Copyright Sociological Research Online, 1997

Martin, M. (1997) 'Critical Education for Participatory Research'
Sociological Research Online, vol. 2, no. 2, <http://www.socresonline.org.uk/2/2/8.html>

Abstract

This article takes the form of a case study of a master's course for health and development professionals working in the field of primary health care. It argues the need for health professionals to critically examine research paradigms and the assumptions that inform them, considering their appropriateness to primary health care, a health strategy based on a recognition of the relationship between inequalities and health status. Conventional training of health professionals does not encourage health workers to reflect critically on their research practice. This can be facilitated through an educational strategy that emphasises issues of inequality as central to health and addresses issues of power and purpose in research activity.

Keywords:

Critical Education; Critical Intelligence; Inequality; Participatory Research; Primary Health Care

Introduction

1.1

This article aims to address three questions: what constitutes critical education for participatory research (PR)? Why is this approach to learning crucial? What form can it take? These questions are considered in relation to work I am currently engaged in as a lecturer in Education for Primary Health Care (EPHC) on a post graduate course for development professionals. Following an introduction to the course itself and something of my history in relation to it, significant issues in the development of PR are introduced. This is followed by an examination of the meaning of critical education, as it applies to the course, and finally I consider ways in which critical learning processes are applied as a means of exploring PR and its relevance to PHC.

The Education for Primary Health Care (EPHC) Course

2.1

The masters course in EPHC has a history of 12 years, ten years of which I have shared as co-ordinator and lecturer. The course is designed for development workers, many of whom are health professionals and include nurses, medical assistants, health visitors and medical doctors. Other professionals are among the minority and include teachers from all levels of education who have an interest in community health, community development workers and social workers. On average there are 20 course participants in a year, each bringing considerable experience. This creates a rich and vibrant learning environment, enhanced by the high level of motivation and commitment to learning that participants bring.

2.2

On average, approximately 15 of the course participants come from countries of the South, primarily Africa, with the remainder from countries of the North, with experience working in the South. Participants vary in age from 25 to 55 years and represent diverse cultures.

2.3

The masters course runs for twelve months full time. It is divided into eight modules. Six modules are taught with the remaining two forming the dissertation. A module refers to a set of 12 teaching units of two and half hours each. Each module is focused on a particular topic for example, Re-Thinking Research for PHC. A taught unit examines some aspect of the overall subject. The module is assessed.

2.4

The course aims to provide an international learning forum for students and tutors to reflect critically on practice in the light of a range of theoretical perspectives that relate to health, education, research and broadly, the management of community-based development activities. A major goal is to strengthen the capacity of learners to examine critically development theory in the light of experience and reading. The ideas of the Brazilian educationalist Paulo Freire (Freire, 1972) have helped to create the learning methods employed on the course. Critical, international feminist perspectives, as represented in the work of for example Marie Mies and Vandana Shiva (1993) and Chandra Mohanty (1991) inform the content, process and thinking which emphasises a people-centred philosophy of education for development (see also Kirkwood, 1989 and Mayo and Thompson, 1996). This explicit political bias finds its mandate in the Primary Health Care Report (WHO, 1978), and international Declaration of PHC, emphasizing the right of all people to equality and the opportunity to participate in decisions concerning their lives.

2.5

I arrived as a lecturer and tutor to the course at a time when my own critical consciousness was beginning to emerge. I have a long established link with India which dates back to my birth and early upbringing there, till the age of eight. My professional career has spanned several disciplines. Following a number of years in nursing I decided to move into community-based work, and undertook a course in social work. This was followed by five years in social work with a special interest in community health. An opportunity then arose to return to India to work with a rural health and development project. It was the challenge of this experience perhaps more than any other, that encouraged me to question the widening inequalities and injustice I saw in the world about me.

2.6

On return to the UK three to four years later, I moved into community-based adult education. I was drawn into this field partly through my experiences in India, but also by a growing interest in the writings of critical thinkers like Illich and Freire. The next few years were spent working with women's health groups in the north east of England and completing an M.Phil. Throughout this period, a political consciousness was gradually awakening within me and something of this was expressed in political action in personal and public life. Working across several areas of development: health, community work and adult education, has helped me see the need to make connections across these disciplines, and to recognize the need for development professionals to take seriously issues of inequality.

2.7

Having offered something by way of introduction to the course and my history in relation to it, I move on now to explore some of the more significant trends in the development of participatory research.

Significant Trends in the Development of Participatory Research

3.1

Participatory research has its origins in the countries of Africa, Asia and Latin America. It emerged almost three decades ago as one of several critiques of the claims of orthodox positivist research to value-free, impartial research. A major concern of PR has been to raise questions about the power relationship between researchers and researched. In presenting an historical perspective of PR, Rajesh Tandon (1996) identifies several trends that have contributed to the development of this emancipatory approach to research. The earliest of these has its roots in the debate on the sociology of knowledge with its implications for epistemology. Namely, the recognition that both dominant and alternative forms of knowledge have existed in all societies. A second trend arises from the experiences of adult educators of the South. Concerned to promote dialogical educational processes between educators and students, adult educators created a process that enabled learners to take greater control over their own learning. They discovered however, a contradiction between the processes they now worked with as critical educators and those with which they carried out research activities, drawing on orthodox, top-down research methodologies (Martin, 1994). They needed to find a way of carrying out research which was consistent with the principles of adult education they had developed. In this way PR was born with its roots embedded in the principles of adult education.

3.2

One of the most important influences in the development of PR has been the work of Paulo Freire. Freire linked the process of knowing with that of learning, through an ongoing cycle of reflection and action (praxis). This learning process stimulates the growth of critical thinking, which raises critical awareness in learners of the world about them. Alongside Freire's ideas came a parallel development, that of the phenomenologists who held experience as a legitimate source of knowledge. Thus, experience was added to reflection and action, as factors that could influence practice. Finally, the late 1970's brought the re-emergence of the debate about peoples' right to participate in their development.

Participatory Research: Some Contemporary Issues

4.1

Budd Hall (1992), a leading practitioner and theoretician in PR, has identified several components in this research methodology, some of which are highlighted here: that the research involves professionals working alongside marginalized and oppressed groups; recognizing the knowledge, power and strengths these groups already possess, seeking to develop these qualities through the process of research; that research questions emerge from the priorities of these groups who become active subjects rather than passive objects of research; that those taking part in the research become committed participants and learners in the process which leads to a committed involvement rather than the impartial detachment claimed by the positivist paradigm. In researching with marginalized groups, PR sets out to facilitate the empowerment of the participants through the creation of knowledge and the taking of action that leads to change on structural and personal levels (Maguire, 1996).

4.2

As the term empowerment can now be found in the vocabulary of virtually all political perspectives today, some clarification of the meaning ascribed to it here is necessary. Empowerment refers to peoples' access to resources which increase their capacity as individuals and groups to take greater control of decisions at personal and community levels, so they might challenge relationships and structures of power. Chambers (1994) draws attention to the need to understand that empowerment of for example the poor, should not just entail representing their concerns, but empowering them to take action which they themselves identify as important:

Poor people have many priorities. What matters most to them often differs from what outsiders assume. If poor people's realities are to come first, development professionals have to be sensitive, to decentralize, and to empower, enabling poor people to conduct their own analysis and express their own multiple priorities. (Chambers, 1994: p. 10 [in Novak, 1996: p. 92])

Participatory Research: A Feminist Critique

5.1

Patricia Maguire (1987) has been a leading voice in developing feminist critiques of PR. Maguire argues that while PR acknowledges the centrality of power in the social construction of knowledge, it has failed to recognize the centrality of male power in that construction. This has been left to feminist researchers:

While PR builds on the Freirian notion of man's alienation in the world, it still too often minimizes or ignores women's alienation from a man-made world. (Maguire, 1996: p. 30)

5.2

Maguire (1987) draws attention to several aspects of PR which reflect male bias. She argues that the language in which PR is discussed by academics and practitioners is more often than not, male-centred; feminist perspectives are not represented as crucial to PR debates; women are frequently excluded from decision-making, especially in research design; the benefits of PR accrued to men (training opportunities, access to information, resources etc.) may not automatically be attributed to women.

5.3

It can be seen from the above that PR seeks to challenge and break down knowledge hierarchies and to create opportunities for development workers among others, to work alongside marginalized groups. This becomes a greater possibility when both share similar motivations and interests (see for example Khanna, 1996). This way of working with community groups rather than for or over them requires a fundamental shift in attitude for professionals, and in their perceptions of their role. The majority of professionals, no matter how well intentioned, have been trained to perceive themselves as experts in their field of specialization. Their often hard won training has taught them that they should be (or at least appear to be) in control: to diagnose, to prescribe, to treat and to hide uncertainty. This mentality can change, though change is likely to be gradual.

5.4

The shift in attitude is not easy for most professionals to take. It can be unnerving to discover that the taken for granted principles and values that have guided your life need to be questioned. It is this road that critical education can take the learner along, provided s/he is ready to take on board the many uncertainties that are an inevitable part of the journey (Khanna, 1996).

5.5

While some participants of the course come with highly developed critical faculties, this is not the case with the majority. Stimulating a critical thinking process presents a tall order for any education course and there are inevitably varying levels of success, as well as resistance to moving towards this goal. Before discussing ways in which I try to facilitate this learning process in relation to PR, I would like to consider something of the philosophical roots of this approach to learning, and to explore ways in which we seek to integrate it into the course.

Towards a Critical Learning Culture on the EPHC Course

6.1

Critical education requires a reflective learning culture within which critical intelligence can develop. The ideas of Freire form the theoretical back bone to this educational strategy (Freire, 1972). Freire helps us see that (formal) education is one of the major channels through which dominant groups maintain inequalities, but education also has the potential of facilitating the promotion of critical intelligence for social transformation:

There is no such thing as neutral education ... education either facilitates the integration of generations into the logic of the present system and brings conformity to it, or it becomes the 'practice of freedom', the means by which men and women deal critically and creatively with reality and discover how to participate in the transformation of their world (Freire, 1972: p. 38).

6.2

Critical education requires both an ontology and an epistemology. The ontology of critical education begins when learners reflect on their experiences and ask themselves what it means to be a human being living within the social relations of present day society. This enables learners to become aware of how structures constrain and oppress specific groups (Allman & Wallis, 1996). This process takes place when course participants begin to address the following kinds of questions: what is happening in the world about me in relation to issues of power? This question leads the learner to identify increasing inequalities in wealth and health, increasing unemployment in certain sections of the community, increasing poverty, homelessness, violence, racism etc.

6.3

The next questions learners are asked to address include: Why are these things happening? Who controls the political, economic and social systems that impact on our lives? For whose benefit do oppressive systems exist and at whose costs are benefits derived? Questions such as these help learners see the influences of power in their daily lives and to question purpose in a way in which they may not have done before. In doing so they are encouraged to situate themselves within the political framework. This analytical framework is taken on board throughout the course although there is variation in the way it is introduced in terms of educational methods.

6.4

While ontology and epistemology are essential elements in critical education, so too is methodology. The methodological aim of critical education is to transform learner/educator relationships from conventional hierarchical ones to those which enable learners and educators to become critical co- investigators of knowledge, through the process of dialogue. A more critical understanding of knowledge emerges from dialogue in which all sources of knowledge (formal and informal) are opened to challenge and critique. This helps learners see that critical learning need not be confined to the duration of the course, but can become a life long process.

6.5

In my experience, the dialogical learning relationship between learner and educator is not easily forged, both student and teacher can be resistant to it. The learner may feel confused and insecure as the relationship may not meet with expectations and past experiences of education. The educator in turn may feel threatened when the power base of the relationship is questioned. The process of building the relationship will vary with those involved. In cases where it does develop, this is likely to be gradual, as the relationship is tested out.

6.6

Some course participants only gradually integrate a critical perspective, while others remain resistant throughout the course. Most of us will accept a particular explanation of the world only when we are ready to do so. Weiler (1991) draws attention to the confusion that questioning issues of power can give rise to, particularly among women learners she has known. Conditioned within patriarchal cultures they have been led to perceive themselves as passive, not expected to 'question the ways things are, to consider how things could be different ... such thinking involves an active not a passive, relationship to the world' (Weiler, 1991: p. 462). Perhaps inevitably, many obstacles stand in the way of pursuing this approach to learning within the context of a formal course in higher education, yet progress can be made, as the remainder of this article aims to illustrate.

Towards Critical Learning for Participatory Research

7.1

In exploring the why, what and how of critical education for PR, it is important to establish what kinds of people participatory researchers need to be. Clearly there can be no blueprint, as what is appropriate in one context may vary in another. Nevertheless some discussion of the often neglected area of attitude in research is important. Appropriate attitudes and skills to engage with local groups are necessary if shared agendas and issues of immediate relevance are to be discussed. As marginalized groups may well be suspicious of outside professionals, development workers need to recognize, respect and value relevant indigenous practices and knowledge systems that the community may bring to the research, and to believe in the capacity of local people to tackle problems and create change. Novak (1996) argues that the extent to which professionals will be able to do this will depend in large part, on where they perceive themselves to be in relation to poverty and injustice: as part of the solution or part of the problem:

Recognizing that they can be part of the problem, rather than simply accepting that what they do invariably benefits the poor, is an important first step (Novak 1996: p. 91).

7.2

This has implications for critical education for PR. The recognition that we are part of the problem can enable professionals committed to social justice, to work towards empowerment of the marginalized, respecting their strengths while also aware of the myriad factors that disempower them. This asks professionals to give time to be with local people, to come to know them, be known by them, to be informed by them. Respect, humility, adaptability, empathy and patience born out of critical consciousness are among the important attributes of those working in this field of research. These qualities may not be much valued or fostered in professional training and conventional research contexts.

The Research for PHC Module

8.1

Each course module, as explained earlier, focuses on a particular subject. In this case the subject is Research for PHC. As the module runs in the second part of the year, participants are familiar with examining issues from critical perspectives. The module aims to continue critical dialogue in relation to a range of research issues. The concern is not to train participants to 'do' participatory research, but to enable them to evaluate critically a range of approaches to research, and to identify the assumptions that inform them.

8.2

Research practice in PHC has been dominated by positivism (de Koning & Martin, 1996). This is not surprising, given the powerful influence of the bio-medical model in the training curriculum of health professionals. A critical analysis of dominant research paradigms can draw the learners' attention to ways in which research designed and conducted from orthodox (particularly positivist) positions is more often than not, imposed on local groups by researchers who do not belong to the community and who may know very little about it. Such studies can be experienced by communities as aggressive, intrusive and insensitive (Pratt & Loizos, 1993). This interventionist or invasive approach (Freire, 1972) has been criticized as taking little or no account of the needs, interests or involvement of local groups as subjects of research (Tandon, 1996). The module aims to encourage participants to recognize different paradigm positions (positivist, ethnographic, participatory, feminist), and the epistemological and ideological roots within which they are embedded. As learners become critically aware of the belief systems and values that underpin these paradigms, they become more able to identify research approaches appropriate for PHC.

8.3

Much of the learning takes place using interactive methods in small groups of between two and eight people. Within these groups, learners are encouraged to reflect critically on practice, to give one another space to speak, to express their views, to listen, to question one another's perspectives as constructively as possible. As we are six months into the course, these learning processes are familiar to them, and many are skilled in their use.

8.4

It is important at the start of the module to help the group feel relaxed with 'the idea' of research. For many, research is perceived as a highly specialist subject which belongs to the expert alone. Time is spent encouraging participants to share their views and experiences of doing research. This leads to a broad definition of the term. Once basic research terminology has been clarified, the concept of the research paradigm is presented. This is done by introducing a variety of case studies which the group are asked to read and examine from critical perspectives. The case studies represent research studies designed from different paradigm positions: dominant (positivist and ethnographic) and alternative (participatory and feminist). Each group member is given one case study to read individually, then joins others who have read the same study. Once some familiarity with these studies has been reached, participants are asked to consider what questions they might address to the case study in order to examine the power balance in the researcher/researched relationships. A range of suggestions may emerge. These might include social class, gender, race, culture, educational background of researched and researcher. Once these factors have been identified, the group is asked what significance this has for the research design, process, outcome and dissemination of findings. This exercise helps participants move towards recognizing different paradigm positions in research and to see how these are informed by different value assumptions influencing design, process and outcome.

8.5

While participatory research aims to reduce inequalities, an examination of much of what may be described as PR, reveals that it is not in fact rooted in concerns for radical transformation of inequalities. Rather it involves local people participating in research often initiated by outsiders and carried out on local groups rather than with them. Such research may be concerned to benefit outsider research interests rather than those of local groups (Pratt & Loizos, 1993). I have found that a more critical approach to what constitutes participation and what does not, can be developed if the participatory process is examined using the concept of a continuum. Heron (1981) suggests it is useful to conceive of PR taking place along a continuum. At one pole is what he describes as 'experiential' or community controlled processes and at the other, 'traditional' or researcher controlled processes. It becomes possible to think critically about power distribution in research by drawing on a similar method to the one described above, addressing a series of questions to a study that uses the term participatory to describe itself. Questions might for example include: Who initiated the research? Who funded it? Who is likely to have benefitted from it? Who decided which problems or issues the research should focus on and which research methods to use? Who was given access to resources such as information, money, skills etc. through the research process? These questions encourage the group to raise questions about, who has decision-making power? Who is denied this? Does the research result in the transformation of local structural inequalities by for example, the inclusion of marginalized communities such as poor women, disabled people, children, black communities, and so on, in decision-making processes?

8.6

In order to carry out this exercise, we use case studies from the participants' experiences, whenever possible. These provide diverse examples of research in terms of cultural, political and economic contexts. Once participants, working in small discussion groups, have addressed the questions to the case studies and established at which point(s) on a participatory continuum their case study can be placed, they are asked to use a framework such as that provided by Pretty (1995) (reproduced here in Table 1), to consider which mode of participation they would place their case study in. Learners who prefer to develop their own participation framework do so, as not all feel able to 'fit in' with conceptual frameworks constructed by others. A danger of drawing on a framework such as Pretty's, is that it can reduce participatory processes to simplified and fragmented explanations, thus defeating the original educational purpose. At the same time, a framework offers a useful conceptual model that all learners can relate to and from which critical dialogue may be triggered.

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Table 1: Participatory Methods: Means to What End?

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Mode of Participation	Involvement of Local People	Relationship of Research and Action to Local People
Cooption	Token; representatives are chosen, but no real input or power	On
Compliance	Tasks are assigned, with incentives; outsiders decide agenda and direct the process	For
Consultation	Local opinions asked, outsiders analyze and decide on a course of action	For/with
Cooperation	Local people work together with outsiders to determine priorities, responsibility remains with outsiders for directing the process	With
Co-learning	Local people and outsiders share their knowledge, to create new understanding, and work together to form action plans, with outsider facilitation	With/by
Collective action	Local people set their own agenda and mobilize to carry it out, in the absence of outside initiators and facilitators	By

[Adapted from Pretty (1995) in Cornwall (1996: p. 96)]

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8.7

Having discussed, identified and to some degree agreed upon where on the conceptual framework the research should be placed and more importantly why it should be placed at that point (for example at the point of consultation on Pretty's framework), the next step is to consider why participation is limited and whether or not it would be possible to increase participatory processes in that context. This entails an examination of the obstacles that might prevent participation and a discussion of how these might realistically be tackled, through short and long term strategies. This exercise enables learners to identify factors that may be constraining participation and those that appear to promote it. The exercise can be used equally well in the research situation itself, as a form of ongoing praxis.

8.8

I have found critical education for participatory research, as outlined here, a valuable means of introducing learners to critical inquiry of research paradigms and the particiaptory process. It helps demystify research, so it is less likely to be regarded as solely the realm of the 'expert', but an activity that local groups can, and have a right to contribute to. Participatory learning processes help engage learners in an active role of inquiry in which they share experiences, and reflect critically on practice in a context that many group members find stimulating and relatively safe.

Some Concluding Points

9.1

Evaluation has consistently shown that the majority of participants find the process of critical education, as experienced on the course, challenging and enlightening. To many it affirms their understanding of the world in relation to their own observations and experiences of inequality. The course content speaks to their lives in a way in which former experiences of conventional education have not done. This has been most marked among those who have known themselves or through the experiences of others, what it is like to be excluded from main stream society because of gender, race, sexual orientation, disability etc.

9.2

The course has raised the confidence of many learners and has helped them find a language with which to articulate their ideas. However, there is concern expressed about how, on returning to their own countries, they will be able to influence colleagues and employers in putting their ideas into practice. We try to deal with this at various levels while students are still on the course. For example, one of the objectives of dissertation work is to develop small scale, manageable strategies for developing more critical approaches to training, research and management activities on return home. This however, may not be possible where for example, the political situation is sensitive or unstable. But where it is possible, the dissertation provides an opportunity to think through realistic strategies for change. Whenever possible, my colleague and I keep in touch with students to offer encouragement and support. An effort is made to meet them in their work settings when there is an opportunity to visit their countries. Some however, are posted to remote areas where it is difficult to make contact. The course selects applicants from the same training institutions in some countries where links are long established. This means that, on leaving the course, colleagues can network offering support to one another in creating change in their institution. To date this strategy has been most successful in Tanzania, Zambia and the UK, where contacts have now been well established for over a decade.

9.3

On returning to their home country, students have been able to re-write aspects of the training curriculum for PHC in order to include critical perspectives and draw on educational methods that help learners reflect on their practice in the field. Others have developed small scale participatory research projects linked to local concerns of inequality. These include improving the quality of local health services for disabled people in village communities as part of a wider community health programme in Uganda; increasing access to and control of basic drugs distribution to poor and marginalized groups in a district in Kenya; identifying and prioritizing the needs of carers of people with Acquired Immune Deficiency Syndrome (AIDS), and developing local services more appropriate to their needs in a country in Central America.

9.4

Many course participants from the UK choose to return to work in countries in the South. Of those who have taken up work in the UK, several have moved into health promotion at community level. Many maintain links with the course and return to share ideas about ways they have applied their work on the course to their professional and personal lives. Examples of politically active community-based initiatives in which course participants have partaken are varied. For example, one person working with a Manchester community group helped to acquire resources, establish and offer ongoing support to a health group for young women from materially poor backgrounds. This followed a participatory needs assessment in which she incorporated ideas she had developed on the course. The young women themselves control and run the group which has now been in existence for over seven years. Following this, the same person went out to Mozambique where she worked with local health workers in the training of indigenous midwives from rural communities. Another went out to a country in West Africa where she was involved in establishing literacy and health groups among women in the poorer marginalized communities. The literacy work here draws on Freire's ideas. Yet another went to a central African country where she is living and working with marginalized groups in urban areas. Story telling and drama are used as ways to provide opportunities for groups to discuss their health development needs and to see how these might best be met. Other course participants have taken up employment as lecturers on health courses in institutions of further and higher education, and we network closely, both in the UK and overseas. Much of the work mentioned above has involved small pieces of research which might not have been carried out from a critical perspective had the learner not been encouraged to thinking critically about research issues in PHC.

9.5

It should not be assumed that the critical perspectives presented on the course speak to the needs or interests of all participants. There are those who are uncomfortable or threatened by radical, controversial perspectives. The intention here is not to suggest that critical education as developed on the EPHC course is always successful in awakening or raising critical consciousness. There is no doubt however, that the course can make an important contribution to this process. At a time when formal education in the UK is undergoing rapid change, and increasingly an instrumentalist mentality permeates educational policy and practice, an education strategy that stimulates a reflect criticallyive learning culture of resistance has an important contribution to make.

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Copyright Sociological Research Online, 1997