Venera Zakirova, David Zakus

1. Bashkir State University, Ufa,Russia

2. Faculty of Community Services, School of Occupational and Public Health, Ryerson University, Toronto, ON, Canada

'Feeling of despair' as the leading cluster theme of conceptual descriptive analyses in participatory assessment: Russia Oxfam GB case study

Venera Zakirova1, David Zakus2

1. Bashkir State University, Ufa,Russia

2. Faculty of Community Services, School of Occupational and Public Health, Ryerson University, Toronto, ON, Canada

This article provides a case study on participatory assessment based on experience gained from an EU–Oxfam GB project entitled "Empowering Municipalities to Effectively Address Poverty"conducted in five small towns in Russia. Participatory assessment through focus group discussions (FGDs) was the main approach used in the implementation of the project. A participatory assessment was performed through 25 FGDs in five remote areas in central Russia. More than 200 participants representing people living in poverty, such as single mothers, people with disabilities, families with many children, families with disabled children, and pensioners, voluntarily participated in the meetings. Most of the participants were women (75%) aged between 25 and 70 years. We consider that the participants' representation is relevant in accordance with the official poverty studies. Through identification of patterns of recurrent ideas and opinions, a qualitative method helps us understand social phenomena from the views of and on the basis of the opinions of the participants. The FGDs' narratives underwent pattern analysis, resulting in the framing of the cluster themes and narrative conceptualization. Cluster analysis of the FGDs' narratives led to the framing of 10 cluster themes of importance, followed by conceptual descriptions and related narratives. The conceptual description of the leading theme, feeling of despair (theme 1), was described by respondents' expressions/narratives, such as "Nobody needs us and there is no future for us and our children in this town," the narrative idea that crosscuts the subsequent themes. The following nine themes are of equal importance, are interlinked, and for the major part constitute the leading theme, feeling of despair (theme 1): state social and family support (theme 2); health care (theme 3); who are those living in poverty? (theme 4); housing (theme 5); living costs (theme 6); employment (theme 7); children's well-being and future (theme 8); environment and recreation (theme 9); and legal rights (theme 10). Equal importance of these themes is justified by the analysis of patterns and recurrence of the FGDs' narrative ideas. The assigned numbers from 2 to 10 are given to simplify the references to the corresponding cluster throughout the analysis and do not reflect the ranks of the clusters. The leading theme (theme 1) touches on the psychological status of the FGDs' participants, while the remaining nine themes (themes 2–10) relate to the state system of social services, including health care. For example, per the conceptual descriptions, the state social and family support (theme 2) is described by the following narrative: "Those who have a family network get their support, for those without family help, state support is crucial but is very little and not everybody can get it. Nobody wants to help or provide decent services – people in local government get fed up with you, you get sent from one place to another." The frustration("Nobody wants to help or provide decent services; the government gets fed up with you, you get sent from one place to another.") caused by poor services ("State support is crucial but is very little and not everybody can get it.") crosscuts the theme's conceptual description. In this article, feeling of despair refers to a psychosocial condition caused by people living in poverty and their dissatisfaction with state services. Details of the remaining themes are given. The purpose of this article is to draw the attention of practitioners and policy makers to the participatory results rather than their focusing on the qualitative methodological details. We argue that a participatory understanding of community needs, through cluster theme analysis and conceptual descriptions, can help local municipalities develop more targeted community programs on poverty and vulnerability reduction.

Poverty; Oxfam GB; participatory assessment; cluster themes; conceptual description; Russia

Background

In the fight against vulnerability and poverty, international development arenas adopted participatory assessment (PA)[1]. The purpose of PA is to improve the effectiveness of public actions aimed at reducing vulnerability. PA is a method for determining a better depiction of vulnerability from the insiders' point of view that helps identify which programs and policies are needed and can be supported. Only the vulnerable know very well these extreme consequences, because of their exclusion, injustice, and lack of human rights. It is important to understand why people do not have decent housing, good-quality food, and good-quality health care, what barriers and hardships they face, and why they are unable to improve their lives.Oxfam GB1Oxfam GB is a development, relief, and campaigning organization dedicated to finding lasting solutions to poverty and suffering around the world. Oxfam GB's global program is delivered by eight regional centers and by a ninth team responsible for an antipoverty program in the United Kingdom (www.oxfam.org.uk).conducted the project "Empowering Municipalities to Effectively Address Poverty" in 2007–2009.The project focused on strengthening and enabling municipalities and community service organizations to work in partnership with people living in poverty to develop and implement small-funded projects that respond to poverty and vulnerability in five small towns in Russia. To better understand the poverty characteristics, needs, and constraints of people living in poverty, a PA was performed through 25 focus group discussions (FGDs) in five remote small and medium-sized towns:Ostashkov, Aleksin, Vyshny Volochek, Shchyokino, and Yaroslavl. More than 200 participants representing people living in poverty, such as single mothers, people with disabilities,families with many children, families with disabled children,and pensioners, voluntarily participated in the meetings. Most of the participants were women (75%) aged between 25 and 70 years. We consider that the participants' representation is relevant in accordance with the official poverty studies [2,3]that identify the population groups, similar to those who participated in the FGDs; namely, those living in remote and rural areas, women, single mothers, people with disabilities, families with many children, families with disabled children, and pensioners are the ones prone to poverty.

Through identification of recurrent ideas and opinions, the narratives underwent pattern analysis, resulting in the framing of the cluster themes and narrative conceptualization.'Feeling of despair' stood out as the leading theme among the 10 themes identified. The other nine themes are of equal importance, are interlinked, and for the major part constitute the leading theme, feeling of despair: state social and family support; health care; who are those living in poverty?; housing;living costs; employment; children's well-being and future;environment and recreation; and legal rights. One of the main results of participatory descriptive analyses discussed in this article is that people who live in poverty express feelings of despair through negative thoughts; experience stress and frustration and lack of hope in the state support system.

Feeling of despair as the leading cluster theme:Result of conceptual descriptive analyses in participatory assessment

Narratives from FGDs provided a comprehensive qualitative picture of poverty from an insider's viewpoint. The core activity in narrative analysis was to reformulate and frame the patterns of opinions of the people who have different backgrounds and experiences in their life living in poverty. The participants of the FGDs expressed their struggles and needs in their everyday life. Identification of patterns and clustering of the most prominent themes, ideas, and narratives was the main methodological approach for the analysis of qualitative data from FGDs. Cluster analysis identified the following 10 themes: (1) feeling of despair; (2) state social and family support; (3) health care; (4) who are those living in poverty?;(5) housing; (6) living costs; (7) employment; (8) children's well-being and future; (9) environment and recreation; and(10) legal rights. The first cluster, feeling of despair (theme 1),was the most vocal and outstanding theme describing the psychosocial status of the participants. The pattern crosscut throughout the discussions and therefore appeared as the most important among the 10 themes of the cluster analysis of the narratives. The leading pattern reflects the psychological status of the FGDs' participants, while the remaining nine themes relate to the outer environment, which includes the state system of social services, such as health care. As a result,a feeling of despair is induced by those equally important nine cluster themes (themes 2–10), which describe challenges and unmet needs of these vulnerable populations. As themes 2–10 are of equal importance, the corresponding numbers do not necessarily reflect the rank, but are used to simplify reference to the related cluster throughout the text.

Cluster themes (hereafter referred to as 'themes') are followed by conceptual narrative descriptions. The leading theme, feeling of despair, is expressed by the participants'negative thoughts; namely, "Nobody needs us and there is no future for us and our children in this town." As documented by clinical studies, feeling of despair or hopelessness might arise from a loss of motivation, negative expectations,or negative feelings toward the future; when a person feels that something goes wrong, and the situation is out of that person's control, that person feels frustrated that the situation is hopeless [4, 5]. Most mental health research focuses on feelings of despair and hopelessness as symptoms of medical diagnoses, such as depression or suicidal tendencies. In this article, feeling of despair refers to a psychosocial condition induced by people's negative thoughts, stress, and frustration2'Frustration' is "a deep chronic sense or state of insecurity and dissatisfaction arising from unresolved problems or unfulfilled needs" (www.merriam-webster.com/dictionary/frustration).caused by their living in poverty and their dissatisfaction with the social services system.

While the first theme (feeling of despair) touches on mental health status, the remaining nine themes relate to social structures, such as social services, including the health care system. These nine themes are not ranked as they are equally important, closely connected, and interlinked. The conceptual descriptions and narratives summarized in these nine themes provide a qualitative picture of the life of people living in poverty, and consequently consolidate people's feelings of despair or hopelessness. The challenges that were summarized by the conceptual description of the themes (see later) pose obstacles that prevent people from fulfilling their survival and living needs, let alone enjoying their human rights in full, which subsequently constitutes a feeling of despair. For example, theme 2(state social and family support) is described by the following narrative: "Those who have a family network get their support,for those without family help, state support is crucial but is very little and not everybody can get it. Nobody wants to help or provide decent services – people in local government get fed up with you, you get sent from one place to another." As we may see,the frustration ("Nobody wants to help or provide decent services; the government gets fed up with you, you get sent from one place to another.") caused by poor services ("State support is crucial but is very little and not everybody can get it.") crosscuts the theme's conceptual description. Similar frustrations were expressed in the rest of the themes.

While state support, health care, and legal rights are guaranteed by the Constitution of the Russian Federation, conceptual descriptions of the corresponding themes – state social and family support (theme 2), health care (theme 3), and legal rights (theme 10) – suggest the opposite. We may see that legal rights (theme 10) – "No passport means no constitutional rights, health care, social security, vote, or employment" – is closely connected to housing (theme 5) – "Most vulnerable people don't have/or can't afford good-quality housing. Not having a permanent place to live means you are not registered and officially you don't exist." The family network (theme 2)is seen as the main support system ("Those who have a family network get their support."), while state support is seen as the system reluctant to serve the people it is supposed to serve("Nobody wants to help or provide decent services – people in local government get fed up with you, you get sent from one place to another."). Health care (theme 3) is not affordable for everybody: "In spite of state insurance, which is to provide free health services to everyone, health care is expensive and not accessible to everyone." The following themes were identified as important quality-of-life factors:

? Who are those living in poverty? (theme 4): The stigma attached to some vulnerable groups, such as the homeless and disabled, keeps them from seeking state services, or no state services are provided at all.

? Living costs (theme 6): Low salary, high prices. One of the economic characteristics of the quality of life of vulnerable populations is low income, which in most cases puts families at a survival level.

? Employment (theme 7): High rate of unemployment among people living in poverty. No affordable job in the town.

? Environment and recreation (theme 9): Poor road conditions, litter everywhere, unfriendly environment for people with disabilities, no recreational facilities, crimestricken environment.

Another challenging pattern that came out as a cluster theme is theme 8 (children's well-being and future):lack of hope and family capacity for a prosperous future for the children.The cluster themes described together constitute the leading theme, feeling of despair (theme 1).

Analysis of the results and narratives may help local municipalities to develop more targeted community programs on poverty and vulnerability reduction. For example, a group of single mothers in one of the pilot towns (Ostashkov) expressed the urgent need for a playground for young children (theme 8),and indicated a deteriorated and crime-stricken environment with dirty streets (theme 9) as one of the most disturbing factors for their children. As we may see, analysis of the FGDs revealed that, for single mothers, the absence of a playground and a deteriorated environment are the most significant problems, along with low child benefits and lack of state support and services (theme 2). Hence within the programs tackling poverty and its factors, it is important to understand the crosscutting issues, all of which increase the complexity but give a much truer picture of what is really going on in people's lives. The results of the cluster theme framing and narratives of the responses underlying the conceptual descriptions of the themes are given next.

Theme 1: Feeling of despair

Conceptual description: "Nobody needs us and there is no future for us and our children in this town."

Narratives:

? "Life is getting harder and harder every year."

? "I never think about myself, I never have time for myself.I spend all my time taking care of the children."

? "I feel very isolated and lonely and don't feel that my life will improve much. It's very difficult to see a future."

? "I'm unemployed and … I feel like I'm not needed anymore, that I'm not useful to anyone."

? "Nobody needs us."

? "I'm desperate for help, but nobody wants to help me.Outside these four walls [prison] I would be kicked around like a football and would have no chance. I have more dignity inside prison than outside."

Theme 2: State social and family support

Conceptual description: "Those who have a family network get their support, for those without family help, state support is crucial but is very little and not everybody can get it. Nobody wants to help or provide decent services – people in local government get fed up with you, you get sent from one place to another."

Narratives:

? "My family live nearby and they help me a lot with my children, buying clothes for them and sometimes food too."

? "When I leave here [prison], I will be in the same situation with nowhere to live and no direct family. So yes, I will commit a crime and end up here again."

? "I don't have a family who could help me so I ended up here [shelter]."

? "There are only nine state shelters [for the homeless] in Russia but they are underfunded and offer very basic support."3State support for the homeless is limited to a few places where people can warm themselves during cold weather. There are some day care centers supported by the donor organizations.There are about 5 million homeless people in Russia (www.homelessworldcup.org/content/homelessness-statistic).

? "I receive 110 rubles [3.5 US dollars] a month from the state as child allowance. I buy sets of diapers with this money."

? "Nobody wants to help or provide decent services –people in local government get fed up with you if you start to complain to them, you get sent from one place to another."

? "I was hungry for a year, so hungry and I was malnourished and sick."

Theme 3: Health care

Conceptual description: "In spite of state insurance, which is to provide free health services to everyone, health care is expensive and not accessible to everyone."

Narratives:

? "People have to come to the hospital reception at 5 am to make an appointment with a physician, his/her office is open for only 3 hours."

? "I worry about my son becoming sick because the health care here is terrible. You have to phone the physician many times and they still don't show up."

? "Medicines are expensive so it's very hard to buy medicines."

? "Around 30 of the prison inmates receive antiviral treatment; they wouldn't get this on the outside so you have a situation where if you have HIV, you are healthier in prison than out in the real world."

Theme 4: Who are those living in poverty?

Conceptual description: "The stigma attached to some vulnerable groups, such as the homeless and disabled, keeps them from seeking state services, or no state services are provided at all."

Narratives:

? "Hard to identify people living in poverty; it's not always easy to try to help these individuals as we don't know who they are."

? "Often these people feel ashamed of how they are living and don't seek assistance."

? "The authorities view homeless people as criminals. The people see them as antisocial."

? "No passport means you don't exist, no constitutional rights, health care, social security, vote, or employment."

Theme 5: Housing

Conceptual description: "Most vulnerable people don't have/or can't afford good-quality housing. Not having a permanent place to live means you are not registered."

Narratives:

? "People can't afford to live in good-quality housing….They have no privacy and are stressed, which causes problems in relationships [among family members]."

? "There are nine of us living in a very small two-room dormitory."

? "I live in a one-bedroom dormitory and I cook in the same room that I live in."

Theme 6: Living costs

Conceptual description: "Low salary, high prices. One of the economic characteristics of the quality of life of vulnerable populations is low income, which in most cases puts families at a survival level."

Narratives:

? "I buy things that my son needs and give the rest of the money to my mother for food and other things."

? "My son is studying at college but it is hard because we can't afford to buy his uniform."

? "My husband is the only one working, and so it's a struggle for us to live off one salary."

? "What stands out from other towns are high prices because we are close to Moscow and have problems with utility services – no running water for more than 1 month."

? "I want to go back to my studies, but I can't afford to."

Theme 7: Employment

Conceptual description: "High rate of unemployment among people living in poverty. No affordable job in the town."

Narratives:

? "Employers prefer women with no children."

? "Even if you have a good education, it's pointless as there are no jobs, or you have to do low-skilled jobs."

? "My last job was in 2004 and I haven't worked since."

? "I used to work, but I was made redundant and I had no way of getting another job."

Theme 8: Children's well-being and future

Conceptual description: "Lack of hope and family capacity for a prosperous future for the children."

Narratives:

? "The most important thing is that I should provide my son with a good education."

? "I would like to find another job, but I have a child and need to take care of him."

? "I can't afford these things [visiting theatres, museums]for my children."

? "The future of our children is cheerless and hopeless."? "Lack of playground nearby."

? "Low state child benefit and lack of state support and services."

Theme 9: Environment and recreation

Conceptual description: "Poor road conditions, litter everywhere, unfriendly environment for people with disabilities, no recreational facilities, crime-stricken environment."

Narratives:

? "For people in wheelchairs, the entrances to the buildings are not appropriately equipped."

? "The town is not lit; the roads are just terrible. There is no sidewalk at all."

? "Litter and broken bottles are everywhere despite the city's reputation for its nature, etc."

? "Very little for young people here."

? "Deteriorated and crime-stricken environment and dirty streets; this is what children see around."

Theme 10: Legal rights

Conceptual description: "No passport means no constitutional rights, health care, social security, vote, or employment. Not being registered essentially means that you don't exist."

Narratives:

? "If a woman ends up in prison and there is nobody living in her house, she may find when she is released that somebody has moved into her home and she is homeless."

? "I applied to the regional court to try to get my home back, to get some legal help, but nothing."

? "Twenty percent of homeless people have been defrauded into handing over their flats/homes to criminals."

? "Disadvantaged populations such as the homeless or people released from prison lack or have no legal rights."

? "Without a permanent place [home] to live, Russian citizens can't be registered by the authorities."

Cluster themes with conceptual descriptions explain the high level of despair as pertaining to poverty. Themes 4 and 10 show the stigma attached to vulnerable populations such as the homeless and disabled. Along with this stigma, themes 2, 3,and 5 show exclusion from state services, health care and lack of housing. Through the themes we may see that the working poor, with low income, lack state support and legal rights, and suffer from a poor environment and an absence of recreational facilities (themes 1 and 9).

Conclusion

Poverty characterizes the whole of Russia. An analysis of the structure and dynamics of poverty reveals the low effectiveness of government policy in reducing and in removing inequalities.PA gives a better picture and understanding of community life,most specifically, the characteristics of its poverty. The PA that Oxfam GB introduced through its programs and projects contributed new perspectives to find assets and better the lives of the communities, contributing to community resiliency.

Pattern analysis of FGDs in five pilot towns led to conceptual framing of the data grouped into 10 cluster themes: (1) feeling of despair; (2) state social and family support; (3) health care;(4) who are those living in poverty?; (5) housing; (6) living costs; (7) employment; (8) children's well-being and future; (9)environment and recreation; and (10) legal rights. Theme 1 (feeling of despair), with the conceptual description "Nobody needs us and there is no future for us and our children in this town," is the most vocal and outstanding theme and ranks the highest. The other nine themes are of equal importance and are connected with the leading theme, as they describe unmet needs of the respondents. Identified conceptual cluster themes explain the system gaps and can be addressed by local programs and policies.

The PA introduced by Oxfam GB may help increase the cost-effectiveness of municipal planning and spending in Russia. The distribution of the themes provides conceptual framing and narrative mapping, which yields a qualitative picture of poverty in Russia. This article provides an example of participatory/qualitative analyses of the nature of poverty and can potentially help fill gaps in local policies.

Conflict of interest

The authors declare no conflict of interest.

Funding

This research received no specific grant from any funding agency in the public, commercial, or from non-profit sectors.

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Related Information

By reading this article, we know that poverty can lead to many adverse consequences for people in respects of psychology,welfare, health, education and so on. Meanwhile, psychology, welfare, health and education problems also can cause poverty.This is a vicious cycle. In order to improve the poor outcomes closely related to poverty or economic problems, we should understand and study more about its causes and manifestations.

You can access to the following articles published inFamily Medicine and Community Healthwhich relate with psychology,welfare, health, education and management issues of poverty or economic problems to understand more on the topic.

? How well are families doing? A description of family well-being in South Africa http://www.ingentaconnect.com/content/cscript/fmch/2016/00000004/00000003/art00004

? 'Face' and psychological processes of laid-off workers in transitional China http://www.ingentaconnect.com/content/cscript/fmch/2016/00000004/00000003/art00009

? Maternal health and its affecting factors in Nepal http://www.ingentaconnect.com/content/cscript/fmch/2016/00000004/00000003/art00006

? Primary care clinicians' strategies to overcome financial barriers to specialty health care for uninsured patients http://www.ingentaconnect.com/content/cscript/fmch/2015/00000003/00000003/art00004

Venera Zakirova, PhD Bashkir State University, 32,Validy Str., 450076, Ufa, Russia

E-mail: venera1108@yahoo.com

4 March 2016;

Accepted 12 June 2016