Evaluative Research in Socio-political and Socio-cultural Context: Methodological Challenges and the Urgency of Social Interventions and Health Prevention in Remote Regions

Abstract: A qualitative evaluation research project concerning peer-education among sex workers was carried out in a remote region of Brazil. The project focused on the impact of unpredictable factors on evaluation results, the importance attached to collective forms of experiential learning and the active participation of local social actors in public health actions (i.e. prevention). The evaluation combined a community inquiry perspective (participant observation, individual and group interviews) with an ethnographic emphasis, using prevailing Latin American views on popular education in the search for cultural meanings. The study revealed the project's unanticipated "secondary impacts," such as the development of mutual help practices and changes in personal and collective life trajectories, and changes in collective meaning attributions derived from the recovery of a collective history. Working in close proximity to the setting in which the program was implemented permitted access to the socio-cultural and socio-political movements in force at the time of implementation. Proximity to the local settings enabled the researcher to insert herself into the program's socio-cultural and socio-political context. The research might better deal with unpredictable factors in the qualitative and participatory perspective.

Key words: participatory action-research, qualitative evaluation, health promotion, AIDS prevention, popular education, Latin America

1.2 Participatory-action research as awareness of social, economic and political contexts

2. Methods: Participatory-Action Research and Latin-American Concepts of People Education

4. Discussion: The Evaluation's Socio-political and Socio-cultural Context and Challenges for Participation

4.2 The challenges for participation in the socio-political and socio-cultural context

5. Conclusion: The case of an Emergent Evaluation Community—Unpredictability and Vertical Controls

A qualitative evaluation research project carried out in a remote region (State of Amazonas, Brazil) studied the double impact of unpredictability and the contribution of collective learning by and participation of local actors to better understand health prevention in a public health program. This analysis is based on empirical evaluative research of three HIV/AIDS prevention projects. The perspective of those public health projects emerged from an initial project with female sex workers in 1999. As a nurse and inhabitant of the Amazonian riverside community, I had helped to implement the projects in the field. The perspective of the projects sought to improve citizenship rights and to encourage safer sexual practices, as well as to provide specialized medical care for free diagnosis and treatment of STDs and HIV/AIDS for sex workers. Based on a peer-education approach, community "peer-educators" were initially selected, employed and trained to carry out educational activities about condom use. These took place in bars, on the streets, and in other meeting places. Peer-educators received ongoing training in STDs and HIV/AIDS prevention as well as in various themes related to human rights and citizenship rights. The project was initially sponsored by a foreign funding agency with regional and local collaboration. Returning to the field, now as a nursing researcher, I considered the factors of unpredictability of this participatory-action research that were of four kinds: (a) individual (variable skills for dealing with unforeseen developments); (b) socio-political (inequalities of power, mainly between so-called developing countries and so-called developed countries); (c) socio-economic (inequalities of resources from one country to another, between the periphery and the center); (d) ecological (some geographies are more susceptible to phenomena such as floods and epidemics). [1]

In qualitative research the tension between prior knowledge of a situation and field knowledge is the source of the popularity of "grounded theory." It draws attention to the need for a theoretical model that cannot be completely determined ahead of time (STRAUSS & CORBIN, 1998) but which cannot hope to generate a theory only on the basis of local data (DENZIN & LINCOLN, 1999; SCHWANDT, 1999; KINCHELOE & MCLAREN, 1999; CHARMAZ, 2003). This theoretical perspective had enabled the author (me) to identify various important aspects of prevention which had been neglected in a program evaluation limited to pre-established objectives. In this sense, the results of the present research project can be considered valid for local use (SCRIVEN, 1991), and as a potentially useful pathway for refining empirical evaluation models. The evaluation of this peer-education project centered on sexually transmitted diseases (STDs), the human immunodeficiency virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) paves the way for understanding the evaluation of other prevention projects. "Program evaluation is a process by which society learns about itself and in which 'the evaluator is an educator'" (CRONBACH, 1989, p.412). Acknowledging the autonomy of local actors directly involved in the prevention project as well as those who remained behind the scenes, such as the police and the military, with concealed power, had a direct impact on the construction of the theoretical framework for this research. [2]

The possible rupture between imported conceptualizations and actions and instrumental concepts in direct action (LAPERRIÈRE, 2004) illustrates two different logics of evaluation (SCRIVEN, 2004; MENDEL, 1998; CAMPBELL, 1984). Those two evaluative pathways, indicated in terms of Michael SCRIVEN's distinction, are, on the one hand, instances of objective-based evaluation, which is oriented towards an evaluation/verification of whether results instigated or controlled by program administrators have been met. This kind of evaluation is fundamentally aimed at controlling programmed actions within the framework of its specifications. In contrast, evaluation without preconceived objectives ("goal-free") is a complementary evaluation proposal that deals with the operational situation and excludes administrators' specific mandates, which typically give rise to objectives for managing a program. In this perspective, the evaluator "does the evaluation with the purpose of finding out finding out what the program is actually doing without being cued as to what it is trying to do" (SCRIVEN, 1991, p.180). MENDEL (1998) invites us to explore power not only as the power of some people over others, but also as the power people and collectives have over their deeds, as an appropriation of their deeds in "action," by referring to the idea that infuses it and the discourse that expresses it. The concept of action absorbs deeds as derived phenomena, having neither discourse nor interest, to such an extent that the two are merged in an interchangeable way, though always to the advantage of action. As such, deeds are conceived as distortions by omission on the part of action. Action includes neither resistance to the intentions subjects can imprint on the world nor to the interaction they have with the world. It transforms the research relationship to make it a source of mutual change for the participants as well as for the researcher (MENDEL, 1998). MENDEL's basic argument can be presented as a comparison of two modes of thought. Table 1 shows my creation of a schematic way to represent those modes of thought related to evaluation of action. Action as an ideal process (the first row) flows from a preview of the process and its activities to the expected results. Action as a dialogue between the idea and its implementation (the second row) includes an awareness of the possible receptiveness of actors in the situation to a proposed intervention. Both the activities and the results can be only partially predicted, since they will be the product of an interaction between the intended change, its acceptance by the actors, and the situational possibilities of the actual setting.

Restricting the first row to the level of concepts limits the evaluation of objectives to the realm of the direct relation between 1 and 3, where 2 is simply a more detailed description of the expected transformative activity. An alternative evaluation centered on the totality of impacts places all three stages in a similar state of concreteness and accepts that the act may lead to a result which defies expectations: the act is, after all, the difficult encounter between a preconceived idea with a pre-existing reality that can accept it, resist it, or modify it. The prevision or "pre-act" should not be restricted to a search for the expected result, limiting this search and even distorting it by filtering reality through pre-established indicators. On the other hand, when ideas and concepts can be integrated into the world of action, action processes include the totality of performed acts and take into account how they are accepted or rejected. The result is therefore an history of interaction between a participant's world of ideas, which become a new external reality with its roots in a preceding reality and which opposes the participant with the strength of its pre-existence. [4]

1.2 Participatory-action research as awareness of social, economic and political contexts

Research by REASON (1994a, 1994b, 1995) and REASON and BRADBURY (2001) revealed the growth and convergence of research models that are in line with the above-mentioned aspects. REASON (1995) proposed thought in action in which he presents activity cycles for the collective analysis of action. He incorporated the creation of discussion groups that participate in the articulation of empirical research projects and who can influence them as they are being conducted (REASON, 1994b). This kind of empirical research assume the active participation of participants in the development of the research problem, data collection, analysis and dissemination of the findings. It is a knowledge appropriation process by the participants to foster social transformation actions; participation honors the legitimate rights of people to have a place in decision-making forms (REASON & HERON, 1995). He argues for the integration of three participatory approaches: participatory action research, cooperative research, and action science, such that participatory action research serves the community, cooperative research the group, and action science individual practitioners (REASON, 1994b). [5]

These developments stem from a long tradition in Latin America, a tradition within which Paulo FREIRE (1974), Orlando FALS-BORDA (1992), Carlos R. BRANDÃO (1985, 2002) and Eymard VASCONCELOS (1998, 2002) are emblematic figures. Mohammad A. RAHMAN and Orlando FALS-BORDA (1992) argue that the motivating factors for participatory action research originated with a desire for radical social change that infused Latin America. Action-research has always been linked to the people's movement, in particular to popular education methods, as Carlos R. BRANDÃO (2002) notes in his history of this movement over the past 40 years in Brazil and adjacent countries:

"In many cases, social movements (gender, ethnic, cultural, human rights, itinerant action) see themselves as being incorporated in a sense into founding spirit and the ideals of current popular education practices. The emergence of various forms of participatory research has almost always been carried by popular education ideals and practices" (BRANDÃO, 2002, p.151, translated from Portuguese to English). [6]

The community work method developed by Paulo FREIRE can be defined in more contemporary terms as empowerment which results from a critical consciousness of concrete living conditions. It proposes a methodology for posing problems going from dialogue to an in-depth understanding of the problem's initial causes (MINKLER, 1997). FREIRE (1996) views community empowerment not as the result of adapting to reality, but, rather, as the ability of its members to opt for, to decide and to break with crystallized accommodation ideas to transform and intervene in the world. FREIRE (1974, 1980, 1982) believed that it was possible for people to become active and curious agents of transformation and able to take risks. The political function of action research is intrinsic to the kind of proposed action and with the actors in questions (THIOLLENT, 2003). Rodolfo STAVENHAGEN (1917) goes further in denouncing the historical relationship between colonialism and imperialism as systems of domination and exploitation perpetuated in anthropology and the social sciences. He calls for militant observation fully aware of the socio-political and socioeconomic context. Lastly, Orlando FALS-BORDA (1992) enumerates the methodological considerations of radical participatory action research: (a) authenticity and compromise; (b) anti-dogmatism; (c) systematic devolution; (d) simplifying technical language; (e) thought-action rhythm; and (f) techniques for dialogue. Autochthonous research in Latin American is informed by this multiplicity of philosophical perspectives, which are pertinent to articulate the "transdisciplinary" (SCRIVEN, 2003) framework which guided the researcher's methodological choices and analytical stance during her research activities. [7]

2. Methods: Participatory-Action Research and Latin-American Concepts of People Education

The evaluation was performed using a participatory-action research approach with participant observation, individual and collective exchanges, and an ethnographic perspective, using a Latin-American conceptualization of popular education and sensitivity for cultural significance. During a five-month insertion period, participatory observation and individual and collective interviews with a variety of local actors (35 stakeholders) using a Self-Evaluation Guide for Community Organizations (JALBERT, PINAULT, RENAUD, & ZÚÑIGA, 1997a, b) revealed other dimensions of the project's global impact inside its socio-political context. The starting point was the identification of the variety of actors so as to incorporate them into the participatory process of self-evaluation: users, peer educators (multipliers), representatives of structural elements of prostitution areas, such as health networks, public administration, police, military, political, legal and cultural apparatuses, and research personnel. [8]

This enumeration of actors—who were an integral part of the prevention project—demonstrates the futility and danger of naively believing in research's social autonomy and ignoring the links between social, economic and political activities and their controls and local legitimacies. The strategy to work within this field was an operational plan that progressively took into account the danger level for stakeholders and the researcher inserted in the project's socio-cultural, socio-political and geographic context. [9]

The researcher sought to optimize the information relevant to the evaluative research and how it was used in the contexts of the preventive practices in which it was produced. I used a variety of data collection techniques within the framework of a flexible operational plan adapted both to the opportunities available within the research context and to the participation of local actors directly involved in the project. [10]

Individual interviews took the form of hour-long thematic exchanges with all local actors: patients of the regional reference center living with STDs, HIV and AIDS, the coordinating personnel, users, volunteers, and municipal public administrators. The themes discussed included the perception and assessment of project activities, the collective help relationships developed and the changes that in their view could be attributed to the program's prevention activities. At the explicit request of some participants, information about their own life trajectories in relation to the project was integrated in the form of life histories. [11]

Collective interviews were conducted in three groups, organized according to the "assessment-sharing groups" technique with the 17 participating peer-group educators involved in three prevention projects. Each group met on six occasions to elaborate and discuss the activities of the planned community activities. The one-hour meetings involved discussions of the themes covered in the form of open questions aimed at identifying their views and their assessment of the activities developed in the project and its global impact. [12]

Each meeting was planned as a generative theme research in line with a Brazilian popular education perspective, with a view to facilitating reflection among participants. The open dialogue setting allowed research and analysis of the generated themes discovered by the participants, and led to new thinking and the organization of collective knowledge. This type of work fostered the joint construction of the analysis of the data collected in the prevention activities. Six collective interviews allowed for the completion of the joint assessment analysis of the data gathered in the prevention activities. Throughout the research process, meetings began with a review and a reinterpretation of the data collected in the previous meeting. A final joint meeting of all three groups generated both an exchange between the groups and a global report of local results to the project initiator. Throughout the intensive five-month research project, participant observation enabled an understanding of the actions and interactions of participating actors, increased their awareness of their activities in their visits to their work sites and developed a wider vision of the dynamics triggered by the participatory field research. [13]

The evaluative process within the framework of a participatory action-research perspective draws on four categories of results: (a) the construction of collective learning on the basis of the experience of social and preventive actions; (b) the dissemination of knowledge generated by the process to an external public; (c) the recuperation of individual and collective trajectories linked to the prevention projects; (d) the transformation of a research strategy motivated by a systematic devolution of data to participants and the course of research information to be integrated into action in an urgent situation. This last result was reflected in the research. [14]

Questions about how to know where the sex workers' peer-educators were going and how to organize themselves were asked on several occasions. Discussions with the local actors (peer-educators in particular) demonstrated that it would be difficult to meet the pre-established objectives of the HIV/AIDS prevention program unless there was a continual adjustment to the shifting local context (street gang territories, changes in public administration, and the instability engendered by a pre-election campaign). Also, the free expression of opinion was much more hazardous. The group interviews with peer educators allowed for a discussion of these preset objectives, with a view to studying them in context and to identifying a more realistic action path with regard to the real possibilities for preventive activities. A text collectively written by the peer educators from the three projects presented the elements that were viewed as essential to the self-evaluation experience and that were disclosed to an external public in a community organization's newsletter:

"We want a collective text that makes sense for us ... One begins with one idea, another one develops it ... Ultimately, the process finishes with a collective text that is meaningful for us. That is why it is important to return to the subjects already discussed in a previous session. This is a form of consensus about what is important for our project, to guide us in our action. It is a form of knowledge constructed among us; it is a reflection of us, with its imperfections, but tied to our everyday practices" (Transcription of a group discussion, in LAPERRIÈRE, 2004, p.107; translated from the French). [15]

The contents of the group discussions and life stories were reproduced for the participants, first as meeting notes, then as a recapitulation, including a review of the evaluation process and its results. The participants discussed how the research data would be disclosed and their use as instruments in support of preserving their local prevention actions. Some peer educators took the text summary of their life story, which they had initially had given as a personal testimonial, to use as an educational tool in their interactions with the peers in their practice settings. [16]

Personal changes varied form one person to another. Well aware of the risks related to STDs and AIDS, many participants modified their sexual behavior. The work they accomplished changed their social image within the municipality: "Before, I was seen as an animal, a pleasure toy. I was at the bottom of the hole. Afterwards, I left the night life." His family now accepts him more; his friends respect him because he has become more independent; he is more valued: "now I walk straight." The events in the project opened my eyes to former sex workers who have become peer-educators: "I have changed my way of being … The past is food for thought, not for repeating it." [17]

4. Discussion: The Evaluation's Socio-political and Socio-cultural Context and Challenges for Participation

The field experience made it possible to verify both the prevention project's gradual development and the resistances opposing it to social reality. This reality is a complex one in which prevention is not shut off from the world and cannot happen without disturbing relationships and the balance of administrative, political, and even criminal power. An established order can react with all the means at its disposal to prevent changes that it views as threatening its existence. The reality was characterized by limits to what could be anticipated. The research activities occurred at a time when their managers were going through a critical period—the projects would only survive if they could obtain other self-sustaining funding. As such, the evaluation activities took place in a context of insecurity, something which the research project could not choose to ignore if it was to be conducted with a minimum of consideration for unforeseeable events and contextual realism. [18]

The challenge for this evaluative research project was to contribute to understanding the establishment and implementation of a prevention program situated at the limits of what was controllable and in the presence of and affected by a wide variety of recognized and hidden actors operating in the background of the social order apparatus. Given that the HIV/AIDS prevention project was inserted into the various registers of many local actors, it could not select targets arbitrarily. As such, it had to remain open to all channels of understanding, which presented themselves during 5 months of fieldwork which had been preceded by 6 continuous years of professional work in the same community by the researcher. [19]

The research situation was emeshed in socio-political dangers. Public health, police, government and criminal actors have relations that traditional research prefers to ignore but which play a role in day-to-day situations of the community, obliging the researcher to take them into consideration. The fact of not speaking about smuggling and drug trafficking, as well as tensions regarding police action and political administrators did not isolate the research from its context. [20]

The presence of the unpredictable transformed previous plans, the authors and administrators of which preferred to believe that what was planned would be implemented without change. In fact, the collective action was placed in a space between the urgency of acting and the need to reflect on "What are we to do?" to find a realistic alternative to the preconceived response anticipated by the original project. The planned activities and the activity calendar confronted the unstable reality of a health system in a peripheral municipality, where stability expectancies were minimal: the development of an opportunistic logic was a necessary condition for an action that would respect the original intention, but would adapt it to local possibilities and the moment in which it took place [21]

The reality of the unpredictable went beyond infrastructure problems. It also reflected the need to search for consensus among all the potential participants in the project and to give them assurances that it would have positive impacts not only on the production of useful knowledge, but also on the available services that the preventive action claimed it wanted to improve. [22]

4.2 The challenges for participation in the socio-political and socio-cultural context

The observations and collective interviews drew out the importance of bearing in mind the lucidness of local actors with regard to the possibilities for social change. They knew much more about what could really be made to happen and what was beyond the possible within their own local organizational culture. Their reading of the project presented to them filtered the action proposal in terms of what was possible. Prevention requires dynamic evaluations and a grounding in local cultures that respects the dynamics of preventive practices, especially in settings in which the variables cannot be predetermined. [23]

4.2.1 Translating the researcher's intentions into terms that can be proposed to the participants

Participation demands a local appropriation of project. Active participants must acquire the sense to appropriate the objectives, procedures and methods of analysis: if the participation is to be radical, it has to be present in all the project's aspects and moments. Without this, the appropriation is incomplete (PARK, 1989) and the challenge becomes even greater since this appropriation lies at the heart of any desire for liberty (MENDEL, 1988). Abstract, theoretical explanations of participatory action-research are incomprehensible to participants. They grasp their practices on the basis of a palpable reality and the emerging problems encountered in day-to-day life and survival. We have to accept the premise that science from common people is a vital, empirical knowledge practice that has enabled them to survive, translate, create, produce and work for centuries and that it possess its own rationality and causal structure (FALS-BORDA, 1992). [24]

The researcher had to close the cultural gap accentuated by technical methods from one social class to another that reinforce the fact that one side does not understand the logic and the attitudes of the other. In this sense, Eymard VACONCELOS (2002, p.105) notes that there is a confrontation between the population's diversity and heterogeneity and institutions' universalism and homogeneity, such that the technical methods favored by one social class differ from those of another. Similarly, this cultural gap can be exacerbated by a rigid research method that gives no value to the participants' cultural and personal utterances, especially those from the subaltern levels of prevention projects (users and multipliers). It was for this reason that the incorporation of popular education (BRANDÃO, 2002; FREIRE, 1980; BOFF, 2000, 2003; VACONCELOS, 1998, 2002) came to be used as a tool of cultural communication as much by the participants as by the researcher. [25]

Because participatory focus was the theoretical foundation for the work to be carried out, this empirical project demanded a negotiated awareness of the fact that the project required a jointly constructed signification. As a consequence, participation also presupposed intercultural negotiation. The concrete form of the participants' thinking was the foundation of this agreement. During the group discussions with users and peer-educators, the basis of analogies with their environment, nature, comparisons with similar situations, and individual or collective experiences activated generator themes that the researcher guided. I clearly indicated my own and the project's perspectives, such as the way it was conceived and organized, showing also my integration into users' life in order to take into consideration the participants' mode of understanding research. [26]

4.2.3 Democratic grounding of participatory action-research in a new collective rationality

Cooperation requires a logic of participatory rationality that is not the logic of the local context. It requires communication that is open to social structures of political, social, and economic power. As such, it was necessary to begin the "shared-evaluation group" and action-research process in order to provide the participants with a better understanding of their possibilities for participating, negotiating and deliberating. Adjustments to the times and the content of the meetings were necessary to take advantage of this "small-scale democracy" (HOUSE & HOWE, 1999). As such, the objects of deliberation encompassed not only the content of the self-evaluation of their projects, but also how the project was conducted and the dissemination of research findings. Rebecca S. HAGEY (2000) formulates this as a shared experience of cooptation to bureaucratic subordination that infiltrates communities only for the sake of a way already established by them. A central concern of the local actors was how the information engendered by the evaluation activities would be disclosed. While some participants were not concerned about its disclosure at the international level, most were concerned about its local dissemination, which had direct implications for their personal and collective lives. [27]

Communication of the modifications of foreseeable social action and their insertion in forms of personal and local life can be viewed from the perspective of other cultures or social classes as things which are unforeseeable. The national and international cultures of foreign elite classes are not always able to decode the local contingent factors of variability and view them as obstacles rather than as health-related requests for adjustment. [28]

Insertion into the environment of local actors and frank relationships (characteristics of participants' lifestyles) quickly revealed important socio-cultural elements that had an influence on the way the research was conducted. Verbal communication of information and impressions among social actors was rapid and easy in a relatively small community. The functioning of the community network of local actors in the municipality engaged formal health institutions and informal networks (such as street gangs) alike. Participation was enthusiastic but also demanding because participative activity flows from participants' faith that the project would genuinely improve their life conditions in a relatively short period of time. This entailed a reciprocal service exchange between local actors and the researcher. The results reflected a history of the group and its interpersonal relationships as well as the participants' helping the researcher to confront her own history as an investigator and develop a critical view of her interpretations (TOURAINE, 1978). Moreover, it became clear during the participatory action-research project that the individual interviews engendered the participation of the actors who embraced the Strategic Focus Groups' dynamism. As such, inter-communication among the various social actors from the political and health levels as well as among the members of the prevention projects suggested that they shared the knowledge created in the course of the individual and group meetings. [29]

The validity of the research findings were influenced by the authenticity of the participants as it was incorporated into the internal evaluation process. Several peer-educators were quite frank in expressing their attitudes towards external evaluators. This attitude was reminiscent of Potemkin's villages: "we act as if everything was alright … As soon as the person leaves, we can well see that things are not going well" (translation from an exchange with a group, in LAPPERIÈRE, 2004, p.129; translated from French). The prevention projects are still confronted with the structuring realities of local organizational cultures. Conducting evaluations in a given environment presupposes that researchers bear in mind the historicity (TOURAINE, 1978) of the social and cultural organization in which the participants are immersed. Local insertion optimizes the analysis of social and historical relationships among the participants, groups and local research institutions with whom the researcher is in contact. As MARKOVA (2003) notes, we cannot analyze replies given in focus groups (which foment a particular dynamism and action) if we pay no heed to the political and social context in which this group communication took place. [30]

The analysis should also include a critical vision of vertical relationships in local prevention projects that are subordinated by power structures (LAPERRIÈRE, 2004) and how they influence responses from participants in collective interviews. Participation cannot avoid information manipulation. In conducting the participatory action-research project, it became increasingly clear that participation could be mitigated by information manipulation. At one point during the discussion, we drew out the fact that certain speakers tended to talk in terms of the "development" of their project. For example, if there were 35 work sites indexed in 1998, the kind of effectiveness evaluation of STD/HIV/AIDS prevention projects carried out by international development agencies (e.g., WHO and UNDP) would assume that in 2004 there would an increasing number of site visits. The local actors are very much aware that this—development effectiveness in terms of numbers and innovation—represents the justification for funding their source of income. For this reason, the results cannot be considered only in terms of their factual claims. The problem is larger when there is an awareness of what would be said in these groups will also be made known to authorities and local powers by some of their members who had infiltrated the collective interviews, with important consequences for personal participants' and researcher's security. Talking reveals information, and not all information is guaranteed to have a right to be revealed and published outside the community. [31]

5. Conclusion: The case of an Emergent Evaluation Community—Unpredictability and Vertical Controls

The experience of nursing research and evaluation in Brazil was analyzed via the dual lens of the impact of unforeseen social elements and the verticality of relations among the actors (power, control, and influence relations which often remain at the level of what is commonly unsaid), that is, facts that everyone is aware of but which no one talks about. The area in which this study took place included drug traffickers, owners of bars in which prostitutes plied their trade, street gangs and local political elements with whom the research project had to negotiate, in addition to negotiations with "visible and recognized" peers in the official health system (LAPERRIÈRE, BENZAKEN, & ZÚÑIGA, 2004). Local actors were clearer about the adjustments needed to carry out projects designed at higher levels of the health apparatus and were more realistic about the possibilities of participation in their organizational structures and local cultures. [32]

This experience was rich in gaining insights into the evaluation logic used and its potential to be contextualized in a given setting. Sex workers, peer-educators and other community' members outside the prevention health projects have helped the researcher to insist on the necessary awareness of the multiplicity of actors involved in the everyday life of the project. These actors are blatantly placed in unequal relationships of control and influence, in a "verticality" of power relations underlined by the "context of unpredictability," far removed from the dominant logic of a research design that took for granted the control of the situation that was the object of the evaluation. [33]

There is still no magical response to the challenge of understanding the dialectical relationship between the local and the universal. The possibility and the limits of the transfer of experiences and of the generalization of empirical knowledge meet problems equivalent to those of attempting to impose abstract solutions, produced in very different societies and with other interests than those that characterize the concrete research situation. Closeness allows the perception of details, but increased distance makes it possible to place it in a global meaning context. Academic settings too often confuse proximity and subjectivity on the one hand, and distance and objectivity on the other. To think that closeness to the experience of the other produces nothing but "subjective" distortion and data contamination, and that keeping at a distance is a guarantee of "objectivity" and of data purity is a semantic confusion that owes more to an unreflective use of language than to rigorous analysis. In order to know and to act, closeness and contact are necessary. That this closeness could be a source of convergence of interests is no truer than the claim that distance can breed indifference and incomprehension (ZÚÑIGA, 2003). [34]

There are no magical solutions to the intentions to intervene that take for granted that proposed change is necessarily better than the situation it was meant to change. The critique of "developmentalisms" has been well analyzed by authors such as Pablo GONZÁLEZ CASANOVA (2002), Rebecca S. HAGEY (2002) and Paul FARMER (1998, 2003). Pedro DEMO (2000) has denounced the innovative obsession of scientific knowledge and of the rights it accords itself to impose change, and how it coexists with the inequalities between rich and poor countries and those between national elites and popular sectors that impinge on differential accessibility to existing knowledge and the possibilities for producing and diffusing it. The peer educators in the project were fully aware of these inequalities and of their consequences on their own work—including their job stability and their conditions of personal security. [35]

Assessment-sharing groups allowed for the discussion of objectives, of their insertion in a given context, and of the paths available to make them become a new reality. It was perhaps in the peer-educators' practice where there were inklings of concrete answers to the previous questions, which were hopeless when formulated as abstract dichotomies and as irresolvable social conflicts within the parameters of established power structures. If objectives are utopian and if practices are limited to the opportunism of the easily attainable, the situation will not change in its structuring characteristics and problems will continue to haunt the local community. This was clear to participants, who oriented all their efforts to search for solutions they could live with while accepting the consequences. [36]

"Grounded knowledge" conveys a vision in which knowledge is not only a capacity to discover, understand and interpret reality, but also a means for transforming it in terms of parameters of survival (DEMO, 2001). The foregoing research experience made it possible to identify pathways for thinking that can orient community practices in health prevention, especially the need to include a more acute consciousness of "what is happening" and a greater awareness of the political context in which things are happening. Proximity to the local context allows for better insertion in the social movement of the project's socio-political context. Its impact can incorporate unpredictable factors into a perspective that is both qualitative and participatory. I firmly believe that the professional autonomy of people who work in direct daily contact with affected populations will only develop fully if they are aware of their personal options, of the values that orient them, of their engagement with the communities they serve and of the reasons that guide their actions in society. [37]

I would like to thank Prof. Ricardo ZÚÑIGA for his valuable contribution to the success of this research. The sharpness of his socio-political analysis and his experiences as a Chilean exile have made him a rich source of exchanges about the Latin American context of this research.

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Hélène LAPERRIÈRE, Master's degree in Nursing Sciences. I am currently a doctoral candidate in public health at the Faculty of Medicine, University of Montréal. In looking back over the various stages of my professional practice, I see a commitment to community groups (such as women's associations, sex workers, pastoral health agents, and sailors). I also see my interest for recovering popular knowledge and conceptions of alternative initiatives in caring and care knowledge (BOFF, 1999). For six years, I was involved in the Brazilian "liberation" movement, which guided both my insertion in peripheral neighborhoods and in my work. It enabled me to concretize my participatory action research with a view to assessing health prevention actions with an ethic of compromise and a socio-political consciousness. I view my accomplishments as a personal pathway that cannot be dissociated with community service and professional community practice as a health prevention and research nurse. My current commitments are articulated around community practice as a nurse in active collaboration in evaluation projects with community groups and around my doctoral thesis on a critical analysis of international scientific dissemination and the verticality in dominant social relations of opposition.

Chaire Approches communautaires et inégalité en santé (CACIS)
University of Montreal
Box 6128
Montreal, Québec, H3C 3J7
Canada

Laperrière, Hélène (2006). Evaluative Research in Socio-political and Socio-cultural Context: Methodological Challenges and the Urgency of Social Interventions and Health Prevention in Remote Regions [37 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 7(4), Art. 6, http://nbn-resolving.de/urn:nbn:de:0114-fqs060464.

Forum Qualitative Sozialforschung / Forum: Qualitative Social Research (FQS)

ISSN 1438-5627

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The projection of concepts to future actions	1. The intellectual vision of anticipated actions: THE PRE-ACTION	2. Action as planned, predicted and anticipated: ACTION	3. The expected coincidence of action as predicted and action as executed: The objectives-results evaluation as POST-ACTION
Consciousness in action	4. Knowledge and understanding of intervening actors of the sense of the action to be undertaken	5. Consciousness of the action undertaken as a totality present throughout the action: THE ACT	6. An alternative evaluation model: the totality of impacts with and beyond objectives as the interaction of intentions and the concrete situation