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  • 00:09

    DONNA MERTENS: Hello.I'm Donna Mertens.I was a professor at Gallaudet University for over 30 years.I developed an approach to researchthat focuses on human rights and social justice.The name of this approach to researchis the transformative approach.It's based on philosophical assumptions

  • 00:29

    DONNA MERTENS [continued]: within a framework that allows usto look at how we apply ethics relatedto social justice and human rights,how we come to understand the experiences of people who comefrom different social positions and their relevanceto the research process, how we come to be able to bring

  • 00:51

    DONNA MERTENS [continued]: to visibility the knowledge of the diversity of peoplewithin the research context, and how we design a study sothat we increase the probability that our research will be usedfor social transformation.I'm going to provide you with a case study of a researchstudy that actually used the transformative paradigm

  • 01:16

    DONNA MERTENS [continued]: as a way to guide the thinking of the researchers.This research study took place in Botswana.Botswana is a country in southern Africathat has a very high rate of infection of HIV/AIDS.In fact, 25% of the population is infected with the disease.

  • 01:36

    DONNA MERTENS [continued]: The government in the country saidthat they did not want to have this rate of infectioncontinue.And so they made a priority of tryingto have programs that would reduce the rate of infection.The study that I'm going to talk aboutis one that was funded through the National

  • 01:59

    DONNA MERTENS [continued]: Institutes of Health from here in the United States.And the primary investigator for the projectwas Dr. Bagele Chilisa, who is a professorat the University of Botswana.The study focused on how you coulddesign an intervention that would prevent HIV/AIDS

  • 02:21

    DONNA MERTENS [continued]: infection for youth, and in particular youth in the agerange of 14 to 17.My role in this study was as an advisor.I served on the advisory board.And so I did not go out into the field to collect the data,but I worked with a team of researchersto discuss how a transformative lens could

  • 02:44

    DONNA MERTENS [continued]: be brought to the work that they were doing.So I'll very briefly share with youthe notion of paradigm in researchand the transformative paradigm in particular.And then what we'll do will be to focus particularlyon the epistemological and methodological assumptionsof the transformative paradigm.

  • 03:06

    DONNA MERTENS [continued]: So when researchers talk about paradigms, what they're talkingabout is your worldview.And your worldview is a set of assumptionsthat determines how you understandthe nature of ethics, or axiological assumptionsthat you make; or how you understand

  • 03:27

    DONNA MERTENS [continued]: the nature of reality, or ontological assumptions; howyou understand the nature of knowledgeor the relationship between the researcherand the people in the research context,your epistemological assumption; orthe methodological assumption about the natureof systematic inquiry.

  • 03:49

    DONNA MERTENS [continued]: So transforming a paradigm reallyis constituted by these four assumptions.And I recommend the use of the transformative paradigm,particularly in contexts like this, because I hypothesizethat if we give priority to social justiceand human rights, and we appropriately

  • 04:11

    DONNA MERTENS [continued]: engage members of marginalized communitiesand the full range of stakeholders in our research,that we will produce findings thathave a better chance of actually contributingto the kind of social transformation that we desire.So the transformative paradigm, to give you the overview of it,is that it really serves as a metaphysical umbrella that

  • 04:35

    DONNA MERTENS [continued]: allows us to look at the different dimensionsof diversity that are associated with violations of human rightsand impede our progress toward social justice.So these would include any dimension of diversitythat's used as a basis of discrimination and oppression.So that could be gender, race, ethnicity, language,

  • 05:01

    DONNA MERTENS [continued]: tribal status, refugee status, immigrant status.There are so many dimensions of diversitythat are used worldwide as a basis of discrimination.And the transformative paradigm calls upon usas researchers to bring these consciouslyin to the design of the research that we do.

  • 05:23

    DONNA MERTENS [continued]: So a very brief summary of the assumptionsof the transformative paradigm that, in terms of ethics,we are looking for cultural respect.We're looking for the promotion of social justiceand human rights.We are looking at the inequities that

  • 05:45

    DONNA MERTENS [continued]: exist in a very conscious way in how we can give backto the communities that we work withand how we can recognize strengthswithin those communities.Ontologically, we're critically interrogatingthe nature of the version of realitythat is being used to make decisions

  • 06:06

    DONNA MERTENS [continued]: about what is happening to the people in the communityand the implications of those versions of realityfor the types of interventions that we use.Now, I'm going to focus on epistemology in this casestudy.And what we're going to do is lookat how do we establish those kindsof interactive relationships of trust

  • 06:30

    DONNA MERTENS [continued]: that are necessary for us to really bringthe voices of those who are less powerful, who are marginalized,into the research process and give validationto the local cultural indigenous knowledge thatis necessary for us to develop appropriate interventions

  • 06:51

    DONNA MERTENS [continued]: and to conduct research that has validity within that context.I'm going to share with you an example of methodologyin the form of a transformative cyclical mixed methodsdesign-- in other words, a design in which we collect dataat one stage; we use the data that

  • 07:12

    DONNA MERTENS [continued]: are collected at that stage to decidewhat to do with the research study as we move forward.And so at each stage of the cycle,we're collecting, analyzing data, and making use of itto make decisions of how we move forward.

  • 07:34

    DONNA MERTENS [continued]: In terms of epistemology, we're goingto look at the study in Botswana to see how mixed methods wereused to really address power differentialsin the stakeholder groups.Who had power?What kinds of power?And how do we challenge a dominant powerin order to bring to visibility the knowledge that

  • 07:57

    DONNA MERTENS [continued]: was really critical to understandthe nature of HIV/AIDS infection in youth in Botswana?Epistemologically, what we're looking atis how in the design of the studydo you give voice to those in less powerful positions.How do you establish relationships of trust

  • 08:18

    DONNA MERTENS [continued]: for people who may have been discriminated againstand don't particularly feel trustfultowards those in authority?And how do we understand and bring to visibilitythe local and social knowledge that's necessary for usto truly understand the phenomena that we're studying?

  • 08:40

    DONNA MERTENS [continued]: So we're going to look at this and answer some questionsfrom an epistemological standpoint basedon the Botswanan case study.So when we asked who are the stakeholders here,we're talking about everyone who's goingto be impacted by that study.How do you develop a team, a research team,

  • 09:03

    DONNA MERTENS [continued]: to guide you so that you are askingthe right kind of questions, and you are doing so in a waythat the people who are asked to respondfeel safe in sharing their knowledge with you?How do you negotiate the various versions of reality,particularly if there's one held by the more powerful

  • 09:25

    DONNA MERTENS [continued]: that would not accurately reflectthe experience of reality by those whoare in less powerful positions?How do you use that data from the initial collectionof contextual information to inform later stagesof the research process itself?

  • 09:46

    DONNA MERTENS [continued]: And how does the research processsupport strategies for engagement?So talking now specifically about the Botswanan exampleand the application of epistemological assumption

  • 10:07

    DONNA MERTENS [continued]: to methodology, we can talk about the stakeholdersand the team development.Obviously, the principal investigatorand people from the university need to be engaged.There was also a US partner, a university in the United Statesthat was a partner in this project.There were cooperating schools, where

  • 10:31

    DONNA MERTENS [continued]: the students went to school.There were faculty at those schools.And there were the students at those schools.There were also the families of these students.And then very importantly, there was representationfrom the church community because thisis a very important cultural aspect of life in the Botswanan

  • 10:52

    DONNA MERTENS [continued]: community.And so those constituencies were all brought togetheras an advisory board.And part of their function was to provide inputinto the research process.I served as a member of the external research methodology

  • 11:13

    DONNA MERTENS [continued]: advisory board.And so we had that point of view represented as well.Now, in terms of the research team,we had the faculty from the University of Botswana.We had the US university.And we had the advisory board.In looking at issues of social justice and human rights,

  • 11:37

    DONNA MERTENS [continued]: to look at this from an epistemological point of view,we wanted to bring in knowledge thatwas situated in the experiences of the youth in that community,and bringing in knowledge that made cleartheir experiences in terms of discrimination

  • 11:59

    DONNA MERTENS [continued]: and in terms of oppression.The discrimination and oppression came through loudlyin the way that the youth expressed themselvesthrough specifically being interviewedby other youth who had been trained as coresearchers

  • 12:19

    DONNA MERTENS [continued]: in the project.They also came through in the poetry, in the songs,and in the drama that the youth createdas a part of their way of sharing their experiences.So even the nature of data collectionbecame one of being open to data that was in the form of poetry

  • 12:44

    DONNA MERTENS [continued]: and songs that revealed how povertywas one of the root causes of the HIV/AIDS infection.Also, the notion that there are gender differencesin terms of power relationships in the culture of Botswanathat are not conducive to having equity between men and women.

  • 13:09

    DONNA MERTENS [continued]: And this culture, this cultural belief,was something that needed to be explicitly addressedand brought to visibility in order for the interventionto be one that could address issues of girls whofelt that they couldn't say no when a male pressured them

  • 13:32

    DONNA MERTENS [continued]: for sex.And the youth expressed things in the datathat they shared, saying things like, he told mehe would kill me if I didn't have sex with him.Now, if you can bring out that kind of data,it's very powerful as a way of validating

  • 13:54

    DONNA MERTENS [continued]: that local knowledge needs to be included in the interventionif you're going to have somethingthat's going to be effective.Also, it was important to recognize tribal differencesand language differences, that Botswanais a country with multiple official languages.And English is spoken by many, but not by all.

  • 14:17

    DONNA MERTENS [continued]: So there are tribal languages that neededto be given consideration.All of these factors came out through the useof appropriate methodology that wasrooted in this transformative epistemological assumptionand led to changes in how the intervention was designed

  • 14:39

    DONNA MERTENS [continued]: because the intervention was initially designedas a test of knowledge about do the youth know that you shoulduse a condom or that if you abstain from sex,you're not likely to be infected.The youth knew that.That was another part of the data collectionwas cognitive testing of what the youth already knew.

  • 15:02

    DONNA MERTENS [continued]: And they did know those facts.So it wasn't a question of facts that they needed to be taught.It was a question of how do you deal with the emotion.How do you deal with the poverty?How do you deal with the inequitiesin gender relationships?And though the initial thought was all the training

  • 15:23

    DONNA MERTENS [continued]: would be conducted in English, with the awarenessthat tribal languages were important,it became obvious that the local languageswould need to be used.And so these are parts of the epistemological applicationto methodology that allowed the researchers to move forward

  • 15:45

    DONNA MERTENS [continued]: with identification of additional research, methodsof data collection, and also to informthe development of the intervention that was used.So let's move on now to an exampleof the actual design that was used in this mixed method

  • 16:08

    DONNA MERTENS [continued]: study.And I'll just very briefly talk about how mixed methods designsare commonly talked about in the literature, generallyin terms of either a sequential design or a concurrent design.And sequential would mean that first, youdo your quantitative data collection.Then you do qualitative.

  • 16:28

    DONNA MERTENS [continued]: Or the reverse-- you do qualitative first, and thenyour quantitative.Or concurrently-- you collect both quantitative andqualitative data at the same time.From what I've already told you about the Botswana case study,I think you can see a simple collectionof just quantitative or qualitative data wasn't goingto be adequate to really capture the complexity of what

  • 16:50

    DONNA MERTENS [continued]: was going on here and inform further stages of intervention,development, and measurement of its effectiveness.And so we wanted to apply this methodological assumptionto the development of a cyclical approach-- so collectingdata, using that data to inform next stages-- to engage

  • 17:15

    DONNA MERTENS [continued]: appropriately with the diverse stakeholdersto develop the intervention in a way that was culturallyresponsive to the many elements that I've talkedabout under the epistemological caseexample of local and cultural knowledge;and to facilitate the use of that research data

  • 17:35

    DONNA MERTENS [continued]: so that the intervention and the findings from the studycould be used for social transformationwithin the communities, within the schools,but also at the level of policy change.So this is an example of a transformative cyclical mixedmethods design that Chilisa and her colleagues

  • 17:58

    DONNA MERTENS [continued]: used in Botswana.And what you see is that it has four stages.It starts with a qualitative stage.And in that qualitative stage, theybring together the people who need to be at the table.I talked about this under the epistemological assumption.It has the methodological implication

  • 18:20

    DONNA MERTENS [continued]: that you have a range of stakeholders.You make sure that you don't justhave the powerful at the table.You also have people who are traditionallyin less powerful positions, and you bring them in in waysthat they feel safe, and they areable to share with you their knowledgeso that you can include that as part of the data collection

  • 18:42

    DONNA MERTENS [continued]: decision making.And this is exactly what happened in this study.The local advisory board told the people around the tablethat the youth would not be comfortabletalking to adults about sexual behaviors,that they would want to have it be in a more indirect fashion.

  • 19:06

    DONNA MERTENS [continued]: So it would be better not to ask direct questions,but to talk about some of the metaphors thatwere common within that culture, some of the mythsthat prevailed in that culture, and to use languagefrom the songs that were part of the youth culture

  • 19:26

    DONNA MERTENS [continued]: to really come to understand what their experiences were.And so you can see, as you move into the second stage,that this use of local and cultural knowledgewas used to inform the data collection in the second stage.So they conducted preliminary studies with the youth,

  • 19:47

    DONNA MERTENS [continued]: using the youth who had been trained as interviewers.So youth were adopted into the research team as coresearchers.They went out.They hung out with the youth.They identified themselves as researchers.They explained the purpose of the study.And they were able to gather datathrough these indirect means that

  • 20:08

    DONNA MERTENS [continued]: shed light on the meaning of HIV/AIDSin the youth community.And it was from that that they wereable to determine that the strongest component wasan emotional component related to sadness, loss of peoplethat they love, and that a lot of this

  • 20:30

    DONNA MERTENS [continued]: was also related to inequitable gender relationshipsand related to poverty.And so the youth explained that this was how the disease cameinto their experiences.They also felt that they had no future because they

  • 20:52

    DONNA MERTENS [continued]: see everybody die, and so they think, sex feels good,we should go ahead and have sex because we're notgoing to live that long anyway.And so the youth really informed,through this process of data collection, whatcould happen next.There was also within that same cycle the measurement

  • 21:12

    DONNA MERTENS [continued]: of their knowledge.So there was a quantitative measurement of their knowledgeabout risky sexual behaviors.There was also quantitative data collected about demographics.And that's where the rate of infectionand the desegregation of data by different characteristics--by sex, by age, by tribal affiliation, by language--

  • 21:34

    DONNA MERTENS [continued]: made it apparent that these variables neededto be included as part of the next cycle of datacollection, during which the intervention was developed.Now, the intervention, just as a side note,is changed from teaching knowledgeto finding the youth where they are

  • 21:56

    DONNA MERTENS [continued]: and having a youth-led interventionin the schools over a prolonged period of time.So instead of going in and saying, this is a condom;this is how you use it, they went inand used the same research strategiesthat the early preliminary studies had used and talked

  • 22:18

    DONNA MERTENS [continued]: to the youth in the schools and said,tell us about your experiences.What does HIV/AIDS mean in your life?By this time, they knew HIV/AIDS was not the terminology thatwas used by the youths.They were talking about the sickness.They were able to bring the youth

  • 22:39

    DONNA MERTENS [continued]: into an awareness of their own emotional responses.They were able to bring to visibilitythe dynamics of poverty and how people with moneywould come in and give money for sex or give a cell phoneor give food, and that this was part of the problem that

  • 23:03

    DONNA MERTENS [continued]: needed to be addressed.They were able to bring to visibilitythe inequity in gender relations and have the young people--boys and girls, young men, young women--talk about the meaning of that inequity.So the youth were creating their own strategies

  • 23:24

    DONNA MERTENS [continued]: for responding to these challenges.And they were being able to create a visionof a future for themselves.And that was what was needed, a visionof the future for themselves, not knowledgeabout how to use a condom.And so it's through this process of careful data collection,

  • 23:48

    DONNA MERTENS [continued]: where there's pretesting of knowledge,of attitudes, of behaviors, where there's ongoing datacollection of quantitative and qualitative,where there's an intervention thatlasts over a period of time with critical reflectionduring that period of time and collection of dataaround that critical reflection, and then post tests of data.

  • 24:13

    DONNA MERTENS [continued]: In this particular study, there was actuallya randomized control design, meaningthat schools were randomly assignedeither to the HIV/AIDS prevention programor to another program.And here's where, if you go back to the transformative

  • 24:33

    DONNA MERTENS [continued]: axiological assumption, you might get a little nervous.How can you deny people access to a training programthat, as Bagele Chilisa says, is a matter of life or death?Well, the plain fact of the matteris they couldn't implement that program in every single schoolin Botswana at the same time.They really didn't have the resources to do that.

  • 24:54

    DONNA MERTENS [continued]: And they also didn't know if it would be effective.And so with that rationale, they said,let's give another health-related programto the other schools and see if they change in the same waysthat the students who get the HIV/AIDS-focused program do.

  • 25:15

    DONNA MERTENS [continued]: They were able to demonstrate the effectivenessof the program on multiple measures.They took the information back to the Ministry of Educationfor policy changes in terms of howdo you get this type of educationinto the national curriculum.And they are contacted by a number

  • 25:37

    DONNA MERTENS [continued]: of other African countries who said, we need this.And so you see the aspects of transformationhappening and being documented because it's partof the design of the study.And so I want to leave you with this challenge.How would you, in the context where you do your research,

  • 26:01

    DONNA MERTENS [continued]: apply a cyclical mixed methods designthat would be inclusive of the powerful and the less powerful,that would allow for challenging versions of reality that couldbe harmful and lead to ineffective programs,to design your research so that you're collecting data that's

  • 26:23

    DONNA MERTENS [continued]: viewed as valid by the people who are actually experiencingthe phenomena under study?And then follow up your research to see,how has this research created the transformation thatwas desired.

Abstract

Professor Donna Mertens presents a case study on HIV/AIDS prevention in Botswana. Her project embraced a transformative paradigm to get below the surface of the epidemic and address its root causes. She explains her project as well as identifying what it means to take the transformative approach.

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Researching HIV/AIDS in Botswana: Applying the Transformative Paradigm

Professor Donna Mertens presents a case study on HIV/AIDS prevention in Botswana. Her project embraced a transformative paradigm to get below the surface of the epidemic and address its root causes. She explains her project as well as identifying what it means to take the transformative approach.

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