Is it Heuristics in Use or ‘Ritualistic and Instrumentalist’ in Purpose? Neoliberal Philosophy and the Use of KAPS (Knowledge, Attitude and Practise Surveys) in a Least Developed Nation



Avaniendra Chakravartty*
B.P.Koirala Institute of Health Sciences, School of Public Health and Community Medicine, Dharan, Nepal


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© 2018 Avaniendra Chakravartty.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence: Address correspondence to this author at the B.P.Koirala Institute of Health Sciences, School of Public Health and Community Medicine, Dharan Nepal; Tel: 025-525555; E-mail: avaniendra@gmail.com


Abstract

Background:

Isms affect the way we think, define, approach and seek to understand and solve any particular issue or condition. The particular ism that prevails currently has been labeled as neoliberalism. Here the ways that researchers use KAPS for various health issues or conditions and the extent to which it is connected to the existing reality along with its pragmatic utility are assessed. Based on how heuristics is conceptualized the use of KAPs is heuristics in use. The primary task of this article embarks is on determining whether the researches using KAPS has any heuristic purpose or is it just fulfilling some self- centered ritualistic and instrumentalist objective. The focus here is on Nepal but that does not mean that the arguments made here is not applicable to other nations that have similar socio-economic conditions.

Methods/ Findings:

The data selected here are researches done by an epistemic community presented in two national conferences. The methodology followed is based on dialectical reflexivity and the approach adopted is auto-ethnographic. The dominance of procrustean, atomistic, dehistoricized, reductionist and individualist philosophy that deemphasizes structural relations is seen. The incorporation of neoliberal values has created a trend where researches seem to solely serve ritualistic and instrumentalist purpose.

Keywords: Isms, KAPS, Neoliberalism, Heuristics, Ritualistics, Instrumentalist.



1. BACKGROUND

This article focuses on the use of KAPS by an epistemic community and attempts to discern whether it has a heuristic use and purpose or is it just serving some ritualistic and instrumentalist purpose. Ritualistic or instrumentalist is concerned with positions (or perspectives on the world) that are more ‘useful,’ and hence, more ‘correct,’ than others in facilitating the accomplishment of one’s individual goals. Universities are marketers of knowledge rather than primary producers of knowledge and the individual academician has to work in a competitive work environment where the 'publish or perish culture’ [1] prevails and selling or promoting one’s self is highly desirable. Instrumentalization forces the researcher to see research only as a means to achieve certain specific needs for personal benefits. The reification of research makes researchers to undeniably follow the relentless laws of the market and leads researchers to leap from topic to topic in search for funding rather than following a sustained, self directed research program [2]

KAPS has been in use since the 1950’s and since then its use has increased manifold. KAPS was initially used in family planning and population studies but over the time it has been used for understanding community perspectives regarding various issues, conditions and behavioural practices, moreover, the beginning of an international aid driven approach towards development and the need for monitoring also led to an increase in using KAPS and even today it is a popular method adopted. The author is not questioning its validity and neither has any doubt about its reliability and use in various contexts. But, like any other methods or tools it too has limitations, and if used in certain contexts based on the existing reality of the researched sample, it tends to create findings akin to ‘epistemic pollution’ [3] or even ‘bullshit’ [4].

Based on the characteristics of heuristics, the use of KAPS is application of heuristics. The Oxford English Dictionary defines heuristics as methods learnt from experience to solve problems by finding practical ways to deal with them. Shah and Oppenheimer, have proposed that all heuristics possess either one or more processes for effort reduction such as - examining fewer cues, reducing the intricacies linked with retrieving and storing cue principles, simplifying the weighting principles for cues, integrating fewer information and probing fewer options. What is called as heuristics can differ from researcher to researcher and also many heuristics exemplify a variety of different characteristics. Heuristic assumptions do not signify reality since by their nature it is restricted to a sample of the whole that is supposedly representative of the whole, but even then its use is inevitable [5]. Different individuals can use different heuristics to approach a common issue and this difference in selection of heuristics depends primarily on the individual’s experience. Heuristics is purely a practical act but its selection, and use is based on one’s philosophical assumptions.

Philosophical assumptions underlie all research and they shape the research question, hypotheses, methodology, method, finding and recommendation. Though philosophical assumptions shape all the components of a research they are mostly invisible and remain so unless made explicit by the researcher or until a philosophical analysis of it is done and which is what we are trying to do here. Philosophizing is an important activity and to philosophically analyse and critique a research means to look at the different stages of research based on logical argumentations and reasonableness. Research philosophy itself comprises broadly of the ontological, epistemological and axiological which results in the methodology and the methods. Other terms such as paradigm, worldview, theoretical have also been used with more or less the same meaning. The philosophy that exists at any given time is an outcome of the prevailing ideology, ism, structure, worldview or belief system. The ism that exists and shapes the current world order has been identified as neoliberalism.

Unlike many other isms, neoliberalism does not usually reveal itself and neither is it visible to an individual, no matter what their qualifications are. The users of the term have been labelled as having Trotskyite tendencies, but the author contends that the word neoliberalism has been used by individuals from varied ideological and philosophical leanings. The central presupposition of neoliberalism consists of the ‘rational self-interested individual’, 'free market economics’, a ‘pledge to laissez-faire’ and a pledge to ‘free trade’ [6]. Neoliberalism has formed our cognition and it promotes, ‘neoliberal ideologies that stresses individual-level resolution making about economics and healthcare [7]. Neoliberal vision and application has unswervingly implicated in shaping the way health is promoted [8] and beliefs are shaped [9]. The human being is transformed into an entrepreneur (self-entrepreneur) who is in rational pursuit of self-interest and seeks maximisation of expected-utility. Also looking for opportunism in all settings, optimising behaviour and strategic behaviour should be pursued by all humans in the market. Neoliberalism regime has been described as a wicked and exacting environment [10] for those that do not follow its ways.

Various works on neoliberalism and its influence on different entities such as, ‘neoliberal governmentality’ [11-14], ‘neoliberal technologies’ [15, 16], ‘neoliberal philosophy’ [17], ‘neoliberal citizen’ [18] [11], ‘neoliberal logic’ [19-22], ‘neoliberal university’ [23-25],’‘neoliberal academia’ [26], ‘neoliberal subject’ [27-29],’ neoliberal strategies’ [30-32], ‘neoliberal reforms’ [33-35] and ‘neoliberal axioms’ [36], have been conceptualised.

2. RESEARCH UNDER NEOLIBERALISM – ASSUMPTIONS AND TRAITS

2.1. Assumptions

Neoliberalism forwards a belief system that lay the foundations from within which the assumptions and traits of a research are shaped. The ‘procrustean systems framework’, ‘stochastic approach’, ‘ceteris paribus clause’, ‘tabula rasa’, ‘bounded rationality’ and the ‘mutatis mutandis assumptions’ are some adjectives that have been used to describe the conditions under which both research and researcher are bounded to. The ‘neoliberal axioms’ create a ‘neoliberal myopic’ gaze and researchers are trained at ‘locating the cause and cure of disease solely within the individual’. The neoliberal researcher ‘steps out’ of the world they are researching under the pretext of value-free and unbiased approach. The neoliberal researcher proceeds with the assumptions that all individuals are rational, entrepreneurial, interest seeking, profit making and the whole ensemble of individual life is to be structured in the pursuit of a range of enterprises’.

Assumptions are the bedrock on which researchers build their objectives, research questions, hypothesis and justifications. Research like any social practice, is guided by basic beliefs and assumptions about the nature of reality (that is, ontological assumptions), the nature of (scientific) knowledge of reality, how such knowledge is acquired (epistemological assumptions), and what makes up valid research [37]. ‘Scientific knowledge is established upon a set of tacit convention, beliefs and assumptions which is not different from every day, common sense knowledge. What makes science different from common sense knowledge is due to the nature of rules which recognises these assumptions and subscribes to them. The key to ensure focus, tractability, understanding and comparability in research are logically developed assumptions [38].

Though, assumptions are preordained, the level of understanding and interest of the researchers often limit the selection of specific assumptions [39]. All research proceeds by ‘assuming away’ the incomprehensible through building a framework of inferred knowledge based on that which is recognized with a hope that what is ‘assumed away’ is not crucial to the research questions under study [40]. The assuming away’ [41] is based on various factors, contexts and the philosophical underpinnings of the concerned researcher. Assumptions are inevitable and different levels and types such as the ontological assumptions [41-46], epistemological assumptions [47-50] [51], methodological assumptions [52-54], axiological assumptions [55], fundamentalist assumptions [56] [57],observability assumptions [58, 59], consilience assumptions [60], depoliticizing assumptions [61], social world homogeneity [41], in-house assumptions [62], atomistic assumptions [56], rationalist assumptions [63], taken for granted assumptions [64, 65], and the ‘neoliberal assumptions’ [66] within which all of the above and few other types of assumptions which the author might have missed exists. Though assumptions are inevitable many assumptions can be illogical, unwarranted, spurious and misleading.

2.2. Neoliberal Traits of Research

This section focuses on the characteristic features of research that emerges under neoliberalism and has been identified by others around the world. The philosophy of neoliberalism instils an individualistic gaze which rarely sees beyond individual’s behavioural practices when doing research, making recommendations and creating knowledge. There are no fixed numbers of traits identified with neoliberalism and these traits can vary in time between regions, disciplines, epistemes, nations and even within a nation. The neoliberal traits chosen here are those that correspond with the author’s existentialist, pragmatic and empirical experiences. Neoliberalism touches all aspects of life and research work is no different. Under neoliberalism, researches display the traits as follows positivist [67-69],reductionist/individualist [70-72],objectivist [73-75],decontextualized [76-79],depoliticized [80-81],dehistoricized [82],dissocialized/desocialized [76, 83, 84],deproblematized [85, 86],instrumentalization [87-90],separation [2, 88, 91],detached [92-96], marketisation [1, 32, 97, 98], naturalization [99-109], subjectification [14, 16, 110],invisibilisation [70, 90, 111], and normalisation [112-122].

Not all the sixteen traits will be affecting a single research and particular traits as positivism itself is not an indication of the effects of neoliberalism. Sometimes one may find a research giving a true picture of the reality in quantitative facts, but if it is devoid of any pragmatic purposes or needs based on the existing reality at the ground level, the research can be said to be affected by research traits of neoliberalism. For instance how useful would it be if a research on assessing knowledge about uterine prolapse among women in a community who have to carry water on their back from a kilometre away was done, and recommendations made that awareness raising about not carrying heavy objects along with behavioural change interventions are needed? The neoliberal traits can influence a research at different levels of its conception and when the philosophy of a researcher is shaped by them, researchers tend to produce researches that are aloof from the existing societal conditions of the population it studies.

3. UNDERSTANDING AND CONCEPTUALISING THE RESEARCHED

Understanding the researched sample thoroughly is vital for any scientific enquiry but the decision on what needs to be researched and why is also crucial. Both problem identification and solution recommendation has been a perennial task of research and more particularly for researches done on health conditions. However, before any particular problem is identified and any solution recommended it is essential to know the existing conditions, for without an in-depth understanding the whole endeavour becomes very superficial in nature. Here the focus is on the research papers presented in two conferences. The research paper is an outcome of the philosophical underpinnings of the concerned researcher or a team of researchers. The research and researcher is not just an independent mereological product, rather both are affected by ‘dispositifs’ existing at the proximate and distant levels who through the use of related ‘apparatuses’ and ‘technologies’ create and maintain certain research traditions and practices.

The individual research presentations made at the, ‘First (2015) and ‘Second (2016) National Summit of Health and Population Scientists’ organised by the NHRC (National Health Research Council) are the most basic and primary form of data here. The researched here are those researches or studies that have used the KAP Survey methodology to know about various existing conditions. Various other methods of sampling could have been done but the author reasons that selecting an epistemic community and philosophically assessing their research presentations or which can also be called an epistemic object can provide insights into the ways policies are made, into the ways problems are perceived and solutions proposed. Based on the features that describe an epistemic community the researchers, scientists, professionals and health workers who made presentations at the conference organised by NHRC can be collectively described as an epistemic community. An ‘epistemic community is politically neutral’ ‘is closely incorporated, restricted in number, with great continuity and members have approximately equal status and power’, [123] ' its members have no particular history as a whole, but share ideas’, [124] ‘plays a strong role in shaping which policies are selected in highly specialized policy arenas’, and they also produce policy-relevant knowledge about intricate technical issues and combine various characteristics, political initiative and scientific objectivity’ [125] [126] in issues surrounded by uncertainty and the data they generate has to offer answers (in reply) to specific issues; they have to produce utilizable knowledge' [127].

Mainly ‘four central aspects—shared underlying ideas, shared principled philosophies, shared ideas of legitimacy, and a general policy enterprise’ characterise an epistemic community’ [128]. Epistemic communities arise from different epistemes. Foucault defines episteme, retrospectively, as the strategic apparatus that allows filtering out from all possible statements those that are acceptable within scientificity (not scientific culture) and of which one can say that they are true or false. The episteme is the “apparatus” that enables separation, not the true from the fake, but what can and cannot be characterized as scientific and non-scientific [129]. Epistemes give continuity and maintain the epistemological prior assumptions that establish what is recognized by the society as ‘justified true belief’ or knowledge in any historical epoch. It has also been described as a ‘unitary body of theory’, which tends to privilege some knowledge whilst subjugating certain others and ranking them low in its hierarchical paradigm. Epistemes are formed through an inner structure which is given in things as the inner law and hidden network [130].

Basically, episteme is the “historical a priori that bases knowledge and its discourses and embodies the condition of its prospects within a particular historical milieu [131]. Epistemes are ‘comportments of justifying, elucidating, resolving problems carrying out enquiries, designing and verifying different types of products or results’ [132]. An episteme informs our manner of perceiving which is our world view or Weltanschauung. Leading epistemes or world views get articulated to some extent by establishments, such as healthcare, and through specific scientific disciplines such as public health, endocrinology, psychiatry etc [132].

The epistemes that exist are the result of various historical, social, political, economic, and cultural factors. Though the influence of the present worldview is most on an episteme, the historical processes cannot be excluded when trying to understand an episteme, an ‘epistemic process’, an ‘epistemic culture’ and an ‘epistemic object’. The historical stage that Nepal went through was different from countries that were colonised. Though Nepal was never colonised it has been affected by it and its remnants can still be seen for instance in ‘lahure’ (armed forces) recruitment. The 100 years purpose isolation of Nepal and its people by the Rana oligarchy which also got tacit support as a result of the pact with the East India Company and later the British government led to a condition where ‘nothing happened’. In the 1950’s, when the oligarchic rule ended the literacy rate in 1950 was approximately two percent [133].

The dismal educational and economic conditions led to high dependence on other nations. The year 1956 marks the actual beginning of the modern era in the history of educational planning in Nepal. When education did begin all the disciplines were adopted from neighbouring India which in turn was principally following, that Paulo Freire called the banking system of education. Under the banking theory Freire believed that students were seen as passive objects to be influenced by the teacher, and he further argued that banking edification demobilized people in the existing power realm by making them adopt the dominant cultural, social, political status quo of the prevailing culture. Along with a rigid caste system, poverty, illiteracy and its ruling elites seeing its citizens as commodities to be sold and consumers to be sold to, the nation as a welfare concept has largely been absent.

Since 1950’s when Nepal first opened itself up to the ideas of modernity to the present a lot of changes have occurred. Professions that were the domain of only foreigners earlier have been adopted by hundreds and thousands from the native population. The university is where higher education level is available and also researchers acquire their skills. Over the years beginning from the 1980’s and 1990’s the nature of these universities have been transforming itself in tune with ‘neoliberal reforms’. The neoliberalised universities are seen to be displaying characteristics like, ‘reduction in public funding for universities’, ‘separation of teaching and research with the latter increasingly privileged as a source of external revenue’, ‘the replacement of peer review with market-based mechanisms’, the ‘tyranny of relevance’, and the ‘formidable strengthening of intellectual property protections’ [2].

The existing neoliberalised university system has a ‘performance paradigm’ that has researches completed as a key ‘performance indicator’. The universities and its changing nature has been characterised as, ‘schizophrenic’ or ‘multiple personality disorder university’ [134] and when universities are seen through concepts such as ‘epistemic violence’, ‘epistemological violence’, ‘structural violence’, ‘ontological violence’, universities seem to embody a transnational elite that lay down the standards that must be adhered to for anything to be considered worthy of scientific recognition and to be accepted as knowledge. The tripartite partnership between the government, university and industry has been conceptualised as ‘Triple Helix’ system where market based values hold prominence. The ‘Triple Helix’ is country specific, regional specific, and discipline specific and even university specific. Despite its variability the ‘Triple Helix’ creates one common role of universities around the world, which is its role as a ‘supplier of knowledge and human capital’ [135].

The human whom themselves are a capital and many a times also an investment in a neoliberal system has to use the skills acquired to generate more capital (publications, workshops, grants, inventions, patents) and as a result a higher position. Here the focus in on research and researcher who eventually compose an epistemic community. Epistemic communities have their own levels of connections where some maybe more international in scope where it comprises of researchers from all over the world and there may be others who may be restricted to a nation or a couple of nations. The epistemic community that NHRC brings together is national in scope though a handful of researchers were from Bangladesh and India. Here the particular epistemic community discussed focuses on researches done on health issues which have social, cultural, political and economic relevance which further influences the way policies are planned, solutions sought and it influences public perceptions too.

Way back in 1979 in the first edition of the book, ‘Use and misuse of social science research in Nepal’ the authors raised the issue about misuse of researches and the dominance of the questionnaire method that was prone to fabrication [136]. After more than four decades when the second edition of the book was published the authors lamented that ‘the country of Nepal passed through various changes at the social, political and economic levels but one thing remained in practise which is the ‘development agencies and projects for the most part continued to use, indiscriminately and uncritically, questionnaire surveys to gather information for their policies and projects in Nepal’ [136, 137]. More recently others have also expressed the fact that the vast preponderance of articles were on quantitative research, generally questionnaire-type surveys [138]. Views that public health needs a paradigmatic shift [138] and calls for making health a public health agenda has also been made [139]. Others have discussed issues that echo a political economy of research approach such as – on sources of funding, setting of the research agenda, review costs, research capacity development of Nepal, research findings and the politics behind it and issues related to upcoming ethical and regulatory agendas [140].

Lately, others have shown that public health research has largely focused on family planning, HIV/AIDS, sexual and reproductive health, maternal health, women’s health, nutrition, child health and general health, each representing roughly eleven percent of the overall publications [141]. The vast preponderance of researches was quantitative in nature, by and large questionnaire type surveys and the qualitative researches few in number were based on face to face interviews and focus group discussions [141]. Researchers and the amount of research done have increased not just in Nepal but all over the world and this increase can be attributed to the setting of new audit criteria that values the number of publications and the amount of external research grants generated when evaluating a faculty for promotion also many researches are planned and done by various organisations for acquiring grants as a result of which satisfying the criteria of grant making bodies become more important even if it decreases its relevance to the local context. The incorporation of the, ‘publish or perish’ belief has facilitated the mechanisms through which the individual pursues a range of enterprises that must be done in order to achieve a particular goal. The ‘neoliberal self-enterprise technologies’ adopted views individuals as makers of research and generator of funds and their advancement depends on fulfilling the set criteria.

Neoliberalism has been very supportive of studies that are reductionist and methodologically individualist but, neoliberalism itself does not affect only a part of a system. In fact when any system is neoliberalised the whole ensemble of that system is affected. Here when discussing on research the higher educational environment is crucial in the way researchers are trained. The current BPH (Bachelor Public Health) and MPH (Master Public Health) curriculum provides students with a hands-on understanding of health systems and trains them to work as district public health practitioners, but does not sufficiently train them to work as an academicians, researchers and public health leaders’ [142], this phenomenon can also be seen in other health science disciplines.

Depending upon the social, economic and political situation of a nation, the quest for free-market reform and neoliberalism can have varied affects and consequences. Neoliberal values like, ‘survivor of the fittest’ philosophy has taken hold in all sectors including academic, research and education. The process of ‘ naturalisation of socially produced risk’ [143], ‘normalisation of social divisions’ and ‘neutralization of negative health impacts’ [144] are some of the processes that have been identified to have occurred under neoliberalism. Wayne Brekhus (1998) referred to this as the process of ‘unmarking’ problems so that what was marked as clear and evident becomes virtually unnoticed and, by virtue of that, ‘unremarkable’. The dominant discourse in the health professions is, ‘micro level’, ‘individualized’ biomedical ‘and ‘depoliticized’ and, ‘this belief sees health as the nonexistence of illness or disease in persons and pursues to advance quantifiable features of their lives through the reduction of risk issue via indicators of morbidity and mortality’ [144]. Those espousing this world view typically accept that efforts against disease are empirically advantageous and necessitating no additional rationalization: the epidemiology (the fact) is normally believed to ‘articulate for itself’.

In the conceptual framework, (Fig. 1) the individual forms the core that consists of a population group or cohort and various health issues and conditions affect the population. These issues and conditions are taken up by concerned researchers, scientists, experts and policy makers who belong to various disciplines and combine to become an episteme. Here the episteme as shown in figure one is encircled by neoliberalism which sets the boundaries from within which an episteme works.

Fig. (1). Conceptual framework.

4. METHODOLOGICAL FRAMEWORK

The methodological approach (Fig. 2) adopted is based on ‘dialectical and critical reflexivity’ [145], ‘critical realism’ [146], ‘phenomenological’ [147, 148], ‘existentialist’ [149]and an approach of more recent origin which the author holds combines all of the above mentioned approaches an ‘autoethnographic research’ approach [150] The type of research sample that this study deals with can also be called as a ‘discourse analyses’ and here the study follows an ‘abductive’ approach to analyse the discourse by ‘moving back and front amongst empirical data, research literature and developing theory’ to have an understanding of the structures and apparatuses that influences the way researches are done. The researches selected are individually approached by the author and by ‘interrogating, deconstructing and decentring’ [151] each research is assessed of its connection to the reality on the ground level and the extent to which the researches have a pragmatic heuristic value. The author does not ‘step out of the world’, is not ‘detached’ from the existing reality and acknowledges her/his native belongingness. The methodological steps proceed with the assumption that all the researchers based on the existing ground reality felt the importance and the genuine need for doing a research, and all the researches were done with a genuine intention towards studying things right, recommending things right and making things right.

The basic unit of focus, observation and analysis of this paper are the research abstracts presented at the two conferences. The books of abstracts are available on the NHRC website. The summit/conference brings researchers scholars’ practitioners, scientists and policy makers from all over the country. More than two hundred research findings were presented in the two conferences held in 2015 and 2016.

Findings and recommendations are the end result of all researches and based on these, viable solutions are sought, policies are made and programs conducted. The end result is the result of the research questions asked, hypothesis made, methodologies, methods followed and tools used, all of which make up the research process. But even before the first step is taken in the research process there is ‘a-prior condition’ that shapes the understanding as to what needs research and builds the rational and justification for any proposed research. This ‘a prior’ understanding of a researcher is the research philosophy which is regarded as the bedrock of any research and is implicit in all research. This implicit part that informs any research is invisible and unless made explicit by the researcher or until philosophical enquiry is done.

Any situation can be looked at from different angles and using different methods provide different types of answers. Researcher’s contradictory ontological and epistemological stances frequently lead to dissimilar research approaches to a similar case [152]. Based on pragmatism ‘the most essential determinant of the research philosophy adopted is the research query’ and it also guides the other aspects of research. The ‘ontological nature of reality’, the ‘epistemological nature of knowledge’ and the ‘axiological position of the researcher guides the ‘research questions and the hypothesis which also serves as an extension of the research question’ [153], and hence forth the methodologies, methods, results and recommendations [154]. It is impossible to do any kind of research without being (often implicitly) committed to ontological and epistemological positions [155].

The foremost step was to identify all the research abstracts having the word knowledge in its title, in keywords or if it had assessing knowledge as its objective. Altogether twenty-one research abstracts met the inclusive criteria. Each study was scrutinized and its, research objectives and the research questions were identified. The methodology and methods used to answer the research questions and fulfil the objectives were examined. And, the conclusions, discussions, recommendations made by each research were sought out. Each research was approached with the following questions.

  • What are the stated objectives, justification, rational, aim, purpose and the research questions?
  • What or who are the subjects of study of the research?
  • What are the methodologies and methods followed in the research?
  • What type of data does the methodology aim to generate?
  • What are the findings of the research?
  • What are the recommendations of the research?

The information obtained from each research was then analysed from a philosophical perspective based on an existentialist, phenomenological and empirical experiences of the author. An autoethnographic method of research approach was adopted when analysing and reflecting on each case. Based on a basic categorisation of the philosophical stages which include an ontological, epistemological and axiological part the questions asked during analysis were as follows.

  • What are the ontological assumptions?
  • What are the epistemological assumptions?
  • What are the axiological assumptions?

And

  • What are the methodological assumptions?

The first question on ontological assumptions deals with one of the most important components of our vision of the world and is so elemental that we barely question them. They are central to any investigation in any discipline [42, 43, 46]. The neoliberal ontological project takes for granted ‘homo economicus’ as primary representation for personal conduct which occur from subject’s economic rationality functioning in a world of ‘perfect information’ and ‘static concepts of equilibrium’ [104]. Neoliberalism ‘relies on individualist ontologies of calculative and calculable agency’ [156].

The second on epistemological assumptions deals with what is profoundly entrenched in the culture and world view of society and determines the acknowledgment of a crisis and if the reasons of the crisis are named [157-159]. Neoliberal epistemological approach studies the objects of inquiry by disassembling them into basic components and studies their articulations in isolation [160]. The central axiom that neoliberal epistemology holds is that knowledge is by definition fragmentary, imperfect and socially dispersed’ [161].

The third question on axiological assumptions looks at the values or moral and ethics in the research. Axiology is the theory of values, and values are facets of human conduct that developed during evolution, giving us objectives, goals and opinions that direct our actions through our knowledge [162]. Axiological orientations of researchers are applied to the concerns and problems of the real world contexts within which they work [163]. The axiological assumption of logical-positivist research is that it is unbiased in contrast to naturalistic research, in which the researcher recognizes his values and predispositions as well as the value nature of the information collected from the ground [164]. Although ontology epistemology and axiology have been presented separately, there have been claims that they cannot be considered separable, because axiology, epistemology, and ontology co-evolve [165].

The fourth question on methodological assumption is regarding how the researcher can go about finding out what it is that he or she considers can be identified, based upon aforementioned epistemological assumptions [159]. ‘Methodological assumptions specify which research methods and techniques are considered suitable for the collection of legitimate empirical proof and obviously depend on how the reality of a theory is ascertained’ [166]. Under neoliberal positivist methodology an inherent predisposition towards the individual as the nucleus of contemporary consumer culture [167], which believes a scientifically acceptable action theory has to give exact predictions and explanations exist [168]. The neoliberal methodology is determined by individualism which again is influenced by reductionism and at least 10 modes of individualism such as ontological, logical, semantic, epistemological, methodological, axiological, praxiological, ethical, historical, and political have been identified [169]. The methodological assumption is a product of the ontological, epistemological and axiological assumptions and is evident in the research questions and methodological approaches selected [170].

After all of the above steps the task to seek answers to the research question as mentioned in the title was undertaken. The principal research question was, what heuristic use and value does the research have? Or is it just satisfying some ritualistic purposes? By its nature the question is loaded with value laden notions but then all questions are value laden and more over being so does not reduce the importance of the question.

Contradictory to heuristic use is the ritualistic use of research. By ritualistic use the author means those researches that serve only some instrumentalist purpose such as improving one’s performance measures, obtaining a research grant or filling up the bio data. The author is not saying that these should be done away with and as though it can be done away with. Rather the concern is here that researchers when doing research is serving only some instrumentalist ritualistic purposes, what are the costs incurred by the society at large? Perhaps no other discipline holds the amount of ramification it can have that public health has on the everyday lived experiences at the individual and population level when, researches seemingly heuristics in use is intended only for some ritualistic purpose.

As mentioned earlier, the steps that lead to the findings are reflexive in nature, dialectical in process and critical in its approach. Reflexivity involves a ‘constant comparison method’ [171] with the existing ground reality and is not based only on any fixed canonical priors. Basically reflexivity incorporates ‘historical sensitivity’, ‘radical doubt’, ethical imperative where one is able to recognise ‘the hidden aspects of the other’s and one’s own natural understanding’ and ‘go beyond and get behind oneself and our own norms’ [119]. The ‘dialogic meditation’ in a reflexive analysis allow researchers to understand human action and human condition more closely. By incorporating reflexivity when doing research we can avoid a condition of ‘reflexive paralysis’ in which the mechanist, repetitive, ritualistic and instrumentalist trend in research is seen and by ‘systematized reflexivity’ we can avoid being ‘rational fools’ of neoliberalism.

A dialectical process in thinking involves an awareness of the broader social, cultural, political, economic and other forces that influences how one thinks. It ‘recognizes the ordered nature of culture-bound rationalisms’ or ‘regional rationalisms’ and endeavors to go past instant experience to attain ‘scientific experience’ [172]. ‘It engages consecutive experience of high and low, communitas and composition, homogeneity and segregation, egalitarianism and inequality, lesser to higher status and in dialectics the opposites, as it were, shape one another and are reciprocally requisite ’ [173]. Open mindset, intellectual inquisitiveness, suppleness, intellectual integrity, methodological skepticism, perseverance, objectivity and deference for viewpoints are the attitudes contained in critical thinking’ [174]. In the context of experts being critical involves having a flexible attitude towards learning, not believing that strategies and techniques are epitomes, includes ‘averting of atomistic outlook of logical errors in individual logic ’, has an ‘apprehension about self deception with respect to reasoning’ manages to ‘depersonalize’ one’s world-view, involves ‘capability to efficiently analyse and solve problems, explain, organise and articulate thoughts, and make logical conclusions, and to contextualize the use of these capabilities to diverse germane issues’ and engages ‘a set of logical behaviors and capabilities which have to be used, cultivated and established—but only when such a context exists [46]’. It sees reality as hierarchically stratified ordered levels and is a suitable approach for the examination of any social phenomenon [46]. Much antipathy exists from those in authority and the hegemonic epistemes and many a times the existing hegemons were also seen with antipathy by the hegemons they may have replaced.

Fig. (2). Methodological framework.

5. FINDINGS

Whether the researches had a heuristic use and value or were it just serving some individual instrumental needs of its creator or creators is a question which has to be understood by taking the existing local empirical grounded context in to account. The findings mentioned below are based on the lived empirical experiences and, from the view of a native existentialist phenomenological view. Being a native could bring various images about, who is a native? Even within Nepal we could be having an ‘etic’ or ‘emic’ viewpoint on various issues and in various regions amongst various individuals and communities. The arguments below could appeal or detest the reader, many could point at the lack of definitive scales to measure, the generalist character of the arguments and even be accused of ‘armchair research’ but nonetheless honest reflexive philosophizing is important for any discipline or even an episteme to shed its weakness and cure its myopic gaze (Table 1).

Table 1. Analysis of the researches from the first and second Nepal Health Reseach Council, Health and Population Scientists Abstract Book.
Research Title, Objectives, and Rationales Methodological approach (M), findings (F), recommendations and conclusions (RC) What sorts of assumptions and neoliberal traits are seen in the concerned research?
1 - Influence of mothers, knowledge, attitude and behaviour on diet and physical activity of their pre-school children: a cross sectional study from a semi-urban area of Nepal. To explore knowledge, attitude and behaviour of mothers regarding diet and physical activity of their pre-school children[175]. M - Cross-sectional study in a semi-urban area. Nine trained enumerators interviewed all mothers having children aged 2 to 7 years in their homes and scored knowledge, attitude and behaviour responses.
F - Poor correlation of mothers’ knowledge and attitude with children’s behaviour regarding diet and physical activity.
RC - Improving mothers’ knowledge or attitude may not be enough to improve dietary and physical activity habits of their children. Barriers and facilitators that affect mothers’ practices towards their children should also be explored and addressed[175].
The factory made consumables in various forms, tastes and price are available in the market and to create a desire; various strategies are adopted targeting various age groups. These products are shown to signify various events and also get associated with happiness, adventurism, energizing, sharing, loving, caring, and there is no dearth of superstars endorsing these products. ‘Dietary risk factors and physical inactivity are only partially determined by individual preferences, and are more so substantially influenced by the manufacturing and marketing practices of the food industry and by the built and social environments that permit or impede physical activity’[176]. Programs, projects, researches, campaigns are done such as health literacy, health education and health campaigns. These are all open sources of reliable and accurate information to the society at large. The people at the micro level must act on such information and must make all personal efforts to act responsibly and those who do not, are blamed for sinning. Health is seen as a personal responsibility and individual citizens who do not comply are blamed. The individual has to choose and in this case the knowledge of the mother is assessed and recommendations are made to identify the barriers and overcome them. The whole focus of the research begins and ends with the mother and her knowledge. In fact much research exists to show that social, cultural, economic effects on individual behaviour. But under neoliberalism ‘victim-blaming’[177] [178] rather than, ‘regulatory mechanism defects’ are taken in to account[179]. Knowledge without the ability to buy, without the ability to afford, maintain and sustain can become a burden for further stress.
2 - The effects of an educational intervention on new-born care knowledge, anxiety and confidence among primiparous mothers in Nepal. To determine the effectiveness of newborn care educational program on maternal newborn care knowledge, confidence, and anxiety[175]. M - A randomized controlled trial study with primiparous mothers who delivered a healthy full term baby in a hospital. The intervention group received a one-to-one new-born care educational session 10-15 minutes prior to discharge. Outcome was measured using the New-born Care Knowledge Questionnaire, Karitane Parenting Confidence Scale, and State Trait Anxiety Inventory for Adults prior to the intervention and 5-6 weeks postpartum.
F - Educational intervention increased maternal knowledge of newborn care and maternal confidence; and it reduced anxiety in Nepalese primiparous mothers.
Mothers have been one of the focal point of development but the mother that gets created under neoliberalism bears the responsibility to have a healthy baby, and then nurture it and fulfil the biological needs. The fundamentalist assumption is that the mother is an empty vessel and she needs some programming on new-born care. Most existing health programs focuses on the mothering role during their reproductive programs and these programs are based on the fundamentalist assumption that infant mortality is, ‘simply a question of motherhood and ignorance of infant care and management’ and good mothering is an ‘individual responsibility’. If the mother bears resemblance in lifestyle to that of Rakku[180] or Acéphie [181] would George Newman still hold that the, ‘source of infant mortality was ‘ignorance and feckless mothering?[182] The Beveridge Report (1942), strengthened the belief of the individual responsibility by identifying the five great social evils squalor, ignorance, want, idleness and disease and was a defining moment in changing the course of welfare provision[179]. This individualistic approach has been adopted and now it seems like a truism to policy makers, researchers, intellectuals and the citizens at large.


RC - This educational program could be integrated into routine educational programs to promote maternal and infant well-being in Nepalese society[175].
3 - Knowledge on uterine prolapse (UP) among married women of reproductive age in Nepal. To assess UP knowledge among married reproductive women, and determine the association of UP knowledge with socioeconomic characteristics[175]. M - Cross-sectional descriptive study among 4693 married women aged 15-49 years. Assessed UP knowledge using structured questionnaires.
F - Simple regression analysis identified a possible association between socioeconomic characteristics, ever heard about UP and level of UP knowledge.
RC - UP-related health promotion programs should target women from all caste/ethnic groups, age groups, and education levels, including urban and rural communities[175].
Spreading knowledge among the ignorant is key to a healthy individual and a healthy society. The awareness of the health condition and knowledge on risk factors of this condition will lead to prevention of it. The risk factors for UP have been known[183], and it has been associated with violation of human rights and also as cultural and structural violence[184]. Health literacy programs, health education and awareness programs are the solutions, usually the only solution. The process of desertification[185], industrial toxic pollution which could result in fetching water for millions and factors such as nature of the job, where they are required to squat for prolonged periods or carry heavy loads are rarely taken into account. What about a physician who smokes a scientist who does not wear a helmet on a motorcycle? Would it be correct to blame lack of knowledge or could it be a host of factors (social, political, cultural, economic, geographical, historical, and legal)? But when it comes to the population being researched, the detached, de-politicized, dehistoricized, dissocialized, reductionist stance is adopted. The Cartesian ontology rules and this has shaped native researchers, teachers, students, policy makers etc.
4 - Knowledge and practice on voluntarily blood donation among bachelor level students of Kathmandu. To assess knowledge and practice on voluntarily blood donation among bachelor students[175]. M - Cross-sectional descriptive study using Self-administered structured questionnaire.
F - Programs to promote blood donation in Nepal should focus more on providing information about blood collection facilities or camps.
RC - Direct approach with request to donate would increase blood donation[175].
LET IT PASS BYE.
The nature of the argument is not applicable to certain researches, such as this. Views could differ. Here to promote blood notation knowledge among students is assessed and direct approach with request to donate blood increases blood donation is the recommendation. Blood donation has largely entered in to the discourse of public health due to disease transmission and the act has remained benevolent where we don’t get anything in return and nor do we expect anything in return apart from what science asks to be provided to the donors. Though attempts to commercialise blood donation was made around the mid nineteen sixties in United States this sector has remained free around the world.
5 - Knowledge diversity and resources of traditional Healers and healing practices in western development region of Nepal. To assess the current situation of traditional healers in terms of healing practices, knowledge and resources used in Western Nepal[175]. M - Cross-sectional descriptive study was carried out using qualitative research method between November 2014 and June 2015.
F - Data were collected from 50 traditional healers.
This practice was widely prevalent and medicinal plants, minerals animal products, worshiping certain deities, animal sacrifice and certain native procedures were done as treatment.
RC - The traditional practical healing practices should be scientifically validated and integrated into the health system[175].
With the implementation of various international policies largely in matters of trade, such as patent, rules of origin and along with the development of corporatization there has been instances where products made from traditional plants ( neem, turmeric, extracts of black pepper, ayahuaska, Hoodia gordonii) were filed for patents[186]. Not surprisingly all the applicants were submitted to US Patent and Trademark Office. Nepal recently became the 148th member of the World Trade Organization (WTO) and was the first least developed country along with Cambodia to join this organization through full Working Party negotiations[187]. The practice of claiming ownership and monopoly over products has been restricted to foreign bodies. When a new product is made, invented, created the creator or manufacturers in the case of medicinal products gets twenty years of unhindered access to the market[188]. When recommending the research calls for scientific validation and integration into the health system. Naive it may sound, but what sort of integration does one have in mind? The health system is closely related to the market system under neoliberalism and the societal; health, education and other societal needs are treated at par with other products. The extreme would be choosing which finger to save, since the insurance covers the cost of only one finger.
6 - Assessment of the knowledge and attitude of clinicians towards research writings in Nepal, the factors promoting and barriers to clinical research. To assess the attitude and awareness of clinicians towards clinical research and identify factors promoting and barriers[175].
M - Survey questionnaire based on 28 items under 3 main headings was prepared and distributed in person. Responses were graded according to the 5-point Likert scale.
F&RC. Barriers were lack of structured research training (84.1%), lack of time
(79.5%), lack of resources (70.1%), and financial compensation (67.3%). Providing proper training and research environment would definitely improve the clinical research activities in the country[175].
The need for research publications has become an indispensable criterion for promotion in universities. The ‘publish or perish’ approach has been strongly supported. It is not the routine activities such as patient satisfaction or students mandate that even partially determines the promotion. So to reduce these sorts of value laden evaluations, the blinded peer review process comes in to the picture. All academic, research journals are adopting this process. These journals are being created by likeminded scientists, researchers, organizations and universities. Different journals have different philosophies, purposes and principles. They cater to the needs of various parties ranging from pharmaceutical companies to some pressure group. The profound nature of instrumentalization and commercialization of researches has led to unethical research practices both by individuals, groups, foundations, organizations, companies and even nations.
7 - Health literacy and knowledge of chronic diseases in Nepal. To find the health literacy and knowledge of disease among the patients with chronic disease[175].
M - Cross sectional study with 426 respondents from the tertiary care and the primary care who had one of the chronic, diseases (Hypertension, Diabetes Mellitus and COPD) was interviewed face to face. Health literacy measured using translated, pretested, validated European Health Literacy Survey (HLS-EU-Asia-Q) 2 questionnaire, demographic information was collected. Disease related knowledge was assessed using a validated questionnaire.
F&RC - 27% of all respondents had sufficient health literacy compared to inadequate health literacy (54%) and problematic health literacy (19%). Respondents with inadequate health literacy knew less about hypertension (12.38 ± 5.230) compared to sufficient heath literacy (18.70 ± 4.296) p<0.001; regarding diabetes mellitus, those with inadequate health literacy knew less about diabetes (4.15 ± 2.348) compared to those with sufficient health literacy (7.90 ± 1.973) p<0.001 and regarding COPD, those with inadequate health literacy knew less about COPD (12.65 ± 6.613) compared to sufficient health literacy (23.40 ± 7.734) p<0.001. Sufficient health literacy knew significantly more about the disease than those with inadequate health literacy. Health literacy is independently associated with disease knowledge[175].
Health literacy which goes beyond mere literacy level. Here the health literacy of patients was assessed and sufficient health literacy, inadequate health literacy and problematic health literacy were the categories identified. Knowledge and lack of it, has been the greatest obstacle for less compliance and adherence by patients. These camouflaged assumptions[189]hide the processes that make individuals conduct the way they do in everyday life. The assumption is that the social, economic, cultural, political, professional and ethnical are beside the point. Like others ahead have asked, is it justified to consider individuals themselves responsible for their being?[190] The temptations, desires must be controlled, though the obesogenic environment is being promoted through various processes that occur under neoliberalism. From toddlers to the old everyone is targeted through various means by the sellers of the products. By adhering to basic social, cultural, legal conditions, various advertisements or popular medias are used to portray different phases of life, relations in life and in different activities one does in one’s life. From diamonds to diapers and from an educational degree to the housing address all signify happiness, love, and prestige to comfort.
8 - Effectiveness of an information booklet on knowledge regarding life style management among coronary heart disease (CHD) patients in a cardiac centre, Kathmandu valley. To identify the effectiveness of educational intervention on ‘Living well with CHD’, identifying demographic and disease related characteristics and level of knowledge regarding life style management among CHD patients[175]. M- Pre-experimental research design used among 100 CHD patients. In pre-test base line information were collected. Using prepared education intervention package regular one hour teaching sessions were arranged in hospital regularly for one week. Each participant was provided the booklet prepared in Nepali during the education sessions. After one month of education intervention program the post test was conducted using same interview. Arguments in the above tables are relevant to this research too. The assumption that educational intervention through a booklet will be effective for managing one’s lifestyle and one’s disease. Provided certain basic conditions that are required to live are thought to be in place a priori, this method could have still been rationalized. Here the research is detached from the reality, and by adopting a positivist, reductionist stance the research is seen to be oblivious of the conditions in which the researched lives.
F - Questionnaire and feedback questionnaire and analysed by using percentage and McNemar test for significance at 0.0001 levels among pre and post test score. The patients were categorized into ‘inadequate and adequate knowledge regarding life style management among CHD patients. Education intervention programme had significant role in increasing knowledge of life style management among CHD patients. It was effective and useful for their day to day life style management.
RC - Recommends similar type of programme for CHD patients in community setting should be conducted[175].
9 - Interventional study on knowledge and practice of hand washing among school age children in government school of Kathmandu. To assess the effectiveness of educational intervention on knowledge and practice of hand washing among school age children[175]. M - An educational interventional study was conducted using a self-developed interventional package among 86 participants of grade four and grade five children.
Pre- experimental research design with one group for pre-test and post-test design was used. Data collection was done through distribution of semi-structured questionnaire to the participants. Comparison of level of knowledge regarding different aspects of hand washing in pre and post-test was done using descriptive statistics and significance of the education intervention was assessed using inferential statistics at 0.05 level of significance.
F&RC - Educational intervention can be an effective means for increasing knowledge and practice of hand washing among school age children and change in behaviour was possible if the educational intervention is properly implemented thus this will helps to decline the absenteeism of the students[175].
Modifying risk factors at the individual level have been the dominant approach. Knowledge and practice of hand washing, personal hygiene and sanitation are basic necessities to protect oneself from various diseases such as cholera. From the second half of the nineteenth century onwards rates of mortality and morbidity from infectious diseases began to plummet and behavioural changes regarding hygienic practices such as washing of hand with soap and improved personal hygiene were attributed for the decline. ‘However, it would be erroneous to understand cholera as having been effectively crushed in Western societies due to improved personal hygiene of people in industrialised and industrialising countries in this period’[191].. One factor was historical. In the industrialized West, in the second half of the 19th century, witnessed dramatic improvements in wages, housing, diet, and education. Along with the ‘social uplift’ – and the sanitary movement (‘miasma control’)[192] developed nations erected the solid fortifications of sanitation and public health: sewers, drains, sand filtration, and chlorination of water as defences against cholera and typhoid; sanitary cordons, quarantine, and isolation[193]. Despite the historical evidences (social, economic reforms) of the reasons for decline in disease conditions, the selective approach with its ‘magic bullet’ approach has been the strategy applied in least developed and developing nations. The behavioural change sought in the third world countries relies on strategies taken from health promotion, health education and more recently health literacy. Without accompanying social and economic changes that ensures housing, education and food, the individualistic approach adopted has largely resulted in little success. This research is done in the capital city of Nepal which faces acute shortage of water with irregular water supply usually and that too being available for an hour or too. Also drinking water in Kathmandu is known to be very poor with high bacteriological contamination even in supposedly ‘safe’ water sources[194]. Besides overcoming one’s lack of knowledge regarding hand washing, lack of other enabling factors like regular water supply and financial capacity to buy soaps regularly are also essential to maintain the habit since budgets cuts on public education has seen a deterioration in standards. The colonial way of seeing and understanding has been adopted by the native researchers and when seeing through the colonial lens, the crusades for civilizing the savages have continued till date.
10 - Exploring the level of knowledge, attitude and practices (KAP) of emergency contraceptive (EC) among college students of Banepa Municipality of Kavre district. To assess the knowledge and attitude towards EC, and as well to determine the prevalence of emergency contraceptive use among students[175]. M - Descriptive cross sectional study design was used. Target population was bachelor level students which includes both married and unmarried youths. Total 10 colleges of Banepa Municipality were selected. Simple random sampling was done and 4 colleges were selected randomly for the data collection. Total sample size was 131 including non-responsive errors. Pretesting was done on similar setting to check the validity, consistency, and errors so that necessary modifications on tools can be done. Structured anonymous SAQ was used for the collection of necessary quantitative data.
F - Median age of the respondents was 21 years. Among them 56.5% were female. 90% of the respondents had heard about EC.
RC - Even though majority of the respondents had heard about EC, many of them had misconception about it. Also, unmarried youths were highly engaged in sexual experience since early age which can create lots of health problems regarding unintended pregnancy, unsafe abortion and abortion related complications[175].
Knowledge builds up the attitude and this leads to practice. Knowledge, attitude and practice studies focus on the individual behaviour and it seeks to discard, change or adopt certain ways of doing particular things. In this case KAP of EC among college students is assessed. Historically contraceptive was first used to prevent pregnancy resulting from illicit affairs. Here the focus is on students (married, unmarried) and the reason for using EC varies. For married couples EC could be used to prevent unplanned pregnancy or not having many children. For unmarried couples the reason of use is to prevent pregnancy since it brings immense shame and humiliation. Most behavioural practices like washing hands, wearing helmet, using mosquito nets (overt) can be observed in the act but for use of contraceptives or EC (covert) in this case can only be known by asking, whether it is used or not used. Indeed for married couples the number of children they have can give us some indication of its use. But for the unmarried especially girls even talking about contraceptives can label them as immoral, having a loose character or even a prostitute. Women are seen as the moral flag bearers and this has historically conditioned the image of the ideal woman, as being of shy nature, having a subdued character, speaking silently and a host of other traits. ‘Socially desirable responding’[195] has been shown to under report or over report. Contraceptive methods are not just ‘things-in-themselves’ They cannot be separated from the social, political, and economic contexts in which they are utilized[196]. Knowledge, attitude, availability are important determinants for use of EC, but as illustrated from research findings on China and India, Amartya Sen established a link between women’s power and control over fertility and it has also been claimed that, the ‘best contraceptives’ are , ‘education and economic independence’[197].
11 - Effectiveness of educational intervention on knowledge regarding uterine prolapse among reproductive age group women of Budhanilkantha municipality ward no 7 of Kathmandu District. To assess the effectiveness of educational intervention on knowledge regarding uterine prolapse among reproductive age group women[175]. M - Semi structured interview schedule consisting of questions related to demographic characteristics and knowledge regarding uterine prolapse was developed by review of literature. An education interventional study was conducted among 45 reproductive age group women of Budhanilkantha municipality using a pre- experimental research design with one group for pre-test and post-test design. The level of knowledge regarding different aspects of uterine was compared using descriptive statistic.
F - 45 participants, 57.8% of the participants had good knowledge regarding uterine prolapse in pre-test which was increased to 77.8% in post-test.
RC - Educational intervention can be an effective means for increasing knowledge about preventable disease like uterine prolapse among targeted population away from the central communication Medias such as radio, television[175].
The points mentioned in table three are also applicable regarding this research. Detachment from the realities of everyday life of a women and only addressing the problem through educational intervention at the individual level gives a superficial solution to the problem. Carrying heavy loads, doing extensive physical labour during & after pregnancy, giving birth to many children and having a low maternal weight due to lack of nutritious food have been identified as the main risk factors[198]. The invisibilisation of the social, economic, cultural, gendered and political conditions when dealing with any health condition has been a trait of neoliberal thinking.
12 - Effectiveness of educational intervention on knowledge regarding emergency contraceptives among study and control Group of late adolescent girls. To assess effectiveness of educational intervention[175]. M – Educational intervention about emergency contraceptives was done. A quasi-experimental, pre- post-test study design was carried out among 40 late adolescent girls.
F&RC - Educational intervention was found to be fruitful for increasing the knowledge score of study group. So, this study recommends for doing educational intervention to the students[175].
The arguments made in table ten are relevant to this research also.
The burden of contraception falls heavily on the women[199]. The western forms of hormonal contraceptives has been shown as liberating for women, but with it arrives the baggage of the medical-industrial complex and its underlying ideologies, which seek to benefit from widespread sales, distribution, and use[200]. For women from developing and least developed countries the hormonal contraceptive dosages which has been designed for women in developed nations could be excessively high and resulting in severe side-effects leading to discontinuation and, potentially, unplanned pregnancy[201]. ‘Women are seen as objects rather than subjects (or agents) in their own homes and communities, which is mirrored also within health systems in the philosophy with which reproductive health services were given. Women were considered as means in the course of reproduction, and as targets in the process of fertility control. Services were not provided to women as ends in themselves. Although, women benefited from the process, they were not at its centre[202]. These barriers are often the manifestations of women’s low social status, lack of autonomy, and rights[202]. ‘The Third World market is seen as an incentive, particularly for the less safe hormonal and chemical implants and injectable contraceptives. In addition, it is also seen as a haven for cheap and unethical clinical trials, with easy access to women who can be paid to participate, or can even be experimented upon without their consent’[203]. ‘Contraceptives are important new technological ‘facts’ on the global stage. However, just as importantly they are mental ‘conceptions.’ Methods of contraception ‘do not just ‘work,’ ‘they work in bodies in a wide variety of perceived ways’ and are both medical practices and social constructions[196].
13 - Teachers’ knowledge regarding malnutrition of school children at government schools of Bharatpur sub-metropolitan City. To assess teachers’ knowledge regarding malnutrition of school children at government schools[175]. M - Cross sectional descriptive study was done by using simple random sampling technique. Data was collected through semi-structured self- administered questionnaire. The data was entered into IBM SPSS 19 version and analysed by using descriptive and inferential statistics.
F - 70.7% of respondents had been encountered with malnourished children and 79.3% got information on malnutrition through books. Out of 150 primary school teachers,
35% had good, 33% had average, 20% had below average and 12% had very good level of knowledge. The total mean knowledge score of respondents was 30.12 with 6.32 of standard deviation and the total percent of mean score was 60% which shows average level knowledge on malnutrition of school children.
RC - Emphasis should be placed on periodical in-service education and training program for primary school teachers to increase their knowledge about nutrition, nutritional disorders where the health and education ministry and its policy can play the key role for uplifting knowledge among teachers, students and society[175].
Malnutrition has been seen as an anomaly that results due to individual habits that are offshoots of low literacy and ignorance. The primary reason for malnutrition is lack of knowledge, and because the family, mother, a particular group or a community does not know about proper dietary regime.Here knowledge regarding malnutrition among government school teachers is assessed at the individual personal level and the biomedical, physiological characteristics of malnutrition are considered as appropriate knowledge. Teachers play an important role in shaping the structure of knowledge, at the school level. The reflexive role of teachers has been highly curbed under a banking mode of education system. Under neoliberalism by ‘cutting the vocal chords’ as explained by Evernden, the attitude of ‘callousness’ is hidden under the garb of ‘scientific detachment’[92]. The neoliberal system of education creates researchers, scientists and teachers embedded with objectivity and scientism who carry with them as Santiago Castro has called the ‘hubris of the zero point’[204].‘The ‘monoculture model’ in the food and agriculture system ‘geared towards genetic unification’ has been labelled as ‘agro colonialism’[205]. The individual is targeted and based on the ‘ceteris paribus’ assumption, the problem is understood, defined, studied, approached with a methodological individualist approach. The ‘Foreign Direct Investment’ (FDI) induced ‘American Way of Life’ ‘industrial diet’, ‘neoliberal diet’ ‘industrial diet’, ‘pseudo foods’ ‘meatification’ ‘privilege taste over nutrition’ ‘spread of fast food establishments’ breeds overconsumption and from the 1950’s to date there has been an astounding increase in different products that are manufactured in mass and many a times most of these products are available at a cheaper price than natural food items.
14 - Knowledge and preventive practices related to avian influenza among poultry workers of Kamalamai Municipality, Sindhuli. Aims to assess knowledge and preventive practices related to Avian Influenza among poultry workers of Kamalamai municipality, Sindhuli, Nepal[206].
M - Cross-sectional descriptive design using semi-structured interview questionnaires to assess the knowledge and preventive practices and checklists to observe the preventive practices. Sample size for this study was 132, Forty-four poultry farms having three workers were selected randomly by using lottery method. On the day of data collection some respondents were absent so that only 122 respondents were interviewed by using semi-structured interview schedule.
F - (93.4%) had heard about the Avian Influenza. More than half (54.9%) of the respondents had a 'poor knowledge'; followed by 'average knowledge' (44.3%) and 'good knowledge' (0.8%) about Avian Influenza. Majority of them (93.4%) had 'average practice' for preventing Avian Influenza; followed by 'good practice' (4.9%) and 'poor practice' (1.6%).
RC - extensive health education and health promotion programs are recommended to prevent AI in poultry giving more emphasis on mass communication like electronic and print media[206].
Since the late 1990’s the emergence of new highly pathogenic avian influenza strains of viruses, H5N1 flu on and its resulting devastating effects have resulted in guidelines of practices for protection. The chain of virus transmission has the consumers of poultry at the end and its manufacturers the poultry farmers at its starting point. In between these two agents the production process has acquired a procrustean structure where the farmed animals are imprisoned in alien, dysfunctional, and disease-prone bodies genetically manipulated for food traits alone, bodies that in many cases have been surgically altered, creating a disfigured appearance[207]. According to Hinchliffe and Bingham show that the ‘WHO consensus that avian flu can be traced to the interaction of wild bird migration and domestic poultry has meant that measures to counteract avian flu — particularly culling techniques — have disproportionately harmed the poor and benefited large-scale poultry farms that international officials assume to be biosecure’. WHO-prescribed program of massive poultry culling to mitigate the risk of avian flu contagion. The program, based on an emergency-oriented protocol designed to be implemented automatically in the event of disease detection, is an example of the effort to develop a ‘standard, worldwide approach to dealing with ‘out of place’ biological entities.’ the ‘contemporary project of worldwide integration and harmonization of biosecurity measures,’ exemplified by such mass culling programs, ‘is fraught with risks however appealing it might sound’, it may fail to decrease the likelihood of a flu pandemic, while exacerbating problems of hunger and poverty. They suggest that the uncertainties endemic to contemporary biosecurity threats such as avian flu point to the need to develop new ways of living with and managing the possibility of outbreaks that are more nuanced than current attempts to achieve absolute security at the expense of local wellbeing. ‘An alternative theory — that the spread of avian flu can be traced to the international circulation of poultry through legal or illegal trade, and to industrial poultry production and processing — has been largely ignored in inter- national protocols to contain the disease, but would imply a very different set of measures’. ‘Most humans are culturally conditioned to believe that chickens naturally exist as objects for human consumption and use, their ‘natural’ habitat assumed to be the human-constructed world of a farm’[207].
15 – Knowledge and practice on safe use of pesticides among farmers in rural area of Kaski district. Assess knowledge and practice on safe use among farmers in rural area of Kaski district[206]. M - Cross sectional study was conducted among 384 farmers in Six Village development committee (VDC) and farmers using pesticides for any agricultural product were randomly selected.
F - Majority (66.4%) of the respondents were female. The mean participant scores for knowledge and safety procedures were 15.48 ± 6.41 out of 41 and 9.23 ± 3.27 out of 22, respectively. Nearly four fifth (79.2%) of the respondents knew about safe use of pesticide. Among them 98% knew about importance of safe use pesticide. But only 66.1% used personal protective equipment (PPE). Level of practice has statistically significant relationship with level of knowledge (P<001). Storage of pesticide at animal shed, disposal of unwanted pesticide by burning, not using adequate protective clothing and not reading label/instruction on pesticide container were identified as unsafe practices. Self-reported health problems due to pesticide exposure were headache (66.7%), eye irritation (32.3%) skin irritation (27.3%).
RC - practice regarding safe use of pesticide is still poor among farmers in rural area of Kaski district. Behaviours change and communication programs focusing on proper use of PPE (personal protective equipment), storage, disposal and reading label instruction on pesticide container should be conducted[206].
Pesticides along with many other human creations has created a boomerang effect where traditional geographical boundaries are broken and the risks associated with radioactivity or pesticides have affected the population at all levels irrespective of who they are. Moreover with the pursuit of market oriented goals and the approaches adopted to achieve these goals have led to unethical practices in various sectors throughout the world. Some clear examples such as the thalidomide disaster and Bhopal gas tragedy were the result of narrowing of interest to pecuniary measures. In case of thalidomide the resulting loss of sales which could result if information on its use and effects was disclosed was kept away on purpose and in case of the later gas tragedy cost cutting measures led to the disaster. In both the case the pursuit of commercial gains blinded the actors and the agencies. Pesticides, insecticides, fertilizers, chemicals have been in focus since the publishing of the ‘silent spring; by Carson, and by the nineties the issues of ozone layer depletion, climate change, global warming have come to the forefront in the new international economic order. For a nation like Nepal where most population still rely on agriculture to survive in this new economic order the issue of pesticide is of utmost importance. The government makes decision and based on their decisions the regulation of these products are done by concerned authorities, but since the government is also attached to the world economic order it has to take its decisions based on various international treaties which again recommend principles that are homogenizing, competitive, self-regulatory and profit based. Here the focus of the research is largely focused at the individual behavioural and the local level. Personal actions that must be done for the safe use of a product are identified and if these are adhered to then there will be no negative effects. As to the nature of the ingredients and its qualities its users have to trust the authorities and the government all in all what Foucault termed as the ‘mathesis’ understood as a universal science of measurement and order. The reductionist, commodified approach sees a technocentric solution to problems broken down in parts and the ecology is amenable to change as per human needs and beliefs. Exposure to environmental chemicals has been shown to affect the environment and health of human and non-human beings. ‘Exposure to neurotoxic compounds [like pesticides] at levels believed to be safe for adults can result in permanent loss of brain function if it occurs during the prenatal and early childhood period of brain development’[208]. The acute toxicity testing of pesticides may be reliable to understand the effects from short term but its limitations are unlikely to find out effects on human which may take two or three decades to appear[209][210]. Exposure to environmental chemicals has also been shown to result in increased risk of obesity later in life, and these chemicals have been referred to as obesogens and many of these same chemicals can also increase insulin resistance leading to type 2 diabetes (examples include phthalates, bisphenol A, tributyltins, and several pesticides)[211]. The increased corporate takeover has led to a proliferation of trade agreements, commercial agriculture and encroachment of market values and this has been documented by David Weir and Mark Shapiro in their book ‘Circle of Poison: Pesticides and People in a Hungry World’ and expose the global scandal of corporate and government exportation of pesticides.
16 - Energy drinks: knowledge & perception of consumers and quality parameters. To describe the chemical and microbiological parameters of energy drinks and find out the knowledge & perception of consumers towards it[206]. M - Descriptive cross-sectional and experimental study conducted in different locations Kathmandu valley. Two hundred energy drinks users were interviewed to access the knowledge and perception of consumers. Ten different brands of energy drinks were analysed for chemical and microbial content. The collected samples were evaluated for the compliance of regularity regulatory requirements on labelling.
F - 85% were unaware about the content, 54.1% has believed that it can be used with alcohol, 45% thought that all people should have energy drink, 40.8% thought that it provides energy, 43.1% think it is for refreshment. The major motivating factors were friends (36.2%) and advertisement (31.6%). About 55% responded that they had experienced side effects after using energy drinks out of which 67.7% had some mental changes. About three in four (73%) thought that the advertisement given was false and misleading. Out of 10 samples analysed for the regulatory compliance, none of them fully complied with the regulatory requirements of Nepal. On laboratory testing, the amount sodium (197mg to 476mg), sugar (6-16%), carbohydrate (6-18%), and caffeine (0mg-43mg) were either more or less than the claim in eight samples. Other compounds detected in the samples were not uniform. Methyl amine was detected in nine samples out of ten. All the samples passed the limit of microbial count[206].
RC-
Long-gone are the days of Prakash Padukone a noted player who declined promoting an artificial drink despite being given a hefty payment and presently there is no dearth of players with huge fan following endorsing such drinks, despite the fact most may not even be consuming it.
The ‘hands off policy’ based on self-policing and self-regulation has given the onus to the manufacturers or the companies itself and in products like foods, drinks and medicines where communities of people are affected the reliance on the claims of the manufacturers has proven to be fallacious in many instances[212]. The impact of preferential trade agreements (PTAs), free trade agreements have been shown to increased life style diseases such as obesity and type -2 diabetes[213]. With the changing global economy from the 1990’s post-colonial countries and low income countries undertook extensive economic liberalization that resulted in significant changes, for instance between 1998 and 2012, the Indian soft drink sales quadrupled from 1.2 million to 4.4 million litres with a decline in the retail selling price from US$ 0.6 to $0.4 per litre (in fixed 2012 dollars, constant prices). Advertisements and marketing strategies adopted such as recruiting sports persons, celebrities and also making ties with schools and colleges so as to installing dispensing machines in schools and promoting activities in the name of public private partnerships. Though the research paper deals with energy drinks the marketing strategies and the related affects with its consumption is similar to more traditional soft drinks such as Coca-Cola. The non-availability of clean drinking water and the availability of Coca-Cola has been an issue of pride in the context of Africa. The standards that need to be adhered to have been flouted here and this comes as no surprise for a nation like Nepal due to its weak structure of overall governance. Beginning onwards the mid 1940’s the trend of manufactured foods and drinks spread around the world. Presently, all around the world Americans, Europeans, Asians, Africans and Australians are all having an ontologically uniform experience of taste despite their being significant differences in their living conditions. The ‘‘loss leading’ and ‘value’ strategies to encourage consumption initially with low prices and small package prices, but then later increase package sizes and prices’[214].
17 - Knowledge, attitude & practice of family planning methods among married women of reproductive age of Kakani VDC, Nuwakot. Assess the knowledge, attitude and practice on family planning methods among married women of Kakani VDC[206]. M - Descriptive cross-sectional study design was used. Likewise, PPS sampling procedure was done for sample size calculation. Similarly, simple random sampling was done for the selection of 109 respondents. Structured questionnaires and interview technique was used to obtain necessary information.
F - More than one fifth of the respondents (23.9%) were of age group 28-32 years and more than half of the respondents (51.4%) had marriage at the age of 15-19 years. Similarly two third of the respondents (70.6%) had followed Hindu religion, and majority of them (63.3%) were literate whereas 36.7% were illiterate. Almost all women (93.6%) had reported that Family planning is used to maintain small family. Likewise, Depo-Provera was the device known by all respondents and Implant was the least known (71.6%) device. However, more than half (56.9%) MWRAs had good knowledge on family planning. Similarly, more than half (51.38%) of respondents were currently using family planning devices and among them more than one third had (37.50%) used Oral Pills. Furthermore, attitude towards family planning was positive in most of the MWRAs.
RC - The study population had good knowledge and positive attitude towards family Planning devices; however the use of family planning devices was low. It was mainly due to husband being abroad and side effects of the devices[206].
The focus on reproductive health and the delivery of related services along with emphasis on family planning measures have been in focus since Nepal began its quest to be developed. The arguments made in table, 2, 3, 11, 12 & 17 are also applicable here.
18 - Reproductive health knowledge, attitude and health services utilization among adolescents in Kaski district of Nepal. Assess the reproductive health knowledge, attitude and health services utilization among adolescents in rural and urban areas of Kaski district[206]. M - Community based descriptive cross-sectional study was conducted among adolescents (10-19 years of age) in rural and urban areas of Kaski district, Nepal. The period of data collection was October to November, 2014. Altogether 419 participants were taken for the study.
F - Out of 419, majority (78.8%) of the respondents were known about family planning, among them only 70 % of respondents were aware about family planning methods. Fifty one percentages of the respondents were aware about the sexually transmitted diseases. Before giving a birth there is need to consult with partner with this fact 68.7 % of the respondents were agree, 23.6 % of the them were neutral and very few (7.6%) of them were disagree. Nearly twenty six percentage of the respondents were faced the reproductive health problems within one month. Out of 107 respondents, 57.9 % were did not utilize reproductive health services because of different reasons.
Arguments made earlier in tables 2,3,11,12 & 17 are also of relevance here, but since this deals with adolescents some of the arguments if related from the earlier tables directly may not be relevant. In a patriarchal system morality and honour are strongly attached to the daughters, sisters and other female members. How would one react if one found a condom or a pill with a 16 year old daughter or a sister or in fact with any unmarried female? The ways traits of masculinity and femininity are embedded, internalized, naturalized and systematized begins from birth and exists at all stages in all spheres of life.
RC - knowledge towards reproductive health among adolescents was found low. However, levels of attitude towards different reproductive health components were found favourable. Only 42.1% of the respondents were utilized reproductive health services among those who was faced the reproductive health problems within one month which was low coverage of reproductive health services utilization[206].
19 - Knowledge, attitudes and practices of avian influenza among poultry workers of Chitwan district to determine the knowledge, attitudes and practices relating to avian influenza among poultry workers[206]. M - Descriptive cross-sectional study was adopted, study area were registered poultry farms of Chitwan district. Purposive sampling technique with structured interview questionnaire was used to collect the data.
F - Most of the respondents don't know about the causative agents of avian influenza, 97% of the respondents have knowledge that avian influenza can be transmitted by eating uncooked meat whereas 47% have knowledge that poultry workers are at risk for transmission of AI. Literate respondents were more aware about causes of AI as well as trained respondents were more aware about causes of AI. Whereas Majority of the respondents agreed that AI is a preventable disease whereas almost all of the respondents knew that AI is a serious disease. Most of the respondents use outer garments for the protection of AI whereas only 6% of the respondents use eye protection measures. Notifying DLSO in case of sick and dead poultry is a common norm. Treatment and burial were common in case of sick and dead poultry[206].
RC-
The arguments from table number 14 are also applicable here.
Dr Michael Greger’s book, Bird Flu: A Virus of Our Own Hatching shows how many human ailments from the common cold to AIDS are the result s of cruelty towards animals and more importantly due to the practice of breeding and raising them for food. Though human influenza which has a history of more than 4000 years when ducks were first domesticated and also the previous avian influenza outbreak the 1918 flu pandemic which led to the death of 50 to 100 million human have not changed the ways it has been confronted. The ‘piece meal’, and ‘fine tuning corrections’ has been a trait adopted by industries worldwide where everything is strategized by accepting the neoliberal structure as given. Neoliberalism has established an ‘one dimensional’ ‘presentification’ of ‘eternal present’ of the global way of life.
20 - Knowledge regarding community based newborn care practice among health workers of sub-health posts, Sunsari, Nepal. Assess the existing knowledge of CB-NCP practice among health workers of sub-health posts of Sunsari, Nepal[206]. M. Descriptive cross sectional design was adopted. A total of 49 health workers (AHWs and ANMs) from sub-health posts of Sunsari district, were interviewed by total enumeration technique. Data were collected using a semi-structured questionnaire and analysed using Independent sample t-test, One Way ANOVA and correlation test at 95% confidence interval.
F. (57.1%) ANMs and (42.9%) AHWs who achieved mean score of knowledge (54.00±6.77) and (41.14±9.56) respectively. The existing knowledge regarding the CB-NCP practice was significantly higher (p= <0.001) among female health workers as compared to male health workers. The knowledge was found higher among secondary level, upper caste, married, who received CB-NCP training >2 years period and additional training in concerned area and inversely correlated with the increase in age, family size and increasing years of experience.
Arguments from table 2 are also applicable here.
The total achieved percentage mean score of knowledge was 66.27 ± SD 14.44.
RC. Study concludes the positive correlation of number of handling of PSBI and asphyxia new-borns with the knowledge[206].
21 - Knowledge diversity and resources of traditional healers and healing practices in western development region of Nepal to analyse the situation and document knowledge diversity and resources of traditional healers and healing practices in Nepal[206]. M - Cross-sectional study using qualitative method in Western Development Region between January and April 2015. Based on geographical and ethnic variations, firstly, we purposively selected six districts, followed by selection of single VDC and Municipality from each district. We applied aggregate scoring method for selecting 60 respondents in total. Data were collected by in-depth interview.
F - Majority of respondent was Janjati (30%), and was involving in farming (52%). They have been recognized in society as Jadibutigyata, Fukfake, Pandit, (lama, Baidya, Shoka and Moulana. Forefathers and Guru were the major sources of knowledge. They expressed their confident to treat 170 varieties of diseases and health conditions using 135 different herbs and mineral. Most of the participants (50 out of 60) were not doing anything for preserving their knowledge and 2/3 respondents did not have any training on traditional medicine. Most of the respondents (87%) replied that they were satisfied with their traditional healing practices. Nevertheless, 80 % of them were worried that young generation was not interested to continue the practice. Unavailability of medicinal plant was identified as the major problem faced by traditional healers.
RC - finding indicates that vast diversity of traditional healing practices and resources persist in Western Development Region. However, lack of preservation, lack of interest to continue by young generation, delaying in recognizing, validating and upgrading knowledge pose a serious threat to traditional healing practices[206].
Arguments from table 5 are also applicable here.

CONCLUSION

One could be doing one’s job honestly, sincerely and with a belief about doing well. But, then the work that one does has not resulted in desired changes. When digging for water if after a certain depth if no water is found then the digger shifts to a newer location and starts digging again until water is found. Like the digger a scientist or a researcher too looks to fulfil certain objectives and tries to provide newer solutions. But unlike the digger who knows when water is found and can stop the latter does not have that luxury. Scientists and researchers have to continually update one’s self by adopting strategies, techniques and other relevant developments so as to produce scientifically valid and correct work and when it comes to human behaviour and health the area that it covers is all encompassing.

Scientists and researchers working on issues related to health have to not only be updated with developments in one’s concerned discipline but also have to keep one’s senses open to developments in other disciplines for the need of a multidisciplinary, interdisciplinary and transdisciplinary approach has been deemed essential [215, 216]. The researches that have been dealt with in the findings section above have a focus on health issues and various cohorts were researched and the individuals who constituted the cohorts were from various sectors ranging from adolescents to professionals and children to mothers. All the researches have the ‘individual’ as its focus and indeed the individual is ultimately at the focus of most researches on health issues. But, the ways an individual lives at various stages of life and the barriers and solutions that prevent or enable them to act in certain recommended ways can be many a time located far away from them. For instance going back to the case of the digger who has dug in a hundred different places looking for water to no avail and cursing his/hers fate, when in fact a water bottle company has managed to appropriate all the ground water through use of machinery power.

Based on the nature of the work one does and the ways that it affects those at the receiving end is varied in consequences and implications, also in between these two many other levels exist. Here the focus is on researchers or more specifically an epistemic community and the product it produces i.e. a research publication or presentation and when taken collectively can be said to constitute a discourse. The methodological process and the statistical tools used are not of concern here, since they are an outcome of the research objectives, rationales or hypothesis which is based on one’s assumptions and inferences which again is influenced by one’s philosophical underpinnings. Though philosophical underpinnings are mostly invisible it is omnipresent and influences use of heuristics in approaching a problem in order to seek a solution but many a times these seemingly heuristics could be only fulfilling some ritualistic purposes.

Based on existentialist, phenomenological and empirical experiences when the twenty one researchers were analysed adopting an autoethnographic approach one common theme that was discerned is that all the researches proceeded with the assumption that individuals were ignorant and they needed to be taught. Apart from the researches on blood donation in table 4 and appraisal of knowledge and attitude of clinicians to research writing in table 6, all of the other researches were done on populations who traditionally have been associated as ignorant, lazy, careless and unmotivated. Also the two researches on traditional healers and their practices are different than other researches since they were not done on behaviours that have been recommended to be done in certain ways based on some ‘procrustean’ standard among various cohorts at various stages in life. Though different than the remaining seventeen researches the acceptance of neoliberalism is apparent in all of them. They all take the ‘a prior’ structure of neoliberalism as given and accepted for instance on research and clinicians the need for researches as an important indicator of performance capability is treated as an axiom.

The seventeen researches have a common objective of assessing, identifying or evaluating knowledge on different habits, practices and perceptions. The perception that, lack of knowledge is what causes various negative conditions affecting health, and educating the populace will bring about desired change prevails among the researchers. From a distance the research looks perfectly reasonable, with high quality of evidence, rigour and its methodology seemingly flawless. The problems in the researches arise when viewing its particulars reflexively, critically and philosophically based on existential, phenomenological and empirical experiences. These problems are a result of many other conditions and these in turn by other conditions.

The genesis of these conditions can be traced back to colonial times and the increasing dominance of the Western Newtonian Cartesian system of science. Debating on the western system is not the scope here. Neoliberalism can influence any system be it Asian, African or European and also any discipline/subject be it Ayurveda or be it modern allopathic. The seventeen researches follow an epidemiological approach that rests on the, ‘social world homogeneity assumption’, [217, 218] and follows the ‘dose response inquiry’ despite it being recognized as essentially contextual (developmental or historical) rather than universal [219]. All the researches adopted a quick fix methodology and a hurried approach. The assumption made is that the populations researched would give honest, correct and valid answers when approached.

Questionnaires and interviews were used to obtain information on knowledge possessed and indeed it can provide reliable data, but when used to gauge behavioural practices the results can be misleading since they can easily be influenced by the ‘social desirability bias’. The rational choice theory which treats humans as rational beings, expects all humans to act based on interest maximisation and when it comes down to one’s health the individual should take specific measures so as to stay healthy. The questionnaire in affect assumes that knowledge leads to action. Hence if a pathological condition occurs within a community it must be because the individual ignored or had not known about the risk factor. The structure within which the individual exists is deemed as a level playing field where all humans should compete for the opportunities made available by the market.

As for assessing the heuristic or ritualistic use and purpose of the researches concerned it is essential that the assessment be made by taking the existing lived empirical locally grounded reality of the researched. Also when considering the existing local conditions it is imperative that the global, macro or structural forces that affect it be taken in to account for if these are not taken into account the strong possibility of the research being detached, separated, deproblematized, decontextualized and dissocialized from the researched population. The line that separates when attempting to assess heuristic use from ritualistic use of any research is prone to any procrustean objective that the reviewer who embarks on the task of assessment holds. To have an open mind and an honest intention without preconceived plans of interpreting the study as per one’s desire is essential for attaining scientific credibility in one’s analysis. The consequences when researches are just fulfilling some ritualistic purpose are dire for countries like Nepal where development has been the prime focus with much inflow of foreign loans, grants and aids, both corruption and stagnating human development occurs.

Research is done to discover new facts or information through careful methodological procedures. With the passage of time much change has occurred in the ways researches are done and also the reasons for doing a research have changed in accordance with human needs and interests. In Nepal as in other least developed nations the burgeoning trend of researches and journal publications have been due to the establishment of ‘logocentric ‘and ‘Eurocentric’ ‘character of the main part of the knowledge produced and taught in the universities around the world’, ‘the introduction of managerialism from western neo-liberal universities’, the establishment of the ‘enterprise university’, and ‘the audit feature for neoliberal managing of universities that gives significance to publication indicator and fundamental research’. The character that most universities have acquired around the world has been very aptly described as the ‘schizophrenic university’ paradigm where an ‘institutional fascination with research rankings’ exist and as a result ‘individuals and institutes acquire yet better care in the building and preservation of fabrications ’ and ‘playing the rating game’ which also leads to ‘opacity and complicity’. The separation of university education from the local contexts has seen the ‘tyranny of relevance’ and this has resulted in devising one’s academic research expertise to cater to the needs of the distanced rather than the needs of the immediate and near, the result of which has been that researches when seen from afar seem methodologically sound with the results generated by the latest software but when viewed by keeping the grounded reality of the researched it seems to have no pragmatic value resembling a piece of work which is ‘bullshitting’ or just producing ‘epistemic pollution’.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

Not applicable.

HUMAN AND ANIMAL RIGHTS

No animals/humans were used for the studies that are bases of this research.

CONSENT FOR PUBLICATION

Not applicable.

CONFLICTS OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

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