Why do we need a shift to the transformative paradigm if we are to decolonise global health?

Abstract

There is growing recognition of the need for global health and associated research to decolonise. Yet discourse so far has overlooked the role that research paradigms play within this. Left unaddressed, this omission could further engender hierarchical approaches in global health research. The transformative paradigm articulates the relationships between evidence, power and oppression. With this acknowledgement, we can strive for positive social change through research. In this commentary, we argue the importance of considering the transformative paradigm in efforts to decolonise global health research. We provide an initial overview of key terms in this debate, before exploring what is meant by a research paradigm in more detail and then arguing that a transformative paradigm offers unique and powerful opportunities to address enduring colonial inequities in global health research; we then illustrate how this was applied in a recent mixed methods study which explored experiences and barriers to accessing cancer treatment in Ghana. We show how researcher sensitivity to historical injustices and community-based values were vital to our study design and also in specific methods like a participatory creative task and qualitative interviews. This commentary is important as part of the wider debate about decolonising global health and provides a unique critical insight into how research and how particularly research paradigms are of importance in this task, offering suggestions based on a transformative paradigm.