Shared Participatory Research Principles and Methodologies: Perspectives from the USA and Brazil-45 Years after Paulo Freire's "Pedagogy of the Oppressed".

The trajectory of participation in health research by community social actors worldwide has been built on a history of community participation from the Ottawa Charter Health Promotion call for community mobilization, to the emancipatory educational philosophy of Paulo Freire, to social movements and organizing for health and social justice. This paper builds on this history to expand our global knowledge about community participation in research through a dialogue between experiences and contexts in two prominent countries in this approach; the United States and Brazil. We first focus on differences in political and scientific contexts, financing, and academic perspectives and then present how, despite these differences, similarities exist in values and collaborative methodologies aimed at engaging community partners in democratizing science and knowledge construction. We present three case studies, one from the U.S. and two from Brazil, which illustrate similar multi-level processes using participatory research tools and Freirian dialogue to contribute to social mobilization, community empowerment, and the transformation of inequitable societal conditions. Despite different processes of evolution, we observed a convergence of participatory health research strategies and values that can transform science in our commitment to reduce health and social inequities and improve community wellbeing.

Challenges to participation in action research.

In order to understand and take action in complex health and environmental issues, we intend to analyse the conditions that are needed for those at risk to participate in research and intervention projects. In this study, we describe and discuss an action research experience carried out with an indigenous community in the Brazilian Amazon that suffers from serious sanitary problems, where cultural aspects in the relationship with the environment and health are particularly relevant. Different types of tools were deployed and combined and were subsequently classified according to their dialectic efficacy and ability to both conduct and steer the research and encourage the participation of social actors within a process of feedback. Even tools that were considered to be non-dialectic proved to be important sources of feedback. We present a research flow as a model of analysis and a framework for implementing action research, in which challenges to the participation of social actors are classified according to their priority through a critical review of the methodology developed. These challenges are social mobilization, co-operation, appropriation and a proactive stance. We conclude that a cyclic combination of dialectic and non-dialectic tools can increase participation, which though difficult to achieve is nevertheless necessary. During the development of this process, social mobilization is a prerequisite, whereas a proactive stance, the highest level of participation, requires continuous effort and the successive deployment of a variety of tools.

[The applicability of the ecology of knowledge in health and environment and its permeability in the scientific literature]. / Aplicabilidade da ecologia de saberes em saúde e ambiente e sua permeabilidade na produção acadêmica.

A new epistemology makes it imperative for different knowledge to be incorporated in order to understand and interact with the complex problems that affect humanity, especially those associated with health and the environment. The study aims to explore the applicability of the ecology of knowledge in the midst of traditional scientific literature, focusing on participatory approaches to questions of health and the environment. The methodology involved a bibliographic review of an international scientific database, with the inclusion of 170 papers that were classified by their participatory approaches as: timely; multi-tool; and ongoing/cyclic. Although timely and multi-tool approaches may be effective in terms of aggregating popular knowledge, which is systematically marginalized by traditional science, it is in the ongoing/cyclic approaches that a higher level of potential dialogue is achieved, since it is possible to identify aspects inherent to more symmetric participation processes, with the prospect of empowerment of the social actors and legitimate incorporation of subjectivity and diversity. This corresponds to the premise that promoting global cognitive justice is indispensable for achieving global social justice.

[Exposure to contaminated water: perceptions and practices in a neighborhood in the city of Manaus, Brazil]. / Exposição à água contaminada: percepções e práticas em um bairro de Manaus, Brasil.

OBJECTIVE: To investigate the modes of water supply and the perception concerning the problems caused by this water among residents of a neighborhood without public supply of water, settled in an area previously used as a garbage dump in the city of Manaus, Brazil. METHODS: One hundred and sixty-two semi-structured household interviews were conducted. In addition, a focal group with teachers from a local public school and a meeting with residents were held. The instruments employed focused on the perception and modes of water use and on the process of exposure to chemical contaminants through water. RESULTS: Untreated well water was used by most families. This water was considered to be "good" by 64.8% of the individuals interviewed. Most residents (88.3%) declared knowledge about the garbage dump. Of these, 77.6% stated that the garbage dump caused health and environmental problems. However, qualitative analysis of the responses revealed that the residents were not aware of contamination by chemical elements or of the consequences of such contamination. The activities carried out with teachers revealed that they were partially aware of the problem, but did not design interventions to address the issue. In a meeting with neighborhood residents, the presence of social activism concerning the problem was identified, but it did not extend beyond the neighborhood or reach governmental spheres. CONCLUSIONS: The study identified a situation of critical exposure that tends to be maintained as a result of misperceptions and lack of social mobilization. The dissemination of research results to teachers and residents was useful to empower subjects.

[Sanitary and socio-environmental conditions in the Iauaretê indigenous area, São Gabriel da Cachoeira, Amazonas State, Brazil]. / Condições sanitárias e socioambientais em Iauaretê, área indígena em São Gabriel da Cachoeira, AM.

OBJECTIVE: To describe sanitary, social and environmental conditions that are significant for health of residents in the Iauaretê Indigenous Area in Brazilian Amazonia, notable for its population concentration. METHOD: Qualitative and quantitative methodologies were used, with the action research method deployed mainly for qualitative approaches, through community meetings with tribespeople and researchers in the villages constituting the hub of the Area. Talking maps were prepared and interviews were conducted, together with studies of solid wastes disposal techniques, in addition to locating, sampling and analyzing the quality of water used for human consumption, in parallel to the use of geo-referencing techniques. RESULTS: Of the 65 water samples analyzed, 89.2% presented fecal coliforms, with no adequate sanitary solutions found for the disposal of solid wastes. From the public health standpoint, the sanitary practices of these indigenous peoples caused concern, clashing with their own relative knowledge. CONCLUSIONS: The specific set of problems associated with the way of life imposed by mainstream society requires the implementation of joint activities in the infra-structure and health education fields in order to solve collective health issues, stressing local community participation.