B.P.Koirala Institute of Health Sciences, School of Public Health and Community Medicine, Dharan, Nepal
Isms affect the way we think, define, approach and seek to understand and solve any particular issue or condition. The particular ism that prevails currently has been labeled as neoliberalism. Here the ways that researchers use KAPS for various health issues or conditions and the extent to which it is connected to the existing reality along with its pragmatic utility are assessed. Based on how heuristics is conceptualized the use of KAPs is heuristics in use. The primary task of this article embarks is on determining whether the researches using KAPS has any heuristic purpose or is it just fulfilling some self- centered ritualistic and instrumentalist objective. The focus here is on Nepal but that does not mean that the arguments made here is not applicable to other nations that have similar socio-economic conditions.
The data selected here are researches done by an epistemic community presented in two national conferences. The methodology followed is based on dialectical reflexivity and the approach adopted is auto-ethnographic. The dominance of procrustean, atomistic, dehistoricized, reductionist and individualist philosophy that deemphasizes structural relations is seen. The incorporation of neoliberal values has created a trend where researches seem to solely serve ritualistic and instrumentalist purpose.
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This article focuses on the use of KAPS by an epistemic community and attempts to discern whether it has a heuristic use and purpose or is it just serving some ritualistic and instrumentalist purpose. Ritualistic or instrumentalist is concerned with positions (or perspectives on the world) that are more ‘useful,’ and hence, more ‘correct,’ than others in facilitating the accomplishment of one’s individual goals. Universities are marketers of knowledge rather than primary producers of knowledge and the individual academician has to work in a competitive work environment where the 'publish or perish culture’ [1Adam RJ. Conceptualising the epistemic dimension of academic identity in an age of neo-liberalism. Educ Res Perspect 2012; 39: 70-89.] prevails and selling or promoting one’s self is highly desirable. Instrumentalization forces the researcher to see research only as a means to achieve certain specific needs for personal benefits. The reification of research makes researchers to undeniably follow the relentless laws of the market and leads researchers to leap from topic to topic in search for funding rather than following a sustained, self directed research program [2Lave R. Neoliberalism and the production of environmental knowledge. Environ Soc 2012; 3: 19-38.[http://dx.doi.org/10.3167/ares.2012.030103] ]
KAPS has been in use since the 1950’s and since then its use has increased manifold. KAPS was initially used in family planning and population studies but over the time it has been used for understanding community perspectives regarding various issues, conditions and behavioural practices, moreover, the beginning of an international aid driven approach towards development and the need for monitoring also led to an increase in using KAPS and even today it is a
popular method adopted. The author is not questioning its validity and neither has any doubt about its reliability and use in various contexts. But, like any other methods or tools it too has limitations, and if used in certain contexts based on the existing reality of the researched sample, it tends to create findings akin to ‘epistemic pollution’ [3Teo T. Sciences of the living dead: Race, psychology, and epistemic pollution Doing Psychology under New Conditions 2013; 122-30.] or even ‘bullshit’ [4Belfiore E. On bullshit in cultural policy practice and research: Notes from the British case. Int J Cult Policy 2009; 15: 343-59.[http://dx.doi.org/10.1080/10286630902806080] ].
Based on the characteristics of heuristics, the use of KAPS is application of heuristics. The Oxford English Dictionary defines heuristics as methods learnt from experience to solve problems by finding practical ways to deal with them. Shah and Oppenheimer, have proposed that all heuristics possess either one or more processes for effort reduction such as - examining fewer cues, reducing the intricacies linked with retrieving and storing cue principles, simplifying the weighting principles for cues, integrating fewer information and probing fewer options. What is called as heuristics can differ from researcher to researcher and also many heuristics exemplify a variety of different characteristics. Heuristic assumptions do not signify reality since by their nature it is restricted to a sample of the whole that is supposedly representative of the whole, but even then its use is inevitable [5Lam SY. What kind of assumptions need to be realistic and how to test them: A response to tsang (2006). Strateg Manage J 2010; 31: 679-87.]. Different individuals can use different heuristics to approach a common issue and this difference in selection of heuristics depends primarily on the individual’s experience. Heuristics is purely a practical act but its selection, and use is based on one’s philosophical assumptions.
Philosophical assumptions underlie all research and they shape the research question, hypotheses, methodology, method, finding and recommendation. Though philosophical assumptions shape all the components of a research they are mostly invisible and remain so unless made explicit by the researcher or until a philosophical analysis of it is done and which is what we are trying to do here. Philosophizing is an important activity and to philosophically analyse and critique a research means to look at the different stages of research based on logical argumentations and reasonableness. Research philosophy itself comprises broadly of the ontological, epistemological and axiological which results in the methodology and the methods. Other terms such as paradigm, worldview, theoretical have also been used with more or less the same meaning. The philosophy that exists at any given time is an outcome of the prevailing ideology, ism, structure, worldview or belief system. The ism that exists and shapes the current world order has been identified as neoliberalism.
Unlike many other isms, neoliberalism does not usually reveal itself and neither is it visible to an individual, no matter what their qualifications are. The users of the term have been labelled as having Trotskyite tendencies, but the author contends that the word neoliberalism has been used by individuals from varied ideological and philosophical leanings. The central presupposition of neoliberalism consists of the ‘rational self-interested individual’, 'free market economics’, a ‘pledge to laissez-faire’ and a pledge to ‘free trade’ [6Olssen M, Peters MA. Neoliberalism, higher education and the knowledge economy: From the free market to knowledge capitalism. J Educ Policy 2005; 20: 313-45.[http://dx.doi.org/10.1080/02680930500108718] ]. Neoliberalism has formed our cognition and it promotes, ‘neoliberal ideologies that stresses individual-level resolution making about economics and healthcare [7Sanders CL, McKay KH. The Search for “Strong Medicine”: Pathways to healthcare development in remote Nepal using GIS. Technol Innov 2013; 15: 109-24.[http://dx.doi.org/10.3727/194982413X13650843068799] ]. Neoliberal vision and application has unswervingly implicated in shaping the way health is promoted [8Ayo N. Understanding health promotion in a neoliberal climate and the making of health conscious citizens. Crit Public Health 2012; 22: 99-105.[http://dx.doi.org/10.1080/09581596.2010.520692] ] and beliefs are shaped [9Rose. The politics of life itself. Theory Cult Soc 2001; 18: 1-30.[http://dx.doi.org/10.1177/02632760122052020] ]. The human being is transformed into an entrepreneur (self-entrepreneur) who is in rational pursuit of self-interest and seeks maximisation of expected-utility. Also looking for opportunism in all settings, optimising behaviour and strategic behaviour should be pursued by all humans in the market. Neoliberalism regime has been described as a wicked and exacting environment [10Simandan D. Kinds of environments-a framework for reflecting on the possible contours of a better world: Kinds of environments. Can Geogr 2011; 55: 383-6.[http://dx.doi.org/10.1111/j.1541-0064.2010.00334.x] ] for those that do not follow its ways.
Various works on neoliberalism and its influence on different entities such as, ‘neoliberal governmentality’ [11Hamann TH. Neoliberalism, governmentality, and ethics. Foucault Stud 2009; 0: 37.[http://dx.doi.org/10.22439/fs.v0i0.2471] -14Carr S, Batlle IC. Attachment theory, neoliberalism, and social conscience. J Theor Philos Psychol 2015; 35: 160-76.[http://dx.doi.org/10.1037/a0038681] ], ‘neoliberal technologies’ [15Petersen EB, Davies B. Intellectual Workers (un) doing neloiberal discourse. Subjectivity. Crit Psychol 2005; 13: 32-54., 16Kiersey NJ. Everyday neoliberalism and the subjectivity of crisis: post-political control in an era of financial turmoil. J Critical Globali Stud 2011; 23-44.], ‘neoliberal philosophy’ [17Springer S, Birch K, Macleavy J. An Introduction to Neoliberalism The Handbook of Neoliberalism 2007.], ‘neoliberal citizen’ [18Wacquant L. Crafting the neoliberal state: Workfare, prisonfare, and social insecurity1. Sociol Forum 2010; 25: 197-220.[http://dx.doi.org/10.1111/j.1573-7861.2010.01173.x] ] [11Hamann TH. Neoliberalism, governmentality, and ethics. Foucault Stud 2009; 0: 37.[http://dx.doi.org/10.22439/fs.v0i0.2471] ], ‘neoliberal logic’ [19Rankin KN. Governing development: Neoliberalism, microcredit, and rational economic woman. Econ Soc 2001; 30: 18-37.[http://dx.doi.org/10.1080/03085140020019070] -22Bartlett L, Frederick M, Gulbrandsen T, Murillo E. The marketization of education: Public schools for private Ends. Anthropology <html_ent Glyph=”@amp;” Ascii=”&”/>. Educ Q 2002; 33: 5-29.[http://dx.doi.org/10.1525/aeq.2002.33.1.5] ], ‘neoliberal university’ [23Saunders DB. Neoliberal ideology and public higher education in the united states. J Crit Educ Policy Stud 2010; 8: 41-77.-25Wanyenya P. Neoliberalism and public university agendas : Tensions along the global / local divide. J Fem Scholarsh 2015; 7–8: 93-101.],’‘neoliberal academia’ [26Richter M, Hostettler U. Conducting commissioned research in neoliberal academia: The conditions evaluations impose on research practice. Curr Sociol 2015; 63: 493-510.[http://dx.doi.org/10.1177/0011392114562497] ], ‘neoliberal subject’ [27Smith LT. On tricky ground 2005; 85-108.-29Isin EF. The Neurotic citizen. Citizensh Stud 2004; 8: 217-35.[http://dx.doi.org/10.1080/1362102042000256970] ],’ neoliberal strategies’ [30James D, Reay D, Crozier G, et al. Neoliberal policy and the meaning of counterintuitive middle-class school choices 2010; Vol. 58-32Levidow L. Marketizing higher education: Neoliberal strategies and counter-strategies. Commoner 2002; 3: 1-21.], ‘neoliberal reforms’ [33Armada F, Muntaner C, Navarro V. Health and social security reforms in Latin America: The convergence of the World Health Organization, the World Bank, and transnational corporations. Int J Health Serv 2001; 31(4): 729-68.[http://dx.doi.org/10.2190/70BE-TJ0Q-P7WJ-2ELU] [PMID: 11809007] -35Gerring J, Thacker SC. Do neoliberal economic policies kill or save lives? Bus Polit 2008; 10: 1-31.[http://dx.doi.org/10.2202/1469-3569.1212] ] and ‘neoliberal axioms’ [36Adaman F, Madra YM. Global economic crisis and the politics of diversity 2014; 29-51.[http://dx.doi.org/10.1057/9781137293688_2] ], have been conceptualised.
2. RESEARCH UNDER NEOLIBERALISM – ASSUMPTIONS AND TRAITS
Neoliberalism forwards a belief system that lay the foundations from within which the assumptions and traits of a research are shaped. The ‘procrustean systems framework’, ‘stochastic approach’, ‘ceteris paribus clause’, ‘tabula rasa’, ‘bounded rationality’ and the ‘mutatis mutandis assumptions’ are some adjectives that have been used to describe the conditions under which both research and researcher are bounded to. The ‘neoliberal axioms’ create a ‘neoliberal myopic’ gaze and researchers are trained at ‘locating the cause and cure of disease solely within the individual’. The neoliberal researcher ‘steps out’ of the world they are researching under the pretext of value-free and unbiased approach. The neoliberal researcher proceeds with the assumptions that all individuals are rational, entrepreneurial, interest seeking, profit making and the whole ensemble of individual life is to be structured in the pursuit of a range of enterprises’.
Assumptions are the bedrock on which researchers build their objectives, research questions, hypothesis and justifications. Research like any social practice, is guided by basic beliefs and assumptions about the nature of reality (that is, ontological assumptions), the nature of (scientific) knowledge of reality, how such knowledge is acquired (epistemological assumptions), and what makes up valid research [37Cecez-Kecmanovic D. Basic assumptions of the critical research perspectives in information systems 2005.[http://dx.doi.org/10.4337/9781845426743.00009] ]. ‘Scientific knowledge is established upon a set of tacit convention, beliefs and assumptions which is not different from every day, common sense knowledge. What makes science different from common sense knowledge is due to the nature of rules which recognises these assumptions and subscribes to them. The key to ensure focus, tractability, understanding and comparability in research are logically developed assumptions [38Bendoly E, Donohue K, Schultz KL. Behavior in operations management: Assessing recent findings and revisiting old assumptions. J Oper Manage 2006; 24: 737-52.[http://dx.doi.org/10.1016/j.jom.2005.10.001] ].
Though, assumptions are preordained, the level of understanding and interest of the researchers often limit the selection of specific assumptions [39O’Donohue WT, Callaghan GM, Ruckstuhl LE. Epistemological barriers to radical behaviorism. Behav Anal 1998; 21(2): 307-20.[http://dx.doi.org/10.1007/BF03391970] [PMID: 22478314] ]. All research proceeds by ‘assuming away’ the incomprehensible through building a framework of inferred knowledge based on that which is recognized with a hope that what is ‘assumed away’ is not crucial to the research questions under study [40Peters MA, Besley T. Academic entrepreneurship and the creative economy. Thesis Eleven 2008; 94: 88-105.[http://dx.doi.org/10.1177/0725513608093278] ]. The assuming away’ [41Lucas SR. Beyond the existence proof: Ontological conditions, epistemological implications, and in-depth interview research. Qual Quant 2014; 48: 387-408.[http://dx.doi.org/10.1007/s11135-012-9775-3] ] is based on various factors, contexts and the philosophical underpinnings of the concerned researcher. Assumptions are inevitable and different levels and types such as the ontological assumptions [41Lucas SR. Beyond the existence proof: Ontological conditions, epistemological implications, and in-depth interview research. Qual Quant 2014; 48: 387-408.[http://dx.doi.org/10.1007/s11135-012-9775-3] -46Eastwood JG, Jalaludin BB, Kemp LA. Realist explanatory theory building method for social epidemiology: A protocol for a mixed method multilevel study of neighbourhood context and postnatal depression. Springerplus 2014; 3: 12.[http://dx.doi.org/10.1186/2193-1801-3-12] [PMID: 24422187] ], epistemological assumptions [47Cobern WW. Worldview theory and science education research: Fundamental epistemological structure as a critical factor in science learning and attitude development 1989; 1-25.-50Turyahikayo E. Resolving the qualitative-quantitative debate in healthcare research. Med Prac Rev 2014; 5: 6-15.[http://dx.doi.org/10.5897/MPR.2013.0107] ] [51Miller TR, Baird TD, Littlefield CM, Kofinas G, Chapin FS, Redman CL. Epistemological pluralism: Reorganizing interdisciplinary research. Ecol Soc 2008; 13[http://dx.doi.org/10.5751/ES-02671-130246] ], methodological assumptions [52Barnett C. Culture, geography, and the arts of government. Environ Plann D Soc Space 2001; 19: 7-24.[http://dx.doi.org/10.1068/d236] -54Fink S. Policy convergence with or without the european union: The interaction of policy success, EU membership and policy convergence. J Common Mark Stud 2013; 51: 631-48.[http://dx.doi.org/10.1111/jcms.12018] ], axiological assumptions [55Carrillo FJ. Capital systems: Implications for a global knowledge agenda. J Knowl Manage 2002; 6: 379-99.[http://dx.doi.org/10.1108/13673270210440884] ], fundamentalist assumptions [56Reutlinger A, Koch H. Methodological individualism and the epistemic value of macro-explanations. Percipi 2008; 2: 1-14.] [57Musgrove P. Health Economics in Development 2002.],observability assumptions [58Slife BD, Richardson FC, Reber JS. Critical thinking about psychology : Hidden assumptions and plausible alternatives 2016., 59Wendt DJ. Evidence-based practice movements in psychology: Empirically supported treatments, common factors, and objective methodological pluralism. Intuition 2006; 2: 49-62.], consilience assumptions [60Schwab AP. Epistemic trust, epistemic responsibility, and medical practice. J Med Philos 2008; 33(4): 302-20.[http://dx.doi.org/10.1093/jmp/jhn013] [PMID: 18662947] ], depoliticizing assumptions [61Sugden F. Neo-liberalism, markets and class structures on the Nepali lowlands: The political economy of agrarian change. Geoforum 2009; 40: 634-44.[http://dx.doi.org/10.1016/j.geoforum.2009.03.010] ], social world homogeneity [41Lucas SR. Beyond the existence proof: Ontological conditions, epistemological implications, and in-depth interview research. Qual Quant 2014; 48: 387-408.[http://dx.doi.org/10.1007/s11135-012-9775-3] ], in-house assumptions [62Alvesson M, Sandberg J. Generating research questions through problematization. Acad Manage Rev 2011; 36: 247-71.], atomistic assumptions [56Reutlinger A, Koch H. Methodological individualism and the epistemic value of macro-explanations. Percipi 2008; 2: 1-14.], rationalist assumptions [63Hay C. The normalizing role of rationalist assumptions in the institutional embedding of neoliberalism. Econ Soc 2004; 33: 500-27.[http://dx.doi.org/10.1080/0308514042000285260] ], taken for granted assumptions [64Sastry S, Dutta MJ. Public health, global surveillance, and the “emerging disease” worldview: A postcolonial appraisal of PEPFAR. Health Commun 2012; 27(6): 519-32.[http://dx.doi.org/10.1080/10410236.2011.616626] [PMID: 22014270] , 65Starks H, Trinidad SB. Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory. Qual Health Res 2007; 17(10): 1372-80.[http://dx.doi.org/10.1177/1049732307307031] [PMID: 18000076] ], and the ‘neoliberal assumptions’ [66van Ommen C, van Deventer V. Negotiating neuroscience: LeDouxs “dramatic ensemble.”. Theory Psychol 2016; 26: 572-90.[http://dx.doi.org/10.1177/0959354316659555] ] within which all of the above and few other types of assumptions which the author might have missed exists. Though assumptions are inevitable many assumptions can be illogical, unwarranted, spurious and misleading.
2.2. Neoliberal Traits of Research
This section focuses on the characteristic features of research that emerges under neoliberalism and has been identified by others around the world. The philosophy of neoliberalism instils an individualistic gaze which rarely sees beyond individual’s behavioural practices when doing research, making recommendations and creating knowledge. There are no fixed numbers of traits identified with neoliberalism and these traits can vary in time between regions, disciplines, epistemes, nations and even within a nation. The neoliberal traits chosen here are those that correspond with the author’s existentialist, pragmatic and empirical experiences. Neoliberalism touches all aspects of life and research work is no different. Under neoliberalism, researches display the traits as follows positivist [67Raphael D, Curry-Stevens A, Bryant T. Barriers to addressing the social determinants of health: Insights from the Canadian experience. Health Policy 2008; 88(2-3): 222-35.[http://dx.doi.org/10.1016/j.healthpol.2008.03.015] [PMID: 18471923] -69Krauss SE, Putra U. Research paradigms and meaning making : A primer. Qual Rep 2005; 10: 758-70.[http://dx.doi.org/10.1176/appi.ajp.162.10.1985] ],reductionist/individualist [70Goldberg DS. The errors of individualistic public health interventions: Denial of treatment to obese persons comment on “Denial of treatment to obese patients-the wrong policy on personal responsibility for health”. Int J Health Policy Manag 2013; 1(3): 237-8.[http://dx.doi.org/10.15171/ijhpm.2013.47] [PMID: 24596875] -72Fee E, Krieger N. Understanding AIDS: Historical interpretations and the limits of biomedical individualism. Am J Public Health 1993; 83(10): 1477-86.[http://dx.doi.org/10.2105/AJPH.83.10.1477] [PMID: 8214245] ],objectivist [73Raphael D, Curry-Stevens A, Bryant T. Barriers to addressing the social determinants of health: Insights from the Canadian experience. Health Policy 2008; 88(2-3): 222-35.[http://dx.doi.org/10.1016/j.healthpol.2008.03.015] [PMID: 18471923] -75Barene S. Public health research from a theoretical scientific perspective 2015; 4: 119-25.],decontextualized [76Sugden F. Neo-liberalism, markets and class structures on the Nepali lowlands: The political economy of agrarian change. Geoforum 2009; 40: 634-44.[http://dx.doi.org/10.1016/j.geoforum.2009.03.010] -79Council ISS. World Social Science Report: Knowledge divides 2010; 17],depoliticized [80Brown W. Regulating Aversion: Tolerance in the Age of Identity and Empire. New Jersey, USA: Princeton University Press 2009. http://assets.press.princeton.edu/chapters/s8306.pdf-81Flinders M, Buller J. Depoliticisation: Principles, tactics and tools. Br Polit 2006; 1: 293-318.[http://dx.doi.org/10.1057/palgrave.bp.4200016] ],dehistoricized [82Wengraf T, Chamberlayne P, Bornat J. A biographical turn in the social sciences? A british-european view. Cultural Studies ↔ Critical Methodol 2002; 2: 245-69.],dissocialized/desocialized [76Sugden F. Neo-liberalism, markets and class structures on the Nepali lowlands: The political economy of agrarian change. Geoforum 2009; 40: 634-44.[http://dx.doi.org/10.1016/j.geoforum.2009.03.010] , 83Farmer P. An anthropology of structural violence. Curr Anthropol 2004; 45: 305-25.[http://dx.doi.org/10.1086/382250] , 84Alemanno S, Cabedoche B. As the ultimate response to the effects of globalisation? France télécom, psychosocial risks, and communicational implementation of the global workplace. Intercult Commun Stud 2011; 2: 24-40.],deproblematized [85Gubrium JF, Margaretha J. Turning troubles into problems clientization in human services 2014., 86Juul Nielsen A, Grøn L. Standardising the lay: Logics of change in programs of disease self-management. Cult Unbound 2012; 4: 425-42.[http://dx.doi.org/10.3384/cu.2000.1525.124425] ],instrumentalization [87Magrini JM. 2009.http://dc.cod.edu/philosophypub/13-90Mignolo WD. Epistemic disobedience, independent thought and decolonial freedom. Theory Cult Soc 2009; 26: 159-81.[http://dx.doi.org/10.1177/0263276409349275] ],separation [2Lave R. Neoliberalism and the production of environmental knowledge. Environ Soc 2012; 3: 19-38.[http://dx.doi.org/10.3167/ares.2012.030103] , 88Ojha HR. Engaging bourdieu and habermas to reframe forest governance in nepalese terai 2006., 91Ferguson WJ, Candib LM. Culture, language, and the doctor-patient relationship. Family Medicine 2002; 34: 353-61.],detached [92Illich I. Medical nemesis 2003; Vol. 57-96Guthman J, DuPuis M. Embodying neoliberalism: Economy, culture, and the politics of fat. Environ Plann D Soc Space 2006; 24: 427-48.[http://dx.doi.org/10.1068/d3904] ], marketisation [1Adam RJ. Conceptualising the epistemic dimension of academic identity in an age of neo-liberalism. Educ Res Perspect 2012; 39: 70-89., 32Levidow L. Marketizing higher education: Neoliberal strategies and counter-strategies. Commoner 2002; 3: 1-21., 97Sancar C, Sancar M. Neoliberal mechanisation of education. Turkish Online J Educ Tech 2012; 11: 246-54., 98Frodeman R, Briggle A, Holbrook JB. Philosophy in the age of neoliberalism. Soc Epistemology 2012; 26: 311-30.[http://dx.doi.org/10.1080/02691728.2012.722701] ], naturalization [99Moore K, Kleinman DL, Hess D, Frickel S. Science and neoliberal globalization: A political sociological approach. Theory Soc 2011; 40: 505-32.[http://dx.doi.org/10.1007/s11186-011-9147-3] -109Schulz K, Siriwardane R. Depoliticised and technocratic? Normativity and the politics of transformative adaptation 2015.], subjectification [14Carr S, Batlle IC. Attachment theory, neoliberalism, and social conscience. J Theor Philos Psychol 2015; 35: 160-76.[http://dx.doi.org/10.1037/a0038681] , 16Kiersey NJ. Everyday neoliberalism and the subjectivity of crisis: post-political control in an era of financial turmoil. J Critical Globali Stud 2011; 23-44., 110Barnett C, Clarke N, Cloke P, Malpass A. The elusive subjects of neo-liberalism: Beyond the analytics of governmentality. Cult Stud 2008; 22: 624-53.[http://dx.doi.org/10.1080/09502380802245902] ],invisibilisation [70Goldberg DS. The errors of individualistic public health interventions: Denial of treatment to obese persons comment on “Denial of treatment to obese patients-the wrong policy on personal responsibility for health”. Int J Health Policy Manag 2013; 1(3): 237-8.[http://dx.doi.org/10.15171/ijhpm.2013.47] [PMID: 24596875] , 90Mignolo WD. Epistemic disobedience, independent thought and decolonial freedom. Theory Cult Soc 2009; 26: 159-81.[http://dx.doi.org/10.1177/0263276409349275] , 111Loïc W. Punishing the Poor: The Neoliberal Government of Social Insecurity. Durham and London: Duke University Press 2009. https://libcom.org/files/Lo%C3%AFc%20Wacquant%20-%20Punishing%20the%20Poor.pdf], and normalisation [112Ettlinger N. Governmentality as epistemology. Ann Assoc Am Geogr 2011; 101: 537-60.[http://dx.doi.org/10.1080/00045608.2010.544962] -122El-Ojeili C, Hayden P. Critical theories of globalization Basomgstoke England2006.[http://dx.doi.org/10.1057/9780230626454] ].
Not all the sixteen traits will be affecting a single research and particular traits as positivism itself is not an indication of the effects of neoliberalism. Sometimes one may find a research giving a true picture of the reality in quantitative facts, but if it is devoid of any pragmatic purposes or needs based on the existing reality at the ground level, the research can be said to be affected by research traits of neoliberalism. For instance how useful would it be if a research on assessing knowledge about uterine prolapse among women in a community who have to carry water on their back from a kilometre away was done, and recommendations made that awareness raising about not carrying heavy objects along with behavioural change interventions are needed? The neoliberal traits can influence a research at different levels of its conception and when the philosophy of a researcher is shaped by them, researchers tend to produce researches that are aloof from the existing societal conditions of the population it studies.
3. UNDERSTANDING AND CONCEPTUALISING THE RESEARCHED
Understanding the researched sample thoroughly is vital for any scientific enquiry but the decision on what needs to be researched and why is also crucial. Both problem identification and solution recommendation has been a perennial task of research and more particularly for researches done on health conditions. However, before any particular problem is identified and any solution recommended it is essential to know the existing conditions, for without an in-depth understanding the whole endeavour becomes very superficial in nature. Here the focus is on the research papers presented in two conferences. The research paper is an outcome of the philosophical underpinnings of the concerned researcher or a team of researchers. The research and researcher is not just an independent mereological product, rather both are affected by ‘dispositifs’ existing at the proximate and distant levels who through the use of related ‘apparatuses’ and ‘technologies’ create and maintain certain research traditions and practices.
The individual research presentations made at the, ‘First (2015) and ‘Second (2016) National Summit of Health and Population Scientists’ organised by the NHRC (National Health Research Council) are the most basic and primary form of data here. The researched here are those researches or studies that have used the KAP Survey methodology to know about various existing conditions. Various other methods of sampling could have been done but the author reasons that selecting an epistemic community and philosophically assessing their research presentations or which can also be called an epistemic object can provide insights into the ways policies are made, into the ways problems are perceived and solutions proposed. Based on the features that describe an epistemic community the researchers, scientists, professionals and health workers who made presentations at the conference organised by NHRC can be collectively described as an epistemic community. An ‘epistemic community is politically neutral’ ‘is closely incorporated, restricted in number, with great continuity and members have approximately equal status and power’, [123Pearson M, Anthony ZB, Buckley NA. Prospective policy analysis: How an epistemic community informed policymaking on intentional self poisoning in Sri Lanka 2010.[http://dx.doi.org/10.1186/1478-4505-8-19] ] ' its members have no particular history as a whole, but share ideas’, [124Porta MS. International Epidemiological Association, editors. A dictionary of epidemiology. 5th ed. Oxford ; New York: Oxford University Press; 2008.] ‘plays a strong role in shaping which policies are selected in highly specialized policy arenas’, and they also produce policy-relevant knowledge about intricate technical issues and combine various characteristics, political initiative and scientific objectivity’ [125Smirnova MY, Yachin SY. Epistemic communities and epistemic operating mode. Int J Soc Sci Humanit 2015; 5: 646-50.[http://dx.doi.org/10.7763/IJSSH.2015.V5.533] ] [126Dalglish SL, George A, Shearer JC, Bennett S. Epistemic communities in global health and the development of child survival policy: A case study of iCCM. Health Policy Plan 2015; 30(Suppl. 2): ii12-25.[http://dx.doi.org/10.1093/heapol/czv043] [PMID: 26516146] ] in issues surrounded by uncertainty and the data they generate has to offer answers (in reply) to specific issues; they have to produce utilizable knowledge' [127Meyer M, Molyneux-Hodgson S. Introduction: The dynamics of epistemic communities. Sociol Res Online 2010; 15[http://dx.doi.org/10.5153/sro.2154] ].
Mainly ‘four central aspects—shared underlying ideas, shared principled philosophies, shared ideas of legitimacy, and a general policy enterprise’ characterise an epistemic community’ [128Haas PM. Epistemic communities and international policy coordination. Int Organ 1992; 46: 1-35.[http://dx.doi.org/10.1017/S0020818300001442] ]. Epistemic communities arise from different epistemes. Foucault defines episteme, retrospectively, as the strategic apparatus that allows filtering out from all possible statements those that are acceptable within scientificity (not scientific culture) and of which one can say that they are true or false. The episteme is the “apparatus” that enables separation, not the true from the fake, but what can and cannot be characterized as scientific and non-scientific [129Allen W. The ethical epistemes of anthropology and economics. J Busi Anthr 2014; 20]. Epistemes give continuity and maintain the epistemological prior assumptions that establish what is recognized by the society as ‘justified true belief’ or knowledge in any historical epoch. It has also been described as a ‘unitary body of theory’, which tends to privilege some knowledge whilst subjugating certain others and ranking them low in its hierarchical paradigm. Epistemes are formed through an inner structure which is given in things as the inner law and hidden network [130What is shaping the practice of health professionals and the understanding of the public in relation to increasing intervention in childbirth? 2007.].
Basically, episteme is the “historical a priori that bases knowledge and its discourses and embodies the condition of its prospects within a particular historical milieu [131Unger J-P, De Paepe P, Van Dessel P, Stolkiner A. The production of critical theories in Health Systems Research and Education. An epistemological approach to emancipating public research and education from private interests. Health Cult Soc (Pittsburgh Pa) 2011; 1: 1-28.[http://dx.doi.org/10.5195/HCS.2011.50] ]. Epistemes are ‘comportments of justifying, elucidating, resolving problems carrying out enquiries, designing and verifying different types of products or results’ [132Murray SJ, Holmes D, Rail G. On the constitution and status of “evidence” in the health sciences. J Res Nurs 2008; 13: 272-80.[http://dx.doi.org/10.1177/1744987108093529] ]. An episteme informs our manner of perceiving which is our world view or Weltanschauung. Leading epistemes or world views get articulated to some extent by establishments, such as healthcare, and through specific scientific disciplines such as public health, endocrinology, psychiatry etc [132Murray SJ, Holmes D, Rail G. On the constitution and status of “evidence” in the health sciences. J Res Nurs 2008; 13: 272-80.[http://dx.doi.org/10.1177/1744987108093529] ].
The epistemes that exist are the result of various historical, social, political, economic, and cultural factors. Though the influence of the present worldview is most on an episteme, the historical processes cannot be excluded when trying to understand an episteme, an ‘epistemic process’, an ‘epistemic culture’ and an ‘epistemic object’. The historical stage that Nepal went through was different from countries that were colonised. Though Nepal was never colonised it has been affected by it and its remnants can still be seen for instance in ‘lahure’ (armed forces) recruitment. The 100 years purpose isolation of Nepal and its people by the Rana oligarchy which also got tacit support as a result of the pact with the East India Company and later the British government led to a condition where ‘nothing happened’. In the 1950’s, when the oligarchic rule ended the literacy rate in 1950 was approximately two percent [133Kernot S. Nepal: A development challenge. South Asia 2006; 29: 293-307.[http://dx.doi.org/10.1080/00856400600849167] ].
The dismal educational and economic conditions led to high dependence on other nations. The year 1956 marks the actual beginning of the modern era in the history of educational planning in Nepal. When education did begin all the disciplines were adopted from neighbouring India which in turn was principally following, that Paulo Freire called the banking system of education. Under the banking theory Freire believed that students were seen as passive objects to be influenced by the teacher, and he further argued that banking edification demobilized people in the existing power realm by making them adopt the dominant cultural, social, political status quo of the prevailing culture. Along with a rigid caste system, poverty, illiteracy and its ruling elites seeing its citizens as commodities to be sold and consumers to be sold to, the nation as a welfare concept has largely been absent.
Since 1950’s when Nepal first opened itself up to the ideas of modernity to the present a lot of changes have occurred. Professions that were the domain of only foreigners earlier have been adopted by hundreds and thousands from the native population. The university is where higher education level is available and also researchers acquire their skills. Over the years beginning from the 1980’s and 1990’s the nature of these universities have been transforming itself in tune with ‘neoliberal reforms’. The neoliberalised universities are seen to be displaying characteristics like, ‘reduction in public funding for universities’, ‘separation of teaching and research with the latter increasingly privileged as a source of external revenue’, ‘the replacement of peer review with market-based mechanisms’, the ‘tyranny of relevance’, and the ‘formidable strengthening of intellectual property protections’ [2Lave R. Neoliberalism and the production of environmental knowledge. Environ Soc 2012; 3: 19-38.[http://dx.doi.org/10.3167/ares.2012.030103] ].
The existing neoliberalised university system has a ‘performance paradigm’ that has researches completed as a key ‘performance indicator’. The universities and its changing nature has been characterised as, ‘schizophrenic’ or ‘multiple personality disorder university’ [134Shore C. Beyond the multiversity: neoliberalism and the rise of the schizophrenic university: BEYOND THE MULTIVERSITY. Soc Anthropol 2010; 18: 15-29.[http://dx.doi.org/10.1111/j.1469-8676.2009.00094.x] ] and when universities are seen through concepts such as ‘epistemic violence’, ‘epistemological violence’, ‘structural violence’, ‘ontological violence’, universities seem to embody a transnational elite that lay down the standards that must be adhered to for anything to be considered worthy of scientific recognition and to be accepted as knowledge. The tripartite partnership between the government, university and industry has been conceptualised as ‘Triple Helix’ system where market based values hold prominence. The ‘Triple Helix’ is country specific, regional specific, and discipline specific and even university specific. Despite its variability the ‘Triple Helix’ creates one common role of universities around the world, which is its role as a ‘supplier of knowledge and human capital’ [135Birch K. The neoliberal underpinnings of the bioeconomy: The ideological discourses and practices of economic competitiveness. Genomics Soc Policy 2006; 2: 1-15.[http://dx.doi.org/10.1186/1746-5354-2-3-1] ].
The human whom themselves are a capital and many a times also an investment in a neoliberal system has to use the skills acquired to generate more capital (publications, workshops, grants, inventions, patents) and as a result a higher position. Here the focus in on research and researcher who eventually compose an epistemic community. Epistemic communities have their own levels of connections where some maybe more international in scope where it comprises of researchers from all over the world and there may be others who may be restricted to a nation or a couple of nations. The epistemic community that NHRC brings together is national in scope though a handful of researchers were from Bangladesh and India. Here the particular epistemic community discussed focuses on researches done on health issues which have social, cultural, political and economic relevance which further influences the way policies are planned, solutions sought and it influences public perceptions too.
Way back in 1979 in the first edition of the book, ‘Use and misuse of social science research in Nepal’ the authors raised the issue about misuse of researches and the dominance of the questionnaire method that was prone to fabrication [136Campbell J, Shrestha R, Stone L. The use and misuse of social science research in nepal 2010.]. After more than four decades when the second edition of the book was published the authors lamented that ‘the country of Nepal passed through various changes at the social, political and economic levels but one thing remained in practise which is the ‘development agencies and projects for the most part continued to use, indiscriminately and uncritically, questionnaire surveys to gather information for their policies and projects in Nepal’ [136Campbell J, Shrestha R, Stone L. The use and misuse of social science research in nepal 2010., 137Mahat A, Bezruchka SA, Gonzales V, Connell FA. Assessment of graduate public health education in Nepal and perceived needs of faculty and students. Hum Resour Health 2013; 11: 16.[http://dx.doi.org/10.1186/1478-4491-11-16] [PMID: 23621945] ]. More recently others have also expressed the fact that the vast preponderance of articles were on quantitative research, generally questionnaire-type surveys [138Karmacharya BM. Shifting the paradigm: Nepal as a potential leader in the field of medical education. Kathmandu Univ Med J (KUMJ) 2011; 9(33): 1-2.[PMID: 22610798] ]. Views that public health needs a paradigmatic shift [138Karmacharya BM. Shifting the paradigm: Nepal as a potential leader in the field of medical education. Kathmandu Univ Med J (KUMJ) 2011; 9(33): 1-2.[PMID: 22610798] ] and calls for making health a public health agenda has also been made [139Subedi M. Making health a public agenda in nepal. SASS Journal 2006; 1: 73-96.]. Others have discussed issues that echo a political economy of research approach such as – on sources of funding, setting of the research agenda, review costs, research capacity development of Nepal, research findings and the politics behind it and issues related to upcoming ethical and regulatory agendas [140Sharma JR, Khatri R, Harper I. Understanding health research ethics in nepal. Developing World Bioeth 2016; 16(3): 140-7.[http://dx.doi.org/10.1111/dewb.12109] [PMID: 26841370] ].
Lately, others have shown that public health research has largely focused on family planning, HIV/AIDS, sexual and reproductive health, maternal health, women’s health, nutrition, child health and general health, each representing roughly eleven percent of the overall publications [141Padam P. Simkhada, Yuba R. Baral, Edwin R. van Teijlingen. Health and Medical Research in Nepal: A Bibliometric Review 2010;xx:9.]. The vast preponderance of researches was quantitative in nature, by and large questionnaire type surveys and the qualitative researches few in number were based on face to face interviews and focus group discussions [141Padam P. Simkhada, Yuba R. Baral, Edwin R. van Teijlingen. Health and Medical Research in Nepal: A Bibliometric Review 2010;xx:9.]. Researchers and the amount of research done have increased not just in Nepal but all over the world and this increase can be attributed to the setting of new audit criteria that values the number of publications and the amount of external research grants generated when evaluating a faculty for promotion also many researches are planned and done by various organisations for acquiring grants as a result of which satisfying the criteria of grant making bodies become more important even if it decreases its relevance to the local context. The incorporation of the, ‘publish or perish’ belief has facilitated the mechanisms through which the individual pursues a range of enterprises that must be done in order to achieve a particular goal. The ‘neoliberal self-enterprise technologies’ adopted views individuals as makers of research and generator of funds and their advancement depends on fulfilling the set criteria.
Neoliberalism has been very supportive of studies that are reductionist and methodologically individualist but, neoliberalism itself does not affect only a part of a system. In fact when any system is neoliberalised the whole ensemble of that system is affected. Here when discussing on research the higher educational environment is crucial in the way researchers are trained. The current BPH (Bachelor Public Health) and MPH (Master Public Health) curriculum provides students with a hands-on understanding of health systems and trains them to work as district public health practitioners, but does not sufficiently train them to work as an academicians, researchers and public health leaders’ [142Mahat A, Bezruchka SA, Gonzales V, Connell FA. Assessment of graduate public health education in Nepal and perceived needs of faculty and students. Hum Resour Health 2013; 11: 16.[http://dx.doi.org/10.1186/1478-4491-11-16] [PMID: 23621945] ], this phenomenon can also be seen in other health science disciplines.
Depending upon the social, economic and political situation of a nation, the quest for free-market reform and neoliberalism can have varied affects and consequences. Neoliberal values like, ‘survivor of the fittest’ philosophy has taken hold in all sectors including academic, research and education. The process of ‘ naturalisation of socially produced risk’ [143Nilsson J, Wallenstein S-O. Foucault, biopolitics and governmentality. France: Södertörn University 2013.], ‘normalisation of social divisions’ and ‘neutralization of negative health impacts’ [144Brassolotto J, Raphael D, Baldeo N. Epistemological barriers to addressing the social determinants of health among public health professionals in Ontario, Canada: A qualitative inquiry. Crit Public Health 2014; 24: 321-36.[http://dx.doi.org/10.1080/09581596.2013.820256] ] are some of the processes that have been identified to have occurred under neoliberalism. Wayne Brekhus (1998) referred to this as the process of ‘unmarking’ problems so that what was marked as clear and evident becomes virtually unnoticed and, by virtue of that, ‘unremarkable’. The dominant discourse in the health professions is, ‘micro level’, ‘individualized’ biomedical ‘and ‘depoliticized’ and, ‘this belief sees health as the nonexistence of illness or disease in persons and pursues to advance quantifiable features of their lives through the reduction of risk issue via indicators of morbidity and mortality’ [144Brassolotto J, Raphael D, Baldeo N. Epistemological barriers to addressing the social determinants of health among public health professionals in Ontario, Canada: A qualitative inquiry. Crit Public Health 2014; 24: 321-36.[http://dx.doi.org/10.1080/09581596.2013.820256] ]. Those espousing this world view typically accept that efforts against disease are empirically advantageous and necessitating no additional rationalization: the epidemiology (the fact) is normally believed to ‘articulate for itself’.
In the conceptual framework, (Fig. 1) the individual forms the core that consists of a population group or cohort and various health issues and conditions affect the population. These issues and conditions are taken up by concerned researchers, scientists, experts and policy makers who belong to various disciplines and combine to become an episteme. Here the episteme as shown in figure one is encircled by neoliberalism which sets the boundaries from within which an episteme works.
4. METHODOLOGICAL FRAMEWORK
The methodological approach (Fig. 2) adopted is based on ‘dialectical and critical reflexivity’ [145McNiff J. You and Your Action Research Project 2009.], ‘critical realism’ [146Bhaskar R. Scientific Realism and Human Emancipation 2009.], ‘phenomenological’ [147Kafle NP. Hermeneutic phenomenological research method simplified. Bodhi. An Interdisciplinary Journal 2013; 5: 181-200.[http://dx.doi.org/10.3126/bodhi.v5i1.8053] , 148Moustakas C. Phenomenological research methods. J Phenomenological Psychol 1994; 29: 25-43.[http://dx.doi.org/10.4135/9781412995658] ], ‘existentialist’ [149Lanzerath D. Health and disease as normative concepts. Bioethica Forum 2012; 5: 59-66.]and an approach of more recent origin which the author holds combines all of the above mentioned approaches an ‘autoethnographic research’ approach [150Qutoshi SB. Auto/ethnography: A transformative research paradigm. Dhaulagiri Journal of Sociology and Anthropology 2015; 9: 161.[http://dx.doi.org/10.3126/dsaj.v9i0.14027] ] The type of research sample that this study deals with can also be called as a ‘discourse analyses’ and here the study follows an ‘abductive’ approach to analyse the discourse by ‘moving back and front amongst empirical data, research literature and developing theory’ to have an understanding of the structures and apparatuses that influences the way researches are done. The researches selected are individually approached by the author and by ‘interrogating, deconstructing and decentring’ [151McNiff J. Writing up your action research project 3rd ed. 3rd ed.2016.] each research is assessed of its connection to the reality on the ground level and the extent to which the researches have a pragmatic heuristic value. The author does not ‘step out of the world’, is not ‘detached’ from the existing reality and acknowledges her/his native belongingness. The methodological steps proceed with the assumption that all the researchers based on the existing ground reality felt the importance and the genuine need for doing a research, and all the researches were done with a genuine intention towards studying things right, recommending things right and making things right.
The basic unit of focus, observation and analysis of this paper are the research abstracts presented at the two conferences. The books of abstracts are available on the NHRC website. The summit/conference brings researchers scholars’ practitioners, scientists and policy makers from all over the country. More than two hundred research findings were presented in the two conferences held in 2015 and 2016.
Findings and recommendations are the end result of all researches and based on these, viable solutions are sought, policies are made and programs conducted. The end result is the result of the research questions asked, hypothesis made, methodologies, methods followed and tools used, all of which make up the research process. But even before the first step is taken in the research process there is ‘a-prior condition’ that shapes the understanding as to what needs research and builds the rational and justification for any proposed research. This ‘a prior’ understanding of a researcher is the research philosophy which is regarded as the bedrock of any research and is implicit in all research. This implicit part that informs any research is invisible and unless made explicit by the researcher or until philosophical enquiry is done.
Any situation can be looked at from different angles and using different methods provide different types of answers. Researcher’s contradictory ontological and epistemological stances frequently lead to dissimilar research approaches to a similar case [152Grix J. Introducing students to the generic terminology of social research. Politics 2002; 22: 175-86.[http://dx.doi.org/10.1111/1467-9256.00173] ]. Based on pragmatism ‘the most essential determinant of the research philosophy adopted is the research query’ and it also guides the other aspects of research. The ‘ontological nature of reality’, the ‘epistemological nature of knowledge’ and the ‘axiological position of the researcher guides the ‘research questions and the hypothesis which also serves as an extension of the research question’ [153Carpiano RM, Daley DM. A guide and glossary on post-positivist theory building for population health. J Epidemiol Community Health 2006; 60(7): 564-70.[http://dx.doi.org/10.1136/jech.2004.031534] [PMID: 16790824] ], and hence forth the methodologies, methods, results and recommendations [154Higgs J, Cherry N. Doing Qualitative research on practice 2009.]. It is impossible to do any kind of research without being (often implicitly) committed to ontological and epistemological positions [155Scotland J. Exploring the philosophical underpinnings of research: Relating ontology and rpistemology to the methodology and Methods of the scientific, interpretive, and critical research paradigms. Engl Lang Teach 2012; 5[http://dx.doi.org/10.5539/elt.v5n9p9] ].
The foremost step was to identify all the research abstracts having the word knowledge in its title, in keywords or if it had assessing knowledge as its objective. Altogether twenty-one research abstracts met the inclusive criteria. Each study was scrutinized and its, research objectives and the research questions were identified. The methodology and methods used to answer the research questions and fulfil the objectives were examined. And, the conclusions, discussions, recommendations made by each research were sought out. Each research was approached with the following questions.
What are the stated objectives, justification, rational, aim, purpose and the research questions?
What or who are the subjects of study of the research?
What are the methodologies and methods followed in the research?
What type of data does the methodology aim to generate?
What are the findings of the research?
What are the recommendations of the research?
The information obtained from each research was then analysed from a philosophical perspective based on an existentialist, phenomenological and empirical experiences of the author. An autoethnographic method of research approach was adopted when analysing and reflecting on each case. Based on a basic categorisation of the philosophical stages which include an ontological, epistemological and axiological part the questions asked during analysis were as follows.
What are the ontological assumptions?
What are the epistemological assumptions?
What are the axiological assumptions?
What are the methodological assumptions?
The first question on ontological assumptions deals with one of the most important components of our vision of the world and is so elemental that we barely question them. They are central to any investigation in any discipline [42Patil T, Giordano J. On the ontological assumptions of the medical model of psychiatry: philosophical considerations and pragmatic tasks. Philos Ethics Humanit Med 2010; 5: 3.[http://dx.doi.org/10.1186/1747-5341-5-3] [PMID: 20109176] , 43Eriksen TE, Kerry R, Mumford S, Lie SA, Anjum RL. At the borders of medical reasoning: Aetiological and ontological challenges of medically unexplained symptoms. Philos Ethics Humanit Med 2013; 8: 11.[http://dx.doi.org/10.1186/1747-5341-8-11] [PMID: 24006875] , 46Eastwood JG, Jalaludin BB, Kemp LA. Realist explanatory theory building method for social epidemiology: A protocol for a mixed method multilevel study of neighbourhood context and postnatal depression. Springerplus 2014; 3: 12.[http://dx.doi.org/10.1186/2193-1801-3-12] [PMID: 24422187] ]. The neoliberal ontological project takes for granted ‘homo economicus’ as primary representation for personal conduct which occur from subject’s economic rationality functioning in a world of ‘perfect information’ and ‘static concepts of equilibrium’ [104Madra YM, Adaman F. Neoliberal reason and its forms: De-politicisation through economisation. Antipode 2014; 46: 691-716.[http://dx.doi.org/10.1111/anti.12065] ]. Neoliberalism ‘relies on individualist ontologies of calculative and calculable agency’ [156Adaman F, Madra YM. Understanding neoliberalism as economization: The case of the ecology 2012.].
The second on epistemological assumptions deals with what is profoundly entrenched in the culture and world view of society and determines the acknowledgment of a crisis and if the reasons of the crisis are named [157Dugassa B. Knowledge construction: Untapped perspective in pursuit for health equity. Sociol Mind 2012; 02: 362-72.[http://dx.doi.org/10.4236/sm.2012.24048] -159Hammell KW. Informing client-centred practice through qualitative inquiry: Evaluating the quality of qualitative research. Br J Occup Ther 2002; 65: 175-84.[http://dx.doi.org/10.1177/030802260206500405] ]. Neoliberal epistemological approach studies the objects of inquiry by disassembling them into basic components and studies their articulations in isolation [160Camargo KR Jr, Ortega F, Coeli CM. Modern epidemiology and its discontents. Rev Saude Publica 2013; 47(5): 984-91.[http://dx.doi.org/10.1590/S0034-8910.2013047004777] [PMID: 24626504] ]. The central axiom that neoliberal epistemology holds is that knowledge is by definition fragmentary, imperfect and socially dispersed’ [161Krasovec P. Neoliberal epistemology: From the impossibility of knowing to human capital. Filozofija i Drustvo 2013; 24: 63-83.[http://dx.doi.org/10.2298/FID1304063K] ].
The third question on axiological assumptions looks at the values or moral and ethics in the research. Axiology is the theory of values, and values are facets of human conduct that developed during evolution, giving us objectives, goals and opinions that direct our actions through our knowledge [162Tashakkori A, Teddlie C. Sage handbook of mixed methods in social & behavioral research.Sage; Sage Publications 2010.]. Axiological orientations of researchers are applied to the concerns and problems of the real world contexts within which they work [163Spencer RL. Research methodologies to investigate the experience of breastfeeding: A discussion paper. Int J Nurs Stud 2008; 45(12): 1823-30.[http://dx.doi.org/10.1016/j.ijnurstu.2008.04.008] [PMID: 18514199] ]. The axiological assumption of logical-positivist research is that it is unbiased in contrast to naturalistic research, in which the researcher recognizes his values and predispositions as well as the value nature of the information collected from the ground [164Johnstone PL. Mixed methods, mixed methodology health services research in practice. Qual Health Res 2004; 14(2): 259-71.[http://dx.doi.org/10.1177/1049732303260610] [PMID: 14768461] ]. Although ontology epistemology and axiology have been presented separately, there have been claims that they cannot be considered separable, because axiology, epistemology, and ontology co-evolve [165Allen PM, Varga L. Complexity: The co-evolution of epistemology, axiology and ontology. Nonlinear Dyn Psychol Life Sci 2007; 11(1): 19-50.[PMID: 17173728] ].
The fourth question on methodological assumption is regarding how the researcher can go about finding out what it is that he or she considers can be identified, based upon aforementioned epistemological assumptions [159Hammell KW. Informing client-centred practice through qualitative inquiry: Evaluating the quality of qualitative research. Br J Occup Ther 2002; 65: 175-84.[http://dx.doi.org/10.1177/030802260206500405] ]. ‘Methodological assumptions specify which research methods and techniques are considered suitable for the collection of legitimate empirical proof and obviously depend on how the reality of a theory is ascertained’ [166Orlikowski WJ, Baroudi JJ. Studying information technology in organizations: Research approaches and assumptions. Inf Syst Res 1991; 2: 1-28.[http://dx.doi.org/10.1287/isre.2.1.1] ]. Under neoliberal positivist methodology an inherent predisposition towards the individual as the nucleus of contemporary consumer culture [167Trentmann F. Beyond consumerism: New historical perspectives on consumption. J Cont His Copyright 2004; 39: 373-401.], which believes a scientifically acceptable action theory has to give exact predictions and explanations exist [168Reutlinger A, Koch H. Methodological individualism and the epistemic value of macro-explanations and. Percipi 2008; 2: 1-14.]. The neoliberal methodology is determined by individualism which again is influenced by reductionism and at least 10 modes of individualism such as ontological, logical, semantic, epistemological, methodological, axiological, praxiological, ethical, historical, and political have been identified [169Bunge M. Ten modes of individualism-none of which works-and their alternatives. Philos Soc Sci 2000; 30: 384-406.[http://dx.doi.org/10.1177/004839310003000303] ]. The methodological assumption is a product of the ontological, epistemological and axiological assumptions and is evident in the research questions and methodological approaches selected [170Marley SC, Levin JR. When Are prescriptive statements in educational research justified? Educ Psychol Rev 2011; 23: 197.[http://dx.doi.org/10.1007/s10648-011-9154-y] ].
After all of the above steps the task to seek answers to the research question as mentioned in the title was undertaken. The principal research question was, what heuristic use and value does the research have? Or is it just satisfying some ritualistic purposes? By its nature the question is loaded with value laden notions but then all questions are value laden and more over being so does not reduce the importance of the question.
Contradictory to heuristic use is the ritualistic use of research. By ritualistic use the author means those researches that serve only some instrumentalist purpose such as improving one’s performance measures, obtaining a research grant or filling up the bio data. The author is not saying that these should be done away with and as though it can be done away with. Rather the concern is here that researchers when doing research is serving only some instrumentalist ritualistic purposes, what are the costs incurred by the society at large? Perhaps no other discipline holds the amount of ramification it can have that public health has on the everyday lived experiences at the individual and population level when, researches seemingly heuristics in use is intended only for some ritualistic purpose.
As mentioned earlier, the steps that lead to the findings are reflexive in nature, dialectical in process and critical in its approach. Reflexivity involves a ‘constant comparison method’ [171Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Serv Res 2007; 42(4): 1758-72.[http://dx.doi.org/10.1111/j.1475-6773.2006.00684.x] [PMID: 17286625] ] with the existing ground reality and is not based only on any fixed canonical priors. Basically reflexivity incorporates ‘historical sensitivity’, ‘radical doubt’, ethical imperative where one is able to recognise ‘the hidden aspects of the other’s and one’s own natural understanding’ and ‘go beyond and get behind oneself and our own norms’ [119McAra-Couper JP. What is shaping the practice of health professionals and the understanding of the public in relation to increasing intervention in childbirth? 2007.]. The ‘dialogic meditation’ in a reflexive analysis allow researchers to understand human action and human condition more closely. By incorporating reflexivity when doing research we can avoid a condition of ‘reflexive paralysis’ in which the mechanist, repetitive, ritualistic and instrumentalist trend in research is seen and by ‘systematized reflexivity’ we can avoid being ‘rational fools’ of neoliberalism.
A dialectical process in thinking involves an awareness of the broader social, cultural, political, economic and other forces that influences how one thinks. It ‘recognizes the ordered nature of culture-bound rationalisms’ or ‘regional rationalisms’ and endeavors to go past instant experience to attain ‘scientific experience’ [172Lennon K, Whitford M, Eds. Knowing the difference: Feminist perspectives in epistemology 1994.[http://dx.doi.org/10.4324/9780203216125] ]. ‘It engages consecutive experience of high and low, communitas and composition, homogeneity and segregation, egalitarianism and inequality, lesser to higher status and in dialectics the opposites, as it were, shape one another and are reciprocally requisite ’ [173Dehaene M, De Cauter L. 2009.]. Open mindset, intellectual inquisitiveness, suppleness, intellectual integrity, methodological skepticism, perseverance, objectivity and deference for viewpoints are the attitudes contained in critical thinking’ [174Ikeunobe P. In search of criteria for ‘fallacies’ and ‘begging the question.’. Argumentation 2002; 16: 421-41.[http://dx.doi.org/10.1023/A:1021158632437] ]. In the context of experts being critical involves having a flexible attitude towards learning, not believing that strategies and techniques are epitomes, includes ‘averting of atomistic outlook of logical errors in individual logic ’, has an ‘apprehension about self deception with respect to reasoning’ manages to ‘depersonalize’ one’s world-view, involves ‘capability to efficiently analyse and solve problems, explain, organise and articulate thoughts, and make logical conclusions, and to contextualize the use of these capabilities to diverse germane issues’ and engages ‘a set of logical behaviors and capabilities which have to be used, cultivated and established—but only when such a context exists [46Eastwood JG, Jalaludin BB, Kemp LA. Realist explanatory theory building method for social epidemiology: A protocol for a mixed method multilevel study of neighbourhood context and postnatal depression. Springerplus 2014; 3: 12.[http://dx.doi.org/10.1186/2193-1801-3-12] [PMID: 24422187] ]’. It sees reality as hierarchically stratified ordered levels and is a suitable approach for the examination of any social phenomenon [46Eastwood JG, Jalaludin BB, Kemp LA. Realist explanatory theory building method for social epidemiology: A protocol for a mixed method multilevel study of neighbourhood context and postnatal depression. Springerplus 2014; 3: 12.[http://dx.doi.org/10.1186/2193-1801-3-12] [PMID: 24422187] ]. Much antipathy exists from those in authority and the hegemonic epistemes and many a times the existing hegemons were also seen with antipathy by the hegemons they may have replaced.
Whether the researches had a heuristic use and value or were it just serving some individual instrumental needs of its creator or creators is a question which has to be understood by taking the existing local empirical grounded context in to account. The findings mentioned below are based on the lived empirical experiences and, from the view of a native existentialist phenomenological view. Being a native could bring various images about, who is a native? Even within Nepal we could be having an ‘etic’ or ‘emic’ viewpoint on various issues and in various regions amongst various individuals and communities. The arguments below could appeal or detest the reader, many could point at the lack of definitive scales to measure, the generalist character of the arguments and even be accused of ‘armchair research’ but nonetheless honest reflexive philosophizing is important for any discipline or even an episteme to shed its weakness and cure its myopic gaze (Table 1).
Table 1 Analysis of the researches from the first and second Nepal Health Reseach Council, Health and Population Scientists Abstract Book.
One could be doing one’s job honestly, sincerely and with a belief about doing well. But, then the work that one does has not resulted in desired changes. When digging for water if after a certain depth if no water is found then the digger shifts to a newer location and starts digging again until water is found. Like the digger a scientist or a researcher too looks to fulfil certain objectives and tries to provide newer solutions. But unlike the digger who knows when water is found and can stop the latter does not have that luxury. Scientists and researchers have to continually update one’s self by adopting strategies, techniques and other relevant developments so as to produce scientifically valid and correct work and when it comes to human behaviour and health the area that it covers is all encompassing.
Scientists and researchers working on issues related to health have to not only be updated with developments in one’s concerned discipline but also have to keep one’s senses open to developments in other disciplines for the need of a multidisciplinary, interdisciplinary and transdisciplinary approach has been deemed essential [215Choi BCK, Pak AWP. Multidisciplinarity, interdisciplinarity, and transdisciplinarity in health research, services, education and policy: 3. Discipline, inter-discipline distance, and selection of discipline. Clin Invest Med 2008; 31(1): E41-8.[http://dx.doi.org/10.25011/cim.v31i1.3140] [PMID: 18312747] , 216Neuhauser L, Richardson D, Mackenzie S, Minkler M. Advancing transdisciplinary and translational research practice: Issues and models of doctoral education in public health. J Res Pract 2007; 3: 19.]. The researches that have been dealt with in the findings section above have a focus on health issues and various cohorts were researched and the individuals who constituted the cohorts were from various sectors ranging from adolescents to professionals and children to mothers. All the researches have the ‘individual’ as its focus and indeed the individual is ultimately at the focus of most researches on health issues. But, the ways an individual lives at various stages of life and the barriers and solutions that prevent or enable them to act in certain recommended ways can be many a time located far away from them. For instance going back to the case of the digger who has dug in a hundred different places looking for water to no avail and cursing his/hers fate, when in fact a water bottle company has managed to appropriate all the ground water through use of machinery power.
Based on the nature of the work one does and the ways that it affects those at the receiving end is varied in consequences and implications, also in between these two many other levels exist. Here the focus is on researchers or more specifically an epistemic community and the product it produces i.e. a research publication or presentation and when taken collectively can be said to constitute a discourse. The methodological process and the statistical tools used are not of concern here, since they are an outcome of the research objectives, rationales or hypothesis which is based on one’s assumptions and inferences which again is influenced by one’s philosophical underpinnings. Though philosophical underpinnings are mostly invisible it is omnipresent and influences use of heuristics in approaching a problem in order to seek a solution but many a times these seemingly heuristics could be only fulfilling some ritualistic purposes.
Based on existentialist, phenomenological and empirical experiences when the twenty one researchers were analysed adopting an autoethnographic approach one common theme that was discerned is that all the researches proceeded with the assumption that individuals were ignorant and they needed to be taught. Apart from the researches on blood donation in table 4 and appraisal of knowledge and attitude of clinicians to research writing in table 6, all of the other researches were done on populations who traditionally have been associated as ignorant, lazy, careless and unmotivated. Also the two researches on traditional healers and their practices are different than other researches since they were not done on behaviours that have been recommended to be done in certain ways based on some ‘procrustean’ standard among various cohorts at various stages in life. Though different than the remaining seventeen researches the acceptance of neoliberalism is apparent in all of them. They all take the ‘a prior’ structure of neoliberalism as given and accepted for instance on research and clinicians the need for researches as an important indicator of performance capability is treated as an axiom.
The seventeen researches have a common objective of assessing, identifying or evaluating knowledge on different habits, practices and perceptions. The perception that, lack of knowledge is what causes various negative conditions affecting health, and educating the populace will bring about desired change prevails among the researchers. From a distance the research looks perfectly reasonable, with high quality of evidence, rigour and its methodology seemingly flawless. The problems in the researches arise when viewing its particulars reflexively, critically and philosophically based on existential, phenomenological and empirical experiences. These problems are a result of many other conditions and these in turn by other conditions.
The genesis of these conditions can be traced back to colonial times and the increasing dominance of the Western Newtonian Cartesian system of science. Debating on the western system is not the scope here. Neoliberalism can influence any system be it Asian, African or European and also any discipline/subject be it Ayurveda or be it modern allopathic. The seventeen researches follow an epidemiological approach that rests on the, ‘social world homogeneity assumption’, [217Battersby M. Applied epistemology and argumentation in epidemiology. Informal Log 2008; 26: 41-62.[http://dx.doi.org/10.22329/il.v26i1.430] , 218Lucas SR. Beyond the existence proof: ontological conditions, epistemological implications, and in-depth interview research. Qual Quant 2014; 48: 387-408.[http://dx.doi.org/10.1007/s11135-012-9775-3] ] and follows the ‘dose response inquiry’ despite it being recognized as essentially contextual (developmental or historical) rather than universal [219Wing S. Limits of epidemiology. Med Glob Surviv 1994; 1(2): 75-86.]. All the researches adopted a quick fix methodology and a hurried approach. The assumption made is that the populations researched would give honest, correct and valid answers when approached.
Questionnaires and interviews were used to obtain information on knowledge possessed and indeed it can provide reliable data, but when used to gauge behavioural practices the results can be misleading since they can easily be influenced by the ‘social desirability bias’. The rational choice theory which treats humans as rational beings, expects all humans to act based on interest maximisation and when it comes down to one’s health the individual should take specific measures so as to stay healthy. The questionnaire in affect assumes that knowledge leads to action. Hence if a pathological condition occurs within a community it must be because the individual ignored or had not known about the risk factor. The structure within which the individual exists is deemed as a level playing field where all humans should compete for the opportunities made available by the market.
As for assessing the heuristic or ritualistic use and purpose of the researches concerned it is essential that the assessment be made by taking the existing lived empirical locally grounded reality of the researched. Also when considering the existing local conditions it is imperative that the global, macro or structural forces that affect it be taken in to account for if these are not taken into account the strong possibility of the research being detached, separated, deproblematized, decontextualized and dissocialized from the researched population. The line that separates when attempting to assess heuristic use from ritualistic use of any research is prone to any procrustean objective that the reviewer who embarks on the task of assessment holds. To have an open mind and an honest intention without preconceived plans of interpreting the study as per one’s desire is essential for attaining scientific credibility in one’s analysis. The consequences when researches are just fulfilling some ritualistic purpose are dire for countries like Nepal where development has been the prime focus with much inflow of foreign loans, grants and aids, both corruption and stagnating human development occurs.
Research is done to discover new facts or information through careful methodological procedures. With the passage of time much change has occurred in the ways researches are done and also the reasons for doing a research have changed in accordance with human needs and interests. In Nepal as in other least developed nations the burgeoning trend of researches and journal publications have been due to the establishment of ‘logocentric ‘and ‘Eurocentric’ ‘character of the main part of the knowledge produced and taught in the universities around the world’, ‘the introduction of managerialism from western neo-liberal universities’, the establishment of the ‘enterprise university’, and ‘the audit feature for neoliberal managing of universities that gives significance to publication indicator and fundamental research’. The character that most universities have acquired around the world has been very aptly described as the ‘schizophrenic university’ paradigm where an ‘institutional fascination with research rankings’ exist and as a result ‘individuals and institutes acquire yet better care in the building and preservation of fabrications ’ and ‘playing the rating game’ which also leads to ‘opacity and complicity’. The separation of university education from the local contexts has seen the ‘tyranny of relevance’ and this has resulted in devising one’s academic research expertise to cater to the needs of the distanced rather than the needs of the immediate and near, the result of which has been that researches when seen from afar seem methodologically sound with the results generated by the latest software but when viewed by keeping the grounded reality of the researched it seems to have no pragmatic value resembling a piece of work which is ‘bullshitting’ or just producing ‘epistemic pollution’.
ETHICS APPROVAL AND CONSENT TO PARTICIPATE
HUMAN AND ANIMAL RIGHTS
No animals/humans were used for the studies that are bases of this research.
CONSENT FOR PUBLICATION
CONFLICTS OF INTEREST
The authors declare no conflict of interest, financial or otherwise.
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