The term "paradigm" refers to a systematic set of assumptions or beliefs about fundamental aspects of reality (Kuhn, 1970; Guba and Lincoln, 1989). Paradigms provide philosophical, theoretical, instrumental, and methodological foundations for conducting research and provide researchers with a platform for interpretation of the world (Morgan, 1983). Although the ‘traditional’ positivist paradigm is still dominating in evaluation research - in relation to health promotion the use of the post-positivist and constructivist approaches has been gathering strength in recent years (Labonte and Robertson, 1996).
According to Guba and Lincoln (1989) evaluation approaches have changed during time and the approaches, using constructivist paradigm is the sign of new generation in evaluation - the fourth generation. The ontological and epistemological differences distinguish two main paradigms – constructivism and positivism (Guba, 1990). The basic ontological assumption of constructivism is relativism - that human sense-making is an act of constructions and is independent of any foundational reality. Reality is contextual and depends on the persons who assess it. The basic epistemological assumption of constructivism is transactional subjectivism, that is “reality” and “truth” depend solely on the meaning sets and degree of
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sophistication available to the individuals engaged in forming those assertions (Cheadle et al., 1997; Rosenau, 1994). The researcher and the "object" of investigation interact to influence one another, the knower and the known are inseparable. The basic ontological assumption of positivism is a belief that there is a single tangible reality and universal truth, which exists independently. According to the positivist epistemology the researcher investigates and controls the reality. However reality is constructed by the context and people socializing in the context.
Frequently discussions concerning research paradigms are barely distinguishable at the level of methods – in particular, on the subject of “quantitative” versus “qualitative”
methods. In the empowerment evaluation approach Fetterman et al. (1996) support the importance of the use of both, qualitative and quantitative data. They argue that use of different paradigms within an evaluation process could take place in parallel - constructivist paradigm allows reckon with community member’s opinions and views, and positivists paradigm allows to examine data collected externally in the same time. Both types of methods may be and often are appropriate in all forms of evaluative inquiries. Moreover, the qualitative participatory approaches to healthpromotion and evaluation have been designed to empowerpeople, often evoke a real social change (Fetterman, 1996; Fawcett et al., 1996;
Springett, 2001). For health promotion practitioners, the art of assessing effectiveness is not to what extent it can approximate a randomized controlled trial, but whether it achieves the ultimate purpose in population health, which in authors´ view is to enhance the health and wellbeing of the community members and to do this in a way that is empowering.
Current thesis is a multi-method research. Both qualitative and quantitative methods are utilized in different stages of the study. However, constructivist paradigm formed the
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worldview of the current evaluation research and directed predominantly the data analysis, with and exception of the stage 5 (Chapter VII), what is based on positivist paradigm.
Health promotion techniques that aim to listen more attentivelyto the views of community members, by using interviews,workshop methods, participant observation or other qualitative methods, penetrate into the lives and mind of subjects (Nettleton and Bunton, 1995).
Participation means engaging in dialogue at all stages of the research and shifting power in favourof those being researched. This is in contrast to thepositivist models of research that have dominated in evaluation in the past and where the voice of the community was not often being heard. This is what led to a whole new paradigm of action and was also taken into consideration in current study.
4.3 Settings and people involved in study
In the current study heterogeneous groups in Rapla County, who have been involved and actively participated in three health promotion programs – Safe Community, Drug Use and HIV Prevention and Elderly Quality of Life programs, both workgroups and networks around these programs are considered as communities. Through program planning, shared interests, aims and needs in given locality they worked together towards common goals, searching solutions for common problems. They had certain common needs, interests and goals, and they communicated and interacted socially with each other. The members of the program workgroups organized and mobilized themselves around the programs. These three initiatives in the Rapla County received a grant in the year 2002 from the Health Promotion Fund to implement county-wide approaches for preventing injuries, drug and alcohol use among young people, and unsafe sex and to promote safety, security, and quality of life among the
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elderly. The initiatives shared the mission of involving stakeholders from a variety of sectors in addressing issue-specific health concerns. The participating community programs are described as follows:
The Safe Community program was initially a bottom-up initiative, started four years before the study, guided by a community workgroup. It later involved representatives from municipalities and decision-makers from different sectors and had a large network in the county. The mission of the program was to reduce injuries among the Rapla population and to support the development of safe community principles by modifying policies and practices related to the perpetuation of an unsafe environment. It comprised a combination of top-down and bottom-up initiatives financed on a yearly basis by a health promotion fund. There were many activities, the program workgroup together with larger network were implementing:
organizing safety campaigns, teaching school-children traffic behaviour, publishing printed materials for mothers of newborn babies on the prevention of babies’ injuries, organizing swimming courses to prevent drowning, implementing safe school campaigns, publishing printed materials for elderly persons to prevent falls, distribution of grants to stimulate small prevention projects.
Drug Abuse and AIDS prevention program was a top-down program initiated and planned nationally and expanded into the community three years before the current study was conducted. It had national goals and objectives and an action plan. The objectives were to prevent drug and alcohol use and unsafe sex among young people in the community. This program was financed by the state budget and guided by a local coalition that comprised representatives from different organizations, authorities and sectors in the county.
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The Elderly Quality of Life program was a bottom-up initiative developed by a group of elderly people. The workgroup consisted of women who were interested in improving the quality of life of elderly citizens in their community. The program’s aim was to avoid exclusion of older people, and the group made efforts to keep elderly citizens involved socially. The program workgroup was formed and activities initiated three years before the current study was conducted.
The workgroups and networks which participated during the intervention period consisted of members with different background, education, specialities and affiliations. The mobilization of community members was continuous and expansive. The more precice description of participants who were involved in different stages of the study is given below.
4.4 Study design
As mentioned above there are five stages to this research: conceptualization of the community empowerment process, elaboration of a measurement tool for the evaluation of ODCE, development of the framework for empowerment evaluation, internal evaluation of changes in OCDE and an external evaluation of ICRE. The different stages of current study are based on integration of different worldview and paradigm. Consequently different stages apply different strategies of inquiry. Integration of the qualitative and quantitative research was utilized in the study. Qualitative research is a naturalistic interpretive approach that seeks to describe and explain how participants perceive action, understand concepts and make decisions. Quantitative research seeks to identify factors or indicators in a sample that can be assumed to be true of the population from which the sample was drawn. The qualitative
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research designs were implemented in the 1-3 stages of the study. In stage 5 the quantitative approach was implemented. In the stage 4 the integration of these two approaches were utilized. The choice of study design in current research was influenced by both, theoretic and pragmatic issues, predominantly by participants` considerations.
In the beginning of the study more inductive-oriented design was selected as the concept of empowerment is highly complex and was relatively unfamiliar to participants, and as many authors have declared that the empowerment concept is a context- and culture-specific. The study design consisted of combination of following designs:
1) Explorative research – refers to making efforts to clarify an unclear problem from multiple perceptions and opinions (Stage 1);
2) Participatory action research - empowerment evaluation – refers to the participatory use of evaluation concepts, techniques, and findings to foster community improvement and self-determination (Stages 2 and 3);
3) Descriptive study – refers to description of a possible social change or a condition (Stage 4).
4) Cross-sectional study – refers to a snapshot at a particular time looking at the presence or absence of indicators (Stage 5).