An Analysis of Power Dynamics Affecting Handwashing Interventions in Sierra Leone: Findings From a Qualitative Participatory Study
Bibliographic record
Abstract
BACKGROUND: Handwashing is an effective and cost-efficient health behavior for preventing infectious diseases; however, its practice is shaped by multiple contextual factors and inequalities between different social groups in Sierra Leone. To address these inequalities, participatory approaches that allow a more equitable distribution of resources and the development of locally tailored interventions are increasingly used. However, social power dynamics have not been well integrated into the concept of participation, despite their known impact. OBJECTIVE: We sought to investigate the role of power dynamics in participatory approaches to handwashing in Sierra Leone. METHODS: From a socio-ecological perspective, this qualitative, formative interview study aimed to identify relevant actors and their power relationships before designing a participatory handwashing project in rural Sierra Leone. A field experiment with focus groups and a research diary compared the development of power dynamics in a participatory, community-driven approach with that in a nonparticipatory top-down approach. RESULTS: According to our formative study, in community-based projects, multiple groups and actors interact directly or indirectly with each other, located within a macro level (eg, political institutions), meso level (eg, community leaders and groups), and micro level (eg, families) of a socio-ecological model. Although distinct leadership structures were noticeable and affected intervention attendance and processes of change in nonparticipatory approaches, community-led activities and handwashing increased in the participatory approach, irrespective of the leadership structure. Despite their ambivalence, the strategic inclusion of different community leaders appeared essential to enhance the value of the project, mobilize creative action, and empower lower-ranking individuals to practice handwashing. A similar ambivalent role could be observed in relation to external researchers, especially if they come from a different cultural background than the research participants, for example, from a Western country in a non-Western project setting. Although external researchers can initiate a project or provide certain resources, distinct expectations regarding their roles and resources can impact participatory efforts and power relations. CONCLUSIONS: The results highlight the advantages of participatory approaches for health promotion. Power dynamics should be a core component of continuous reflection and analysis in participatory projects.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.033 | 0.037 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.010 | 0.010 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".