UBC Theses and Dissertations
Interdisciplinary knowledge translation and evaluation strategies for participatory dengue prevention in Machala, Ecuador Mitchell-Foster, Kendra Lynn
This dissertation explores how knowledge management approaches and socio-political systems affect the accessibility to and application of evidence to improve the health of socially and politically disempowered groups of people. As, dengue provides a particularly vivid example of a human health issue intricately linked to biological, environmental, social and political systems, this study is embedded in a participatory dengue prevention and control program in Machala, Ecuador, that is committed to capacity-building and scaling-up. Guided by a transformative emancipatory approach with a focus on equitable participation, a multi-method approach was pursued including ethnographically-framed stakeholder analyses, social network mapping and analysis, illustrative vignettes and participatory indicator development. Six major stakeholder groups were identified in Machala: community, local government, government functionary, government administrator, researcher and private sector. Varying degrees of collaboration and interaction with one another as well as with the problematic of dengue are shaped by the dynamics of differing health priorities, paternalism/equitable participation, quemeimportismo/social resentment, nepotism/centrism/social justice, marginalization/self-determination and Buen Vivir. Power dynamics and knowledge valuation schemes dictate definitions of success and shape evaluation tools and processes tend to marginalize experiential and tacit knowledge, perpetuating narrow conceptions of health, benefit and dengue transmission risk. Overall, opinions regarding evaluation criteria did not significantly differ by stakeholder group, which suggests that social and cultural dynamics, as well as history and narrative of place, may be far more important factors in determining both stakeholder priorities and the character of intersectoral spaces than previously thought. A participatory evaluation tool is developed to assess both impact and process-related performance of proposed dengue prevention and control strategies. A knowledge translation model is developed with a strong emphasis on equitable participation and health equity. This study observes that there is deep need for change in underlying institutional power structures and research-to-policy processes, without which new evaluation tools will likely not “make sense” or result in improved policy, programs and community well-being. These findings and their implications challenge current macro, mid and local-level knowledge management strategies. This study indicates that opportunity for change exists through participatory evaluation processes situated at the interface of equitable knowledge translation and social determination.
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Attribution-NonCommercial-NoDerivs 2.5 Canada