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Wellbeing Research in Developing Countries: Reviewing the Role of Qualitative Methods Laura Camfield Gina Crivello Martin Woodhead Accepted: 13 August 2008 / Published online: 12 September 2008 Ó Springer Science+Business Media B.V. 2008 Abstract The authors review the contribution of qualitative methods to exploring con- cepts and experiences of wellbeing among children and adults living in developing countries. They provide examples illustrating the potential of these methods for gaining a holistic and contextual understanding of people’s perceptions and experiences. Some of these come from Young Lives, an innovative long-term international research project investigating the changing nature of child poverty in India, Ethiopia, Peru and Vietnam (http://www.younglives.org.uk), and others from the Wellbeing in Developing Countries ESRC research group (WeD), an international, inter-disciplinary project exploring the social and cultural construction of wellbeing in Bangladesh, Ethiopia, Peru and Thailand (http://www.welldev.org.uk). The authors show how qualitative methods can be used both alongside and as part of the development of sensitive and relevant quantitative measures, and provide some practical and methodological recommendations. They propose that qualitative approaches are essential in understanding people’s experiences of wellbeing, both now and in the future. However, the authors caution that while these offer many benefits, for example, a less structured and hierarchical engagement between researcher and participant; they require time, energy, and sensitivity. Qualitative methods also work best when used by trained and experienced researchers working in the local language/s in a community where some rapport has already been established. Finally, the paper recom- mends combining data from qualitative and quantitative approaches (e.g. psychological measures or household surveys) to enhance its explanatory power. L. Camfield (&) Young Lives, Department of International Development, Queen Elizabeth House, 3 Mansfield Road, Oxford OX1 3TB, UK e-mail: laura.camfi[email protected] L. Camfield Wellbeing in Developing Countries ESRC Research Group, University of Bath, Bath, UK G. Crivello Á M. Woodhead Young Lives, University of Oxford, Oxford, UK M. Woodhead Child and Youth Studies Group, The Open University, Milton Keynes, UK 123 Soc Indic Res (2009) 90:5–31 DOI 10.1007/s11205-008-9310-z

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  • Wellbeing Research in Developing Countries: Reviewingthe Role of Qualitative Methods

    Laura Camfield Gina Crivello Martin Woodhead

    Accepted: 13 August 2008 / Published online: 12 September 2008 Springer Science+Business Media B.V. 2008

    Abstract The authors review the contribution of qualitative methods to exploring con-cepts and experiences of wellbeing among children and adults living in developing

    countries. They provide examples illustrating the potential of these methods for gaining a

    holistic and contextual understanding of peoples perceptions and experiences. Some of

    these come from Young Lives, an innovative long-term international research project

    investigating the changing nature of child poverty in India, Ethiopia, Peru and Vietnam

    (http://www.younglives.org.uk), and others from the Wellbeing in Developing Countries

    ESRC research group (WeD), an international, inter-disciplinary project exploring the

    social and cultural construction of wellbeing in Bangladesh, Ethiopia, Peru and Thailand

    (http://www.welldev.org.uk). The authors show how qualitative methods can be used both

    alongside and as part of the development of sensitive and relevant quantitative measures,

    and provide some practical and methodological recommendations. They propose that

    qualitative approaches are essential in understanding peoples experiences of wellbeing,

    both now and in the future. However, the authors caution that while these offer many

    benefits, for example, a less structured and hierarchical engagement between researcher

    and participant; they require time, energy, and sensitivity. Qualitative methods also work

    best when used by trained and experienced researchers working in the local language/s in a

    community where some rapport has already been established. Finally, the paper recom-

    mends combining data from qualitative and quantitative approaches (e.g. psychological

    measures or household surveys) to enhance its explanatory power.

    L. Camfield (&)Young Lives, Department of International Development, Queen Elizabeth House, 3 Mansfield Road,Oxford OX1 3TB, UKe-mail: [email protected]

    L. CamfieldWellbeing in Developing Countries ESRC Research Group, University of Bath, Bath, UK

    G. Crivello M. WoodheadYoung Lives, University of Oxford, Oxford, UK

    M. WoodheadChild and Youth Studies Group, The Open University, Milton Keynes, UK

    123

    Soc Indic Res (2009) 90:531DOI 10.1007/s11205-008-9310-z

  • Keywords Wellbeing Mixed methods Qualitative Developing countries Methodological

    1 Introduction

    Openness to insights from other disciplines1 has been the hallmark of organizations such as

    International Society for Quality of Life Research, reflecting the fluid and multidimen-

    sional nature of its object of study. The purpose of this paper is to illustrate through vivid

    example the value of qualitative approaches to researchers, policy makers, and practitio-

    ners who construct or use social indicators to map quality of life, with the ultimate goal of

    enhancing the wellbeing of people in developing countries. It provides a necessarily

    selective mapping of the terrain for future exploration and aims to inspire readers to engage

    with qualitative approaches to and literatures on wellbeing, even if they do not adopt

    qualitative methods. The approaches described in the paper have particular intellectual

    histories that we cannot do justice to here; however, this should not prevent a pragmatic

    recognition of their potential as a resource within an integrated investigation of quality of

    life or wellbeing. For example, the role of participatory methods in understanding, and

    possibly even developing indicators of wellbeing is illustrated with studies exploring

    understandings of poverty, illbeing, and vulnerability; wellbeing; and resilience.

    Concepts of quality of life and wellbeing, which for the purposes of this paper are treated as

    synonymous enable engagement with the whole of peoples lives and provide more accurate

    representations and measures than approaches that focus explicitly or implicitly on a single

    dimension (for example, health or income). However, there are multiple definitions of these

    terms that reflect different philosophical traditions, and little consensus, even within disci-

    plines. For example, wellbeing can be used to refer to any or all of the following, all of which

    have different implications for research or intervention: a subjective experience or state of

    being (Diener 1984); the space where wellbeing can or should occur (Sen 1990) or a process

    with wellbeing as its goal (Aristotle, 350 BC); and, after Veenhoven (2000), the liveability

    of the environment and the life ability of the person. While definitions of wellbeing are

    contested (it is tempting to succumb to the authoritative pessimism of Hird that there is no

    accepted definition of wellbeing [2003, p. 4]), there are some common understandings.

    These were reflected in McAllisters (2005) recent review of the wellbeing literature which

    defined wellbeing as more than the absence of illness or pathology [with] subjective (self-assessed) and objective (ascribed) dimensions; it can be measured at the level of individuals

    or society; it accounts for elements of life satisfaction that cannot be defined, explained or

    primarily influenced by economic growth (ibid, p. 2).

    In the context of research in developing countries these subtleties become more

    apparenthow do local people understand wellbeing and how do these understandings

    vary according to life phase, gender, socio-economic status, etc., within a single com-

    munity? How do people pursue what they see as wellbeing or a good life and what trade

    offs are they required to make to attain or preserve it? (e.g. between self and household,

    present and future) What resources can people draw on in their pursuit of a good life for

    themselves, their families, and communities, and what are the political and social barriers?

    There is a further question of how far development agencies should take peoples priorities,

    1 Two of the three authors trained as anthropologists; two have also engaged extensively with psychologicalmethods and literatures; and all three have conducted multi-disciplinary research with children and adults indeveloping countries.

    6 L. Camfield et al.

    123

  • values and visions of wellbeing into account to ensure the credibility and legitimacy of

    development (Copestake 2007). Additionally, there is growing interest in how public

    conceptualizations of wellbeing are constructed (Deneulin and Townsend 2007), especially

    in relation to children (Hood 2007).

    These concerns are part of a shift within international development and child indicators

    research (e.g. Camfield and McGregor 2005; Ben-Arieh 2006) from a deficit view that

    focuses on survival, to one that acknowledges peoples resources and agency and pursuit of

    wellbeing. The contribution of qualitative approaches to a focus on peoples resources and

    agency is that they can encompass areas of peoples lives that are influential and important,

    but rarely measured (for example, spirituality and religious practice). More participatory

    approaches also challenge the reliance on experts and proxies by taking a subjective

    approach to peoples experiences and treating them as researchers as well as subjects. We

    propose that exploring understandings and experiences of wellbeing using qualitative

    research is valuable in its own right, as the paper illustrates, and also improves the accuracy

    of measurement. Qualitative research can make measures more comprehensible and rel-

    evant to respondents, provide contextual information to explain particular outcomes, and

    most importantly, ensure that the stylised facts such as the a dollar a day metric that

    influence international assistance are based on measures of what matters.

    The paper begins with a brief introduction to the important but slippery concept of

    wellbeing, describing types of wellbeing research that have been undertaken with adults

    and children. This is necessarily selective as wellbeing research is a broad category: most

    international poverty research claims to be about wellbeing (e.g. Coudouel et al. 2001), and

    studies of childrens development are implicitly about their wellbeing. The paper then

    introduces qualitative approacheswhat they are and how they can be helpfulbefore

    focusing on two overlapping approaches to research: qualitative (for example, ethno-

    graphic, participatory) and mixed method, which combines insights from qualitative and

    quantitative. We have ordered the paper in this way as a heuristic device; boundaries

    between the approaches are blurred on paper and in practice, and there is no grand

    narrative. We have also tried to resist the temptation to compare ideal types rather than

    messy realities (for example, the lone anthropologist working for 30 years in a single

    community versus a team of participatory action researchers interviewing villagers over

    the course of a week). A reality check is provided by including some examples from our

    own research with the Wellbeing in Developing Countries ESRC research group (WeD), aninternational, inter-disciplinary project exploring the social and cultural construction of

    wellbeing in Bangladesh, Ethiopia, Peru and Thailand (McGregor 2007), and Young Lives,an innovative long-term international research project investigating the changing nature of

    child poverty in India, Ethiopia, Peru and Vietnam (Young Lives 2008). The paper con-

    cludes with some methodological reflections, including a brief summary of the challenges

    of different approaches.

    1.1 Research on Wellbeing in Developing Countries

    Research into wellbeing and subjective experiences in developing countries is growing

    rapidly,2 and represents a paradigm shift towards holistic, person-centred, and dynamic

    understandings of peoples lives, which are nonetheless embedded in particular socio-

    cultural contexts (Boyden 2006; Gough et al. 2007; Camfield, Streuli et al. 2008). Peoples

    2 See Gough and McGregor (2007) and studies by Biswas-Diener and Diener (2001, 2006), the InternationalWellbeing Group, Moller, Graham, Rojas, Camfield, etc.

    Wellbeing Research in Developing Countries 7

    123

  • values, aspirations, and experiences of happiness or unhappiness are now measured

    directly within some large surveys of individuals and households (e.g. the World Values

    Survey, South African Quality of Life Trends Study) rather than inferred from proxies such

    as income (see Graham 2005; Guillen-Royo and Velasco 2009 for reviews of happiness

    economics in developing countries). They are also explored in participatory studies that

    attempt to identify the pathways to particular outcomes (for example, chronic poverty),

    within the constraints of a cross-sectional study, and the perceived possibilities for change

    in the future (see Table 4, Appendix 1 for a summary of the key studies). The inclusion of

    subjective experiences and meanings is part of a move within international development

    and research on poverty from economic to multi-dimensional understandings of peoples

    lives.3 This is because the latter improves our understanding of the former (for example,

    the role of social norms and relationships in maintaining community savings groups in

    Bangladesh [Goetz and Sen Gupta 1996]).

    However, even multidimensional understandings of peoples lives still focus on what

    they should have or be able to do, rather than what people think and feel about what they

    have and do (McGregor 2007), which is an obvious role for subjective measures and

    qualitative methods. Multidimensional approaches also fail to acknowledge the interper-

    sonal and recursive aspects of wellbeing; for example, the base of shared social and

    cultural capital that defines locally defined necessities or what a person needs to partic-

    ipate and aspire (Gudeman 2004, p. 9). By this we mean that peoples experiences and

    evaluations of their lives are shaped by their perception of their environment and them-

    selves, in the context of what they value and aspire to. The rationale for taking wellbeing as

    the focus is that it places the person, in their relationships and surroundings, at the centre;

    Rojas describes this as engaging with a person of flesh and blood in her circumstance []rather than the wellbeing of an academically constructed agent [2007, p. 261]). Quali-

    tative approaches in particular foreground the presence of both the respondent and the

    researcher, which highlights the fallibility of all data collection by emphasizing their role

    in its co-creation, and encourages reflexivity about the selective process of interpretation

    and representation.

    Methods to explore wellbeing can be highly contextual, so people are not separated

    from their environments, and sensitive to human diversity and its interaction with the

    dynamics of power (McGregor 2007; Boyden 2006). The WeD group, for example,

    characterizes wellbeing as a state of being with others, where human needs are met,

    where one can act meaningfully to pursue ones goals, and where one enjoys a satisfactory

    quality of life (2007). Peoples hedonic experiences (for example, pleasure or emotions)

    are undeniably important: the New Economics Foundation defines wellbeing as the quality

    of peoples experience of their lives (Shah and Marks 2004) and the cognitive psychologist

    Kahneman characterizes it as wanting ones current experience to continue (1999).

    However, peoples values and aspirations also play a role; in particular their response to

    the central question is my life going well, according to the standards that I choose to

    use?4 (Diener). White (2007) makes a further valuable distinction between living a goodlife (values and ideals), having a good life (material welfare and standards of living), andlocating ones life (experience and subjectivity).

    3 See Sumner 2007 and the literature published by the WIDER research project on measuring humanwellbeing (e.g. McGillivray 2006; McGillivray and Clarke 2006).4 See also the work of philosophers writing on these issues such as Valerie Tiberius, Mark Chekola, andDaniel Haybron.

    8 L. Camfield et al.

    123

  • As an integrative or umbrella concept, wellbeing provides the opportunity to combine

    diverse literatures and methodological approaches to attain a holistic picture of peoples

    lives. It enables researchers to explore firstly the way that wellbeing is grounded in and

    mediated by social, cultural and political structures and processes. Secondly, the centrality

    of relationships to understanding, pursuing, and achieving wellbeing, and finally, the

    inevitability of trade-offs and contradictions in this pursuit. In the following section we

    briefly outline the role of qualitative and mixed methods approaches in researching

    wellbeing and provide examples of their value in studies with both adults and children.

    1.2 Methodological Approaches to Wellbeing

    We have loosely categorized the approaches to wellbeing discussed in this paper as

    qualitative and mixed methods, recognising that even pure quantitative approaches often

    contain an element of qualitative work (for example, focus groups or interviews to generate

    the items for measures), aside from the qualitative aspects of survey administration

    (Olsen and Morgan 2005). Similarly distinctions within the category of qualitative research

    relate as much to how researchers choose to position themselves as to any fundamental

    difference in ethos or method (for example, the claims made by some participatory

    researchers or ethnographers that their research empowers or provides unmediated access

    to peoples deepest experiences) (Table 1).

    Table 1 Overview of the approaches described in this paper

    Approach Distinctive feature Methods Examples

    Qualitative,includingethnographicandparticipatoryapproaches

    Holistic & flexible, in-depth, usually arisingfrom long-termengagement. Moreparticipatory workinvolves active, if oftenbrief, engagement toinvolve people indescribing, interpreting,and occasionallychanging their reality

    Interviews; narratives, e.g.biographical essays oraccounts of illness; lifehistories, participantobservation,predominantly task-basedgroup or individualactivities (e.g. bodymapping, time usediaries)

    E.g. understandings of agood life in Cairo(Wikan); concepts ofwellbeing in Bolivia(Calestani 2008) andamong the Cree (Adelson2000); Consultations withthe Poor (Narayan et al.2000); studies of urbanviolence in Columbia &Guatemala (Moser 2003,2004); developing a QoLtoolbox in Madagascar(Farnworth 2004)

    Mixed-methods Combines the opportunitiesand challenges offered bydifferent methods andanalytical approaches;increases data validitythrough iteration &triangulation & enablestargeting of findings todifferent audiences

    Combination of survey,qualitative, &participatory methods ordata (e.g. householdsurveys & participatorypoverty assessments orlife histories); analysis &presentation usingquantitative & qualitativeapproaches

    e.g. WeD, Young Lives,combining ParticipatoryPoverty Assessment &surveys in Uganda(Lawson et al. 2006;McGee 2004) andRwanda (Howe andMckay 2007), combiningsurveys & life histories inBangladesh (Baulch andDavis 2007), structured &open-ended explorationof peoples visions of thegood in South Africa(Clark 2002)

    Wellbeing Research in Developing Countries 9

    123

  • 1.2.1 Qualitative

    The sub-section on qualitative methods covers ethnography, and common ethnographic

    techniques such as semi-structured interviews and participant observation, and task-based

    participatory methods such as drawing. It also discusses the benefits from taking a more

    participatory approach, whatever methods are used. Wellbeings location in the disci-

    plinary and methodological borderlands makes it a classic object of anthropological

    attention (Thin 2005; Corsin-Jimenez 2007). Wilk suggests using ethnography to study

    wellbeing in the same way as it is used to study power (and by extension poverty)

    where

    Unpacking the various meanings of this term has helped make many of us understand

    that it is objective and subjective, measurable and experiential aspects are really two

    parts of the same whole. The objective reality of the exercise of power cannot be

    separated from the beliefs and feelings that motivate, activate, and justify it. Vic-

    timisation and empowerment are subjective as well as objective

    (1999, p. 93)

    Although some anthropologists accuse their discipline of neglecting wellbeing (e.g. Thin

    2005; Wilk 2008), much early anthropology, for example, Margaret Meads study of

    teenage life in Samoa (1928), is grounded in a powerful critique of modernity, possibly

    driven by a romantic vision of the other that relates to the anthropologists own desire to

    find an alternative vision of wellbeing (for example, one that draws on the deep

    connections to ancestors and community that were considered absent in the West). These

    motivations may be familiar to contemporary researchers of quality of life and wellbeing.

    Despite applied anthropologys checkered history (e.g. Keesing 1945), it has produced

    ethnography: a research methodology that is grounded and flexible, and capable of gen-

    erating new and surprising information about the way in which people see the world

    (Hammersley and Atkinson 1995). This is even the case when these tacit understandings

    (Giddens 1997, p. 169) [are] so profoundly internalised that they cannot be asked aboutdirectly (White and Petitt 2005, p. 26). For example, White and Petitt argue that using

    participatory methods to access local perceptions of the good life may not capture the

    deepest values of what people consider well-being (for example, a respondents concern

    about the state of their eternal soul) as these are beyond the frame of a wellbeing ranking

    (ibid). Thin similarly proposes that wellbeing needs to be set in the broader context of

    anthropologys concern with moralitywith what it means to be good, to live a good life

    and to organize social processes and institutions that facilitate or inhibit virtue and well-

    being (2005, pp. 45).

    Ethnographic methods provide what the interpretive anthropologist Geertz characterizes

    as thick description which attempts as far as possible to provide an insiders perspective

    on peoples understandings and actions (our own constructions of other peoples con-

    structions of what they and their compatriots are up to [1973, p. 9]). The illustration

    Geertz gives of thick description is the difference between a blink and a wink; one is

    an involuntary twitch, while the other can be a conspiratorial signal to a friend, or even a

    parody of that signal to confuse an observer. The physical movement is identical but each

    has a distinct meaning (as anyone unfortunate enough to have had the first taken for the

    second knows [Geertz 1973, p. 6]), which varies between different contexts and cultural

    systems. Geertz provides an example of thick description from his own research when he

    was an involuntary participant in a police raid on the village cockfight, which gave him an

    experiential understanding of one of the main components of Balinese wellbeing:

    10 L. Camfield et al.

    123

  • Getting caught, or almost caught, in a vice raid is perhaps not a very generalizable

    recipe for achieving that mysterious necessity of anthropological field work, rapport,

    but for me it worked very well. It led to a sudden and unusually complete acceptance

    into a society extremely difficult for outsiders to penetrate. It gave me the kind of

    immediate, inside view grasp of an aspect of peasant mentality that anthropolo-

    gists not fortunate enough to flee headlong with their subjects from armed authorities

    normally do not get. And, perhaps most important of all [] it put me very quicklyon to a combination of emotional explosion, status war, and philosophical drama of

    central significance to the society whose inner nature I desired to understand

    Geertz (1973, p. 416)

    Geertzs description illustrates the potential of ethnography for understanding how people

    conceptualise wellbeing, how this changes over time and in response to particular

    experiences, and what sacrifices people are prepared to make in its pursuit.5 As peoples

    meanings are often deeply buried-Bourdieu describes how what is essential goes without

    saying because it comes without saying (1977, p. 167)it may be necessary to

    supplement direct questions about wellbeing with participant observation, and listen to

    respondents speaking in their own terms, rather than in the slightly artificial context of an

    interview or participatory exercise. The examples given in the paper illustrate the potential

    of ethnography as a method for studying wellbeing; for example, exploring local

    understandings of wellbeing (e.g. Calestani 2008), collecting detailed information on the

    experiences of people living in poverty using longitudinal ethnography (e.g. Wikan

    1985), and contextualizing understandings of peoples lives and livelihoods (e.g. Reynolds

    1991). While a rich and holistic understanding can be gained through ethnography or

    longitudinal qualitative research, reassuringly even a single interview can provide insight

    into what someone means by quality of life or wellbeing, as described in the section on

    mixed methods. This is especially so in the context of responding to a measure of

    wellbeing, as described in Section 2.2.

    The conventional distinction between participatory and qualitative and ethnographic

    methods is an artificial one as participatory methods are obviously a subgroup of quali-

    tative methods, and many qualitative and ethnographic studies of childrens wellbeing use

    group or task-based activities (e.g. Punch 1998). Ethnography can also encompass the

    altered researcher/researched relationship (for example, the anthropological classic

    Reflections on fieldwork in Morocco [Rabinow 1997]), where participants have some

    role in setting the agendas of the research, the course of data collection, and/or analysis and

    presentation of results. Conversely, so-called participatory methods encompass many

    degrees of participation, as illustrated by Harts ladder of child participation (1992), which

    moves from child-initiated and directed to manipulation. Participatory research on

    poverty is distinct from mainstream economic approaches in its emphasis on experiential

    aspects of poverty such as being respected, having meaningful choices, and being able to

    preserve ones dignity (e.g. Brock 1999). As in all qualitative research, participatory

    studies aim to be experience-near, but they also aim to create a space for people to share

    and reflect upon their experiences and to conduct research that generates valuable out-

    comes for participants, policy makers, and practitioners. Good participatory work can

    widen the lens to include aspects of peoples lives that are often overlooked in purely

    quantitative studies such as companionship, everyday pleasures, and sources of meaning

    5 The acceptance tale that Geertz recounts can also be seen as an example of the anthropological rhetoriccritiqued by Clifford and Marcus (1986).

    Wellbeing Research in Developing Countries 11

    123

  • that enable them to sustain their wellbeing in insecure and resource-poor environments

    (Laderchi 2001; White and Pettit 2005; Camfield and McGregor 2005). The process of

    collective discussion and decision is seen as a good in itself, which can also spur col-

    lective action (e.g. the Participatory Learning and Action approaches advocated by Reason

    and Bradbury 2000), for example, the Childrens Forums in Vietnam carried out as part of

    Young Lives (Pham and Jones 2005).Participatory research has become increasingly popular during the past twenty years,

    evidenced by the mainstreaming of Participatory Poverty Assessments in the 1990s (e.g.

    Norton et al. 2001) and the World Bank funded Consultations with the Poor study(Narayan and Walton 2000, 2002; Narayan et al. 2000), although its integration or

    co-option into the mainstream has attracted some criticism (e.g. Cooke and Kothari 2001;

    White 1996). The main claims made by participatory methodologies is that they more

    closely reflect respondents worldviews than traditional, scientific approaches by (i)

    recognizing the contextual, subjective and non-material dimensions of human experience,

    (ii) illustrating the complex dynamics behind poverty and well-being, and (iii) draw[ing]

    out culture, location and social group-specific understandings of the dimensions of well-

    being (White and Pettit 2005, p. 13). For example, White and Pettit (ibid) cite two

    volumes of practitioner reflections on participatory methods, which note their value in

    identifying improved quality of life according to local standards (Cornwall and Pratt

    2002), and capturing local perspectives (Cornwall et al. 2001).

    Connecting with participants understandings is even more important for studies of

    childrens wellbeing (as explored in Sects. 2.3 and 2.4) because childrens interests and

    priorities may differ and even at times conflict with those of adults (Qvortrup 1994; Prout

    and James 1997; Woodhead and Faulkner 2008). Childrens participation in analysis as

    well as data gathering can increase the reliability of the research (Kirk and Miller 1986 and

    Kefalyew 1996, p. 204, both cited in Ben-Arieh 2005) and may also help diminish the

    ethical problem of imbalanced power relationships between researcher and researched at

    the point of data collection and interpretation (Morrow and Richards 1996, p. 100). Hill

    (1997) and Thomas and OKane (2000) provide several examples of how to involve

    children during the data collection process, for example, by selecting methods that enable

    them to control the form and content of the discussion, interviewing children on more than

    one occasion, working in small groups to aid collective interpretation, or having a few

    peer analysts draw out important messages from other childrens accounts.

    Participation is assumed to enhance childrens subjective wellbeing in the short-term

    through the act of participating in the research, and in the long-term as a means of

    improving the accuracy of data collected to inform child-related policy making. Doing

    research with children rather than on children enables researchers to engage critically withtheir own assumptions about childrens capabilities and about the nature of a good

    childhood, and create spaces where alternative voices can be heard. However, participatory

    research with children involves more than simply using participatory techniques as no

    method is inherently participatory (White 1996; Morrow and Richards 1996) and

    research methodologies need to be flexible to communicate appropriately with different

    respondents and respond to changing contexts and emergent findings. Visual and inter-

    active methods may be helpful, especially with younger children, to allow all participants

    to engage in generating and reflecting on their data (Crivello et al. 2008). Nevertheless,

    drawing, speaking confidently in front of a group, or talking with adults are culture specific

    skills which children acquire gradually.

    12 L. Camfield et al.

    123

  • 1.2.2 Mixed Method

    The sub-section on mixed methods distinguishes between different approaches to com-

    bining methods (for example, the timing of the qualitative input), and describes the role of

    qualitative techniques in drafting, piloting, and validating measures of wellbeing. Well-

    being is a truly hybrid concept because it is both objective and subjective and these

    aspects cannot be separated or reduced to each other (Wilk 1999). For this reason Wilk

    recommends mixing qualitative and quantitative methods as any indicator no matter

    how clever, is going to miss an essential quality of what needs to be measured. There is no

    alternative but to combine measurements with assessments of what the measures mean to

    the people being measured (1999, p. 93). Both quantitative and qualitative methods

    provide answers on the nature and extent of wellbeing that can be used separately to

    validate each others findings (triangulation) or brought together to deepen insights and

    possibly raise new questions. Mixed methods research6 is defined as the combined use of

    both quantitative and qualitative methodologies within the same study in order to address a

    single research question (Hewson in Jupp 2006, p. 179). However, this simple definition

    obscures the challenges involved in reconciling the different values, goals, epistemologies,

    and analytical approaches held by different disciplines (see Olsen 2006; Bevan 2007b). For

    example, Brannen describes how

    Quantitative researchers have seen qualitative researchers as too context specific,

    their samples as unrepresentative and their claims about their work as unwarranted

    that is judged from the vantage point of statistical generalisation. For their part

    qualitative researchers view quantitative research as overly simplistic, decontextu-

    alised, reductionist in terms of its generalisations, and failing to capture the meanings

    that actors attach to their lives and circumstances

    (2005, p. 7, op. cit. Jones and Sumner 2008)

    Disputes continue even within mixed methods research, for example, Bevan (2005) makes

    a further distinction between Q-squared (called after the conference series of the same

    name, see www.q-squared.ca/) and Q-integrated approaches as she contends that only the

    latter is genuinely integrated. According to Bevan, while Q-squared approaches collect

    and analyse data separately and bring it together to answer specific research questions, Q-

    integrated approaches entail cross-disciplinary research using a range of research instru-

    ments to produce different types of data that can be analyzed both quantitatively and

    qualitatively. An example of Q-integration is the research on subjective wellbeing by the

    WeD team in Ethiopia (Bevan 2007a, June) which reported aggregate responses to mea-

    sures of wellbeing (Woodcock 2007) and also used individual responses in household case-

    studies alongside qualitative data (Lavers 2008; Pankhurst 2006).

    Mixed methods approaches sequence the input from qualitative and quantitative

    methods in different ways, depending on whether they are combining methods to

    increase understanding, initiate new research questions, create complementary insights,

    or highlight contradictions for future exploration (Brannen 2005, pp. 1214). For

    example, qualitative methods like semi-structured interviews, focus groups, and even

    ethnography (Ware et al. 2003) are often used to generate item content for measures of

    6 Cresswell (2003) and Brannen (2005), provide a useful overview of this area, and Carvalho and White(1997), Kanbur (2003), and Jones and Sumner (2008) explore the potential of these methods in relation tostudies of poverty and childrens wellbeing respectively.

    Wellbeing Research in Developing Countries 13

    123

  • subjective health, which can be an important component of wellbeing. Cognitive inter-

    views are used to understand more about how people respond to these measures

    (Barofsky 1996), both with established measures (e.g. Mallinson 2002), and as part of

    pre-testing (e.g. Bowden et al. 2002), and qualitative methods can be used in the vali-

    dation of subjective measures, as they shift the focus from the measure to the respondent

    by aiming to assess the accuracy with which a measure has represented their worldview

    (Paterson and Britten 2003). Examples of cognitive interviewing and qualitative vali-

    dation are given in Sect. 2.1.

    2 Examples of Qualitative and Mixed Methods Approaches to Wellbeing

    Section 2 illustrates the value of the approaches described above in exploring wellbeing

    with both adults and children. Sections 2.1 and 2.2 provides examples of studies with

    adults using qualitative (ethnographic and participatory methods) and mixed methods

    (participatory numbers (Chambers 2003), validating measures of wellbeing, and inte-

    grating qualitative and quantitative data). Sections 2.3 and 2.4 provides similar examples

    from studies with children using qualitative (ethnographic and participatory methods) and

    mixed methods (developing indicators or measures and integrating qualitative and quan-

    titative data).

    2.1 Studies with Adults Using Qualitative Methods

    In this section we use Wikans longitudinal ethnography of a poor community in Cairo as

    an example of an ethnographic approach to wellbeing. This method has a long history as

    Oscar Lewis conducted similar studies with families in rural Mexico (1959) and Puerto-

    Rican families in New York (1966), which informed his theory on the culture of poverty

    (1966). Wikan (1985) carried out fieldwork with 17 families (100 individuals) from a small

    neighborhood in Cairo, which she visited regularly for 13 years (19691982), four of

    which were spent living with one of the participating families. Her sample was selected

    through natural networks of friendship and amity to help her develop a rapport and

    observe her respondents in their natural surroundings. Her main finding was that while the

    expert judgment is that standards of living are in decline,

    In terms of their own values the poor argue that they dress better, have better health,

    better entertainment, more and better education, more employment opportunities,

    better chances for savings and investments, less need than before for borrowing, and

    much, much more in the way of prestigious consumer goods. And they celebrate the

    feast [Eid]

    (1985, p. 8)

    Wikan notes the effects on peoples wellbeing of a change in their self conception from

    seeing themselves as poor and shameful to experiencing increased self-esteem from having

    a better style of living. This expresses itself in new clothes, which enable nearly all

    families to celebrate the feast days, household equipment, and most importantly television.

    Television not only provides a focal point by attracting husbands and sons who previously

    hung out in cafes, but is also pleasurable as the entertainment introduced in such lives by

    Egyptian TV comedy and soap opera genuinely changes the level of living (1985, p. 12).

    She maintains that as goods have accumulated, so have all family members self-pride.

    Whereas previously men were too ashamed of their homes to bring acquaintances there,

    14 L. Camfield et al.

    123

  • they now have items to show off with pride (1985, p. 24). Wikan assert that the

    importance of appearances in Egyptian society mean that material acquisitions play a

    significant role in increasing self-esteem and argues therefore for their inclusion in

    international measures of standards of living (noting also that standard measures such as

    housing have little relevance in this context, due to the tenure system and positive attitudes

    towards overcrowding). In addition to providing an alternative perspective on its

    constituents, Wikan gives a detailed account of peoples dogged pursuit of wellbeing

    (mak[ing] swift use of marginal improvements in opportunities and circumstances

    (1985, p. 23), and unpacks issues of intra-household allocation (for example, how

    employed daughters are more beneficial than sons for their mothers wellbeing because

    they feel obliged to share their income).

    Corsin-Jimenez (2007, pp. 12), in his edited collection on the anthropology of well-

    being, uses Evans-Pritchards evocative description of the Nuer of the southern Sudan as

    an illustration of how ethnography can contribute to our understanding of wellbeing

    through extraordinarily rich descriptions of the social and political forms of life

    [which] provide an alternative route into the political and theoretical imagination ofwellbeing. For example, Evans-Pritchard defines wellbeing for the Nuer as that in which

    a family possesses several lactating cows, for then the children are well nourished and

    there is a surplus that can be devoted to cheese making and entertaining guests (1940, p.

    21, in Corsin-Jimenez, op. cit.). Ethnographies can overcome a common criticism of

    wellbeing research as individualistic and politically nave (e.g. Sointu 2005; James 2007)

    by providing socially and politically embedded accounts of wellbeing. James (2007, pp.

    2021) criticizes the current rhetoric of wellbeing for a fastidiously modern and a his-

    torical presumption about how individuals ought to fare in life and suggests that it is

    absurd to look for wellbeing in contexts such as Sudanese refugee camps in Ethiopia

    where a communitys historical sense of purpose has been evacuatedwhere people are

    told and slowly come to realize, that they will never return to their old ways of liveli-

    hoods. Calestani (2008, this issue) similarly explores potential contradictions between

    individual and collective definitions of the good life in the Bolivian plateau, and Adelson

    (2000) notes how for the Whapmagoosti Cree wellbeing or being alive well is inex-

    tricably linked to the life of their community (if the land is not healthy then how can we

    be? [2000, p. 3]). Contributors to Corsin-Jimenezs edited collection (2007) continue to

    emphasise the social and political dimension of wellbeing by tackling subjects such as the

    depoliticizing effect of international health and literacy programs in Nepal (Harper and

    Maddox) and changing concepts of wellbeing (mad ife) among the Fuyuge in Papua NewGuinea in response to increased pressure from international mining companies and a

    modernizing state (Hirsch).

    The interaction between global and local dimensions of wellbeing was also captured by

    Farnsworths work with smallholder organic farmers in Madagascar (2004), which aimed

    to develop a simple and flexible QoL toolkit for use by local researchers. The methods

    needed to be specific enough to produce unique meanings in particular situations, and

    universal enough to speak to other stakeholders (for example, the German consumers at the

    other end of the organic supply chain). She also felt the methods should be dynamic as well

    as grounded as wellbeing is a process of becoming rather than a state. Farnsworths

    approach has obvious value as a way of fully understanding local peoples realities before

    developing a measure, and is quicker than the long-term ethnographic engagement

    described in the earlier part of this section.

    Wellbeing Research in Developing Countries 15

    123

  • 2.2 Studies with Adults Using Mixed Methods

    More recently participatory research has been used in developing countries in con-

    junction with household surveys (for example, Participatory Poverty Assessments), or as

    a means of generating quantitative data (e.g. Barahona and Levy 2003). Community

    wealth and more recently wellbeing rankings are often used in the initial stages of

    participatory research as they provide valuable insights into how local people define

    wellbeing and the referents they use when asked to make judgments about their own

    lives (e.g. Seeley et al. 1995; Chadwick et al. 1995). According Van Campenhout (2007),

    the advantage of wellbeing ranking over conventional poverty indicators in developing

    countries is that they (i) use local conceptions of poverty and wellbeing that acknowl-

    edge the complexity of rural settings (Scoones et al. 1995), (ii) include intangible

    elements such as status, bargaining power, and access to support networks, and (iii) are

    less vulnerable to individual biases (for example, underestimating current consumption to

    increase the chance of receiving development assistance in the future). They also

    acknowledge inequalities in household distribution that affect the wellbeing of household

    members; for example, Van Campenhout noted that the major contribution of girls and

    women in fetching firewood and water were captured by participatory methods, but not

    by poverty indicators.

    Findings from qualitative studies emphasise the importance of paying attention to

    peoples subjective wellbeing or QoL, and qualitative methods have an additional role in

    interrogating these constructs and improving their measurement. Within WeD subjective

    QoL was explored both qualitatively (Camfield 2006) and quantitatively (e.g. Woodcock

    et al. 2007). The WeD definition of QoL as the outcome of the gap between peoples

    goals and perceived resources, in the context of their environment, culture, values, and

    experiences (Camfield et al. 2006) was developed through a combination of literature

    review and exploratory research in the WeD sites7 to identify dimensions of QoL and test a

    range of methods. The definition builds on the World Health Organisations work on cross-

    cultural quality of life measurement (WHOQOL group 1995) by highlighting the interplay

    between peoples conceptions of their goals and satisfaction with their achievement, given

    their material and social circumstances. It shows the additional influence of gap theories

    such as Calman (1984), Michalos (1985), and Ruta et al. (1994). During the exploratory

    research, WeD used the Global Person Generated Index8 (GPGI) as this represented the

    best operationalisation of the WeD definition. However, WeD subsequently developed an

    individualized measure of weighted goal attainment (the WeDQoL) where the level of

    satisfaction with a goal reported by the respondent is weighted by how important they

    perceived this goal to be. This is assumed to be a more accurate proxy for subjective

    7 WeDs exploratory research took place in rural, peri-urban, and urban sites in Bangladesh, Ethiopia,Thailand and Peru. The average sample size for the countries was 360 (range 314419) and age and genderwere used as the key breaking variables, followed by religion or ethnicity. The fieldwork used qualitativeand quantitative methods, including semi-structured interviews, focus groups, the Global Person GeneratedIndex and the Satisfaction with Life Scale, all of which had been piloted in similar WeD sites.8 The Global Person Generated Index (GPGI) is an individualised QoL measure that uses a mix of open-ended questions, scoring, and points allocation to establish peoples satisfaction with the areas of life that aremost important to them. It was developed in 1994, revised four years later to broaden the focus from health-related QoL to QoL itself, and piloted in Ethiopia, Thailand, and Bangladesh in 2004 (Ruta et al. 1994,2004; Ruta 1998)

    16 L. Camfield et al.

    123

  • wellbeing. The WeDQoL bridges the gap between the ideographic approach of the GPGI

    and nomothetic (abstract or universal) approach of international measures such as the

    WHOQOL. By developing and validating a questionnaire with a common format and

    additional items that reflected the priorities of people in particular countries (for example,

    having metta-karuna for others in Thailand; see http://www.bath.ac.uk/econ-dev/wellbeing/

    research/methods-toobox/qol-toolbox.htm), it was possible to not only integrate subjective

    and objective data (for example, the Index of Needs Deprivation and total household

    expenditure, Camfield and Guillen-Royo 2009), but also to relate the subjective data to

    qualitative case study material for both individuals (Lavers 2008) and groups (Camfield,

    Guillen-Royo et al. 2008).

    Cognitive interviewing is rarely part of the process of developing a subjective measure

    in developing countries, although arguably even more important due to the acknowledged

    problems of these measures outside their original context (Camfield 2004). Bowden and

    Fox-Rushbys development of the KENQOL (Bowden et al. 2001, 2002; Fox-Rushby et al.

    2003, Fox-Rushby and Bowden 2003; Nzioka et al. 2001) is an example of good practice

    as it involved first identifying the local concepts of health that the scale was based upon

    through extensive qualitative research and long-term participant observation, and then

    rigorously pre-testing the measure using six separate methods to ensure that it was cap-

    turing the self-perceived and locally defined health of people in Makueni district,

    Kenya (Bowden et al. 2002). Qualitative methods can also be used as part of validating a

    measure, for example, Camfield and Ruta (2007) compared the content of the GPGI (Ruta

    1998; Ruta et al. 1994) and in-depth semi-structured interviews as part of the validation of

    the versions that were administered in Ethiopia, Bangladesh, and Thailand during the WeD

    exploratory quality of life research (see also Martin 2007). This was a disconcerting

    exercise as more than half of the cases analysed found minor discrepancies between the

    GPGI and the interview, which related to the overall score, the relative weights in one area,

    or basic errors of comprehension. Some discrepancies can be attributed to interviewer

    competence; for example, Bangladesh had almost twice as many successfully completed

    GPGIs as Thailand. However, there were some patterns: in Bangladesh the discrepancies

    related to areas that were abstract, or personal, and thus difficult to capture in a few words

    (e.g. own boredom and lack of fulfillment) while in Thailand they mainly related to

    debt. This suggests that people will talk about different things in the more relaxed context

    of a semi-structured interview, not merely topics that are abstract, or idiosyncratic (i.e.

    important to them, but not important), but also ones that are potentially shameful. The

    impression is reinforced in Table 2, which compares the GPGI scores for importance and

    satisfaction given by a 73 year old man from rural Ethiopia with his responses in the

    accompanying semi-structured interview. His overall score was low but positive (63 per-

    cent), however, his description of his current situation was I am living a dead life, and

    I want to die [] I am living a life that is horrible and very bad/worst, which suggests amuch lower score. Similar discrepancies can be seen in Table 2 between the weights given

    to areas and the number of times they were mentioned, and between the score for satis-

    faction and his verbal evaluations. This type of exercise underlines the need for caution in

    interpreting both quantitative and qualitative data outside the contexts in which they were

    collected. Since the respondent also said he wanted to die because he had no farming

    implements, this may be a manner of speaking that relates to his age, location, or religion,

    and would mean something quite different in the mouth of another respondent. It highlights

    the value of thick description, or at least having local anthropologists or historians at hand

    to resolve these puzzles (Table 2).

    Wellbeing Research in Developing Countries 17

    123

  • 2.3 Studies with Children Using Qualitative Methods

    Ethnographic approaches have been used in studies of childhood wellbeing, with the

    obvious proviso that it is less easy for an adult researcher to be a participant observer, or

    blend into the background. For example, Punch (1998) used a mixture of semi-participant

    observation, informal interviews and task-based methods to investigate how children

    negotiate their independence as they grow up in rural Bolivia. Corsaro and Molinari (2005)

    conducted a seven-year longitudinal ethnography of a group of Italian childrens transition

    from pre-school to middle school, which sets the unique opportunities offered by the

    Northern Italian school system in an international context and reflects on the potential

    threat from Italys changing political climate. Nonetheless, the authors are careful not to

    diminish childrens agency, and show how peer-to-peer social interactions are as salient to

    their educational development as support from parents and teachers, and create effective

    rites of passage that maintain childrens wellbeing. Reynolds (1991) undertook a detailed

    study of childrens time use in the Middle Zambezi Valley that used case studies of

    precarious rural livelihoods to illustrate the impact of large-scale development projects

    such as dams and game parks on peoples well-being. By intensively studying the activities

    of 24 children her research provides an excellent example of how small facts speak to big

    issues (Geertz 1973, p. 23), namely the impact of market-driven development strategies

    on the wellbeing of rural populations. It is also a good example of mixing methods as

    interviews and observations were combined with extracts from childrens diaries and

    secondary data from district records.

    There are many good examples of international participatory studies9 (e.g. Ungar 2003),

    which address the related concept of childhood resilience (often defined as maintaining

    subjective and psychosocial wellbeing in adverse circumstances, e.g. Masten 2001). For

    example:

    Day-in-a-life (Gillen et al. 2007, http://dayinthelife.open.ac.uk/index.cfm), whichfilmed five days in the lives of 30-month olds in Peru, Italy, Canada, Thailand, and the

    UK to explore cultural differences in development and learning in early childhood

    Table 2 Comparison of quantitative and qualitative data on the subjective experiences of an Ethiopianrespondent

    GPGI area Quantitative data Qualitative data

    Wealth,poverty,& assets

    Score 2 of 6, 30% weight, mentioned [20times

    It is good to die rather than to live in poverty. Iam very poor

    Education Score 4 out of 6, 30% weight, mentionedindirectly twice

    I am not skilful, knowledgeable, and sociablebecause of my poor living condition

    Labour/work

    Score 4 of 6, 20% weight, mentioned 16times

    I am not benefiting from my life because noreturn from my work

    Health Score 6 out of 6, 10% weight I am getting physically weak and old

    Peace Score 6 out of 6, 10% weight, mentioned 5times, but not in relation to the currentregime

    This day I am not happy with any thing butduring the Haile Selassie regime I was happywith life

    9 See also Johnson et al. (1995) on environmental resources in Nepal; Woodhead (1998, 1999, 2001) onchild labour; Ennew and Plateau (2004) on physical punishment; and Boyden and De Berry (2004) onreintegrating child combatants.

    18 L. Camfield et al.

    123

  • International Resilience Project (Ungar and Liebenberg 2005, www.resilienceproject.org), which examined how young people grow up well in 14 challenging environ-

    ments, despite exposure to what local informants characterized as atypical levels of risk,

    using culturally appropriate methods such as talking circles, and

    Negotiating resilience study, which applied the day-in-a-life methodology to the livesof 1315 year olds in matched sites in Canada, China, India, South Africa and Thailand

    who are making successful transitions between two (and possibly more) culturally

    distinct worlds (Didowsky, pers. comm.)

    All these studies seek relatively unmediated access to childrens perspectives and expe-

    riences (for example, by using video diaries), and involve children and/or significant adults

    from their families and communities in interpreting the data. For example, teenage par-

    ticipants in Negotiating Resilience are asked to discuss both their own video tape and atape from a child of the same gender in a paired research site and reflect on any similarities

    or differences (e.g. Saskatoon in Canada and Cape Town in South Africa were paired as

    both contain young people in ethnically-based informal settlements). This encourages

    participants to interrogate their own ideas about what constitutes wellbeing, in the context

    of examples from another country where similar challenges are responded to in a very

    different way.

    As discussed earlier in the paper, a key finding from participatory research with adults

    in developing countries is that the quality of interactions and relationships matter as much

    to peoples wellbeing as the quality of their assets. This is especially true of family and

    community relationships which are both intrinsically and instrumentally valuable (Devine

    et al. 2007) and have positive and negative dimensions (Wood 2003). Johnston (2006)

    generated similar data with children when she used participatory poverty trees in a

    collective exploration of childrens ideas about the causes (roots) and outcomes (fruits)

    of poverty. For example, Johnston found that the quality of family relationships featured in

    childrens definitions of poverty, and having parents who were absent or still very young

    was identified as one of the causes of poverty. Incidentally, the similarity of responses to

    questions about poverty and wellbeing in developing countries seems to support Jones and

    Sumners premise that the distinction between the two concepts is perhaps overdrawn

    (2008). It suggests that the concepts may be linked in the minds of both researchers and

    respondents through a positive/negatively connoted dualism [of] well-being/poverty

    (Neff and Olsen 2007, p. 12), in the same way that when people are asked to describe the

    experience of wellbeing, they invariably list the resources required to attain it.

    Fattore et al. (2007) also used group dialogues, combined with individual interviews and

    self-directed task-oriented projects (for example, keeping a visual journal) to understand

    what Australian children (aged eight to 15) saw as positive well-being. The goal of the

    study was to identify new or important indicators to monitor the well-being of Australian

    children, for example, feeling valued and secure in relationships, being a moral actor in

    relation to oneself and others, and being able to make choices and exert influence in

    everyday situations. Young Lives similarly used participatory methods to explore childrenswellbeing (Crivello et al. 2008) through group exercises and individual interviews with

    children and adults, which built on their previous participation in the group exercise. The

    exercises produced voluminous data on important components of wellbeing during pilot-

    ing, especially from older children and caregivers, and showed surprising regularity across

    respondents and contexts (for example, community focus groups vs. individual interviews).

    Key themes that emerged in all countries were the importance of family support, education

    and recreation, good social relationships, and good behavior. The inclusion of good

    Wellbeing Research in Developing Countries 19

    123

  • behavior may relate both to its role in facilitating smooth social relationships, and prob-

    lems in the translation of wellbeing, which often gave it a strong moral tone. Common

    indicators of illlbeing were also predominantly social and respondents even described

    material indicators such as dirty clothes or irregular meals as reflecting a lack of care and

    support (Table 3).

    As an illustration of the potential of this approach, we describe a wellbeing exercise

    conducted with boys aged 1113 in Addis Ababa, Ethiopia (October, 2007). The example

    underlines the importance of comprehensive note taking as the most surprising insights

    came during the discussions of each childs presentation (described below). According to

    the researchers notes, the first child to present (a 12 year old boy) was an orphan. He

    emphasised that a child that is doing well has both parents. He has a house with many

    rooms, CD [player], and TV. He has a good variety of food prepared for him by his parents.

    The child goes to entertaining places with his parents. He goes to a school that has a field

    and equipment for kids to play on such as a shertete (slide), jiwajiwe (swing), and merry-go-round. The school is not far [from his home], it has good classrooms and clean toilets

    for boys and girls separately; and it also has a library. The presenter characterised a boy

    who is not doing well as having no parents and living alone. The roof of his house has

    holes so during the rainy season, water goes into the house and as a result the boy gets sad

    and cries. He doesnt go to school and does not have any food to eat because his parents are

    dead.

    The other participants raised a number of questions about the boy who was doing badly,

    for example, why isnt he helped by relatives or neighbours? (answer: people do not get

    close to him because he has dirty clothes), why cant he do paid work such as shoe

    shining? (answer: there is no-one to buy the boy polish for the shoe shining), why cant

    he get help from an NGO? [Non Governmental Organisation] (answer: no-one gets close

    to him so he doesnt have any access [] no-one can prove his problems to the Kebele[local authority] or NGOs). One participant observed that the child who was doing well

    didnt have a school bag to carry his books, which seemed incongruous, but the presenter

    responded does living well means being rich? No, living well does not mean being rich.

    The two most important indicators for wellbeing ranked by the participants were getting a

    good education, because education is key to achieving wellbeing, and having a good

    family that can advise the children. Getting a balanced diet was only slightly less

    important because if a boy does not get a balanced diet he would not understand what he

    learns. The four indicators of illbeing generated during this exercise (being an orphan,

    lacking family support or proper follow-up, leaving school, and bad behaviour) were

    considered equally important and interlinked, for example, leaving school led to bad

    behaviour as a child who does not learn will finally be a thief. The participants were also

    asked how the situation of the child who had the worst life could be improved. Apart from

    one mention of basic needs, their responses centred around relationships (advice and moral

    education, receiving care and support from family, having positive role models and

    avoiding bad boys, and good relationships with family and neighbours) and the childs

    own agency (studying and working hard, being obedient, sensitive to others needs, and

    disciplined) (Wellbeing exercise, October 2007).

    2.4 Studies with Children Using Mixed Methods

    Developing wellbeing indicators based on childrens experiences and perspectives is ben-

    eficial from an analytical as well as an ethical perspective as children are usually the best

    source of information on their daily activities (Ben-Arieh 2005). They can also provide

    20 L. Camfield et al.

    123

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    Wellbeing Research in Developing Countries 21

    123

  • reliable information on other aspects of their lives and children as young as seven can

    engage with abstract concepts such as children and human rights (Melton and Limber

    1992). For this reason the Psychosocial Working Group (http://www.forcedmigration.

    org/psychosocial/PWGinfo.htm) used child-focused qualitative methods to develop a cul-

    turally appropriate measure of psychosocial wellbeing for use in post-conflict Afghanistan

    (2005). Davis et al. (2003) initiated the process by combining intensive participatory

    methods with children (the Childrens Ideas Project) and focus groups with parents and

    grandparents to learn how war-affected children in Kabul experience and understand their

    situations. Wellbeing was understood by respondents in four separate senses: as an ideal, as

    hoped-for achievements, as a standard for the important things in childrens lives, and as

    the qualities that children should develop (ibid, p7), and was centered on the local concept

    of Tarbia which refers to childrens manners and the quality of their relationships withothers. A second study two years later (PWG 2005) developed and administered a 23-item

    questionnaire based on Davis et al.s findings, which was used with children and adults to

    assess the effect on psychosocial wellbeing of three types of intervention (psychosocial,

    water, or a combination of psychosocial and water) and was combined with qualitative and

    participatory research and a sub-study on means of coping. The value of a mixed methods

    approach is illustrated by the fact that the quantitative and qualitative research presented

    contrasting results. Both considered the combined intervention the best, but the quantitative

    measure rated water only as almost as effective as the combined and psychosocial only

    as ineffective, while the qualitative results supported the value of both. For example,

    children said that the psychosocial intervention helped them communicate with parents and

    reduced beatings by teachers. The qualitative results also highlighted the gendered nature of

    risk and coping and enabled exploration of the differences between the sites identified in the

    quantitative results, which were hypothesized to relate to their internal cohesion and level of

    initiative in helping children.

    Another example of combining qualitative and quantitative comes from Young Liveswhere econometric analyses of panel data from Ethiopia demonstrate that children who lost

    one or both parents early on are not only resilient, but may have better cognitive and

    educational outcomes than their peers (Himaz and Camfield 2009). This surprising finding

    challenges the homogeneity of the administrative category orphans and other vulnerable

    children (Meintjes and Giese 2006) and draws attention to the importance of timing in

    predicting the effects of key events. Young Lives integrated data set enables the processesbehind it to be explored with descriptive statistics and qualitative case studies using data

    from multiple sources (see Crivello et al. 2008).

    3 Conclusion

    While the authors perspective on mixing methods can be summarized as whats the

    alternative? it would be unwise to ignore the challenges this involves, especially on

    international collaborative projects. Some methodological cautions with using qualitative

    methods in studying wellbeing in developing countries include their lack of credibility with

    certain audiences (for example, local policy makers) who may be more familiar with

    aggregate statistics. It can be difficult to find local researchers and translators with qual-

    itative experience, due to the absence of qualitative research infrastructure in developing

    countries, and consequently data collection is costly. Even qualitative researchers who

    speak the local language/s cannot participate in every research interaction during a large

    scale project, which means interpreting some field data second-hand. This is a challenge

    22 L. Camfield et al.

    123

  • even when the data is transcribed and accompanied with detailed field notes. A further

    potential loss of meaning occurs from working through an interpreter or with translated

    data, which means that is difficult to share qualitative data through data archives. Finally,

    qualitative approaches generate an enormous amount of data for analysis and even with

    qualitative data analysis software it is hard to share analysis across the team and ensure

    transparency and accountability in the conclusions drawn.

    More participatory work presents further challenges and some authors have expressed

    discomfort with its recent entry into the mainstream, emphasizing that participatory

    methods can also be top-down and extractive. Other concerns are that the emphasis on

    community consensus rather than individual priorities may provide cultural context at the

    expense of individual experience, emphasise public goods over private (e.g. services rather

    than family relationships), or marginalize minority interests. There is often a pronounced

    framing effect from its link to development practice, and starting from poverty may

    miss the opportunity to understand peoples lives in their own terms. Finally, there are

    great variations in the quality of participatory research and the extent of participation that

    are not always apparent from the project reports. The challenges described in relation to

    qualitative methods also affect studies using mixed methods where researchers have to

    overcome unhelpful dichotomies (for example, between hard and soft data), intellec-

    tual-stereotyping, and disciplinary conflicts, which are often exacerbated by institutional

    structures. Finding researchers with a sufficiently broad skill-set is also challenging

    (especially in the study countries); as is the meaningful combination of data in analysis

    when the data collection was underpinned by different epistemologies. The need to

    evaluate and reconcile findings from different methods also necessitates a common means

    of establishing validity, which may require more inclusive criteria (see Sumner and Jones,

    this issue).

    The examples provided in the paper demonstrate the value of qualitative research in its

    own terms, despite the above challenges, but have they answered the more pressing

    questions of what researchers more familiar with quantitative methods can learn from

    qualitative approaches, and how they can use them in their work? We advocate a pragmatic

    approach that engages on three levels:

    (i) with qualitative literatureethnographies, social history, reportage, novelsto gain a

    fuller understanding of peoples contexts and influences;

    (ii) with the skills and knowledge of multi-disciplinary teams, which involves

    understanding and respecting the world view of other researchers as well as

    respondents; and

    (iii) with qualitative methods, which used strategically can both enrich and improve the

    accuracy of quantitative data.

    For example, if a researcher wanted to adapt a measure of childrens subjective wellbeing

    for use in schools in Addis Ababa, a good place to start might be Poluhas detailed

    ethnography of the Ethiopian school system (2004), or Tekolas research on the experi-

    ences of children in Addis Ababa (2008), or findings from any of the cross-sectional and

    longitudinal studies that have worked in this area (e.g. Young Lives, WeD). The measurewould need to reflect the different competencies and experiences of school-aged children

    and the characteristics of the setting where it was administered. It would need thorough

    pre-testing to ensure the validity of the content and method of measurement, and it might

    be prudent to check conceptual validity (Herdman et al. 1998) through exploratory qual-

    itative work. Cognitive debriefing would be helpful and might throw up unanticipated

    problems, which would be resolved through discussion with key informants and local or

    Wellbeing Research in Developing Countries 23

    123

  • country-specific researchers who could set responses in their cultural context. Finally,

    when interpreting the data it might be useful to complement it with other sources,

    especially qualitative sources, so that the dynamics, complexity, contradictions, and

    diversity of peoples positions can be understood in a nuanced way. It is likely that

    personal and family health, community involvement, and cultural capital may all con-

    tribute to well-being and that transport, insecurity, vulnerability and family worries may all

    contribute to ill-being [] but these are each in turn construed differently from place toplace and from time to time (Neff and Olsen 2007, p. 18).

    Acknowledgements The authors thank the participants in WeD and Young Lives research, as well as thecountry researchers who generated much of the data referenced in this paper. Elaine Chase providedinvaluable comments on an earlier draft of the paper. In relation to WeD, the support of the UK Economicand Social Research Council (ESRC) is gratefully acknowledged. Young Lives is funded by the UKDepartment for International Development (DFID) and based on a collaborative partnership between theUniversity of Oxford, Save the Children UK, The Open University, UK, and a series of prominent nationalresearch and policy institutes in the four study countries.

    Appendix 1

    Table 4 Comparison of the characteristics of wellbeing, illbeing, and poverty found by selected partici-patory studies in rural and urban communities in developing countries (Camfield 2006)

    WeDa

    Bangladesh, Ethiopia,Thailand, Peru

    Moore et al. 1998South Asia

    Consultations with thePoor 2000b

    Over 50 developingcountries

    Brock 1999c

    12 developingcountries

    Infrastructure and services

    Basic infrastructure Govt.and NGO services

    Security (civil peace, aphysically safe andsecure environment,personal physicalsecurity, lawfulnessand access to justice,security in old age,confidence in thefuture)

    Clean environmentBasic infrastructure and

    servicesCommunity relationshipsNeighbourhood violence

    Home

    Good house (e.g. water andelectricity, furniture)

    Secure access tohousing (urban)

    Quality of homeDomestic violence

    Economic security/Material wellbeing

    Economic stability/needsatisfaction throughlivestock and farming and/or business activities andemployment

    Land and other assets

    Land/assetsDiverse sources of

    incomeType of job (urban)Food sufficiencyHousehold

    structure (e.g.adult malelabour)

    Material wellbeing:having enough

    (food, assets, work)

    Access to employmentWork and working

    conditionsMoney and assetsLandAccess to natural

    resourcesFood securityResilience in response to

    seasonality and shocks

    24 L. Camfield et al.

    123

  • Table 4 continued

    WeDa

    Bangladesh, Ethiopia,Thailand, Peru

    Moore et al. 1998South Asia

    Consultations with thePoor 2000b

    Over 50 developingcountries

    Brock 1999c

    12 developingcountries

    Education and Health (physical and mental)

    Health (self and children)Education (self and children)

    Education Bodily wellbeing: beingand appearing well(health, appearances,physical environment)

    Psychological wellbeing(peace of mind,happiness, harmony,including a spirituallife and religiousobservance)

    HealthPeace of mind

    Respect

    RespectGood appearance

    Respect and acceptancefrom others

    Freedom from responsibility, independence

    Independence (specificperiods and relationships)

    Freedom of choice andaction

    Having choices; not beingin relationships ofdependency

    Feeling able to act andhave some control overthe outcome

    Family relationships, community relationships

    Relationships within thehousehold and extendedfamily

    Having a partnerChildrens physical, socio-

    economic and moralwellbeing

    Social wellbeing (beingable to care for, bringup, marry and settlechildren, peace,harmony, goodrelations in the family/community)

    a The WeD data in the tables has been compiled from the country reports of the exploratory phase,supplemented by re-analysis of translations of the original interviews. They represent the most commonresponses, determined by qualitative and quantitative analyses and for ease of comparison, they have beengrouped into the categories of Family and Community relationships (also friendship, sociability, goodcharacter/ behaviour, preserves social harmony, helping/ supporting each other, participating in communitydevelopment), Economic security/ material wellbeing, Education, Health (physical and mental), Freedomfrom responsibility, independence, Achievements, Respect, Access to infrastructure and services, Home, andReligion, which appeared in the original country reportsb The Consultations with the Poor (Narayan and Walton 2000; Narayan et al. 2000) identified economic(risk and vulnerability) and non-economic (empowerment and participation) dimensions to wellbeing.Sources of wellbeing were grouped under five domains, Material, Physical, Security, Freedom of choice andaction, and Social wellbeing, which partially reflect the structure of international measures of wellbeing suchas the Personal Wellbeing Index (Cummins et al. 2001)c Brocks review (1999) foregrounds the experiential aspects of poverty which impact on peoples agencyand mobility; for example, fear, insecurity, dependence, shame, hopelessness, and powerlessness. Partici-pants recounted not feeling accepted or respected by others, and feeling powerless in front of officials.Changes in their environment or bodies that seemed to be beyond their control made them feel vulnerableand reduced their confidence and agency

    Wellbeing Research in Developing Countries 25

    123

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