THE RESEARCH APPROACH AND METHODS
| Participatory action research (PAR) is not
just research
that we hope will be followed by action, it is action which is
researched,
changed and re-researched within the research process by the
participants.
Change does not happen at “the end” – it happens throughout.
Yolanda Wadsworth (1998)
|
The Research Cycle
Figure 1 represents the research cycle that
has
evolved through our work. At the outset we assumed that the
process
would be completed once through. First, with the participation of
the local community we would diagnose the problem(s), then engage in
fieldwork,
develop community plans generated from our “answers,” put into
practice
the new actions and lastly evaluate the results. In reality, there is
not
one path from participation to research to action; instead, countless
smaller
cycles of participatory reflection on action, learning about action and
new informed action, all of which feed back on one another. After six
months
into the field we have already developed small-scale plans, carried out
simple actions and used these experiences to focus and refine our
understandings
of what is really happening and what is really important to us. 
What follows below is a more detailed description of the first two
stages,
describing their rationale and identifying the participants. The
first phase that includes building the inter-institutional links and
the
project team is described in greater detail in Convenios
and The Project Team. Although we have
only
recently touched on the stages of planning, action and evaluation, at
the
end we re-visit the process explaining how it evolved and adapted
during
implementation, and discuss the methodological implications for the
development
and application of an ecosystem approach to improve human health.
Refining Hypotheses and Study Variables
This entire phase was done in close collaboration with our local
partners
as well as being augmented with several focus group meetings with the
only
women’s organization, AMUCAU, the main indigenous organization, AIDESEP
and key informant interviews with leaders of other local organizations.
Together we determined the selection
criteria
for the project sites, identified the eight
communities
that were representative of the region and decided upon the timing of
visits
necessary to capture seasonal fluctuations.
We initially developed hypotheses that address the causal linkages
between
natural resource use and health. The links between nutritional status
and
other ecological, social and economic factors are shown in Figure
2, Figure 3 and Figure
4. From these hypotheses,
socio-economic,
disease, health, nutritional and environmental indicators
and research variables were identified. The
Household Survey table presents these variables at the different
hierarchical
levels, and describes the type of collection methods and period of
recall.
Two tables also outline the variables and methods used in the ethnographic
and participatory health assessment and spatial
mapping. Figure 5 and Figure
6 demonstrate the levels at which these quantitative and
qualitative
variables are being measured.
Field Work
Through collaboration with the Ministry of Health and local
organizations,
all communities were supposedly informed of our pending arrival.
In reality this was not always the case. In two villages we
arrived
late in the evening, unannounced. Fortunately, however, members of our
team recognized a familiar face and were able to explain the purposes
of
our large, somewhat intimidating group. Having friends or family at
each
site provided an initial foundation of trust upon which we could then
build.
In a region characterized by failed projects and unfulfilled government
promises, there is little trust and hope in outside support.
Doctors
without Borders were forced to leave Caco Macaya as the villagers did
not
like their methods. A group of PAHO and Canadian health workers were
not
permitted to enter Santa Rosa. Had we not had local people on our
team as well as the explicit support of their organizations, we would
not
have been able to include these communities in our study.
Upon entering each village, we organized a community meeting in
which
we presented the goals of the project and introduced the team. In
many cases we spent several hours addressing people’s anger and
frustration
with past projects that have left them empty handed and hopeless.
In hindsight, it is only now on our second visit, that one feels that
the
villagers are taking us seriously and are ready to participate in a
more
meaningful manner. The very action of returning to them,
fulfilling
our promise speaks louder than words.
Methodological Reflections
Reflecting on the methods used so far in the project, several insights
have emerged. Their contribution to the development of an
ecosystem
approach to human health improvement is discussed below.
Methodological pluralism: data versus process approaches
Our approach includes methods that are both “hard” (quantitative) and
“soft”
(qualitative). We assessed which methods would be most useful,
appropriate
and effective at answering particular questions. Once that method was
implemented
we examined how it well provided accurate and complete
information.
For example, reliable information on morbidity and mortality failed to
be captured by the individual surveys. Their responses were
simplified
and restrained. When instead we held focus group discussions in a
private place away from the earshot of men, women actively engaged in
conversations
regarding their illnesses. The recognition that others suffered
similar
illnesses was a catalyst that prompted further exploration of
treatments
and prevention measures. From these discussions women asked if
they
could have more meetings where specific illnesses that they identified,
could be discussed in more detail. They were eager to analyze
their
problems. This example highlights the distinction between a “data
approach” and a “process approach”. At the outset, we sought
data,
however, in reality the situation demanded a process through which
understanding
could be generated. What was lacking, besides exact figures on
morbidity,
was the creation of space or process through which the women can better
understand their problems and develop tools to do something about it.
Our
experience with Parasite Testing similarly
reinforces the importance of a process approach. Despite the fact
that the analysis of stool samples possesses the qualities of hard,
data-oriented
science, when implemented in the field, we were surprised by its
ability
to initiate a process more powerful than the actual information
collected.
During our most recent field trips, our parasitologist set up his table
and microscope outside the house where we were all staying (see
photo at right). As the mothers arrived with their
children’s
samples he analyzed them in their presence. Once he found a
parasite with the microscope, the mother and in many cases father, were
able to see them for themselves. Seeing the parasites first hand
had a dramatic effect. Suddenly the importance of purifying water
became real, they could understand why poor water and hygiene was
detrimental
to their children. Subsequently we were inundated with a series
of
questions regarding water treatment and other means by which they
reduce
the risks of parasite infection. In response to this interest we
have developed large colourful posters of the main parasites,
illustrating
their cycles, sources and simple ways to avoid infection. The
mothers
have asked to have more meetings where we can discuss how to improve
basic
hygiene and reduce contamination. Having both the mother and
father
involved was key, as in most cases water purification requires money,
which
is controlled by men.
When data approaches are complemented with more participatory
process
approaches, we can cross-check information. In participatory
methods,
where participants realize that the information and understanding of
the
problems directly relates to their actions and benefits them, they are
more motivated to describe their world as accurately as they can.
The likelihood of gathering false information, where either the
informant
deliberately lies, or does not take the time to provide more complete
information,
is significantly reduced.
Recognizing that different approaches tap different information
sources
and produce different outputs, the critical question is one of
complementarity.
Data and process approaches are complementary. The challenge comes in
not
only collecting reliable and accurate data, but rather in seeing how
the
actual process of gathering information, initiates other processes and
changes in existing processes within the community itself. These
processes will ultimately extend beyond the life and boundaries of the
project.
Research versus Action: Participatory Action Research
When we initially planned the activities of the project, we envisioned
two distinct and sequential phases; research (“el diagnostico”) and
action
(“desarrollo”), with participation occurring in both phases. Now
immersed in the research phase, we have found ourselves in a number of
situations where taking action is already appropriate and
necessary.
The examples below show how the separation of reflection and action in
reality is somewhat artificial and in fact the continual feedback
between
analysis and action enhances both the analysis as well as the
action.
This then raises the question of how much diagnosis is needed before we
can decide to do something. In contrast to the longer more
conventional
route of data collection, analysis, followed often years later with
policy
recommendations or development projects, we can engage in shorter
cycles,
whereby questions are raised, hypotheses tested in the field, plans
generated
from the answers found and new actions/projects employed. This
process
is then immediately evaluated. If it is successful, it is
expanded
upon, if unsuccessful, hypotheses are re-visited, methods adapted and
the
necessary fieldwork carried out. This cycle occurs several times
within the life of the project, each time re-focusing and expanding our
understanding of the problem and its appropriate solutions.
In
this project there are some questions that require a longer cycle,
where
rigour in methods and analysis demand years of work. Determining
the causal factors of nutritional status is an example. However
there
are other questions that are more suited to a smaller time interval
between
analysis and action. Often these areas are where the role of the
community is more critical. Our experience demonstrates that less
complex variables such as water quality and parasite loading provide a
very good starting point from which to link analysis and action.
The community is more able to grasp the significance of the results and
incorporate them into their understanding. For example, stool and
water testing have already initiated action in cleaning and controlling
defecation along stream banks and reducing contamination of wells. With
time, we will be able to deal with these results from the more complex
issues such as the linkages between the hydrological cycle and seasonal
fluctuations in nutrient intake and disease. In addition, actions have
meaning to the community. Although they can attempt to appreciate the
importance
of the research, this world of countless questions is foreign to
them.
Once we started talking about what to do and how, their interest was
more
genuine, and they were better able to see their role in the process.
This
is a sensitive issue. Locals have been the subject of a myriad of
projects where the findings do not return to the community and the
promise
of seeking solutions and making concrete changes is rarely
fulfilled.
We have dedicated substantial effort in explaining to the community how
and why the project will benefit them and emphasizing the local
ownership
of the information, findings, and solutions.
The examples below illustrate the importance
of action research:
In Naranjal, we have established a small rice experimentation
project
with both the primary and high school. When we were there during
our first visit, the community was preoccupied with the widespread
destruction
of their plantain crop by a fungus, sigatoka. As historically
most
farmers have depended on plantain as their main source of income as
well
as staple, knowledge of other crops is limited. They asked if we
could set up a rice project through which we would then train those
interested.
As the schoolteacher is an agronomist, coordination was facilitated and
we provided seeds for this small experiment. Since then we have
re-visited
the sight three times, monitoring growth and diseases.
Upon our return to Hierbas Buenas in October we were able to share
with
the community the results of the water quality tests of their 16
wells.
This information in combination with the parasite testing, initiated a
series of actions. The villagers asked if we would give an
informal
talk about the different parasites found, explain their sources and
what
they can do to prevent further infection. In addition, two of our
health workers presented a talk on hygiene practices. With the
village
we identified common areas where hygiene could be improved. For
example,
they agreed that the areas along the streams from which they draw
water,
should be cleaned and no one should be allowed to defecate there.
In addition they need to ensure that buckets at each well stay there
and
are not carried off to people’s homes where they are then
dirtied.
These buckets when dropped back into the well, contaminate it.
In the focus groups discussions on health, women identified certain
health issues about which they would like an educational session.
The next day we held a meeting (see photo
above)
attended by 35 women where we discussed causes and prevention of acute
diarrheal episodes.
In Puerto Belén, the teachers asked if we would give a
presentation
to the high school explaining how we each came to be
professionals.
As the team consists of agronomists, foresters, nutritionists and
health
workers, they were able to present a variety of different options
available
to the youth. In our second visit we will spend more time with
them,
administering a vocational questionnaire so they may see what is of
most
interest to them.
The
Researchers, the Researched and the Researched-For: Co-Researchers
The researchers are those conducting and carrying out the research; the
researched are those who are directly questioned, and the
researched-for
are those with the problem. Our experience has shown that the
boundaries
between the researchers, researched and researched-for, become less
distinct
with time and with each cycle. We all become co-researchers and a
shared
purpose is created (Wadsworth 1998). Commitment and sustained action
comes
from a shared purpose. This shared purpose is founded on the
understandings
people have developed together about what is of value. In
addition
incorporating community members into the team greatly increases
efficiency
and sustainability. Ultimately the community may then have the
tools
and capacity to evaluate our work and therefore reverse the tables
putting
the power and decision-making back in their hands.
If our final goal is to see the community as co-researchers, we, the
researchers, are seen therefore as agents of change, recognizing and
acknowledging
our role as catalysts in the community. The role of ourselves as
“outsiders”
is not as independent experts in search of The Truth, aided by the
assistance
of the community. Rather, we become a facilitator or catalyst,
assistants
to the community’s own pursuit of their truths (Wadsworth 1998).
Sequence of methods in the research process
Having recognized the importance of a plurality of methodologies, the
sequence
in which they are implemented is important as it affects our ability to
compensate for weaknesses in individual techniques and to build on
knowledge
systematically. We are able to use different methods to verify
and
cross-check information. Although we did conduct several focus groups
and
include representatives of local organizations in our project team, the
household survey was developed and implemented first. The
ethnographic
participatory assessment followed. In hindsight it would have
been
better to start with the ethnographic participatory assessment and from
the information gathered, design the survey around such identified
priorities.
Flexibility and Continual Adaptation of Methods
Flexibility and adaptation is necessary as contexts vary and situations
change. Our activities in the community are continually evolving
as we respond to changes. This is evident in the fact that in
each
community we are engaged in different activities. Although we are
implementing the same overall process, the details vary within the
different
contexts.
Heterogeneity of the Community
Sites were carefully selected to reflect the heterogeneity of
Ucayali.
However, this heterogeneity extends to the community level. The
communities
are clearly not homogenous in their composition and concerns.
Differences
in interests and conflicts within the community shed light on power
relations
and structures. From the outset we have ensured that all methods
are sensitive to gender issues as well as including activities that
specifically
identify inequalities in access to resources, exploring their impact on
health and nutrition. However gender is not the only difference,
nor is it always the main difference that affects people’s decisions
and
options. Qualifying the category of women into smaller groups of
older, poorer, or minority, shows that in some settings, their
identification
as “women” may be less important than their relative wealth, level of
education,
or age (Cornwall 1999). Differences between men and women are not
fixed, often they emerge and become significant in different ways and
in
different contexts. We are exploring this complexity by trying to
identify in which settings there is inequality, whose voices are not
heard
and why. For example, families who are more recent arrivals in
the
communities tend to be located on the outskirts of the community, often
several kilometres from the health post, schools and areas where most
village
meetings are held. We made a special effort to transport them to
and from meetings that we organized for the project.
Multiple scales in time and space
Figure 2 demonstrates the different levels at which variables are being
measured. We are not only addressing the health issues at the
individual,
family, community and regional scale, but also focusing attention on
how
and when these variables interact. The use of satellite images
has
been instrumental in training the research team in the issues of scale
and holarchy. The maps clearly illustrate how different parts of
the ecosystem are connected to one another. We intend to use
these
maps with the communities themselves, as a tool to expand their area of
reference and begin discussions on the importance of the ecosystems
beyond
the boundaries of their community. Community exchanges will also
help to broaden the perspective of their community and locate their
activities
in a larger context.
| PHOTOS (from top to bottom): |
| A gathering of kids in Santa Rosa; Analysis
of stool
samples with Wilson the parasitologist and friends; A charla on women's
health and hygiene; The town of Puerto Belén bids us farewell. |
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