'Lady, is this civilisation?' : a case study of community participation in a health development programme in Aotearoa New Zealand : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Development Studies at Massey University, Palmerston North, New Zealand
Community participation is a key feature of major global health declarations
and a fundamental principle of health strategies in Aotearoa New Zealand.
However, the frequency with which it is espoused belies the complexities
associated with its practical application. Engaging communities in primary
health care programmes designed to improve their health has been identified as
a major challenge.
This study’s objective was to explore community members’ perspectives of
participation within a health development programme. The programme chosen
aimed to increase the fruit and vegetable intake of targeted population groups,
including M ori, Pacific peoples, and low income earners. A qualitative
instrumental case study approach was adopted to examine the programme and
investigate what influenced, constrained, and sustained community
participation. Data collection included fieldwork over an eighteen-month
period. Two programme projects were selected as the study foci: a communityled
project involving distributions of thousands of free heritage variety plants;
and, instigated by health services, a project establishing community gardens.
These projects provided markedly different pictures of participation occurring
within the same programme. The plant distributions had widespread appeal,
while the community garden faltered.
Community participation fitted within a description of ‘focused social action’.
Participation was motivated by needs, values, and interests. While some were
personal and family based, the programme also became an imagined vehicle
for addressing wider health, social justice, and environmental sustainability
goals. Ongoing challenges related to defining targeted communities and
groups, varying degrees and types of participation, and different perspectives
of participation, especially as health sector staff worked from an equity
mandate and community members spoke of equality.
Programme groups established as mechanisms to foster community
participation had contradictory effects, engaging some as advisors, while
failing to reach communities targeted for the programme. The complexities of
health sector bureaucracy both enabled and constrained the programme and
This thesis provides an in-depth examination of the complexities of community
participation in action, the contradictory effects of contexts enveloping
programmes, and the resolve of community members. It increases our
understandings of how community members perceive health programmes and
community participation, which are critical factors in improving population