Applying a participatory action research model to assess and address community health concerns among tribal communities in Gujarat, Western India : the potential and challenges of participatory approaches

Abstract

Scheduled Tribes are a highly marginalised minority population in India as a result of discrimination and oppression of the historic caste system that still exists post-independence. Poverty is endemic amongst the tribal population along with poor health indicators disparate to those of the broader population. It is within this challenging environment of layered disparity (geographical, socio-cultural, gendered and socio-economical) in addition to tribalism, casteism and conflict with government and corporate structures, that this international collaborative research study was undertaken. Using a multi-stage approach, the objective of this study was to explore community perceptions of health issues in five rural, tribal villages in Gujarat, Western India and transform community knowledge into action. A modified framework of the widely used applied research methodology, participatory action research (PAR) was used for this study.Stage 1 generated knowledge of community health problems by applying rapid participatory appraisal (RPA). Based on the knowledge and perceptions of the local community, and using the RPA information pyramid as a framework, data was collected from each village in 2009, using a combination of semi structured interviews with community key informants, direct observation through community visits, focus group interviews and review of existing records. In total, 82 people were interviewed throughout the RPA process. Later returning to communities, a process of confirming and prioritising the health concerns was undertaken in preparation for Stage 2.Community based participatory research (CBPR), an action focused approach, was applied in Stage 2 to design action-interventions to address community prioritised health issues. In the early stages of Stage 2, the practicality of developing and implementing action-interventions was impeded by multiple contextual, social and cultural factors and the research was discontinued before completing a full cycle of PAR. To further understand the complexities of working with communities for change, insider perspectives and experiences of working with local communities towards empowerment and social change were sought from eight key informants, contributing to further understanding of the study.The results of this study reveal the priority health issues identified by the communities, uncover challenges inherent in participatory research, and present key informants’ perspectives of their work with marginalised communities. The RPA results provided a documentation of community-identified and prioritised health problems in each of the five selected study villages. Alcohol abuse was endemic in all study villages. Sanitation issues were also significant with 50% of homes in some villages having no access to toilets. Further issues of concern were environmental pollution, access to and quality of health care, road traffic safety, and underlying poverty. The employed participatory methods produced new shared knowledge unique to this study setting. For the first time, perceptions and voices of marginalised communities in these villages have been recorded, study findings compiled and distributed among the community.The transparent audit trail of activity in Stage 2 of the research combined with the documented perspectives of local social activists informed the discussion on the challenges of participatory research approaches in complex environments. It also provided information to further modify the PAR framework for future application. The resultant modified framework presents a practical approach and proposes some new improvements to practice when working with communities for knowledge generation through needs assessments, to needs-based action-interventions. Its combination of theoretical and practical considerations makes it suitable for non-government organisations (NGO), field practitioners and academics.The researcher argues that tested methodologies, approaches and methods alone cannot ensure a successful outcome to the knowledge to action transition and subsequently, PAR approaches. External factors separate from methodological decisions impact on a study and combined with the complex nature of community problems can cause less than desired outcomes. A recommendation is made for further research into these factors, as resources may be better directed by assessing if community efforts are likely to evoke action, leading to beneficial change. Whilst participatory action research is inherently challenging when applied in disadvantaged communities in complex environments, there is hope that with continual improvements community led action can bring about change for the communities where the applied research is undertaken.