Jo A. Tacchi

‘The public is too subjective’: public involvement at different levels of health-care decision making

There are a number of impulses towards public participation in health care decision making including instrumentalist, communitarian, educative and expressive impulses and the desire for increased accountability. There has, however, been little research looking systematically at the publics preferences for being involved in particular types of rationing decisions, nor indeed, has there been a critical examination of the degree of involvement desired by the public. The research reported here uses findings from focus groups and in-depth interviews to explore these questions. Eight focus groups were conducted with a total of 57 informants, four amongst randomly selected members of the public and four with informants from health and non-health related organisations. Nineteen interviews were conducted to allow the elaboration of focus group comments, to probe views more deeply and to pursue emerging themes. The findings show variations in the willingness of members of the public to be involved in health care decisions and consistency across the different forms of the public as represented by the focus groups with randomly selected citizens and pre-existing organisations. There was a strong desire in all the groups for the public to be involved both at the system and programme levels, with much less willingness to be involved at the individual level. At the system and programme levels informants generally favoured consultation, without responsibility for decisions, but with the guarantee that their contribution would be heard and that decisions taken following consultation would be explained. At the patient level informants felt that the public should participate only by setting criteria for deciding between potential beneficiaries of treatment. The public has much to contribute, particularly at the system and programme levels, to supplement the inputs of health care professionals.

The need for radio theory in the digital age

This article makes an argument for connecting old and new technologies in our efforts to create a coherent field that we might call ‘radio studies’. The lack of academic work to date on radio - the ‘secondary medium’ (Lewis, this issue) - has left us with a void in media and cultural studies. Radio’s pervasive nature in everyday lives is less apparent in precisely those settings (the developed world in particular) where it has become a part of the everyday fabric of life. Currently there is a revival of interest in radio studies, which coincides (perhaps not accidentally) with the growth of new digital media technologies. The ‘Radiocracy’ conference at Cardiff demonstrated not only the resurgence of interest in academic studies of radio, but also the many and innovative ways in which radio is used (and sometimes abused) globally. In each location the medium is used differently, demonstrating not only that a global definition of the meanings and uses of ‘radio’ cannot be assigned, but also that new evolutions of ‘radiogenic’ technologies should not be dismissed as being different from ‘radio’ and therefore not a part of the remit of ‘radio studies’. Many net.radio initiatives seek to circumvent governmental restrictions on analogue radio broadcasting by incorporating and developing new ‘radiogenic’ technologies. Examples are given to illustrate the arguments in this article; a small-scale net.radio operation in London is contrasted with a large commercial net.radio company located in the USA, and a development initiative in India is also considered.

Evaluating communication for development : a framework for social change

Evaluating Communication for Development presents a comprehensive framework for evaluating communication for development (C4D). This framework combines the latest thinking from a number of fields in new ways. It critiques dominant instrumental, accountability-based approaches to development and evaluation and offers an alternative holistic, participatory, mixed methods approach based on systems and complexity thinking and other key concepts. It maintains a focus on power, gender and other differences and social norms. The authors have designed the framework as a way to focus on achieving sustainable social change and to continually improve and develop C4D initiatives. The benefits and rigour of this approach are supported by examples and case studies from a number of action research and evaluation capacity development projects undertaken by the authors over the past fifteen years. Building on current arguments within the fields of C4D and development, the authors reinforce the case for effective communication being a central and vital component of participatory forms of development, something that needs to be appreciated by decision makers. They also consider ways of increasing the effectiveness of evaluation capacity development from grassroots to management level in the development context, an issue of growing importance to improving the quality, effectiveness and utilisation of monitoring and evaluation studies in this field. The book includes a critical review of the key approaches, methodologies and methods that are considered effective for planning evaluation, assessing the outcomes of C4D, and engaging in continuous learning. This rigorous book is of immense theoretical and practical value to students, scholars, and professionals researching or working in development, communication and media, applied anthropology, and evaluation and program planning.

“If there were a war tomorrow, we’d find the money”: contrasting perspectives on the rationing of health care

In spite of the substantial academic effort being devoted to the subject of health care rationing, there is little clarity about the views of those working in health care who have to implement rationing nor about the views of citizens who are (potentially) affected by the rationing of care. This paper reports the findings of a study conducted using focus groups and semi-structured interviews to explore and compare beliefs about rationing among citizens and those with a role in the health service (service informants) within the context of health care provision in the UK. Citizen and service informants both identified external pressures on the resources available for health care including technological improvement, the ageing population and increasing public expectations. Citizens, however, also identified such factors as the political choice to provide insufficient funds to the health service and the wasteful use of resources that are available. The predominant view was that these latter factors were amenable to change and thus that there are alternatives to the rationing of care. Some citizens accepted that some health care rationing might be necessary. Service informants, on the other hand, were cynical about prospects of increased funding and viewed further reductions in management as untenable. For them, rationing was an inevitability to be managed. A number of these informants felt that rationing should become more explicit, suggesting that openness made rationing both more democratic and more practical. Others, however, believed that explicit rationing would have a number of uncomfortable implications. The paper concludes by suggesting that if rationing is to become more explicit, its inevitability, as perceived by those working within health care, will have to be communicated to citizens.

Meaningful Mobility: Gender, development and mobile phones

In this paper we explore development, gender and technology through a focus on mobile phones and examples of their everyday use by rural women in India. We introduce ways in which technologies might be thought about in terms of “meaningful mobilities” by discussing attachments, structures of labour, agency and specifically how mobiles are an active agent in complex and evolving gendered relationships.

Open content creation: The issues of voice and the challenges of listening

This article explores the potential role of participatory or open content creation for development. It does so by examining ideas around voice and listening, and their relevance to the field of information and communication technology for development (ICT4D). It first explores participatory development and the idea of open ICT4D before elaborating on issues of voice as process, and as value. Research findings from a project in Asia that experimented with participatory content creation are discussed in relation to notions of voice. The research was concerned with the ways in which processes of voice might lead to wider social action and change. Findings are explored, and discussed in relation to the importance and challenges of ensuring that voice is valued through listening, and the implications of this for ICT4D.

Participatory content creation: voice, communication, and development

This article uses the example of a mobile mixed-media platform – a converted three-wheeled auto-rickshaw – in Sri Lanka in order to explore whether and how content-creation activities can enable marginalised communities to have a voice. It draws upon research into participatory content-creation activities conducted in 15 locations across India, Indonesia, Nepal, and Sri Lanka. The main findings are: the need to pay attention to context when thinking about what might be locally appropriate, relevant, and beneficial in terms of participatory content creation; the benefits that can be gained from creatively reaching out to and engaging marginalised groups and encouraging a diversity of voices; the usefulness of locally produced content for generating local debate around local issues; and the benefits of encouraging participation at all stages of content creation, so that content is locally meaningful and might lead to positive social change.

Rethinking ethnography: an introduction

This special issue of Media International Australia seeks to ‘rethink’ ethnography and ethnographic practice. Through the six contributions, the authors consider the variety of ways in which changes in our media environment broaden what we think of as ‘media’, the contexts through which media are produced, used and circulated, and the emergent practices afforded by digital media.

Researching Creative Applications of New Information and Communication Technologies

This article describes two ‘ethnographic’ research projects – one in Australia and one in South Asia. These projects stand apart from more traditional ethnographies in the way in which they combine ethnography with action research; they are, in effect, applied ethnographic research. Both projects reflect an interest in examining the changing processes and applications of creativity, production and consumption and the desire to gain deeper understandings of what roles new technologies play in all of this. The research attempts to develop answers to some very basic questions about the implications of new technologies on the everyday lives of a wide range of people and the implications of the everyday lives of those people on the uses and potential uses of new technologies.

A holistic, learning-centred approach to building evaluation capacity in development organizations

There is growing pressure on development organizations to improve their evaluation systems and capacities. This presents considerable challenges for time- and resource-poor organizations in developing countries. Evaluation capacity development (ECD) approaches are needed that are appropriate and effective for such organizations. We argue that this requires a long-term, holistic, participatory, learning-centred approach that aims to develop learning organizations and build the capacity of whole organizations and their stakeholders. It also needs to incorporate local knowledge and ideas and ongoing meta-evaluation of ECD activities. We describe this approach and how it was applied in a four-year action research project with a non-governmental organization in Nepal. Drawing on findings from this project and various follow up activities, we suggest some principles and strategies for designing and implementing an effective and sustainable approach to ECD that can help to address the many challenges and issues we have identified.