Abstract
The field of public health has long sought to improve health and well-being. Originally incorporating socially embedded views of health, the field of epidemiology has largely abandoned this perspective in exchange for statistics-based approximations in population health research. However, a new movement in public health has been gaining momentum slowly that legitimizes other ways of approaching this research. In particular, value has been placed on lived health experiences, and supporting both social justice and community-based health research. By challenging the epistemological grounds of traditional epidemiological research, an argument is put forth for a constructivist epistemology in health research. Simply put, researchers should view health within the context of the lived experience of persons. Accordingly, health research should seek to interpret and understand the ways in which people construct definitions about health and their decisions related to pursuing care. Only through this interpretive understanding can relevant interventions be devised. This theoretical argument is applied in a yearlong qualitative study of a community in the Dominican Republic. The research goal is to understand the construction of health and resultant health-relevant decision-making in the community. The specific community is a former sugarcane plantation (batey) populated mostly by people of Haitian descent. This community was chosen as the study site, in part, because of the economic and social marginalization of these persons, in relation to the larger Dominican society, largely due to contention between Haiti and the Dominican Republic. The study is conducted from a phenomenological perspective that supports a constructivist methodology. The motivation of the research is founded in a social justice perspective and, as such, is informed by a community-based approach. The analysis of interviews, contextualized by the researcher’s participation in community life, revealed ways in which experiences both inside and outside of the health system influence how these persons construct their definitions of health and the decisions made about appropriate care. Five main themes emerged that open a path for an outsider to understand how persons make sense of their health and that of their families. First, people define health in broad socioeconomic ways. Second, their immediate worldview often becomes normalized, thereby obscuring other possibilities. Third, limited resources shape the ways in which people make decisions regarding health. Fourth, decisions that reflect the greater socioeconomic context carry meaning for their daily lives and current situations. And finally, gender norms and expected roles were an organizing influence in many person’s lives in ways that affected their health. These analytical findings led to several broader conclusions. Primarily, people engage in an active epistemology and construct their definitions of health. This process must be appreciated by planners who hope to achieve effective health interventions, especially in marginalized communities. Holistic approaches must be employed because a.) people conceive of their health broadly and b.) many aspects of life influence health beyond what is considered traditionally to be relevant. Appropriate holistic approaches to improving health can be developed only after their biographies vis-à-vis health are understood. Accessing these narratives is a crucial point of entrée for health researchers, in order to enter the lebenswelt (life-world) of a community and develop appropriate health improvement projects.