Meetings with meaning : health dynamics in rural Nepal.
This thesis investigates the understanding of health needs of women in rural
Nepal using a participatory action research (PAR) framework. This framework
was evaluated using a multiple case study design. The cases were women's
groups being observed and researched by the researcher. The thesis is
concerned with developing and evaluating the PAR methodology and is thus
second order research i.e. it considers the process of researching research
and the issue of multiple perspectives is an important feature.
The justification of the use of a PAR framework is to be found in the forms of
research that takes place 'with' people. The distinction between PAR
methods and other qualitative methods is a philosophical one (Tolley and
Bentley, 1996) between the roles played by the researcher and researched.
The researcher "outsider" and participants "informants" are partners, sharing
and learning together.
The work is divided into two stages. The first is to determine the usefulness of
the PAR framework in helping participants make assessments of their health
needs, analyse their situation, develop strategies for solving problems
themselves, and implement their own action plans. The second is to reflect
on the research process itself, which allows for generation and testing of the
This thesis has enhanced the contribution to the literature in this field. A
development of the PAR framework emerged called the Health Analysis and
Action Cycle (HAAC), via evaluating the PAR framework. The HAAC was
found to be useful in allowing women's groups to assess their health needs,
plan and take action to improve their health situation. For example, five of the
six groups considered the importance of diarrhoea and developed strategies
to reduce the incidence of diarrhoea in their communities. The sixth group's
work centred on reducing the incidence of respiratory illness in their
community. All the groups were able to assess, plan and implement projects
to improve their environmental and hence health situation. The research
stimulated collective action and empowerment of women participating in the
research as it was the first time women had worked together to identify issues
of diarrhoeal disease and respiratory illness and introduced preventative
measures within their community.
The HAAC approach, an additional innovation in this field, has relevance to
the current theory and practice debate within the development sector. The
model developed has possible implications for t~e concept of developing
'partnership' within the health and development sector and the development
of emergent evaluation through developmental decision science.