5.3 Participatory research methods to transform inequitable gender norms

A common critique in the design and delivery of disease control efforts and services is that too often the solutions or strategies to problems are conceived by those in positions of power, with limited consideration of the needs and priorities of those who are supposed to benefit (61).

Friere’s work emphasized that poor people can and should conduct analysis of their own reality (62). This work, and others, led to the development of values and principles such as democratic education and learning, social justice and equality that guide participatory research and their associated methods (63–66).

Participatory research methods seek to place people most affected by a problem at the centre of the research and allow for the sharing of community norms, beliefs and practices that can guide the development of health interventions at minimal cost. These methods can be used at any point in your research study to understand key issues facing study populations and to support them to work out solutions to their challenges that are both feasible and acceptable. When using these to contribute toward gender transformative approaches, it can help us to understand how to navigate and challenge existing power hierarchies in communities in ways that are strategic and directed by those affected.

Table 10 ► provides a brief overview of some participatory methods and provides practical examples of how they can be used in relation to infectious diseases of poverty. The dialogue in producing the output is often what tells us most about a situation. Conducting the same methods with lots of different groups also shows us a lot about how different people see or understand the same issue, which can provide opportunities for change.

These methods can be used at any point in your research study to understand key issues facing study populations and to support them to work out solutions to their challenges that are both feasible and acceptable. When using these to contribute toward gender transformative approaches, it can help us to understand how to navigate and challenge existing power hierarchies in communities in ways that are strategic and directed by those affected.

5.3.1 Participatory action research as a catalyst for change

More recently, participatory action research (PAR) that draws on the methods described above has been used as a tool to encourage both communities and health systems actors to recognize their own problems and create solutions that can promote social change.

PAR often takes a cyclical approach of co-learning between researchers and communities. It encourages collaborative problem identification, action and reflection, leading to further inquiry and action for change. See Figure 11 ►. It shows the cyclical nature of participatory action research processes.

The use of participatory methods described above enables individuals and communities to make the last shift to be engaged in action and joint planning processes. These can shape how power imbalances are addressed as society changes and evolves (67). Box 9 ► presents a practical example of how participatory methods have been used in a study related to Neglected Tropical Diseases in Nigeria to inform a larger PAR process aimed at improving the equity in delivery of mass drug administration campaigns.

5.3.2 Participatory health research and the links to feminist principles

PAR prioritizes those who are less powerful, and encourages researchers and practitioners who are frequently outsiders to continue to challenge their own position and power within the research process ( See Module 6 ►). Power relations frequently act as a barrier between communities and health interventions and services. Breaking down these power relations is essential for the development of person centred health systems that allow for sustained health development and social change (69,70).

Participatory action research and participatory research methods are rooted in ideals of social justice and, as such, aligns to feminist principles. Feminist or intersectional participatory research seeks to assess the way gendered power relations shape societies. Feminist PAR approaches then seek to move communities along the last step of the participatory continuum to change underlying gendered power relations (71).

When used effectively, participatory approaches can raise a critical consciousness among individuals and communities regarding gender and health issues. They also allow for the development of a strategic alliance between communities and health workers, cumulating in the implementation of solutions for transformative change.

Just as participatory methods and PAR approaches can be catalytic in transforming gender and other social norms, they can also be gender-blind and reinforce underlying power dynamics. For this reason, it is critical that even when using more transformative approaches, we consistently consider the ways in which underlying gendered power relations are shaping participatory processes and make a conscious effort to consider how they can be challenged and progressively changed. We discuss this in greater detail in Module 6 ►.

View Key Resources ► for literature sources to consider reading after this section.