Ways of promoting a healthy community: A critical ethnography of rural Thai women

Abstract

The purposes of this critical ethnography were to identify community health promoting strategies; to uncover the influence of power inequality on women's participation in community health promotion; and, to describe visions for change from rural Thai women perspectives. Participant observation was employed. Twenty-one women from one rural village in southern Thailand were interviewed in addition to focus groups during a six months period. Three sources of ethnographic materials were used: taped-recorded verbatim transcriptions from individual interviews and focus groups, field notes from participant observations, and journal entries. The processes of data reduction, data display, and data conclusion and verification were employed for data analysis and synthesis. Ethical issues and rigor of the study were primary considerations. Emerging themes were validated by the participants, two experts in qualitative research, and one expert in community health. The findings were translated into English and validated by three bilingual Thai faculty members. The women identified eight elements of a healthy community: good living, good eating, togetherness, unity, safe and secure environment, pollution-free environment, availability of infrastructure, and accessibility to services. Getting together, balancing power and exercising power were strategies these women employed to create a healthy community. Power inequality due to socio-economic and cultural constraints was described as both productive and oppressive influence on these women's participation in promoting a healthy community. Women in this study believed knowledge is power. They expressed the needs "to know more" and "to be known" as their vision for change. Critical ethnography facilitated the process of enlightenment, empowerment, and emancipation among study participants. Policy implications and imperatives for nursing practice and nursing research were presented. The findings provide the baseline information for planned community health empowerment program for women aggregate in rural Thailand.