Institute of Health Management Pachod (IHMP)

This 15-page paper presents a methodology for measuring social determinants of health outcomes such as attitudes, socio-cultural beliefs, intentions, perceptions, and the like. Pachod-paisa is a numeric response scale which is meant to be a culturally sensitive alternative to the Likert-type scale. Based on the Indian monetary system (100 paisa = 1 rupee), Pachod-paisa is a ratio-level scale that, according to the authors, may be used in both community and clinical settings.

Specifically, the authors begin by explaining the difficulty, within the South Asian context, of using response scales developed in or for Western countries, such as the Likert, Thurstone, and Guttman scales (e.g., those that consist of a 5-point scale ranging from "strongly agree" to "strongly disagree"). As the authors explain, this is because the "agreement" categories, when translated into various local languages, are prone to subjective interpretation within Indian culture. In contrast, the Pachod-paisa scale integrates the traditional "anna" denomination of the rupee (100 paisa = 16 annas), which has been used for hundreds of years in India as part of daily speech to denote various analogies. For instance, one might say that "this year the crop was only 50 paisa good".

Thus, the Pachod-paisa scale uses a culturally relevant categorisation to measure attitude, the authors argue, by eliciting agreement in paisa (0 to 100). Lack of literacy is not an obstacle, they indicate, since everyone - literate or not - deals with money and can therefore relate to the 'amount' of agreement.

In order to illustrate the properties and uses of this scale, the authors provide empirical examples from 3 different studies to demonstrate its application:

1. Measuring the emotional appeal that child messengers (Bal Sevaks) in a child-to-community intervention designed to promote handwashing with soap after defecation - Sample question: "How many paisa in a rupee do you feel like learning from Bal Sevaks?". The authors conclude that, by using the Pachod-paisa scale, researchers were able to show, for example, that women who had a high score on the emotional appeal index were 8.4 times more likely to change their behaviour than women with a low score.
2. Assessing gender attitudes related to reproductive and child health - Sample question: "How many paisa in a rupee do you feel that the woman should be given more food during pregnancy?". A table in the article demonstrates the use of the Pachod-paisa scale as a continuous variable, and illustrates the different between this type of scale and an ordinal scale.
3. Gauging cultural beliefs about sanitation - Sample question: "How many paisa in a rupee do you feel that defecation in a latrine is impure? What about in an open field?". In short, the authors state that this example demonstrates how the scale can be used to measure cultural concepts of purity and pollution, and the significance of these concepts in predicting latrine use.

The authors conclude by indicating that "there is scope in other cultures to adapt locally relevant constructs to improve measurement of attitudes, beliefs, and perceptions" in social and health science evaluation.

Note: This paper is being published in the journal "Demography India" (June-Dec 2007).