How Not to Do Community-Based Participatory Research: Media Campaign for Social Change in Pakistan's Tribal Districts

"[P]ositive outcomes of...community-oriented projects depend on community-based inputs in accordance with the principles and processes of CBPR [community-based participatory research]."

Pakistan's Pakhtun tribes living in Khyber Pakhtunkhwa (formerly designated as Federally Administered Tribal Areas, or FATAs) are doubtful about the polio eradication campaign, even as their children are the ones in the region mostly affected by poliovirus. To address or assuage the fears and suspicions of the local communities about polio vaccination, communication interventions need to reach stakeholders at the grassroots level. This paper analyses the extent to which "Pakhto Voices", a project run by the Public Engagement Policy Lab., a United Kingdom-based non-governmental organisation, adhered to community-based participatory research (CBPR) principles and approaches.

The paper begins by providing background information on Pakistan's tribal districts, the place where the project was implemented. Because of a perennial form of militarised violence, the tribal districts are not only the most violent place in the region but also the most underdeveloped areas of the country. Furthermore, the inhabitants of the region have strong tribal and linguistic ties with Pakhtuns in Afghanistan and see little reason for the border that divides them. Pakhtun identity is stronger for those in the tribal districts than Pakistani national identity, and this, tied with very low levels of economic development, makes the local people feel less part of Pakistan than other ethnic groups. This situation makes it difficult for the state of Pakistan, or more so international organisations, to successfully run health campaigns in the Tribal Districts.

The Pakhto Voices project sought to improve, through an integrated radio, print, and SMS (text messaging) communication programme, the two-way communication flow between those living in the tribal districts and displaced citizens living in Khyber Pakhtunkhwa. This communication initiative had two key objectives: (i) to present and support socially positive examples of contemporary peace‐building activities, role models, and behaviours; and (ii) to encourage popular exploration of eroded elements of traditional Pakhtun culture. To achieve these objectives, six radio stations and three newspapers were part of the project from October 2012 to February 2013.

Addressing the issue of social injustice and health disparities among Pakhtun tribes, the aim of the first phase of "Pakhto Voices" was to focus on the community. To change social norms and behaviours around different issues including vaccination rates (e.g., poliovirus vaccination), the project's access to the local Pakhtuns was made possible through designing different communication interventions divided into three parts: (i) formative research, (ii) development of intervention, and (iii) evaluation.

The formative research design of the project employed a fusion of unobtrusive and obtrusive quantitative, qualitative, and ethnographic methods. The formative research design had three components: content analysis; citizen consultation; and SMS (text messaging) data gathering. For example, each month, "Pakhto Voices" expected to receive text messages from Tribal Distrists' citizens who had heard their radio output or read their monthly magazine. These texts, which were facilitated and stored by iMedia software, constituted feedback for the project. The officials claimed that since the feedback of the members of the tribes was taken in the development and improvement of the communication intervention, their project was an example of CBPR.

CBPR in public health is a partnership approach to research that equitably involves community members, organisational representatives, and researchers in all aspects of the research process and in which all partners contribute expertise and share decision making and ownership. CPBR: (i) acknowledges community as a unity of identity; (ii) builds on the strengths and resources within the community; (iii) facilitates a collaborative, equitable partnership in all phases of research, involving an empowering and power-sharing process that attends to social inequalities; (iv) fosters co-learning and capacity building among all partners; (v) integrates and achieves a balance between knowledge generation and intervention for the mutual benefit of all partners; (vi) focuses on the local relevance of public health problems and on ecological perspectives that attend to the multiples determinants of health; (vii) involves systems development using a cyclical and iterative process; (viii) disseminates results to all partners and involves them in the wider dissemination of results; and (ix) involves a long-term process and commitment to sustainability.

This paper argues that "Pakhto Voices" did not adhere to the principles of CBPR. The project did not look at the strengths or resources of the local communities. In conducting formative research, the first part of the Pakhto Voices project looked into what kind of medium the tribesmen use to communicate with each other. According to this analysis, the citizen panel and interviews were done with certain presumptions, such as that the people residing in those tribes are "illiterate". The project also did not take into account the prejudices and institutional racism the tribal men face in FATA. Not recognising those issues as part of the problem, the project could not look into the oppression that these tribes might have gone through and the way it influences their communication choices.

"Another principle of CBPR is that it involves community members as equitable partners in all phases of research....Pakhto Voice project, on the other hand, did not involve community members....The community members were used as units of analysis. Data was gathered from community members, but their advice and opinion were never taken or valued at any stage. Rather the researchers reached the community members with a position of power and treated them as 'Others' during the whole research process as described in the final report of the project presented to the government of Pakistan in (2014)."

The authors also challenge the concept of "cultural competence" used during the creation of "Pakhto Voices" messages and interaction with the community in this programme. They argue that showing "cultural humility" - having an interpersonal stance that is other-oriented rather than self-focused, characterised by respect and lack of superiority toward an individual's cultural background and experience - could have improved the outcomes of the project.

In short: "The Pakhto Voice project did not involve the community as equal partners at any stage. The formative research done in the shape of content analysis and interviews focused on getting information about the habits of the native Pakhtun tribes. The project did not take into account local history, context, and culture....The evaluation of the project through mobile feedback and citizen panels was also problematic."

According to the Department of Health, the project failed to achieve its goals and was, therefore, closed after two years of operation, when the World Health Organization reported that despite the investment of millions of dollars and many campaigns the poliovirus vaccination rate declined among children of the Pakhtun tribes residing in FATA.