This dissertation was designed using a qualitative research mode of inquiry that utilized a mixed methodology approach. This dissertation was an ethnographic narrative study tracking eight young women who were “aging out” or forced to leave their orphanage in Peru, where most of them had spent a majority of their lives. The study examined the way in which a collaborative art community could support the participants as they narrated their lives over a 16-month period of time through photojournaling and social media outlets. This study relied upon interviews, on-site observations, personal journaling, and photographing, in addition to an overall thematic analysis of the output of each of the eight participants and two nuns. From these data, six key themes emerged concerning the outcomes of each young girl’s continuing life at the Hogar and their endeavors outside of the orphanage. The focal points of this study were community building via art making and building of personal aesthetic, community engagement, reflection on self-identity, cross-cultural art education, and shared experience via photo-art narratives and social media. This research also examined the role of collaborative art experiences in helping these young women structure new identities and form collaborations with their peers designed to sustain them into their future lives. This dissertation studied not only the formation of singular identities but how these functioned within a collaborative identity that supported the young participants as they moved out of their orphanage and forward into the outside world.

This dissertation is composed of three papers examining the predictors and consequences of increasing school segregation following widespread release from court ordered desegregation orders. Paper one investigates factors shaping districts’ choices to pursue release from desegregation orders. This serves to provide context for papers two and three, and to outline whether there are systematic differences between school districts that were released from orders and those that were not. Paper two tests whether release from court ordered desegregation orders coincided with racially disparate changes in elementary and middle school test scores. Paper three presents an analysis of how property taxes – an indicator of housing values - responded to release from desegregation orders.

Unacceptably high rates of maternal morbidity and mortality affect the Global North and the Global South. Among many challenges, policy-makers and researchers cite concerns about quality of care, respectful maternity care, and implementation of evidence-based strategies and national guidelines at the frontlines of the health system. Informal payments are one concern that cut across these three challenges; they represent poor quality care; they are often experienced as disrespect by patients; and, health care worker demands for such payments by definition conflict with national policy. Social accountability and legal empowerment are two approaches that are increasingly used to address quality of care concerns in maternal health and poor implementation at the frontlines of the health system. This dissertation is comprised of three chapters (papers), all of which focus on these challenges in maternal health in low and middle income countries (LMICs). They apply concepts and methods from health policy and systems research (HPSR) to undertake theoretically-informed analyses that straddle two fields: (1) accountability, and, (2) global maternal health. The first chapter is a critical interpretive synthesis that summarizes the evidence base on the prevalence, drivers, and impact of informal payments in maternal health care; critically interrogates the paradigms that are used to describe informal payments; and, finally, synthesizes the policy and funding debates directly related to informal payments. The paper finds that though assessing the true prevalence of informal payments is difficult given measurement challenges, quantitative and qualitative studies have identified widespread informal payments in health care in many low and middle income countries in Asia, Africa, and Latin America. Studies and conceptual papers identified both proximate, immediate drivers of informal payments, as well as broader systemic causes. These causes include norms of gift giving, health workforce scarcity, inadequate health systems financing, the extent of formal user fees, structural adjustment and the marketization of health care, and patient willingness to pay for better care. Similarly, there are both proximate and distal impacts, including on household finances, patient satisfaction and demand for health care, and provider morale. Despite the ground level relevance of informal payments, they are generally not adequately addressed in global policy frameworks and strategies, or in standard metrics of health system performance. Though this absence does not necessarily imply lack of financial or other attention to informal payments, it makes inattention more likely, and regardless, represents a notable silence. Informal payments have been studied and addressed from a variety of different perspectives, including anti-corruption, ethnographic and other in-depth qualitative approaches, and econometric modeling. Synthesizing data from these and other paradigms illustrates the value of an inter-disciplinary approach. Each lens adds value and has blind spots. These attributes in turn affect the solutions proposed. The paper concludes that the same tacit, hidden attributes that make informal payments hard to measure also make them hard to discuss and address. A multi-disciplinary health systems approach that leverages and integrates positivist, interpretivist, and constructivist tools of social science research can lead to better insight and policy critiques. The second chapter is a descriptive case study of a social accountability project seeking to decrease health provider demands that women make informal payments in Uttar Pradesh (UP), India. Women in UP are often asked to make informal payments for maternal health care services that the central or state government has mandated to be free. The chapter is a descriptive, contextualized case study of a social accountability project undertaken by SAHAYOG, an NGO based in UP. The study methods included document review; interviews and focus group discussions of program implementers, governmental stakeholders, and community activists; and participant observation in health facilities. The study found that SAHAYOG adapted their strategy over time to engender greater empowerment and satisfaction among program participants, as well as greater impact on the health system. Participants gained resources and agency; they learned about their entitlements, had access to mechanisms for complaints, and, despite risk of retaliation, many felt capable of demanding their rights in a variety of fora. However, only program participants seemed able to avoid making informal payments to the health sector; they largely were unable to effect this change for women in the community at large. Several features of the micro and macro context shaped the trajectory of SAHAYOG’s efforts, including caste dynamics, provider commitment to ending informal payments, the embeddedness of informal payments in the health system, human resource scarcity, the overlapping private interests of pharmaceutical companies and providers, and the level of regional development. Though changes were manifest in certain health facilities, as a group, providers did not necessarily embraced the notion of low caste, tribal, or Muslim women as citizens with entitlements, especially in the context of free government services for childbirth. SAHAYOG assumed a supremely difficult task. Project strategy changes may have made the task somewhat less difficult, but given the population making the rights claims and the rights they were claiming, widespread changes in demands for informal payments may require a much larger and stronger coalition. The third paper is an explanatory case study of a hybrid legal empowerment and social accountability effort led by the Mozambican NGO, Namati Moçambique. Established in 2013, Namati Moçambique runs a multi—pronged health paralegal and policy advocacy program that employs community paralegals as Health Advocates and trains Village Health Committees (VHCs). The study sought to uncover how the program affected the relationship between citizens and the health sector, how the health sector and citizens responded, and what role contextual factors played. The case study had two components: 1) a retrospective review of 24 cases 2) qualitative investigation of the Namati program and program context. The cases came from a total of 6 sites in 3 districts. Program implementers, clients, Village Health Committee (VHC) members, and health providers were interviewed or participated in focus groups as part of the research. The study found that though they are unable to address some deeply embedded national challenges, Health Advocates successfully solved a variety of cases affecting poor Mozambicans in both urban and rural areas. Health Advocates took a variety of steps to resolve these cases, some of which entailed interactions with multiple levels of the government. We identified three key mechanisms, or underlying processes of change that Namati’s work engendered, including: bolstered administrative capacity within the health sector, reduced transaction and political costs for health providers, and provider fear of administrative sanction. In addition to case resolution, stakeholders highlighted individual satisfaction at having one’s complaint remedied and individual empowerment among clients and Health Advocates as stemming from the project. Health Advocates and VHCs developed functional working relationships with providers, in part because they addressed issues that providers felt were important, and engendered community satisfaction with the Health Advocate, and ultimately, trust in the health system. The case resolution focus of legal empowerment brought procedural teeth, helping to ensure that new relationships result in immediate improvements, thus instigating a circle of relationship building and health system improvements.

Resettlement of humans from protected areas conserves habitats for wildlife. However, impacts of resettlement on the well-being of resettled communities and on broader conservation goals at the landscape level have been poorly quantified until now due to inadequate documentation and baseline information. Recent documentation and advances in measurements of human well-being enable studies that examine the impacts of resettlement for both people and conservation. In India, the current standardized resettlement policy by the National Tiger Conservation Authority (NTCA) is explicit in its goal to create inviolate habitats for tigers within protected areas. More than 70% of the global tiger population lives in protected areas in India. The central Indian national parks hold approximately 40% of Indian tiger populations. Implementation of the NTCA policy provides an opportunity to study resettlement with relatively accurate records of where resettled households moved, a standardized monetary compensation and the potential for replication with large representative groups to study impacts in various landscapes across the country. This dissertation focuses on resettlement in Kanha National Park in central India, one of the most well-known and oldest tiger reserves in the country. The Kanha National Park (KNP) landscape mirrors the realities of many people-park interactions in human-dominated areas with high percentages of indigenous human populations, historical forced displacements, and current resettlements that follow a standardized national policy. From a conservation point of view, connectivity between KNP and other protected areas across central India is crucial for genetically healthy tiger populations. This dissertation consists of three analyses that combine data from field surveys and existing data sources to examine the impacts of resettlement on food security, landscape connectivity for wildlife, and human-wildlife conflict in the KNP landscape. In Chapter 1, I use household surveys to compare the food security and livelihood associations of resettled households compared to their non-resettled neighbors at new settlement locations. I show that resettled households have similar availability and access to foods as their non-resettled neighbors. Increases in off-farm income sources are associated with higher food access for all households. In Chapter 2, I explore the pattern of low food access in the KNP landscape using the five capitals model for sustainable development to illustrate significant associations between livelihood factors and household food access. Salaried stable incomes and kitchen garden diversity are significantly associated with higher food access. Financial capital dwarfs the contributions of social and natural capitals which have supplementary roles in times of financial stress. In Chapter 3, I address resettlement impacts on habitat connectivity between protected areas and human-wildlife conflict that resettled households face after relocating outside the park. Resettled households are not disproportionately moving into corridors between protected areas, especially when compared to the manifold more non-resettled households already residing in these areas. Resettled households however are moving into areas of high human-wildlife conflict due to their continued proximity to KNP. Outcomes from Chapter 3 also confirm that steady incomes can alleviate forest use and lower human activities in forests reducing human-wildlife conflict. In human-dominated landscapes such as KNP, financial capital and the stability of household incomes can aid both food security, lower pressures on non-protected forests and potentially lower human-wildlife conflict. The results counter assumptions that resettled communities continue to follow traditional natural resource reliant livelihoods. Local populations are not likely to engage in livelihoods that are heavily reliant on natural resources as rural populations become integrated into urban economies. The results from this dissertation imply that managers in the KNP landscape can alleviate food security and aid landscape wide conservation goals by increasing off-farm salaried incomes. Finally, in India, there is a high potential for replication of this study around other protected areas, with nationally standardized resettlement in landscapes that vary geographically, ecologically and socially.

In this volume, I present a collection of three articles that are representative of my research on the targeting of humanitarian & development aid. These papers focus on highlighting the role of non-targeted, non-elite community members in fostering or hindering the process of aid distribution to vulnerable community members. In the first paper, “Allocating Resources To The Poor: The Effects of Targeting Instructions, Community Involvement and Monitoring”, I use a lab-in-the-field ex- periment to examine resource allocation at the micro-level. More specifically, I study how small groups within rural communities in eastern Democratic Republic of the Congo — each composed of elites, poor, and non-poor village members — decide to share money among themselves. In a dictator-game like setting, I vary whether the groups are provided with instructions to target the poor, whether the decision-making process is private or public, and whether it is monitored by a third-party or not. I find that (1) by themselves, instructions to target the poor seem to actually benefit both the poor and the non-poor, but that (2) the effectiveness of targeting instructions in reaching poor group members is largely moderated by the presence of community members during the decision-making process, while (3) by contrast, monitoring does not contribute much to the effective allocation of resources to the poor. In the second paper, “Inside & Out: The Role of the Non-Poor in Targeting Resources to the Poor”, I use a similar experimental set-up to study further the nature of the community dynamics that affect the allocation of resources to the poor. More specifically, I look at the role of non-poor, non-elite community members in influencing how elites choose to allocate resources to the poor. I find evidence that (1) community effects have to do with bargaining dynamics more than peer-pressure; (2) non-elite, non-poor members of the community have an significant role in fostering the allocation of resources to the poor, and that (3) their influence on resource allocation depends crucially on existing alliances or rivalries between various group members. Finally, in the third paper, “Is Bigger Always Better? How Targeting Bigger Aid Windfalls Affects Capture and Social Cohesion”, co-authored with Laura Paler & Kohran Kocak, I model the provision of targeting instructions as enforcing a bargain- ing environment in which three groups - the target group, the elites, and the excluded group - compete over the aid windfall. I predict that success in aid targeting depends primarily the size of the windfall, the relative influence and the historical relationships between these three groups. Poor, vulnerable groups are more efficiently targeted in environments in which the elites and the excluded group are rivals, as they will then both prefer for the windfall to be allocated to the target group rather than for it to be captured by one another. I provide support for these predictions using a regression discontinuity design and original survey data from an aid program implemented in Aceh, Indonesia. With these three articles, I aim at providing a substantive theoretical and empirical contribution to the growing literature on aid targeting effectiveness by bringing light to the role in the targeting process of a part of recipient communities that is otherwise largely overlooked, namely all those community members that are both in the community, yet left out of targeted aid programs.

The purpose of this study was to examine the effectiveness and exposure of an implementation strategy, which included a 4-day in-class training with two follow-up technical assistance calls, on mediating factors hypothesized to be positively associated with staff’s intention to use a five-session, couples-based HIV and other sexually transmitted prevention intervention. The Consolidated Framework for Implementation Research (CFIR) guided the study aims and analysis of the direct effect of exposure to the implementation strategy and 3 factors hypothesized to mediate the implementation strategies’ effect on intention to implement a couples-based intervention. Individual staff characteristics and an organizational process variable informed by Social Cognitive Theory (SCT), the Diffusion of Innovation Theory and Theory of Planned Action were examined. Two hundred and fifty-three staff, predominantly African American and Latina, from 80 organizations, were recruited from HIV service agencies, clinics and community-based organization from New York City and other regions of New York State. They were randomized by agency to either a multimedia condition or a traditional paper-based version of the couples-based intervention and received the implementation strategy 4-day, in-class intervention training followed by a technical assistance phone call at 3 and 6-months post training. Findings suggest that greater exposure to the implementation strategy in days and contacts was significantly associated with an increase in staff’s intention to implement the intervention at six months. Further, while a statistically significant effect of the implementation strategy dose on the mediators examined was not detected, the implementer’s experience of these mediators defined as self-efficacy for couples-based implementation, positive perception of the intervention’s characteristics and the perceived availability of an organizational intervention Champion was found to be significantly associated with the outcome variable intention to implement, and also was found to reduce the dosage effect of the implementation strategy on intention. Further examination of the implementation strategy’s content and dosage is needed to identify how increased intention to utilize an intervention at 6 months and 12 months following training and technical assistance may be enhanced through greater attention to and measurement of these mediators in addition to the implementation strategy dosage effect. Of note, the dosage effect on intention was found to diminish at the 12 month follow-up period suggesting the importance of timely support and planning prior to and post implementation strategies to increase utilization of an innovation. Implications for HIV prevention theory, and social work research, practice and policy are discussed.

Research in resource-limited, multi-cultural contexts raises complex ethical concerns. The term ‘over-researched community’ (ORC) has increasingly been raised as an ethical concern and potential barrier to community participation in research. However, the term lacks conceptual clarity and is omitted from established ethical guidelines and academic literature. In light of the concern being raised in relation to vitally needed HIV prevention research in developing countries, a critical exploration of the meaning of the notion was undertaken. Guided by Emanuel et al.’s (2004) eight principles for ethically sound research in developing countries, this study explored the relevance and meaning of the terms ‘over-research’ and ‘over-researched community’ through a thorough review of ethical guidance documents and analysis of key stakeholder perspectives. In-depth interviews were conducted with 23 resource persons from research ethics committees, community advisory boards and research organisations in South Africa. Interviews were transcribed and translated where necessary and data were analysed thematically. ‘Over-research’ was found to reflect a conglomeration of ethical concerns, often being used as a proxy for existing ethical concepts. ‘Over-research’ might be interpreted to mean exploitation. However, exploitation itself could mean a range of different things. ‘Over-research’ seemed fundamentally linked to disparate positions and perspectives between different stakeholders in the research interaction, arising from challenges in inter-stakeholder relationships. Analysis of the data suggests that using the term may lead to an obscured understanding of real or perceived ethical transgressions, making it difficult to intervene to address the underlying concerns. It is recommended that the term not be used in research ethics discourse. However, because it represents other legitimate concerns, it should not be dismissed without careful exploration. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

This study aimed to profile social science researchers' experiences of ethically challenging incidents and ethics review and to consider these experiences in terms of the two institutions from which participants were selected. Data was gathered by means of an email survey sent to social science researchers working in both a university and a research organisation. The findings reveal that ethically challenging incidents involving privacy, confidentiality and anonymity, harm, beneficence, poor science, role conflict, informed consent, recruitment of participants and publication were encountered frequently by social science researchers. While respondents reported both positive and negative experiences of ethics review, researchers at the university reported significantly more ethically challenging incidents and negative experiences of ethics review than did researchers from the research organisation. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2007.

This study engaged in a micro-genetic analysis (Wertsch, 1984) of facilitation in participatory research (PR). The research conducted in this study explored the facilitation process of two facilitators using two participatory techniques (a 'road of life' technique and a ranking exercise) with children in a rural context. The facilitators' perceptions of facilitation and their experiences of facilitating a PR technique were examined through the use of individual interviews, and were analysed using a reading guide method (Mergendollar, 1989). Of particular concern was that in PR, there is no account of the mechanisms which bring about successful facilitation. This study exposed how some PR techniques, like the ranking exercise can simply be implemented through using a set of instructions, but other kinds of techniques such as the 'road of life' technique are inherently embedded in the principles of PR and are more difficult to implement. A lack of an understanding of the PR principles has major consequences for the implementation of PR processes, and whether or not PR processes achieve their aim i.e. critical reflection. The importance of training in PR was thus emphasised, and the importance of providing a theoretical framework of the facilitation process in PR was accentuated. / Thesis (M.Psyc.)-University of KwaZulu-Natal, Pietermaritzburg, 2007.

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Background: The aim of this study was to determine the attitudes of Chiropractic students towards research at Durban University of Technology (DUT). The Chiropractic profession has made significant progress with regard to the production of high quality and clinically relevant research (Newell and Cunliffe, 2003; Hawk et al, 2008) and the continuation of this research effort will be the responsibility of the graduates that constitute the future profession (Newell and Cunliffe, 2003). Furthermore Cull, Yudkowsky, Schonfeld, Berkowitz and Pan (2003) state that the greatest predictor of this is a positive attitude, therefore it is essential to establish the present attitudes amongst the students. Method: The study was a quantitative questionnaire based, self administered, attitudinal survey. The sample group included all the Chiropractic students registered at DUT (n=185). Results: There was a response rate of 74,59%. The results indicated that on average students thought that the research subjects and courses taught at DUT were not interesting and that they did not adequately prepare them to perform research. The majority of the students felt that the research process was completely vague to them and that they felt insecure about their knowledge of research methodology. It was evident that students thought that DUT staff members placed a great emphasis on research and that they were easy to approach with regards to research. The area of greatest concern was that although students thought that the student researcher relationship was of great importance, they indicated that it was difficult to find a supervisor and they also indicated that inadequate supervision had delayed their research progression. For the most part students thought that research was important and they enjoyed listening to and reading research. However, only slightly positive scores were recorded when students were asked if they wanted to do research in the future, as they felt it was difficult and time consuming. Conclusion: Many factors were significantly associated with positive attitudes towards research at DUT and the strongest correlation between scales was between the importance of research and positive feelings towards research (r=0.713). Most students felt research was important and that it made them more knowledgeable however, if given the choice they would study at an institute where research was not mandatory.