INTRODUCTION
The objective of this chapter is to help holistic health practitioners to gain an understanding of what’s is meant by research and how systematic action research can be carried out by them.
Included in the chapter are research designs followed by some of the students of our Holistic Health Practitioners Course. These will serve as guidelines to anyone wishing to undertake research in holistic health.

What is Research?
Research is scientific undertaking which by means of logical and systematised techniques aims to (I) discover new facts or verify and test old facts (ii) analyse their interrelationships and causal explanations which were derived within an appropriate theoretical frame of reference and (iii) develop new scientific tools, concepts and theories which would facilitate reliable and valid study of the phenomena.
Thus research of a scientific study aims at the discovery, verification, validation, and finding relationship among accumulated data. It aims to solve a problem -- the problem may be a practical theoretical or methodological one.
Yet another definition of research is ". . . finding explanations to unexplained phenomena, clarifying the doubtful and correcting misconceived facts." Gathering knowledge for knowledge’s sake is termed `pure’ or `basic’ research. Gathering knowledge for more immediate application is termed `applied’, `practical’, or `action’ research.₁
Some important elements of research are (I) a theoretical framework which lifts the research work progressively and meaningfully to new relevant stages of the work and spotlights the major research problem involved in the undertaking (ii) definition of terms which aids the development of a system of classification and helps to relate various phases of data to each other and compare their significance.
________

1. Pauline V. Young. Scientific Social Surveys and Research. Prentice-Hall of India Pvt. Ltd., New Delhi, 1982

Scientific definitions are dependent on the purpose of the study and its theoretical framework. Each unique study has to formulate it’s own technical definitions. (iii) logical, and systematised plan it is important to have a clearly laid out plan of action before embarking on the research. The plan of action includes the strategies and methodology to the adopted, the evaluation criteria and evaluation methodology should also be clearly spelt out at the beginning, because on this will depend our decisions about the kind of data to be gathered.

FRAMEWORK FOR ACTION RESEARCH
In this section, we give a guideline for research design that can be followed by holistic health practitioners. The guideline is followed by some illustrations based on studies carried out by some students of the Holistic Health Practitioners Course.

A Suggested Structure

1. Problem Definition
   The problem that you wish to work on should be clearly defined. The definition should result from a literature survey; it should be supported by theoretical constructs. It need not, however, be a definition straight from literature. As mentioned above, the definition should be suited to your particular study.
2. Strategy, Interventions, and Methodology of the Study as Planned
   This section should outline all the steps that you intend to follow in carrying out your study. The steps can include the phase of your own preparation, how you would select your clients or population, what interventions you would use and why. The time frame, the sources that you would require (in term of personal, information, books/aids, equipment, and the financial implications) should also he clearly spelt out in this section.
3. Evaluation Parameters and Methodology
   In this section you need to outline the criteria on which you will base your evaluation, how or the process you would adopt for the evaluation, when would you evaluate, what kind of mid-term checks and correction mechanisms would you have.

PROCESS OF SELECTING THE RESEARCH TOPIC OR PROBLEM
The experiences of our past students have shown that the process of deciding on research topic has been extremely meaningful and individualised for each of them. One student who was suffering from Rheumatoid arthritis for years, and after participating in her own healing process, decided to do her study on this condition. Another student was undergoing a process of search, a turmoil within herself, a midlife crisis. Through her own search for meaning, she decided to work with old people and found great satisfaction and meaning in this work. Yet another student was an obstetrician and gynaecologist-- she was disturbed by the social stigma attached to `barren’ women. She decided to focus on the problem of sterility. Another student--a retired hospital nurse, decided to work in the area of herbal medicines, because her father had been an ayurvedic doctor. All these years, she had been part of an allopathic system, but somewhere in her psyche, the nostalgia for growing and processing herbs, still lingered!
Thus the process select a research topic can be a rich and personalised one for each of us. It can be another unfolding in the evolution of our own selves.

SOME RESEARCH DESIGNS OF PAST STUDENT

A. Rheumatoid Arthritis

I. Definition of the Problem
Symptoms of Rheumatoid Arthritis (RA) include morning stiffness, pain or tenderness in at least one joint, joint swelling, nodules under the skin, X-Ray changes, a positive test for the rheumatoid factor in the blood, cloudy fluid in the joint lining and changes in the composition of the synovia. At least seven of the above symptoms must be observed in order to classify patients Rheumatoid Arthritics.

II. Strategy of Research

1. To document the process of my own healing.
2. To work over a period of time with a group of people having RA (according to the above definition).
3. To document the process of healing of at least two of the group members.

III. Methodology

1. Select the persons according to pre determined criteria by circulating the information widely,
2. Conduct a one-week Intensive Healing Workshop
3. Conduct a follow up four-day Value Education Workshop after two months.
4. Follow up through letters for a period of six months after the second workshop.

IV. Evaluation

Through the two workshop and follow up reports, one will know what difference the healees will be feeling in their physical conditions, whether their life style has changed for the better.

B. Sterility- a social stigma

I. Definition of Sterility
. . . is a phenomenon where the couple do not have an off spring within a period of three years of successful married life.
It could be primary sterility or secondary sterility.
Primary Sterility -- When the man is incapable of producing (impotence) and the woman is incapable of covering due to inherent physical psychological and emotional factors.
Secondary Sterility-- When the man is only capable of producing defective off spring, ending up with dead foetus, stillbirth, premature birth or abnormal babies. Or, when the woman conceives, but is not capable of carrying it over till term and ends up with ana bortion or as above. Or when the couple are not able to have a second child after the first live child.

II. Stategy

1. Screening of patients who come to my OPD according to established clinical criteria. Regular routine check up of male and female, general and local, including semen analysis, and ovarian uterine examination, analysis of psychosocial factors and psychic factors.
2. Starting a monthly sterility clinic. Advising screened couples to attend this clinic.

III. Methodology to be used in the clinic

1. Individual
   Detailed history of the couple through various questionnaires.
   Physical examination of both partners.
   Psychological counseling - individually and of the couple together.
2. Couple
   Education of couple-- cognitive input.
   Help them to assess self to define the specific nature of their problem.
   Plan with the couple on specific therapy.
   Appropriate therapy-- medical, nutritional, counselling and stress management : imagery and change of beliefs.
3. Group
   Periodic ongoing workshops of all sterility couples. Purpose of the workshops will be educational, mutual support, integrated therapy, etc.

IV. Evaluation

(a) by individual couples and (b) by group, with a view to assess effectiveness of (I) the integrated therapeutic approach on each couple and (ii) group support in managing the problem of social stigma.
Evaluation will be done once in six months.

C. `Old People’

I Definition of the Task
`Prepare old people for death and dying’. This definition was refined after some preliminary work. Old people are willing to die but not willing to live fully. This attitude is manifested by the following behaviours : no initiative to do anything; no expression of self, either thoughts or feeling; no talking to each other, let alone relating deeply with each other; not ready for any for any physical movement, walks, etc. ritual prayers.
So the task was defined as `Help old people to Live Life Fully!’

II. Strategy and Interventions

(a) Work with old people at shanti Bhavan (an old people’s home)

1. Daily visits to Shanti Bhavan with the following activities:

• telling stories to awaken interest
• listening to problems
• giving massage and foot reflexology
• prepared prayer and fantasy sessions
• physical fitness-- games, etc.

2. Need assessment visit by researcher.

3. Three day workshop conducted by holistic health team with the old people.

4. Followup action after the workshops including weekly group sessions, sharing of life stories, etc.

(b) Running a Holistic Health Clinic at Holy Cross Hospital, Kalyan.

1. Cafeteria approach of therapies
2. Bibliotherapy
3. Clients will help each other, i.e. become co-therapists and co-healers. This will give them a meaning and a purpose and help them live more fully.

IV. Evaluation

(a) By assessing changes in the behaviour of the old people at Shanti Bhavan.

(b) (I) Attendance at Holistic Health Clinic -- number and regularity.

(ii) Clients’ evaluation of the Holistic Health Clinic in terms or changes in their own lives they started coming there.

INTENSIVE CASE STUDY METHOD

One of the way of doing action research in holistic health is the intensive case study method.1
In this section we will cover the basic skills required for doing studies, the need for a pilot case study, and then the research methodology of the intensive case study method.
The basic skills required for doing case studies might include :

• A person should be able to ask good questions, and to interpret the answers.
• A person should be a good "listener" and not be trapped by his or her own ideologies or preconceptions.
• A person should be adaptive and flexible, so that newly encountered situation can be seen as opportunities, not threats.
• A person must have a firm grasp of the issues being studied, whether it be a theoretical or policy orientation, even if in an exploratory mode. Such a grasp reduces the relevent events and information to be sought to manageable proportions.
• A person should be unbiased by preconceived notions, including those derived from therapy. Thus, a person should be sensitive and responsive to contradictory evidence.

The Pilot Case Study
A final preparation for data collection is the conduct of a pilot study. The pilot case may be chosen for several reason unrelated to the selection of final cases in the case study design. For example the informants at the site for the pilot case may be unusually congenial and accessible; or the site may be geographically convenient; or may have an unusual amount of documentation and data.
The pilot case study helps investigators to refine their data collection plans with respect to both the data and the procedures to be followed. In this regard, it is important to note that a pilot test is not a pretest. The pilot case is used more formatively, assisting an investigator to develop relevant lines of questions-possibly even providing some conceptual clarification as well. In contrast, the pretest is the occasion for a formal `dream rehearsal’, in which the intended data collection plan is used as faithfully as possible as a final test run.
__________

1. Developed by Celine Payyapilly as part of her doctoral dissertation.

The pilot case study can be so important that more resources may be devoted to this phase of the research than to the collection of data from any of the actual cases. The inquiry for the pilot case can be much broader and less focused than the ultimate data collection plan.

Research Methodology
Objectives

The objectives of theses case studies are to :

1. Test the method of Intensive Case Study and assess its worth.
2. See what lessons we can learn from the lives, values, and experiences of those who followed a holistic method of healing.
3. Assess and document which healing therapies are effective and for which illnesses. Compare costs and effects.
4. Validate use of a wide range of therapies other the allopathic.
5. Interest other holistic health and allopathic practitioners in the need for ongoing research in their practice.
6. Provide instructional materials for education of Holistic Health Practitioners and of the public in holistic healing methods and techniques.
7. Develop lesson plans on each study for group involvement and learning for participatory researcher/healers and their clients, for other participants of this co-operative inquiry process, and for the general public.
8. Organise workshops to enhance participation :
   (a) For the participatory researcher, participants of the co-operative inquiry, and for the participant clients in the case studies to share and internalise learings. Value education input will be provided by resource person.
   (b) For all researchers and participants to present the case studies at a final terminal workshop.
9. To publish some of the case studies for education and sharing both in holistic health courses, in medical circles, and for the general public.
10. Develop a true partnership between healer/healee.
11. Show the education is as important as treatment. Knowledge is healing.
12. Trace out, described and analyze the values, beliefs, and attitudes of clients and their effect on health
13. To assess the importance of spiritual aspects in healing.
14. To validate the use of the mind/body connection in healing and to enlarge its meaning and scope.
15. To show the effectiveness of participatory research and the value of medical anthropological approach.

Methods

1. Intensive Case Study will be principle method used.
2. Incorporated into the case study will be :

(a) Client’s writeup of

1. His./her life history from conception to the present.
2. All past illness, treatment and nutritional/physical status.
3. History of the present illness, all the treatment received, the effect of each.

(b) Interviews with clients to fill in any gap :

1. First Interview:Use Appendix 1 as a guide to collect data on personal history. This interview will be subject structured leading into the life, values and philosophy of the person studied, and how these effected health. You may need several interviews to cover this material.
2. Second Interview:Use Appendix 2 and 3 to focus on the client’s goals, strategies, roles, methods and skills of working and living and their impact on health. The two critical incidents will be discussed, clarified and revised at this interview. After this, the client will be asked to write them up.
3. Third Interview:Use Appendix 2 as a help to focus on the client’s views of the healing process, blocks, problems, difficulties and achievements.

Also hold interviews with the relatives and important person is their healing process. This may include doctors, nurses, other professionals, friends, etc.

3. Value education and its use in healing :

1. Clarifying values/stories/role play/discussion.
2. Integrating religious values/drawing your mandala.
3. Value developments to enhance personal growth, interpersonal, skills, instrumental skills,develop imaginal skill, and system skills.

4. Critical Incident : Select one critical incident which motivated you to go for holistic healing. Write it up using Appendix 3. Select one critical incident which marked the turning point in your healing process and write it up using guidelines in Appendix 3.

Field, Focus, Method

Field: The client can be selected from any walk of life or community provided the criteria for selection are followed.

Criteria for Selection of Clients for Case Study

1. Agree not only to take part in the study, but to the use of the materials, even if under as assumed name.
2. Show potential for participation in an ongoing education process to heal others.
3. Be willing and able to give sufficient time to complete the case study within established time frame set up mutually.
4. Be willing to take part in the workshop, motivated to learn and share from experience, co- operative inquiry.
5. Be open and articulate with regard to their own healing process.
6. Be creative in drama/art/role play/story telling etc.,
7. Demonstrate skills in ongoing healing of self.
8. Ability to empower others in the healing process.

Focus : The process of healing is the focus. All methods of healing are included as are all factors which effect health.

Method : Within the case study methods of will be used :

1. The oral history method especially to discover the client’s values, goals, etc.
2. The critical incident approach to detail why the client moved to holistic healing and what was the most decisive element in the healing process. Details of how the clients faced the issue and the process used in selecting treatment, setting, goals, strategies and especially methods, communications, culture, in the light of new values and with what results.

Appendices 1,2 and 3. are helpful in obtaining this information. If available, the researcher should take along a tape recorder and camera to record the interview and to take pictures which can form part of the case study presentation. This must only be done with the explicit permission of the client.

An Application of the Intensive Case Study Method
Described below is an application of the intensive case study method in the correspondence course for holistic health practitioners conducted by the authors.

Specific Plan : Identify and make four intensive (indepth) case studies of effective healing work done in your clinic. Trace out, describe, and analyse the values, belief, and philosophy, the causes of illness and the beginning of the healing process. By two critical incidents written in detail, point out the reason for shifting to holistic healing and the most powerful means of healing. Trace out, describe, and analyse what are the religious meaning ideas and the healing symbol for the client.

Administrative Structures :

1. Staff of Correspondence Course of Holistic Health Practitioners is responsible for initiating and developing the objectives and research design for the case studies and for guiding the students in their writing of four case studies.
2. Work with each student as needed to help them do the case studies i.e. selection of clients, methodology, etc.
3. Aim is to complete the four case studies in one year.
4. To edit, select, and prepare the case studies for publication.
5. To plan and organise the workshop with each student and their four clients.
6. To plan and organise the final workshop where all students present one or more of their case studies.
7. Draft of each study to be sent to the faculty guide in an ongoing manner, or on completion.
8. Target Dates : End of the year for completion of four case studies, two workshop, and graduation.

Two Workshops:

Sharing Workshop
When a correspondence course student has completed the four case studies. Holistic Health Centre staff will set up dates to come for a workshop to the student’s place. The clients will attend and share learning of each cases. Four to six days will be tentatively planned for this workshop. Lesson plans will be developed for each case to be used for the final workshop presentation. The group can learn as much from developing the lesson as they can from using it in class learning. The outline for a lesson plan follows:

1. List the educational objectives for the case study.
2. List the points of knowledge a student should be able to grasp at the end of the lesson.
3. Identify the attitudes you want to highlight from the case.
4. Content: List the important points that can be considered in the discussions.
5. Work out the teaching methods: Role Play; Puppetry: Discussion; Develop questions to bring out the content.
6. Evaluate the lesson plan and revise as needed.

Value education will form a part of the educational input at this workshop. A sample format for this workshop can be seen in Table 1. See Appendix 4 for the exercises included.
We use all methods of clarifying values such as role play, storytelling discussions, etc. It will move people to integrate their religious values through the mandalisation process. The group will learn how to develop values which. enhance their own perosnal growth, interpersonal skills, instrumental skills, that is, general, specialised and cognitive skills. The workshop will include how to develop imaginal skills. (developing right brain healing can bring about whole brain functioning). Participants, researcher plus the four clients, will be taught how to develop system skills and how values can enhances good leadership.

Kind
When a group of Correspondence Course students have completed their sharing workshops and all other correspondence course requirements, the graduation workshop will be scheduled. At this workshop, each student will present one or more case studies. In group participation they will follow the draft lesson plans developed at the site workshop. See Appendix 5 for some questions which may be helpful to stimulate the group thinking. Each student also gives a report of their progress in becoming an effective holistic health practitioner through the experiences of the correspondence course. They will report changes in values, beliefs and attitudes. The over-all findings of the case studies will be shared and the group will reflect on similarities, differences, methods and implications for theory and practice. This may result in changing the objectives, research design, and methodology in the light of the shared experiences. One person in the group can act as devil’s advocate, questioning, attacking, critiqueing- to be a radical to stimulate thinking and to move closer to truth.

Evaluation :
The broad objectives of the case studies are to discover the lesson we can learn from holistic healing methods, to see whether the intensive case study method is a valid form of research, more suited to the person than traditional research; to produce materials for education of holistic health practitioners. It will test each of the objectives we had set, and see how far they were achieved.
We will as a group take one objective at a time and evaluate the level of achievement.
The next step in evaluation will be to review and assess:

1. Research cycling: and see the effect using the four phases.
2. The balance between divergence and convergence.
3. The balance between reflection and experience.
4. Falsification: one member will take the role of Devil’s Advocate.
5. Open and closed boundaries: taking into consideration the world view before and after.
6. Chaos/Order: to see if any order came out of chaos.
7. The management of unaware projections.
8. Sustaining authentic collaboration: did all contribute fully?

The next step will be to assess and revise, if need be, the Case Study/lesson plans based on the experience of using them in our groups.
Then we will evaluate the use and impact of symbols, myths, metaphors and stories in the healing process. This will include looking at the healing potential of the social system on all levels: physical, spiritual, psychological, and emotional - in the family, group, social system and cultrue as a whole, including religion and medical ideologies. How did their world view change?
The use of the Intensive Case Study method is aimed at helping each client initiate their healing process. The tow workshops help the researcher learn and share from the data.
In this chapter we have tried to explore a new research paradigm that takes into account that every human being is unique and therefore, his/her healing process is also unique. In the next chapter, we present two case studies thus developed of the healing process.

[index]