Stimulating Community Participation in a Group of Farm Workers Using Action Research. Abstract Background to the Problem

This study assessed whether community participation in health related activity was a reality or just popular development rhetoric.Using action research methodology, focus group discussions and informal contacts were made with farm workers consisting of twelve families in Umkomaas, south of Durban in the province of Kwa Zulu Natal. The aim was to establish whether this community could be actively involved in all aspects of community participation. The level of participation was described using Rifkin's model (Rifkin et al , 1988). Results of this study revealed that the community was able to identify their own health problems, prioritize them and plan appropriate strategies to meet the needs identified. " .. .there seems to he a potential for the community to become more cohesive , to influence one other and to function effectively as a group... "

".. .thereseems to he a potential for the community to become more cohesive , to influence one other and to function effectively as a group..."

A Research Article
36 Curationis March 1999

Background to the problem
According to Senghor (1987) one of the most disadvantaged groups am ongst others are agricultural workers in the countryside.In order to assist those in greatest need active participation at local level needs to be sought.Community participation is frequently advocated throughout the world but according to Shoo (1991), this is hardly practiced.The involvement of the community in primary health care is not a social nicety ; it is a technical necessity as prim ary health ca re p ro g ra m m e s c a n n o t a chieve adequate coverage and effectiveness w ith o u t the fu ll p a rtic ip a tio n o f the co m m un ity (Bryant, 1988).In South A frica c o m m u n ity p a rtic ip a tio n is s tro n g ly e m p h a size d in the G o v e rn m e n t's w hite p a p e r on R e c o n s tru c tio n and d e v e lo p m e n t program as well as its National health plan (Chimere-Dan,1996).Hildebrandt (1994), a d v o c a te s th a t health p ro fe s s io n a ls need to b eco m e community partners and enablers who empower communities to choose health strategies based on information, local resources and support.The new political era in S outh A fric a o ffe rs u n iq u e opportunities for the developm ent of innovative services that will involve the people at grass roots level (Rispel, Doherty, M akiw ane & W ebb, 1996).H ealth p ro g ra m s th a t fa il to reach families and that fail to involve "ordinary people" are seldom considered to be successful (Pick, 1992).E m p o w e rm e n t w ith in a n u rsin g perspective can be said to stem from the World Health Organization's definition of hea lth p ro m o tio n as a p ro c e s s of enabling people to increase control over, and to improve their own health.Nurses therefore have to be active in the socio economic and political sphere in order to influence health and this necessitates the developm ent of a more reflective practitioner who is flexible and assertive (Clay, 1992).Nurses need to turn their atte ntio n to c o n d itio n s th a t co n tro l, influence and produce health and illness in human beings.It is a top priority for nurses to develop primary health care at a local level and this can only occur as a result of small experiments where working with pilot groups can illustrate th a t th in g s can be don e d iffe re n tly (Colliere, 1980).For the nurse to be well prepared for this work, she must become involved in the global issues of the day such as p ove rty, u n e m p lo y m e n t, e n v iro n m e n t, e n e rg y and fo o d production ( Me Murray,1991).Nursing is uniquely prepared in both education and in p ra c tic e , to a lso a s s is t c o m m u n itie s in a s s e s s in g and developing survival techniques often under difficult circumstances.

Objectives and theoretical framework
The objectives of the study were firstly to establish whether a specific co m munity can ide ntify th e ir own health needs and p rio ritiz e th em , and a lso in s titu te strategies to meet their health needs.A second objective was to identify factors that influenced success or failure in group participation and a third objective was to describe this community's level of participation in a health activity.Lombard's Social Community Develop ment model was used as a theoretical fram e w o rk fo r this study (Lom bard, 1992).The variables of this model seem to fit with the principles of community d e v e lo p m e n t as it e m p h a size s the process by which client and health care professional together determine health decision s and actions.The p oint of d e p a rtu re in th is m odel is th a t the community members themselves are in the best possible position to develop their community and to obviate needs.There must thus be active involvement o f lo ca l le a d e rs h ip , e m u la tio n of democratic proceedures, involvement of in te r g ro u p and in te rp e rs o n a l relationships and the achievement of self help and self reliance.

Methodology
Action research methodology was used th ro u g h o u t the study.This typ e of research aims to study interventions in the real w o rld and was d e ve lo p e d primarily by the people of the third world.Smith, Pyrch & Lizardi (1993) and Webb (1989) s u g g e ste d th a t re se arche rs should involve the people being studied in planning , carrying out and in acting upon research so that people use the research itself as a resource to change their own lives.Individuals with common concerns come together as a group to achieve specific goals.It is considered to be an innovative way of creating partnerships at the local level, whilst promoting all health partners to learn in th e p ro ce ss.Both q u a lita tiv e and quantative information is continuously collected , analysed and acted upon.The community are active participants and n ot ju s t p assive s u b je c ts and informants.This is a flexible process and implies a willingness to change as new s itu a tio n s arise and old issues are resolved.All partners have an equal opportunity to participate and contribute although all may not do so at the same level.C ycles of planning, acting and observating, reflecting and replanning are followed (McTaggart,1989).
The action research approach was used in conjunction with a small community who were geographically and so cio econom ically isolated from both the formal and informal health development structure.The community consisted of 12 fam ilies (54 ind ivid ua ls) w orking as fa rm h a n d s in an area a b o u t 70 kilometers from Durban.The area had poor infrastructure, with no proper roads, no e le c tric ity , no p o ta b le w ater or sanitation.The researcher met with the two farmers who employed the majority of the workers to elicit how they felt about getting their workers being involved in health m atters.The researcher also in fo rm e d them a b o u t c o m m u n ity participation and what it entailed and gained their permission for involvement of the workers.The two farm ers were w illin g to a llo w th e ir w o rk e rs to participate in the project provided the workers themselves gave their consent.A house to house visit was then made to the fa m ilie s to assess w h e th e r the community was interested in meeting to discuss their needs and a date was set to have a meeting.An initial m eeting was arranged at a m u tu a lly a g re e a b le venue.At th is meeting each family selected at least one adult representative for the focus group discussions that were to follow.The workers were all Blacks who spoke the Zulu language.An interpreter from the sam e c o m u n ity was pre sen t to ensure that the researcher recorded the information obtained correctly.Focus group discussions were used, this was considered to be effective for the first four m e e tin g s o ver a p e rio d o f tw o m on th s.T h e se d is c u s s io n s were followed by informal contacts between the researcher and m em bers of the com m unity forth nightly.During focus group discussions, health related issues co n sid e re d to be p ro b le m a tic were identified and discussed by participants.Problems of lack of electricity, housing, finances and inadequate fo od were identified.Each of these issues were then discussed by the members regarding its feasibility and practicality.After a long discussion the group concluded that the most pressing problem was inadequate money for food.Alternative solutions were explored by the group.The final decision was that planting vegetables would decrease the cost of buying food.Issues related to initiation of a garden were explored by the group including a lack of ownership of land, inadequate equipment, no seeds, a need for water for irrigation, pest control and thieving.S o lu tio n s fo r all the a bo ve w ere d isc u s s e d by the g ro u p and the participants planned for the initiation of the g a rd e n .Five fa m ilie s w orked together and cleared up the plot.It was then subdivided into twelve (one per family) as decided by them.Two families continued to plant vegetables such as pumpkin, herbs, beans and mealies and took care of the garden even after the researcher had completed her study.

Descriptions and interpretation of findings
The meeting with the two farmers, the house to house visit, the four successful g ro u p d is c u s s io n s , the in fo rm a l meetings with the participants thereafter and the actions resulting from these fo rm e d the data to be a na lyse d.A qualitative descriptive method was used to analyse the data, incorporating the v a ria b le s of the s o c ia l c o m m u n ity d e ve lo p m e n t m odel and the action research methodology.The variables of the co m m u n ity d e ve lo p m e n t m odel seems to fit in well with the the action research m ethodology and the use of focus group discussions as far as level of research, participants in research and role of researcher is concerned.See table 1.
OBJECTIVE 1: To establish whether a community can identify their own health needs, prioritise them and institute strategies to meet their needs.
The v a ria b le s from th e c o m m u n ity development model used were: Basic suppositions of the nature of man, the community and the interest of communal subgroups.According to Lombards model (1992) the community members themselves are in the possible position to identify their own needs and problems and to see to the satisfaction of their needs and and the solving of the problems themselves.T his fu rth e r re in fo rc e s th a t the involvement of the community members th ro u g h o u t the p ro c e s s as a ctive participants in the research ensured that their own needs were being identified and that they did find solutions to their problems.

Primary level of intervention, Goal strateg y, m edium throu g h which change could be effected and typical techniques and modes of intervention.
In support of the above variables the role played by the researcher was that of (l) s u p p o r te r w hen ideas id e n tifie d seem ed fe a s ib le , and th a t o f (11) fa c ilita to r as she d id n ot lead the discussions, but rather promoted it and one of (111) educator with regards to nutrition and good health.A c co rd in g to the m odel used inter-Curationis March 1999 37 Here the Primary level of intervention is at grass roots level (Lombard, 1992).
1.This type of research in volves those people who are the expected beneficiaries with the hope of finding the gap between researcher and researched.Co operative enquiry (Katzenellenbogen, 1991). 1.
There is a direct inter action between re searcher and partici pants (Stewart and Shamdasani, 1990).

2.
Community members are in the best position to identify their own needs.(Lombard, 1992).

2.
Helps establish self critical communities who participate by identifying problems, planning activities, im plementing and reflect ing on them (Smith et al 1993).

2.
Provide a rich source of data close to the emic side of the con tinuum, it allows peo ple to respond in their own words and context.(Stewart & Shamdasani, 1990).

3.
The role of the re searcher is a resource person or supportive scientist, Lombard, 1992).

3.
Researcher has limited role as he or she is part of a group.Control of the research lies with the people involved.

3.
Data obtained from focus groups is mini mally imposed by the researcher.(Stewart and Shamdasani, 1990).The technique and mode of intervention according to the model must be centred around cooperation, group decision m aking and c o n s u lta tio n .Process orientated goals, group decision making and consultative techniques made the group feel empowered such as when they identified insufficient finance for food as a need and they could offer alte rn a tive s to try and alle via te the situation.They did realize that even though they did not own land they could still grow their own vegetables and thus cut down some of their costs, in other words , they had the power to improve their financial status to a certain degree.
Local le a d e rsh ip w hich c o u ld have developed during the process did not occur.A lth o u g h one p erson w ith p o te n tia l le a d e rs h ip q u a litie s was involved throughout the process and did try to motivate others to join in.Perhaps with more time he could have acted as a leader in the community.Sustainability was difficult to describe in this project as it was still getting off the ground.But it was heartening to note that the two families who participated in the project throughout the study continued to do so even when the researcher had completed her study.This com m unity did identify a priority need of insufficient m oney for food, planned around it and im plem ented strategies to improve access to food.

OBJECTIVE 2: To identify factors that influenced success or failure in group participation
The va ria b le from th e c o m m u n ity d e v e lo p m e n t m odel used was : Suppositions concerning the etiology of the impediments in the community.Some of the impediments that may be found in communities hindering parti  Lombard (1992) w ere anom y, p o o r p ro ble m so lvin g capability, feelings of powerlessness and w o rth le ssn e ss.In a n a lysin g the migratory nature of this community it was fo u n d th a t p e o p le cam e into th is community when jobs were not found elsewhere or sought shelter as a result of faction fighting in their own areas.This acted as an impediment as their stay was seen as te m p o ra ry and real committment was difficult to obtain.See table 2. Linked to this was the absence of traditional leadership.Apparentally there was no leader of any kind for example a religious or traditional leader.It seems as if there was no role model fo r the co m m un ity to fa cilita te their p a rtic ip a tio n in the p ro je c t as a community.Some of the workers did how ever belon g to a trib a l ch ie f of another area.Workers did not own the land and had voiced the fear of the loss of their labour and crops should they m ove aw ay and th is c o u ld have influenced their participation.The lack of ownership of land and housing further highlights the temporary nature of stay in this area.They also feared losing their jobs.One w orker who was often drunk and an erratic w orker was retrenched.This re tre nch m e nt d e trim e n ta lly affected som e o f the re m a in in g eleven participants, six of whom did not join in clearing the plot.The reason given was that they feared they may also lose their job s and thus their efforts w ould be w o rth le ss.This left five in d iv id u a ls representing five families who cleared the plot for planting.In referring to the nature of the project chosen it could have been perceived as tedious.Majority worked on the farm during the week and going back to the farm over weekends could have proved tedious.Starting a garden dem ands energy and is tim e consuming.Because of the participatory nature of the project the community was allowed to im plem ent what they had planned.It also took three to four months before any food could be harvested and th is co u ld have d e m o tiva te d the com m unity if immediate returns were expected.The average joint earnings of a family was approxim ately R400 to R500 per month .This was used to feed an average family of four to six dependants.These families are living below the household subsistence level (S.A.Institute of Race Relations 1990.)The CASE survey for Henry J Kaiser Family Foundation (1995) reveals an average earning for Blacks was R 679 in South Africa.Victims of poverty are easily caught up in a cycle of of powerlessness and apathy , this hinders them from organizing th em selves to improve.(Pinderhughes, 1983) The next variable used by Lombard (1992) was: Community subgroups have com m unal in tere sts or reconcilable differences.Overtly they did not seem to have sub group interests as th e y d id n ot m eet on re lig io u s , traditional or social grounds.One of the farmers at the first meeting said that this was the very first time that he had seen the community together.Yet later when a member of the community demised they rallied around to help the bereaved family.On another ocassion three families were seen assissting another family to extend their house.There seems to be a potential for the community to become more cohesive , to influence one other and to fu n c tio n e ffe c tiv e ly as a group.During the period of the study the community groups planned together to identify their needs and to initiate the gardens but thereafter preferred to work on their own plots.

Role of the community in dealing with impediments
This variable deals with the strategies that can be e m ployed even though challenges exists to impede the process of participation.Active participation of the community was sought throughout the process.The community was involved in identifying their main need, looking at p o s s ib le s o lu tio n s and w ays of implementing their plans.Their partici pation was imperative in the formulation of process oriented goals, in group decision m aking and in initiating the g arden.A lthough the m ajority of the c o m m u n ity p a rtic ip a te d in the identification of their problems and in identifying resources for the solution , five families participated in clearing up the p lo t and o n ly tw o fa m ilie s a c tu a lly planted the vegetables.The researcher also moved at the pace of the community and did not rush the process.The participants realized that they could seek the help of the farmers should they want to improve their lives in the future .This was voiced by the participants after they were given the plot of land and equipment.It was also clarified that they could continue using the plots for as long as they resided in the area.In order to meet the second objective of identifying the factors that influenced success or failure in group participation were : the action research methodology which readily stim ulated participation and the fact that available resources  This model identifies five areas including needs assessm en t, le a d e rs h ip , organisation, reource mobilization and managem ent.With regards to needs assessment the researcher initiated the s tu d y as part o f req uirem en ts fo r a masters program.The community did not approach her.The actual health needs were identified by a fo cu s g ro u p re p re s e n tin g the community as previously described.The health needs were verbalized during discu ssion s and not by m eans of a survey.In describing leadership initially tw o farm ers co uld be d e scrib e d as leaders as they had a positive attitude to the introduction of the programme.No real leadership from the group emerged, although one person participated readily throughout the study and seemed to have leadership qualities and probably with time would have developed as a leader in the community.Because no organizational structure was visible and identified a new organiza tional structure in the form of a focus group was created.This group had an im portant decision making role in the identification of problems and planning for implementation.Appropriate available resources were mobilized including a piece of land within the com m unity and gardening equip ment.Each family was allocated a piece o f the land.The b en e ficia rie s of the programme contributed in the way of la b o u r and tim e and in d e c is io n making.The interest of the group was served as it was planned that whatever w as p la n te d was th e ir p ro p e rty to dispose of as they pleased.The c o m m u n ity was a lm o s t to ta lly responsible for the management of the program m e as they decided when to clear up the land, when to subdivide plots, how much time to spend in the garden and what to plant.On the whole participation was present but to varying degrees as depicted in fig u re 2. In th is fig u re needs assessment, resource mobilization and management reflected the highest level of participation, whilst organization and leadership demonstraed lower levels.In order to meet the last objective of identifying the factors that may have in flu e n c e d g ro u p p a rtic ip a tio n the fo llo w in g seem ed to have favou re d active participation : the action research m ethodology which readily stimulated p a rticip a tio n , the fa ct th a t available resources were optimally utilized without any cost being incurred by participants.
The fa c to rs th a t seem ed to d e te r participation were the migratory nature of the community.The lack of ownership of land, fear of job loss and thus of time and energy and a lack of traditional leadership.

Limitation of the study
The p o p u la tio n co n siste d of tw elve fam ilies only (small scale) and came from a unique setting, w hich was a m igratory rural area and adults were mainly engaged in a specific occupation.G e n e ra liz a b ility m ay be p o s s ib le in sim ilar settings only.Because of the hom ogeneity of the population caution needs to be exercised with regards to generalizability to other populations.The researcher had to work within a tim e frame of approxim ately seven months and ide ally a p ro je ct o f th is nature sh o u ld n ot have a tim e fram e as it develops at the pace of the community.The researcher had some knowledge of Zulu, the language of the community, but had to use an in terpreter to ensure adequate communication.

Recommendations and conclusions
Further studies on similar lines need to be done to establish whether community participation can be a reality.Perhaps a longer preparation period for partici pation is needed .This was not possible in this study due to the migratory nature of the population and the short period of the study.lfpossible a researcher who resides in the area with more frequent contacts may stimulate a greater level of participation, but one has to be wary of this as it could also mean that the co m m un ity is still d ependant on the re s e a rc h e r and th is c o u ld be debatable.This type of study could form a good starting p oint for com m unity participation as a whole.Small scale activities could encourage m ore and more to become involved over time and th u s m eet the real n ee ds o f the community.
v e n tio n s m ust be ca rrie d o ut at grassroots level.Therefore families were visited in their homes.A central open air venue for focus group m eetings was chosen.The communal garden initiated was w ith in easy reach of the comm unity.AII these fa cto rs co u ld have stimulated community participation.The strategy for interventions must be goal oriented or process goals and this was encouraged throughout the research.Cycles of activities related to each other form ed an ongoing process at focus group meetings as illustrated in figure 1.This taught the group that once a problem had been identified by them, it was their responsibility to thoroughly investigate it prior to solving it.A ctio n research as a m e th o d o lo g y facilitated com m m unity participation.A c c o rd in g to W ebb (1989) a ctio n rese arch m ay be in itia te d by the researcher or by the community who are motivated to improve their life styles and circumstances.Smith et al (1993) said th is typ e o f rese arch m o b ilize s com m unities to becom e developed, more humane and helps them to grow in confidence and enter new learning cycles.Focus group technique allowed the groups actual feelings and thoughts to be directly observed.Working at grass roots level allowed observation of group activities.Rational em pirical change strategy was used so that the group saw how th e y c o u ld b e n e fit from th e ir behaviors such as planting their own vegetables and thus not having to pay for them.The basic assumption here is th a t p e o ple are able and w illin g to change should they derive some benefit from the change process.

Figure
Figure 1 : Process orientated goals

Figure 2 :
Figure 2 : Level of participation of community

Table 1 : An ilustration of the correlation between model and research design COMMUNITY DEVELOPMENT PARTICIPATION ACTION RESEARCH FOCUS GROUPS LEVEL OF RESEARCH
1.