Participatory Rural Appraisal, often abbreviated as PRA, is a systematic yet adaptable methodology that has long been used in development work to gather insights into the realities of rural communities. Rather than extracting data through one-way surveys, PRA emphasizes a bottom-up approach in which local residents and professionals learn collaboratively. Its toolkit includes visual and conversational techniques such as social mapping, seasonal calendars, twenty-four-hour activity calendars, cob-web diagrams, focus group discussions, and key informant interviews. Information gathered through these techniques is cross-checked through triangulation, meaning that findings from different key informants and direct observations by the field team are compared and reconciled to build a more reliable picture of community life.

The study was embedded within the Family Adoption Program, a component of India’s Competency Based Medical Education framework introduced by the National Medical Commission, which requires medical students to engage longitudinally with families in an adopted village. A total of 135 first-professional-year MBBS students participated, after 15 additional students took part in a pilot phase and were excluded from the main analysis. Before entering the field, the students received structured training in PRA methods through lectures, role plays, and hands-on sessions led by mentor faculty. They then carried out house-to-house family health data collection using structured questionnaires, and subsequently applied the PRA tools in the community under faculty mentorship, supported by medico-social workers and field staff from the institute’s outreach program.

To assess how students experienced this approach, the researchers administered a self-administered, Google-form-based questionnaire after the field implementation, with informed consent obtained from every participant. Perceptions were captured on a Likert scale, and the resulting data were analyzed using descriptive statistics, with categorical variables expressed as frequencies and percentages. The study received ethical approval from the Ethics Committee of Symbiosis Medical College for Women, Symbiosis International (Deemed University), and was conducted in accordance with the Indian Council of Medical Research’s National Ethical Guidelines for biomedical and health research involving human participants.

The results reveal a clear hierarchy in which tools students found most usable in the field. The cob-web diagram topped the list, used and rated feasible by 68.2 percent of students for collecting information from villagers. The twenty-four-hour calendar followed at 57.8 percent, then focus group discussions at 41.5 percent, social mapping at 38.5 percent, and the seasonal calendar at 36.3 percent. These figures suggest that visual, diagram-based techniques that can be drawn and discussed with families in an informal setting may be easier for novice students to deploy than more structurally complex methods, although the study’s perception-based design means the numbers reflect student experience rather than measured learning outcomes.

Beyond feasibility, the students’ overall verdict on the methodology was strikingly positive. A majority, 63.33 percent, felt that PRA techniques were the best-suited approach for learning about the conditions in an adopted village. Even more emphatically, 92.6 percent of the medical students agreed that using PRA tools improved their communication skills, a core competency that medical educators have long struggled to teach outside of simulated clinical encounters. Nearly all respondents, 96.8 percent, agreed that focus group discussions helped them understand the problems faced by villagers, pointing to the particular value of moderated group conversation in surfacing community concerns that individual household visits might miss.

Why would diagrammatic tools and group discussions have such a pronounced effect on communication skills? The authors’ framework offers a plausible mechanism. PRA techniques require students to sit with families, draw maps and calendars together, listen actively, and negotiate meaning with people whose daily realities differ sharply from their own urban academic environments. A cob-web diagram, for instance, invites a family to map the relationships and resources that connect their household to the wider village, turning an abstract interview into a shared visual exercise. The twenty-four-hour calendar asks residents to walk through an ordinary day hour by hour, revealing patterns of work, water collection, childcare, and food access that structured questionnaires rarely capture. In each case, the student must ask, listen, clarify, and confirm, exercising precisely the conversational muscles that clinical communication training aims to develop.

The study sits within a broader shift in Indian medical education toward experiential, community-embedded learning. The Family Adoption Program was designed to move students beyond hospital walls and into the social determinants of health that shape their future patients’ lives. Yet implementing such programs raises practical questions: which methods actually work for inexperienced students, how much mentorship is required, and whether the techniques translate into durable skills. By documenting which PRA tools students found feasible and which they felt improved their abilities, this research provides an evidence base for curriculum designers weighing how to structure community medicine rotations in the first professional year, when students have little clinical experience to draw upon.

The authors are careful to frame their conclusions appropriately. As a perception-based, cross-sectional study relying on self-reported Likert-scale responses, the findings indicate that PRA tools, when used alongside the Family Health Proforma, may enhance the teaching-learning experience within the Family Adoption Program. However, they note that these findings warrant further validation through objective outcome measures. Self-reported confidence in communication skills does not necessarily equate to independently assessed competence, and the study design cannot establish causality between PRA use and skill development. Future research using structured observation, standardized communication assessments, or longitudinal follow-up would be needed to confirm whether the enthusiasm students expressed translates into measurable educational gains.

Nevertheless, the study’s central message resonates with a growing international consensus that medical training must engage communities as partners rather than subjects. PRA’s emphasis on collaborative learning, triangulation of information, and respect for local knowledge offers a methodological bridge between public health data collection and the humanistic communication that modern medicine demands. For the 135 students who drew cob-web diagrams on village doorsteps and moderated focus groups under faculty mentorship, the exercise appears to have been, in the authors’ assessment, helpful, informative, and interesting for their community learning. If subsequent studies validate these perceptions with objective measures, the humble tools of participatory rural appraisal may find a permanent place in the medical curriculum, not as relics of development practice but as instruments for training physicians who can truly listen.

Subject of Research: Medical students' perceptions of Participatory Rural Appraisal tools for community learning and communication skills in rural health training

Article Title: Perceptions of medical students on the utility of Participatory Rural Appraisal (PRA) tools for community learning and communication skill development in a rural health setting

Article References: Barhate, A., Narendran, M., Patil, R., Usman, M., & Palve, S. B. (2026). Perceptions of medical students on the utility of Participatory Rural Appraisal (PRA) tools for community learning and communication skill development in a rural health setting. BMC Medical Education. https://doi.org/10.1186/s12909-026-10484-4

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10484-4

Keywords: Participatory Rural Appraisal, medical education, Family Adoption Program, communication skills, community-based learning, MBBS students, rural health, focus group discussions, experiential learning, Competency Based Medical Education, India, BMC Medical Education

The study, conducted by Tonderai Manezhu, S. Sruthy and Raji Pushpalatha of Amrita Vishwa Vidyapeetham’s Amrita School for Sustainable Futures in Kerala, sits at the intersection of two methodological traditions. The first is Participatory Rural Appraisal, or PRA, a family of techniques developed in the 1980s that transfers the tools of analysis from the outside expert to the community itself, using exercises such as resource maps, seasonal calendars and transect walks. The second is non-native ethnography, in which a researcher works in a cultural and linguistic setting that is not their own. The study’s central contribution is to show how these two traditions, often treated separately, can be woven together to investigate water governance in complex rural environments.

The theoretical spine of the research is hydrosocial theory, a framework that rejects the idea of water as a purely physical substance moving through a natural cycle. Instead, hydrosocial analysis treats water and society as mutually constitutive: political decisions, economic inequalities and cultural norms shape how water is captured, distributed and valued, while the resulting water systems in turn reinforce those social arrangements. Viewed through this lens, a tap that runs dry in one neighbourhood while another overflows is not a technical malfunction. It is an expression of the social order, made visible in infrastructure.

Applying that lens in Mohlai, the researchers identified a cluster of systemic problems. The village suffers seasonal drinking water scarcity, with availability fluctuating across the year rather than remaining uniformly poor. Distribution and supply are marked by inequality, meaning that some households reliably obtain water while others are left with insecure access. Wastewater management is inefficient, allowing greywater to circulate in ways that pose hygiene concerns. And groundwater levels are declining, a slow-moving crisis familiar across much of rural India where aquifers are drawn down faster than they recharge.

The crucial interpretive move came in the analysis of why these problems persist. The study concludes that water access in Mohlai is driven by economic capacity, infrastructural position, institutional authority and social power relations rather than physical scarcity. In other words, even where water physically exists, the ability to obtain it is unevenly distributed along social lines. Households with money, connections to functioning infrastructure and standing within local institutions fare better than those without. This reframing matters enormously for policy: interventions that simply add supply, without addressing the social architecture of distribution, risk reproducing the very inequalities that produce scarcity in the first place.

Reaching that conclusion required a methodological journey that the paper documents with unusual candour. The fieldwork was ethnographic and conducted across multiple stakeholder groupings, engaged through household and session-level PRA exercises rather than a fixed enumerated sample. That design choice reflects the logic of ethnography itself: instead of extracting data from a statistically representative cross-section, the researcher builds an understanding of the village as a lived social system, following conversations, events and relationships as they unfold. PRA exercises then structured that immersion, giving villagers tools to record their own knowledge and making community members co-investigators rather than passive subjects.

Being a non-native researcher presented formidable barriers, and the study treats these not as noise to be filtered out but as central to the research process. Linguistic limitations complicated everyday communication, since an outsider cannot catch nuance, idiom or irony in a language learned late. Cultural barriers risked misreading social cues and local etiquette. Perhaps most intractable were power asymmetries in developmental deliberations: in village meetings about water and development, dominant voices can crowd out marginalised ones, and an outside researcher with institutional backing can inadvertently add yet another powerful presence to the room. The researchers’ positionality, meaning their social position relative to the community, shaped every interaction.

Their response to these barriers was a strategy of deliberate rapport-building and collaborative validation. Rapport, in the ethnographic tradition, is the trust that allows a researcher to move from visitor to participant, and the study identifies it as the key to effective engagement in fieldwork, alongside strategic engagement for gaining entry into the research field in the first place. Collaborative validation then worked on two fronts. Technocentric PRA tools, such as a seasonal calendar in which villagers charted water availability month by month, and resource mapping, in which the community depicted its own water infrastructure and sources, produced structured records that could be checked against interview and observational data. Cross-cultural immersion, sustained over the fieldwork period, allowed the researcher to test interpretations against lived experience and reduce translation error. The study describes this as supporting triangulation across evidence sources, the practice of confirming a finding through multiple independent routes.

The ethical scaffolding of the research was correspondingly careful. Ethical clearance was obtained from the Institutional Ethics Review Board of Amrita Vishwa Vidyapeetham, with procedures conducted in accordance with Indian Council of Medical Research guidelines and the principles of the Declaration of Helsinki. Informed consent was obtained from all participants, who were told the study’s purpose, the voluntary nature of participation, how confidentiality would be protected and how data would be used for academic publication. The board’s approval noted the study’s focus on waste and water management with little to no sensitive inquiry, and a contingency plan addressed potential risks of greywater contact during the intervention. The work was supported by the E4LIFE International Ph.D Fellowship Program at Amrita Vishwa Vidyapeetham, with field support from the Amrita Live-in-Labs programme, the village local authority and Mohlai villagers themselves.

The wider significance of the study lies in its methodological lesson for sustainability science. As funding bodies and governments push for participatory approaches to resource governance, a persistent critique has been that participation can become tokenistic, with communities consulted but power relations left untouched. By foregrounding the researcher’s own positionality, the Mohlai study models a form of reflexivity in which the outsider’s limits, and the strategies for working within them, become explicit parts of the method rather than hidden assumptions buried in a methods section. For the millions of rural households across India facing seasonal water scarcity and declining groundwater, the message is that durable solutions will not come from pipes alone. They will require understanding who controls the taps, who is heard in village deliberations, and how a community, working with an honest outsider, can chart its own path to equitable water governance.

Subject of Research: Participatory rural appraisal and hydrosocial analysis of community-based water governance in rural India

Article Title: Participatory rural appraisal for community-based water governance in rural India through a researcher’s positionality-informed approach

Article References: Manezhu, T., Sruthy, S., & Pushpalatha, R. (2026). Participatory rural appraisal for community-based water governance in rural India through a researcher’s positionality-informed approach. Discover Sustainability. https://doi.org/10.1007/s43621-026-04753-x

Image Credits: AI Generated

DOI: 10.1007/s43621-026-04753-x

Keywords: water governance, participatory rural appraisal, hydrosocial theory, ethnography, rural India, groundwater, wastewater management, positionality, Chhattisgarh, water scarcity, PRA methods, sustainability