Doctoral Dissertation Research: Local-level Effects of Centrally Mandated Change

社会科学家通过关注社会行为发生的更大背景，有助于理解社会行为特定领域的复杂动态。 目前，一个潜在的富有成效的竞技场，为发展新的理论，强制性的变化是世界范围内的关注的原因，不同的健康结果。观察家们注意到，前所未有的资源正被投入到资助医疗保健计划中，但严重的差距仍然存在。改变这种状况的努力给社会科学家提供了宝贵的机会，使他们能够在多个相互作用的尺度层次上研究社会系统中的因果关系。 这些研究成果对发展新的社会科学理论以及在社会领域的应用具有重要意义。莫拉莱斯在P.肖恩·布罗瑟顿博士的指导下，将对这样一个有计划的、自上而下的变化的自然实验进行研究。这种情况发生在玻利维亚，该国政府提议通过制定一项广泛的新国家卫生政策来结束卫生不平等。新政策增加了低成本的农村初级卫生保健，其中还纳入了土著世界观，包括一种不寻常的健康和福祉、社区决策和跨文化护理的整体模式。这是社会科学研究的一个令人着迷的机会。这些变化现在才刚刚开始，玻利维亚的小规模背景使深入研究成为可能。研究人员将首先研究首都的政策制定和卫生保健提供者的培训，然后调查农村地区新计划的地方实施情况。将使用一系列社会科学方法收集数据，包括：半结构化访谈，口述历史，治疗叙述，参与者观察，档案调查和文件分析。通过借鉴这些民族志方法，这项研究将大规模的社会变革过程与对实施和实地影响的细粒度分析联系起来。所吸取的经验教训将对那些关心许多有计划的社会干预领域的人有用。

Social scientists contribute to understanding the complex dynamics of particular areas of social behavior by attending to the larger contexts in which they occur. Currently, one potentially fruitful arena for developing new theory of mandated change is the worldwide concern about the causes of differential health outcomes. Observers have noted that unprecedented resources are being poured into funding healthcare initiatives, yet serious disparities persist. Efforts to alter this situation give social scientists valuable opportunities for investigating the causal relationships in social systems at multiple interacting levels of scale. Findings from such investigations have important implications for developing new social science theory as well application in many social spheres.In this research project, Yale University doctoral student Gabriela E. Morales, with the guidance of Dr. P. Sean Brotherton, will undertake research on one such natural experiment of planned, top-down change. It is occurring in Bolivia where the government has proposed to end health inequalities by creating an expansive new national health policy. The new policy increases low-cost, rural primary healthcare that also incorporates indigenous worldviews, including an unusual holistic model of health and well being, community decision-making, and intercultural care. This is a fascinating opportunity for social science investigation. The changes are only now underway and the smaller-scale of the Bolivian context makes intensive research feasible. The researcher will first study policy making and the training of health care providers in the capital city and then investigate local implementation of the new program in a rural district. Data will be collected using a range of social science methodologies including: semi-structured interviews, oral histories, therapeutic narratives, participant-observation, archival investigations, and document analysis. By drawing on these ethnographic methodologies, this research links large-scale processes of social change with a fine-grained analysis of implementation and on-the-ground effects. Lessons learned will useful for those concerned with many areas of planned social intervention.