interaction and reduced experiential immersion.

The revised training program, implemented as the second training program in August 2025, incorporated interactive learning, communication activities, and experiential exercises from the introductory stage, followed by practice-oriented workshops.

Participants

This study involved three analytically distinct groups: organizers (n=10), participants (n=79), and researchers (n=9), although some individuals held overlapping roles as both researchers and organizers within the action research process. The training team consisted of Japanese and international organizers and core trainers.

Participants in the training programs were recruited by the organizing committee through announcements on the program website and through professional and international PAOT networks using a network-based recruitment approach, primarily via email. Participation in both the training and the study was voluntary.

An overview of participants in the first and second training cycles is presented in Table 1. Participants varied in professional background and experience with participatory workplace environment improvement, ranging from first-time participants to experienced facilitators.

Table 1. Overview of participants in the two training programs.

Training	Total number of participants (n)	Vietnamese participants (n)	Participants from other countries (n)	Countries represented	Professional backgrounds
First	39	21	18	Japan, Indonesia	Occupational physicians, OH nurses, NGO staff, master’s students, others
Second	40	18	22	Japan, Korea, Thailand, Indonesia	Occupational physicians, OH nurses, NGO staff, master’s students, others

NGO, non-governmental organization; OH, occupational health.

Researcher involvement and reflexivity

Nine researchers participated in both the implementation and evaluation of the training programs. As per the study design, they also participated in planning and facilitating the training as well as in reflection meetings that informed the program’s redesign. The reflexive discussions were treated as opportunities for program improvement and data analysis.

Since the researchers performed a dual role as interventionists, decision-making processes and interpretations were documented and discussed collaboratively among the organizing team to reduce individual bias and enhance analytic rigor.

Data sources

Qualitative data for the second action cycle were collected from three sources:

1). Participants’ written reports

Participants submitted written reports after completing the revised PAOT program. These reports described their learning experiences, perceptions of facilitation, and reflections on the applicability of PAOT principles to their professional practice.

2). Reflection meeting and steering committee documents

The organizing team collected minutes, memos, and presentation materials from reflection meetings and steering committee discussions held between the first and second training programs. These focused on reviewing participant feedback, identifying challenges, and planning the program’s redesign.

3). Supplementary training documents

Supplementary data provided additional contextual information. These documents consisted of official reports and newsletters that documented the training program and its outcomes. These diverse data sources enabled the triangulation of the findings during the data analysis. The process also enhanced analytic rigor and credibility.

Data analysis

The data were analyzed using a qualitative descriptive analytic approach to provide a comprehensive and straightforward account of participants’ learning experiences, facilitation processes, and program redesign decisions. This approach was selected to remain close to the data and to summarize participants’ and organizers’ perspectives in a minimally interpretive manner, rather than to generate new theory¹⁷⁾.

All textual data were read repeatedly to gain an in-depth understanding of the content. Meaningful units related to learning experiences, facilitation practices, training design, and organizational decision-making were identified and inductively coded. Through constant comparison of similarities and differences in meaning, the codes were organized into subthemes and subsequently integrated into overarching themes that captured key aspects of the action research process and its outcomes.

This analytic process was guided by principles of action research^15,16), with particular attention to the iterative relationship between action and reflection. Convergences and divergences between participants’ and organizers’ perspectives were examined to clarify how reflections from the first action cycle informed program redesign and how the revised training influenced learning experiences and facilitation processes.

Ethical considerations

This study was approved by the Research Ethics Committee of the Japanese Red Cross College of Nursing (2024-029). All participants and organizers provided informed consent. Confidentiality was ensured through the anonymization of all data, and participants were informed of their right to withdraw at any time without penalty.

Results

Overview of the second action cycle

The second action cycle revealed how systematic reflection on the first post-pandemic PAOT program led to concrete program redesign and changes in learning and facilitation processes. Figure 2 presents the reconstructed PAOT model as an empirical outcome of the action research process, illustrating the transition from the initial post-pandemic resumption to the redesigned participatory model and the iterative cycles of reflection, redesign, implementation, and evaluation that supported this transformation. The qualitative analysis identified key themes related to (1) organizers’ recognition of structural and educational challenges, (2) a shared understanding of the need for program redesign, (3) participants’ learning experiences in the revised training program, and (4) organizers’ evaluation of program outcomes and remaining challenges. These themes describe the process through which the training program was reconstructed and the outcomes that emerged following implementation of the revised program. The relationships among action research phases, data sources, and thematic outcomes are summarized in Table 2, and the structure of the qualitative themes is illustrated in Table 3.

Fig. 2.

Reconstruction of PAOT Following COVID-19 Interruption

Table 2. Action research process and outcomes in the reconstruction of PAOT.

Action research phase	Data source	Key reflections / issues identified	Program redesign decisions	Observed outcomes
First post-pandemic training (2024)	Participant evaluation forms and written feedback reports collected during the training	Limited interaction during introductory phase; lecture-centered structure; weakened continuity of facilitator development	Introduce interactive and experiential activities from Day 1; strengthen early engagement	Recognition of limited participant engagement and weakened continuity of facilitator development in the resumed training
Review of participant comments	Participant evaluation forms and written feedback reports from the first training	Need for clearer facilitator roles and more experiential learning opportunities	Clarify facilitator roles as process-oriented; expand field-based and group activities	Clarification of participants’ perceived barriers to engagement and experiential learning in the resumed training context
Six organizers’ reflection meetings	Meeting records and steering committee discussions	Inconsistent facilitation approaches; weakened international mentoring network	Standardize the facilitation framework; strengthen intergenerational and cross-border exchange	Consensus on redesign priorities and clarification of facilitator roles
Redesign and implementation (2025 training)	Training program documents	Need to rebuild collaborative and reflective networks	Integrate communication activities; maintain hybrid elements to support inclusion	Increased participant engagement and smoother facilitation processes
Post-training evaluation	Participant reports and organizers’ evaluation	Remaining communication and preparation challenges	Consider structured pre-training orientation and follow-up mechanisms	Identification of key requirements for sustainable facilitator training

PAOT, participatory action-oriented training.

Table 3. Structure of qualitative themes derived from participants’ reports and organizers’ reflections.

Theme	Subthemes	Representative data excerpt
Organizers’ recognition of structural and educational challenges	Disruption of facilitator development continuity	Organizers noted that the prolonged interruption had weakened mentoring relationships and the continuity of facilitator development within the international network, thereby raising concerns about sustaining intergenerational learning processes.
	Lecture-centered introductory structure	“Although the lectures were informative, there were opportunities chances to interact with other participants at the beginning, which made it difficult to fully understand how facilitation works in practice.”
Shared understanding of the need for redesign	Need for an experiential introduction	“I understood the concept of PAOT, but I wanted more opportunities to experience participation and discussion from the start.”
	Clarification of facilitator roles	“Through the revised program, I came to understand that the facilitator’s role is not to instruct but to create space for dialogue and mutual learning.”
Participants’ learning experiences in the revised program	Positive participatory learning environment	“Participants listened carefully to each other and freely exchanged ideas, even when our professional backgrounds and experiences were different. The atmosphere made it easy to speak up without hesitation.”
	Learning through experiential practice	“Learning by doing during the field visits helped me understand the facilitator’s role not as directing activities but as supporting dialogue among participants.”
	Broadening occupational health perspectives	“In my country, occupational health tends to follow a top-down approach, but this training showed me how participatory and low-cost improvements can be initiated locally.”
	Strengthening international and intergenerational networks	“Working with colleagues from different countries and generations helped me reflect on my own practice and expand my perspective.”
Organizers’ evaluation and remaining challenges	Improved facilitation and group processes	“Compared to the previous training, group discussions were smoother and participants took more initiative.”
	Need for structured pre-training orientation and follow-up	“Language differences sometimes limited deeper discussion, suggesting the need for more structured preparation before the training.”

Reflection following the first training program: Issues identified by organizers

1). Recognition of structural and educational challenges

Through reflection meetings held after the first post-pandemic training program, organizers expressed concern that the prolonged interruption of international PAOT activities had disrupted the continuity of facilitator development. Rather than focusing solely on logistical constraints, organizers emphasized that weakened connections among facilitators and core trainers created significant challenges for re-establishing participatory learning processes. They further noted that mentoring relationships within the international network required deliberate reconstruction in order to restore sustained intergenerational learning.

In addition, organizers identified educational challenges related to the structure of the training program. Participant feedback indicated that the lecture-centered introductory sessions limited opportunities for interaction among participants with diverse professional backgrounds and varying levels of experience. As one participant noted, “Although the lectures were informative, there were few chances to interact with other participants at the beginning, which made it difficult to fully understand how facilitation works in practice.” Another participant similarly remarked, “I understood the concept of PAOT, but I wanted more opportunities to experience participation and discussion from the start.”

These reflections suggested that some participants struggled to fully engage with PAOT principles and facilitation processes during the initial phase of the training.

2). Shared understanding of the need for program redesign

Furthermore, the organizers agreed that the introductory phase of the training required a fundamental redesign. Meeting records indicated that the organizers emphasized the importance of experiential learning and early engagement in participatory processes. Rather than introducing PAOT concepts primarily through lectures, they agreed that participants should experience participation, dialogue, and facilitation from the beginning of the program.

Moreover, the organizers discussed the need to clarify facilitator roles, to strengthen support for group processes, and to create an environment that would encourage mutual learning among participants from different countries, professions, and generations. Participants likewise emphasized that effective facilitation involves creating space for dialogue and collaborative learning rather than delivering direct instruction. These reflections formed the basis for concrete decisions regarding the program’s redesign.

Implementation of the revised training program

Based on the reflection process, the training program was redesigned over the course of approximately 6 months. The revised program placed a greater emphasis on interactive introductory sessions that incorporated communication activities, games, and group exercises, followed by practice-oriented workshops and field visits. These changes aimed to foster a participatory learning environment as well as to enable participants to understand facilitation through direct experience.

Learning experiences of participants in the revised training program

1). Experiencing a positive and participatory learning environment

Participants in the revised training program consistently described the learning environment as positive, participatory, and motivating. Written reports highlighted an atmosphere of openness, mutual respect, and active engagement. This atmosphere was reflected in active participation during group discussions, spontaneous sharing of ideas, and supportive responses to differing perspectives. For example, one participant noted that “participants listened carefully to each other and freely exchanged ideas, even when our professional backgrounds and experiences were different.” Another participant commented that “the atmosphere made it easy to speak up, and I felt encouraged to share my thoughts without hesitation.”

Participants also noted that the interactive activities encouraged communication and helped them to feel comfortable expressing ideas despite differences in language proficiency and professional background. Moreover, learning was described as emerging through interaction with peers, facilitators, and local workers, rather than being limited to formal instruction. Many participants emphasized that this participatory atmosphere enhanced their motivation and deepened their understanding of PAOT principles.

2). Learning being facilitated through experiential practice

Participants also reported that the revised program enabled them to understand facilitation through “learning by doing.” Field visits and group-based activities provided them with opportunities to practice observing workplaces, identifying good practices, and facilitating discussion among group members. Several participants described gaining confidence in supporting group processes and encouraging participation, even when communication was challenging.

These experiences contributed to a shift in participants’ understanding of the facilitator role, from directing activities to supporting dialogue and collective problem-solving.

3). Broadening perspectives on occupational health practice

Participation in the international PAOT program prompted reflections on the differences in global occupational health systems and practices. Participants contrasted legally driven, top-down approaches to occupational health with the participatory, low-cost, and context-sensitive approaches emphasized in PAOT. This comparison led them to reconsider the roles of occupational health professionals, highlighting facilitation, neutrality, and respect for local contexts as essential competencies.

4). Strengthening international and intergenerational learning networks

Furthermore, participants highlighted the value of learning with diverse colleagues. The revised program facilitated the formation of international learning networks in which shared goals and nonverbal communication helped them to overcome linguistic and cultural barriers. Experienced participants noted that interactions with early-career practitioners fostered intergenerational learning, while younger participants valued opportunities to gain experience from senior professionals.

Hybrid elements of the program, including online participation, were also recognized as contributing to inclusivity and the sustainability of international collaboration.

Organizers’ evaluation of program outcomes and remaining challenges

(1). Improved facilitation and group processes

Organizers’ evaluation records indicated that the revised program achieved smoother group facilitation and more balanced participation than the first post-pandemic training program. Facilitators took clearer roles in supporting discussions, and participants demonstrated increased initiative and collaboration during group activities. These improvements corresponded to the redesign priorities identified during earlier reflection phases of the action research cycle (Table 2) and were consistent with participants’ reports of enhanced engagement and confidence.

(2). Remaining challenges and directions for further action

Despite the overall positive evaluation, organizers and participants identified challenges that remained. These included variations in participants’ prior understanding of PAOT concepts, differences in language proficiency, and the need for more structured pre-training orientation and follow-up mechanisms. Organizers also emphasized the importance of follow-up activities for assessing whether learning outcomes translated into sustained practice after the training.

Discussion

This action research study explored the reconstruction of an international PAOT facilitator program after a prolonged interruption due to the COVID-19 pandemic. The research consisted of two action cycles, the first of which involved the implementation of an initial post-pandemic international PAOT program, while the second involved a demonstration of how systematic reflection on challenges identified in the first cycle informed the program’s redesign.

The results highlight the value of action research in contexts where established training programs must be reconfigured under substantially changed conditions. This means that organizers must engage in deliberate reflection and redesign, acknowledging the loss of field sites, weakened networks, and changing participant profiles. This approach aligns with the core principles of action research, which emphasize iterative cycles of action and reflection in real-world settings^15,16).

Importantly, the need for reconstruction should not be interpreted solely as a response to temporary logistical constraints caused by the pandemic. Rather, the prolonged interruption affected the relational and experiential foundations upon which facilitator development had historically depended, including the continuity of experiential learning and intergenerational exchange within international networks.

The findings of this study further indicate that PAOT functions not only as a training event but as an ongoing system for sharing and refining practice-based facilitation knowledge across borders. When this circulation of knowledge was disrupted, the facilitator development system was weakened. Consequently, reconstruction required the deliberate redesign of participatory learning structures and network relationships, rather than the simple resumption of previous formats.

Experiential learning in facilitator development

A key finding of this study is the vital role of experiential learning in developing facilitator competencies. Participants in the revised training program reported that understanding facilitation emerged primarily through “learning by doing,” which included field visits, group work, and interactive activities. This finding is consistent with those of prior research on participatory workplace improvement, which has emphasized that facilitators acquire skills through practice, reflection, and dialogue rather than through didactic instruction alone^10,12,14).

These findings can be further interpreted through experiential learning theory. According to Kolb, learning is a cyclical process that involves concrete experience, reflective observation, abstract conceptualization, and active experimentation¹⁸⁾. The revised PAOT program provided opportunities for participants to engage in all stages of this learning cycle, particularly by combining field-based experiences with structured reflection and group dialogue. PAOT’s effectiveness at promoting workplace improvement in small enterprises has previously been demonstrated in Vietnam¹⁹⁾. While these evaluation studies confirmed the practical value of PAOT under stable implementation conditions, this study extends this body of evidence.

Furthermore, the shift from lecture-centered introductory sessions to interactive, experience-based learning addressed challenges identified in the first training cycle, particularly difficulties in participant engagement and uneven group facilitation. By embedding participatory principles from the outset of the program, the revised training program enabled participants to internalize facilitation roles more effectively. This supports existing evidence that participatory approaches are most effective when learners experience participation directly instead of being taught about it abstractly⁵⁾.

Facilitator roles in participatory occupational health practice

Participants’ reflections indicated a shift in perspective from directive, expert-driven roles toward facilitative roles that support dialogue, neutrality, and worker-led improvement. This shift mirrors conceptualizations of facilitation in PAOT and related approaches, where facilitators are expected to guide processes rather than prescribe solutions^12,20).

Comparisons made by participants between legally driven, top-down occupational health systems and participatory, context-sensitive approaches further underscore the relevance of facilitation competencies in diverse settings. In small-scale enterprises and resource-limited contexts, participatory methods have been demonstrated to promote feasible, low-cost improvements that align with local needs^2,5). The present findings suggest that transformations in facilitator role warrant greater attention in facilitator training, particularly in contexts where occupational health professionals are traditionally oriented toward regulatory or expert-centered models.

International and intergenerational learning as a strength of PAOT

International and intergenerational learning emerged as a core strength of PAOT. Participants valued opportunities to collaborate with colleagues from different countries, professions, and generations, and they reported that shared goals and nonverbal communication helped them to overcome linguistic and cultural barriers. These findings were consistent with those of a prior study that highlighted the importance of international networks in sustaining participatory workplace improvement initiatives^2,10,11).

Some participants recognized that hybrid elements of the program contributed to greater inclusivity and facilitated continued international interaction. In the context of global occupational safety and health, these perceptions suggest that hybrid and flexible training formats may offer potential value in supporting international collaboration by reducing barriers related to cost, travel, and accessibility. However, further research is needed to examine how such hybrid approaches can be systematically integrated into PAOT programs while preserving their experiential and participatory foundations.

Role of organizers as interventionists

This study also illustrates the significance of organizers’ roles as interventionists within the action research process. Reflection meetings and steering committee discussions functioned as managerial activities and as critical sites of knowledge generation. Organizers explicitly examined their assumptions, facilitation practices, and program structures, translating reflections into concrete actions.

Such reflexive engagement is a defining feature of action research and enhances the credibility and relevance of the findings¹⁵⁾. By documenting decision-making processes and incorporating them into the analysis, this study demonstrates how practitioner knowledge can be systematically integrated into research on training and capacity development.

Implications for facilitator training and occupational health practice

The findings have several implications for facilitator training and occupational health practice. First, facilitator training programs should prioritize experiential and interactive learning from the earliest stages, particularly in diverse, international contexts. Second, explicit attention should be given to role transformation, with participants supported in shifting from expert-driven approaches to facilitative practices. Third, sustained international and intergenerational networks should be recognized as essential resources for participatory workplace improvement.

For occupational health practitioners and organizations, these findings reinforce the importance of investing in facilitator development as a means of promoting sustainable workplace improvement. This occurs particularly in small-scale enterprises and community-based settings.

Limitations and future research

Several limitations should be considered when interpreting the findings. First, as this study focused on a single international PAOT program, the findings may not be generalizable. Second, although multiple qualitative data sources were used, long-term follow-up data on participants’ application of PAOT in their workplaces were limited. Hence, future research should examine how learning outcomes from facilitator training translate into sustained practice and workplace improvements over time. Future research could also examine how online training for OSH was conducted virtually during the pandemic.

This study provides valuable insights into the reconstruction of facilitator training post-COVID-19 as well as demonstrates the utility of action research for developing context-responsive training programs.

Conclusion

This study demonstrates that systematic reflection and experiential redesign, implemented through an action research approach, can strengthen facilitator training for participatory workplace environment improvement under conditions of disruption and change.

Importantly, the findings identify several requirements for effective facilitator training in disrupted and transitional settings. First, experiential learning should be integrated from the introductory phase so that participants can internalize facilitation principles through practice. Second, facilitator roles should be explicitly framed as relational and process-oriented rather than directive or expert-centered. Third, structured mechanisms for reflection and iterative redesign are necessary to ensure responsiveness to changing conditions. Fourth, sustained international and intergenerational networks are essential for maintaining the accumulation and circulation of practice-based facilitation knowledge. Fifth, structured pre-training orientation and post-training follow-up mechanisms are required to support the continued application of such knowledge beyond the training setting.

By integrating participants’ learning experiences with organizers’ reflexive practice, the reconstructed PAOT program fostered participatory learning environments and the renewal of collaborative networks. The findings underscore the importance of iterative cycles of action and reflection in sustaining and adapting participatory occupational health initiatives, not only in post-pandemic contexts but also in other situations where established training systems must be reconstructed. The results contribute to the conceptualization of facilitator development as a dynamic, network-based, and practice-oriented process that requires continuous reconstruction in response to contextual change. In this regard, action research provides a useful framework for developing context-responsive facilitator training programs¹⁴⁾ that can remain effective amid evolving social, organizational, and global conditions.

Sources of funding

This research was supported by a grant from the Japan Society for Occupational Health for the International Collaborative Research Project for Sustainable Industrial Health in Asia, and by JSPS KAKENHI Grant Number 23K21575.

Conflicts of interest

The authors declare that there are no conflicts of interest.

Author contributions

All authors contributed to the study design and development of the facilitator training program. EY, TK, TN, NT, TK, and KK contributed to the planning and organization of the international training program and participated in the reconstruction of the facilitator training framework. EY, TK, TN, NT, SN, and WS participated in the on-site training activities and contributed to the data generation through program implementation and reflection processes. EY led the data analysis and drafted the initial manuscript. All authors critically revised the manuscript for important intellectual content and approved the final version.

Approval of the research protocol

The Research Ethics Review Board of the Japanese Red Cross College of Nursing approved the study procedures (No. 2024-029).

Informed consent

Participants of the evaluation session were provided with written and oral explanations of the study objectives and ethical considerations. Consent was obtained from each participant when they completed the anonymous evaluation sheet.