Philosophical foundations of research, and the case of the epistemic well, in a least developed nation.

Inspired by an ancient tale of kupamanduka (Well Frog) that never ventures out of the well and lives to think the well as the world and see nothing beyond it. This article conceptualises the ‘Epistemic Well’ and the native epistemic community that dwells in it remains within the connes of the epistemic well. Philosophical foundations are the core of each individual researcher and all research questions, hypothesis, methodologies, recommendations are shaped by it. Particular modes of governance instil particular modes of philosophies. Under neoliberalism the prevailing philosophical foundations have been identied as, detached, decontextualized, depoliticized, dehistoricized, dissocialized, deproblematized, reductionist/individualist, instrumentalization, separation, marketisation, positivist and objectivist. The combination of these attributes builds the epistemic well. The epistemic well of research is not absolute and is not meant to provide quantication data. The epistemic well is a reexive tool that can be used to evaluate a research especially for a nation like Nepal. The research funds or the benets that ensues a researcher are important criteria for research. When thinking of a research topic, the primary determining factor becomes the amount of fund available the gaze of a native researcher can overlook various conditions and processes. The epistemic community that is formed by these researchers maintain and sustain particular epistemes. The NCD’s were selected primarily to stick to a cohort but this does not limit the scope and purpose of the epistemic well. focus on individual habits, morals and life-style. Assumption at an ontological level of the reality and the epistemological assumptions about the knowledge generated. Atomistic, individualistic and reductionist in nature. The life-style one acquires must be based on rational choices and if one gets diabetes it is because of the individual who makes wrong decisions. Public health inuenced by the biomedical model has a tendency of victim blaming,(Lupton, 2015) which locates the cause and cure of disease as exclusively within the individual.


Introduction
The rationales, objectives, methodologies/methods, results and recommendations are predominant and evident aspects of most research. Following these are the philosophical foundations which remain usually invisible and which also build up the visible components of most research. Philosophical understandings about nature of reality are crucial to understanding from an overall perspective from which studies are designed and carried out (Krauss and Putra, 2005). Methodology and methods are determined by researcher's world view and bias (Brown, 2003), re exivity and researcher positionality (Walt et al., 2008), ontological & epistemological positions (Rowe and Oltmann, 2016) (Weed, 1999) and axiological positions (Carter and Little, 2007). The scope of this article is not to discuss about these varied philosophies and its strengths and weakness and neither is the scope to discuss which philosophical perspective is better. The attempt here is to explore the philosophical foundations and the assumptions that inform researchers (epistemic community of researchers) under neoliberalism. Research is an outcome of prevailing epistemes. Epistemes are crucial in maintaining, establishing and sustaining the prevailing knowledge. An episteme is the accepted and leading method of gaining and organizing knowledge in a given historical epoch. Epistemes are 'manners of justifying, explaining, solving problems, conducting enquiries, and designing and validating various kinds of products or outcomes' (Land, H.F.Meyer and Baillie, 2010). An episteme controls and regulates the way in which conceptualisation can occur (Howson, 1993). Episteme is the historical a priori that grounds knowledge and its discourses and thus represents the condition of its possibility within a particular, historical context (Unger et al., 2011). Dominating epistemes or world views are articulated in part through institutions, such as healthcare settings, education systems and through speci c scienti c disciplines such as public health, nursing, psychiatry, endocrinology, engineering etc (Murray, Holmes and Rail, 2008). Epistemes are established and sustained through processes of epistemi cation by epistemic communities. "Epistemic communities are recognized by four central elements -shared causal ideas, shared principled beliefs, shared notions of validity, and a common policy enterprise" (Dunlop, 2012). "An "epistemic community is politically neutral, and has been described as a community who apply their standards of credibility, and epistemic values, to the practice of theory choice and knowledge production" (Kinsella and Whiteford, 2009). It has also been described as "a professional group that believes in the same cause-and-effect relationships, truth tests to assess them, and shares common values" (Maffra and C, 2013).
Based on available literature on epistemic communities and the features that characterise an epistemic community as mentioned in the above paragraph the National Health Research Council (NHRC) can be identi ed as an epistemic community. The Second National Summit of Health and Population Scientists in Nepal which was held from April 11-12, 2016, with the theme, "Health and Population Research for Achieving Sustainable Development Goals in Nepal" provides the background and the data needed for the study. One hundred and sixty ve papers were presented. The research papers were classi ed into nine different themes. The summit was attended by a rich diversity of participants from academia, research institutes, government, I/NGOs and external development partners(Bahadur Karki Dharma Kanta Baskota, 2017). This diversity of views available in an event present an excellent opportunity to build the objective of this article which is to explore the philosophical foundations and the assumptions that guide researches done on health issues by a native epistemic community of researchers in an era of neoliberalism.

Rationale
The indiscriminate and uncritical use of questionnaire surveys to gather information was raised more than three decades ago in 1979 in the rst edition of the book, 'Use and misuse of social science research in Nepal' (Campbell, Shrestha and Stone, 2010). More recently others have also expressed the fact that the overwhelming majority of articles reported on quantitative (Karmacharya, 2011) and calls for making health a public health agenda have also been made(Subedi Sharma Madhusudan, 2016). Others have discussed issues that re ect a particular political economy of research -where funding comes from, who de nes the research agenda, the costs of review, developing Nepal's research capacity, through to the politics of publication of research ndings -and includes questions relevant to emerging regulatory and ethical frameworks (Sharma, Khatri and Harper, 2016). The public health education has also been characterised as having its stress on managerial, administrative and project speci c and lacking academically the public health graduates are trained to work as public health practitioners in districts (Mahat et al., 2013). Studies of philosophical nature in dealing with ontological and epistemological issues on Nepal have been few and those that do deal with caste, religion, semantics and forestry (Ahlborg and Nightingale, 2012) (Schulz and Siriwardane, 2015) (Ojha et al., 2016) (Campbell, Shrestha and Stone, 2010). Working with an epistemic community to generate a range of options for further analysis may itself yield important insights into policy, as well as into how the epistemic community operates, perceives the problem(s) and proposed solutions. The rationale of the study to explore the philosophical foundations of research arose due to three primary reasons.
The rst reason is due to the historical processes that has conditioned contemporary Nepal. The second reason is due to the in uence of neoliberal values and the third reason is due to the empirical experiences of the author. A very brief history of Nepal is discussed since; a historicized understanding of the present condition has been deemed an important approach (Rosenberg, 2003). Nepal though never colonized has been substantially affected by colonialism in ways which are different from other past colonial nations. The Rana period from 1848 to 1950 pushed Nepal towards isolation by deliberately keeping the population away from the modern ideas of development such as education. Literacy rate in 1950 was approximately two percent (Kernot, 2006).
More than one hundred years ago in 1887 when various inventions, discoveries were taking place around the world, Richard Temple had declared Nepal to be 'closed to the eyes of science' (Chene, 2007). The year 1956 marks the end of oligarchy, the beginning of an egalitarian political system, introduction of universal access to education, introduction of the General Health Plan, becoming an aid-recipient country and the launch of the Nepal began neoliberalising from the late eighties onwards. In the early 1990's Nepal was subjected to structural adjustment policies (SAP) in line with neo-liberal principles (Sugden, 2009). As a process, neoliberalization is variegated, un nished, and contingent (Annetts et al., 2017). It is a slippery concept to theorize(Nik-Khah and Van Horn, 2016), let alone study empirically(Nik-Khah and Van Horn, 2016). Most scholars tend to agree that neoliberalism is "broadly de ned as the extension of competitive markets into all areas of life, including the economy, politics, and society" (Porter, 2005a). Key to this process is "an attempt to instil a series of values and social practices in subjects (Petersen and Davies, 2010) and by virtue of being embedded in practices of governance at the local level often leads to a sense of neoliberalism being everywhere" (Castree, 2011).
Depending upon the social, economic and political conditions of a nation, the adoption of free-market and neoliberalism can have varied affects and consequences. Neoliberal values and principles like, survivor of the ttest philosophy has taken hold in all sectors including academic, research and education. In academics and research the 'publish or perish' philosophy prevails as a result of which hundreds of researches are being done every year in Nepal. Rei cation of research has led to research being done for ful lling objectives leading to personal gain. Research is done to know about a particular condition that we do not know much about by using methods that are scienti cally based. But how do we know what needs research? And what are the reasons for doing a research? Even before identifying the research topic, subject or object they are cognitive processes that in uences us to decide on a particular research topic, research questions and the research hypothesis.
In gure one the research process shows, the researcher at one end of the process and the results, recommendations and the knowledge generation that the research provides at the other end. In between these two, lay the other determining factors that affect the research output. The researcher is at the bottom as shown in the gure one. Varied range of classi cations have been done on the different factors that affect and guide our research at different stages such as, ontology(metaphysics), axiology, epistemology in totality our philosophy or paradigm. Though ontology and epistemology have been shown separately, claims have been made that these cannot be considered separable as axiology, epistemology and ontology co-evolve (Allen and Varga, 2007). Theoretically the research process ows within the framework of research process as shown in gure one. The sections highlighted in bold are the most visible outcomes of research. The philosophical aspects of research are usually invisible (ontological epistemological and axiological conditions). The focus of this article is on factors that guide us to choose a particular methodology and through which results are generated, ndings are made and recommendations done.
Since the neoliberal environment condition our ideas, it is imperative that neoliberalism and its ideology, its assumptions and its processes be discussed and understood. Since its coinage the term has been in constant use and its popularity can be fathomed by the fact that a Google scholar search of the term neoliberal in its title since 2019 yielded more than 1500 results. With so much use of the term, neoliberalism risks being tagged as just another buzzword (Noonan, 2018) or fuzz word, or is it already one? Use of the term neoliberal has also led to some describing as being lazy, too vague, too ready to denounce, frequently unde ned, unevenly employed, too overblown and the need for it to be 'severely circumscribed' has been called for (Clack and Paule, 2019). Despite the allegations, neoliberalism still holds an important place as evident by the large number of publications which mention the term.
The term neoliberalism resulted from the participants during the Walter Lippmann Colloquium held in Paris in 1938 to discuss the French publication of, An Inquiry into the Principles of the Good Society by Lippmann (Cahill et al., 2018). The central presuppositions of neoliberalism include the rational selfinterested individual, free market economics, a commitment to laissez-faire and a commitment to free trade (Olssen and Peters, 2005). Neoliberalism has shaped our cognition and it espouses neoliberal ideologies that emphasize individual-level decision making about economics and healthcare (Sanders and McKay, 2013). Neoliberal view and practise has directly implicated in shaping the way health is promoted (Ayo, 2012) and thoughts are shaped (Rose, 2001).The neoliberal ontological project supposes homo economicus as principal model for individual behaviour which occurs from subject's economic rationality functioning in a world of perfect information and inert notions of equilibrium(Madra and Adaman, 2014). Neoliberalism touches all aspects of life including research.
Under neo-liberal in uence research is predominantly positivist (Esposito and Perez, 2014) by nature and the recommendations, ndings; interventions are predominantly individualist in nature (Rentmeester and Dasgupta, 2012). This knowledge of interventions stems from the ontological and epistemological assumptions one has and under neoliberalism it has been predominantly guided by, "a positivist ontology which suggests that all things exist in some sort of objective universe and this includes human beings" (Stahl, 2007). A positivist ontological approach, "presumes the existence of a ''real,'' apprehendable reality driven by immutable natural laws and mechanisms and that researchers are capable of studying objects without in uencing them or being in uenced by them" (Carpiano and Daley, 2006). "Positivism relies on a reductionist view in its search for universal mechanistic rules that are not contextually bounded and seeks to verify hypotheses" (Carpiano and Daley, 2006). Positivists view the individual as an essentially biophysiological and neurophysiological system, a reductionist view (Yadavendu, 2013). An offshoot of the positivist school of thought is methodological individualism (MI) which, "emphasises; homo economicus, based on assumptions of individuality, rationality, self-interest; and the doctrine of spontaneous order"(Roberts and Peters, 2019). Methodological individualism has been the "central monistic-ideological stand of existing economic theory, from which individual economic policies fastidiously acquire neoliberal basis" (Draskovic, 2016).
Methodological individualism as a position and process consists of several assumptions. Some of the assumptions inherent within the approach which have been identi ed are ontological assumptions (Prozorov and Rentea, 2016), epistemological assumptions(Cosgrove and Karter, 2018), fundamentalist assumptions(Sparke, 2020), atomistic assumptions (Mcdowell, 1994), methodological assumptions (Rillo, 2018), observability assumptions (Backhouse, 2007) and axiological assumptions(de Camargo, Ortega and Coeli, 2013). A "positivist ontological approach combined with methodological individualism can create a disposition to treat humans as objects" (Stahl, 2007). "Treating humans as things means that one can treat them as means rather than ends, thus violating Kant's well-known account of the categorical Imperative" (Amstutz, 2013), "according to which humans should never be treated as means or to put it in more contemporary words": "Such research may end up by recommending most people to be handled like billiard balls" (Nissen, 1985).
This combination of methodological individualism and positivism has been incorporated in epidemiology, the discipline most actively involved in the study of health problems (Breilh, Campana and Hidalgo, 2005). Claims against mainstream/traditional epidemiology being "too dull to analyse the complexities of today's health problems was made in 1994". The Leeds declaration "emphasized the need to refocus upstream and to use research methods that are appropriate to the level at which intervention will take place" (Pearce, 1996). "Epidemiologic techniques can be used in other settings (e.g., clinical epidemiology) and for other purposes (e.g., studies of disease progression and prognosis), but the key contribution of epidemiology to public health is its population focus" (Pearce, 1996). Citing the Leeds declaration in 1994, "the Lancet editors concluded that common epidemiological research has always been based on simplistic notions of causality"(van Der Maesen and Nijhuis, 2000). "The Research Unit in Health and Behavioural Chance at Edinburgh University construed that mainstream epidemiology has little to offer in modernising public health, that its positivistic orientation highlights a key aw in its recognition of the social dynamics of health and disease, therefore weakening its potential to achieve transformation in public health"(van Der Maesen and Nijhuis, 2000).
The dominant risk factor epidemiology prevailing has several limitations (Pearce, 1996) (Goldberg, 2013) and operates under 'atomistic metaphysics'(de Camargo, Ortega and Coeli, 2013) and individualistic suppositions (Wemrell et al., 2016). "The principal approach of epidemiological explanation takes place entirely within the con nes of a scienti c way that has been termed Cartesian reductionism, an analytical advance categorized by a focus on factors measured in seclusion from their context" (McPherson, 1998). "The dominant theoretical developments in epidemiology have effectively ignored the true dialectic that exists between people's actual chances and their real possibility of making choices" (Doll, 1999).
The practise of victim blaming does not question, structural, social and other external forces that puts an individual at risk. Individualistic approaches do not deal with the root causes, "which not only include industrial activity but also elements of the global political economy that give rise to the crisis in the rst place". Occasionally called the 'causes of the causes of the causes', "several commentators argue that these broader societal factors can be tackled only by passing policies that deal with structural drivers, particularly those that generate poor nutrition: liberalisation of food trade; the acceleration of foreign investment by transnational food companies; the rapid spread of cheap, ultra-processed food that affect the availability, affordability and acceptability of what people eat; and deregulation of commodities markets that cause food price instability and dietary dependency" .
The hallmark trait of contemporary public health has been dominated by behavioralism (Staddon, 2004) and the individualization of risk (Peet, Robbins and Watts, 2010). This individualization along with the belief in positivist ontology and epistemology has resulted in the much acclaimed evidencebased medicine or to put it more broadly evidence-based practise. The materialization of Evidence-based medicine (EBM) as the gold-standard practice was followed by Evidence-based public health (EBPH) which resulted in signi cant ontological and epistemological shift which resulted in "proactive use of evidence conducted within a realist ontology using positivistic empirical strategies" (Gray and Mcdonald, 2006). The emergence of evidence-based practice must be appreciated within the context of neo-liberalism (Gray and Mcdonald, 2006). The EBPH like EBM tries, "to position health policies and interventions on 'sound facts' and this uncritical acceptance of evidence-based medicine by the public health eld has been seen to substantiate blaming individual patients for health problems ensuing from social conditions or that the EBPH approach may rationalize cuts in public health spending" (Nadav and Dani, 2006). Both EBM and EBHP presuppose universal biological response and hence do not take into account the social and historical grounds of the researched sample, and thus they assume that conclusions of a speci c set of researches can be generalized to any population(Victora, Habicht and Bryce, 2004).
"The critics of EBP warn that the concept of 'what works' evidence is parochial and myopic, because it de nes 'evidence' scienti cally and mechanically that is too limited from public health perspective" (Ahmed, 2014). The evidence-based approach has been claimed to have led to the commodi cation of health care and public health (Nadav and Dani, 2006). The "model's limitations are especially salient in the eld of public health, where conditions considering problems to be the result of simple, one-directional, causal relationship, is even more reductionist" (McGuire, 2005). "Commonly ignored, yet seriously healthdamaging, contextual factors include: being a second-class citizen or being made to feel like a second-class citizen" (Monaghan, 2013). Epidemiologically informed 'lifestyle' approaches thus obscure how health is an embodied multi-dimensional construct. As a social construct, health also comprises different meanings to different people"(Rich, Monaghan and Aphramor, 2010).
Most theoretical debates about the pros and cons of public health approaches are con ned to the methodological scienti c level. "Philosophical foundations such as fundamental ontological notions are seldom part of public health debates, but these are always inherent and lie behind the opinions and interpretation of diverse standpoints or traditions"(Nijhuis and van der Maesen, 1994). "In empiricist science, dominant in contemporary epidemiology, exposure and risk assessment, the principal accepted philosophical approach is that of the positivist paradigm -unbiased examination; the separation of 'facts' from ''values''; and the stress on veri cation to build up universal laws" (Briggs, Sabel and Lee, 2009).
The combined empirical experiences of the authors gained in day to day academic activities such as classroom interactions, seminars and research activities have also considerably prompted us to explore research philosophy in the eld of health. Experiences such as when teaching public health and community medicine at the post-graduate level in the rst semester when asked what causes an individual to have ischemic heart disease or any other diseases that have been historically linked to social, economic and environmental conditions? The answers received comply with the dominant paradigm of proliferating blame the victim 'life-style' theories which emphasize individual's responsibility to choose so called healthy life-styles and to cope better with stress, illiteracy, ignorance, superstition and other individual attributes. The principal causes of ill-health are situated at the micro level. The lack of historically informed analysis is absent and this lacuna manifests itself when doing health research.  (Glasgow, 2012). These dozen features identi ed in the study can be said to make an imaginary well, which the authors try to conceptualise as epistemic well of research (see gure two).

Methodological Approach
The epistemic well a product of neoliberalism can exist in any discipline. The dozen features of the epistemic well when viewing health does not question the social, economic and political structures; it takes them as given and deals with health issues from within these pre-existing structures. The epistemic well is not absolute in nature and not all researches will display all the twelve characteristics of the epistemic well. Some of the characteristics of the epistemic well like positivism as a trait of a research may not mean that a research is in uenced by the epistemic well. The epistemic community that dwells in the epistemic well produces the researches. The epistemic well exists but due to its invisibility and the processes through which it exists, makes discerning researches in uenced by the epistemic well a re exive exercise. The researches that are affected by the epistemic well can produce results and recommendations that may serve no purpose, other than some instrumentalist purpose bene tting the self. The epistemic well of research is not absolute and is not meant to provide quanti cation data. The epistemic well is a re exive tool that can be used to evaluate a research especially for a nation like Nepal. The research funds or the bene ts that ensues a researcher are important criteria for research. When thinking of a research topic, the primary determining factor becomes the amount of fund available, the gaze of a native researcher can overlook various conditions and processes.
From the depths of the epistemic well when researches are done, health issues are assumed to be self-evident problems (Krieger, 2010). The process of naturalisation of socially produced risk (Schulz and Siriwardane, 2015), (re)production and normalisation of social divisions (Steinberg, 2002), neutralization of negative health impacts (Nilsson, 2009) shapes researches in uenced by neoliberalism. "Wayne Brekhus referred to this as the process of 'unmarking' problems so that what was marked as clear and evident becomes virtually unnoticed and, by virtue of that, 'unremarkable'" (Gubrium and Järvinen, 2013). "The prevailing dominant discourse in the health profession is biomedical, micro level, individualized and depoliticized and this tradition treats health as the absence of illness or disease in individuals and pursues to improve quanti able aspects of their lives through the lessening of risk factors via indicators of morbidity and mortality" (Brassolotto, Raphael and Baldeo, 2014b). Those espousing this world view typically accept that work against disease is empirically desirable hence necessitating no additional rationalization: the epidemiology (the evidence) is normally believed to "speak for itself"(Seedhouse, 2004) (Battersby, 2008).
In order to explore the philosophical foundations that guide the philosophical foundations of health research of native researches an analysis of the health researches on noncommunicable diseases presented during the NHRC conference in 2016 was conducted. The book of abstracts for the year 2016 was available from the NHRC website for public use. In total twenty two researches were presented under the theme of NCD in the conference. Amongst these two were excluded one was on a clinical study of Maxillary Anterior Teeth and the other was on gender-based study of pattern reversal visual evoked potential.
Based on pragmatism we hold that the most important determinant of the research philosophy adopted are the research questions which also guide the other aspects of the research(Higgs, Horsfall and Grace, 2019). The nal and visible product of any research are the ndings, results and recommendations which are shaped by the methodologies and methods adopted, but behind these lie the usually invisible part which are the 'ontological nature of social reality', the epistemological nature and understanding of knowledge and the axiological position of the researcher(Held, 2019). A research question or a hypothesis, (hypothesis serves as an extension of the research question) can be looked at from different angles and using different methods to provide different types of answers (Carpiano and Daley, 2006). Research methods are linked through methodology and epistemology, to an ontological position (Johnstone, 2004). It is impossible to engage in any form of research without committing (often implicitly) to ontological and epistemological positions. Researchers' differing ontological and epistemological positions often lead to different research approaches towards the same phenomenon (Mingers, 2003) (Grix, 2002).
The selected twenty researches were analysed of their a) research objectives, aims or goals b) methodology and methods used and c) conclusions, discussions and recommendations made (see gure3). Each research was approached with the following questions.
What are the stated objectives, justi cation, rational, aim or purpose of the research?
What or who are the subjects of study of the research?
What are the methodologies and methods followed in the research?
What type of data does the methodology aim to generate?
What are the ndings of the research?
What are the recommendations of the research?
After obtaining the answers to the above mentioned questions these components were then subjected to questions philosophical in nature. The rst question deals with ontology and involves the philosophy of reality (Last, 1986). Ontology is the study of reality/being and it shapes our views and affects our sight(also called metaphysics) (Rychetnik et al., 2004). "The researcher's view of reality is the corner stone to all other assumptions, that is, what is assumed here predicates the researcher's other assumptions. As applied to healthcare research, ontology is about the nature of reality that is worth investigation" (Turyahikayo, 2014). For instance, one could view poverty as the result of individual attributes like laziness, drunkenness, ignorance or one could view poverty as the result of the development model followed.
The second question deals with epistemological beliefs that the researcher has about the nature of knowledge what counts as educational knowledge and how is it obtained' or 'how can we as researchers gain knowledge about the external world?' (Bryant, Raphael and Travers, 2007) Epistemology addresses how we come to know the reality (Onoruoiza et al., 2015). Researcher's differing ontological and epistemological positions lead to different research approaches towards the same phenomenon (Voros, 2008). For instance the differing ontological views on poverty as mentioned in the above paragraph leads to different epistemic beliefs. The rst view on poverty can lead the researcher to believe that knowledge about proper counselling and knowledge that can bring about behavioural change is desired. The second view on poverty can lead the researcher to believe that the limitations of the particular developmental model be identi ed and acted upon so as to reduce poverty.
The third question deals with the methodological approaches, the researcher uses. Methodology can be individualist, holist, quantitative, qualitative, inductive, deductive and mixed. Continuing with the example on poverty, the differing positions will pursue different methodology. The rst view that poverty is the result of individual attributes can employ methods such as in-depth interviews and study the life style practices that act as hindrances to lessening poverty. The second view can look at the reasons why a particular developmental model is followed and in the process could interview policy makers and development experts. The chosen methodology and "methods can be traced back, through methodology and epistemology, to an ontological position". The researcher's ontological and epistemological perspective affects the topic selection of the research. "Researchers' ontological and epistemological assumptions are apparent in the questions and methodological approaches that they select. If one's answer to the ontological query is that a knowable reality exists, then his or her research will vary greatly from researchers who hold the conviction that reality is individually or socially constructed. " (Marley and Levin, 2011) The fourth question deals with the axiological nature of the researcher and focuses on values in the research process or morals and ethics. Axiology is the theory of values, and values are aspects of human behaviour that emerged during evolution and gave us aims, goals and opinions which through our knowledge direct our actions. The axiological nature of the research is inherently present during all stages of a research. In (See gure 1) the process of research has been shown.
The characteristics of the epistemic well can affect a research at different levels. The research could be giving us the true nature of the problem in quantitative measure but the understanding of the problems could be decontextualized, deproblematized and detached. For example if a research was done to study the breast feeding practices of mothers with children up to six months in an industrial/manufacturing region. I do house hold visits and collect data on breast feeding practices and I conclude that breast feeding is low since mothers are ignorant and need to be motivated through health literacy and health promotion programs. Also I suggest proper counselling to the mothers about the importance of breast feeding. My methods of data collection were semistructured questionnaire and interviews. I visit the houses on a Saturday since it is a holiday and hence informant would be at home. Based on the recommendations of the study an intensive promotional program was developed and mothers were given health literacy awareness, awareness programs in local radio and posters and pictures in schools to increase awareness among the children who in turn would diffuse the message in the family. Now another researcher comes to the same study site and studies the same issues on breast feeding among the same sample population. The researcher goes to the site and does an ethnographic study and comes up with the conclusion that women giving birth only get 40 days of leave with salary from the factories. After forty days the mother's have to work 9 hours shift and if they start taking leave after the allotted 40 days of leave their daily wage or salary will be subtracted.
Moreover if she does not join the work after a maximum of two months their job contract will be terminated and she will be replaced. The researcher nds that mothers know the importance of breast feeding for the rst six months but she is faced with a choice, the choice of losing a job in a region with high unemployment. The researcher sees the solution in having a collaborative effort at solving the problem by bringing in the factory management, local and national government, the mothers and health workers.
In gure three the methodological process has been shown. The epistemic well informs the researcher as a result of which the research methods, ndings and recommendations display certain assumptions on which the research is built. These assumptions of different nature that exist at different levels when taken together can be identi ed as the philosophical foundations of the researcher. The philosophical foundations of a researcher when shaped by components of the epistemic well can produce research that is detached from the reality it studies. For instance, how useful is a research if a researcher conducts a research on effects of teaching hand washing practices among school going children, how valid will the research objectives, research questions and the ndings be if the researcher were to discover that the school has no regular and constant water supply.

Findings
The ndings of the study are discussed in table one. The rst column mentions about the research title, objectives and rationales for the selected research presentations. The second column mentions about the research methodologies, methods, recommendations and conclusions of the selected researches. The third column contains arguments made by the author about the selected researches. The author seeks to identify the assumptions inherent in the researches and also seeks to discern the traits of the epistemic well displayed by the researches. The comments have been informed by literature review and the ontological understanding possessed by the authors. Being a native the authors attempt to look at the researches not by detaching one's self but by incorporating the real lived empirical experiences of the authors. Historically from the 1916 onwards the understanding that ignorance of the mother was the primary cause for poor health conditions of the children was accepted as a truism (Porter, 2005b). This understanding has continued strongly and under a neoliberal system when commodi cation is the norm, "women are often assumed to have no speci c health needs outside of their mothering roles, an assumption borne out by most of the existing health programmes that target women only during their reproductive years" (Parsitau, 2008). The vicious cycle of ill health, ignorance, and poverty starts in the womb (Green, 2012). The mother's apparent lack of interest can be appreciated when one realizes that parents in highly impoverished families have varied and tremendous burdens to bear" (Fox, 2002). The ontological assumption that ignorance of mother's knowledge attitude is barrier regarding children's eating behaviour. The epistemological assumption that barriers can be studied epidemiologically and facilitating factors can be explored at the individual level. Methodological assumption that the process of study and data collection at the individual level will provide a true picture. Atomistic nature dealing at the individual behavioural level. "Cross-sectional studies do not resolve problems relating to health care systems or the results of quantitative research methods are often not implemented in clinical practice, particularly using cross sectional studies in examining attitudes, beliefs, and values and quasiexperimental designs" (Tavakol and Aa, 2004 . The epistemological and "ontological problems in de ning the concept mental disorder and in delineating clinical entities are conspicuous, and many clinicians and psychotherapists nd the categories and diagnostic criteria of both the DSM and the WHO's ICD-10 in many ways inconvenient or trivial when applied to individual cases in clinical practice" (Helen, 2011). "The general way in which the questions are asked raises the suspicion that even people who would not fall into the category of "depression" if diagnosed by a professional psychiatrist might be pushed to believe that they are depressed and in need of medicines" (Ecks, 2005). The murky relationship between the universalistic biomedical perspective of psychiatric problems and a locally informed one Has been discussed by Harper. Much psychiatric research in Nepal is a direct outgrowth of the former, wherein statistics that suggest how prevalent conditions like "depression," etc. are generated. Such research not only contributes to the Westernization of psychiatric problems, but in Nepal also perpetuates structural inequality by the very categories used in statistical studies (Harper, 2014). The "pharmaceutical industry is increasingly employing strategies of direct-to-consumer marketing, aiming to create a popular recognition of depressive symptoms, to "grow the market", and to foster a demand for speci c medications" (Ecks, 2005). The increasing trend of the use of pharmaceutical products for various mental conditions has termed this era as "the antidepressant era" (Jefferson, 2000).Assumptions that a questionnaire will give the correct answers. Prisoners will give the correct answers irrespective of their present mood condition. "Subjectifying nature" of the questionnaire has been criticized on many counts. "Interest in depression in the eld of international health was intertwined with the emergence of a new generation of antidepressant drugs, the serotonin reuptake inhibitors (SSRI)" (Ecks, 2005 The "concepts of perceived health status, quality of life and health-related quality of life can be complex to analyse as they might be mediated by several interrelated variables, including self-related constructs (e.g. selfe cacy, self-esteem, perceived control over life) and subjective evaluations could be in uenced, in theory, by cognitive mechanisms (e.g. expectations of life, level of optimism or pessimism, social and cultural values, aspirations, standards for social comparisons of one's circumstances in life)" (Bowling, 2001). Without taking into consideration "political unrest, environmental disaster, declining economic performance, the introduction of structural adjustment programmes, un-responsive governance, and weak public-health infrastructure changing population dynamics, the advent of HIV/AIDS, and the onset of globalisation". The HRQL is limited. "A universal questionnaire to elicit the relevant information for a number of conditions would need to be of enormous length" (Bowling, 2001).Assumes checklists and "HRQL (health related quality of life) instruments are enough to gather information. Controversy around validity of these measures; investigators concerned with the question of whether these systems are measuring what they intend to measure. Given an absence of a benchmark of health, determining criterion validity-comparing the results achieved to an accepted gold standard-is impossible" (Gold, Stevenson and Fryback, 2002). "HRQL measures placed a greater emphasis on issues such as measure responsiveness, sensitivity and reliability, paying less attention to generating overall models of disease distribution, severity, and mortality" (Gold, Stevenson and Fryback, 2002 The awareness program that it talks about is with an ontological understanding of the reality guided by the individualist, reductionist and de-politicized philosophy. Without taking into account the structure of neoliberalism and by naturalising the commodi cation and marketisation the school level curriculum based awareness program will focus on individual habits, morals and life-style. Assumption at an ontological level of the reality and the epistemological assumptions about the knowledge generated. Atomistic, individualistic and reductionist in nature. The life-style one acquires must be based on rational choices and if one gets diabetes it is because of the individual who makes wrong decisions. Public health in uenced by the biomedical model has a tendency of victim blaming, (Lupton, 2015) which locates the cause and cure of disease as exclusively within the individual. Assumptions that government has full control and power along with willingness. The policies it implements such as removal of subsidies, cutbacks in social expenditures and austerity measures indicate a contradictory approach to welfarism. Ontological assumptions regarding functional activities. For example, A has to share a common toilet where as B has a private bathroom and hence their functional needs are different. Epistemological assumptions seen when physical activities and functional activities are considered as knowledge that is desirable and needed.

Analysis of the researches
6. Find the health literacy and knowledge of disease among the patients with chronic disease.
Cross sectional study was conducted, interviewed face to face, translated, pretested, validated European health literacy survey (HLS-EU-ASIA-Q)2 questionnaire.
Respondents with su cient health literacy knew signi cantly more about the disease than those with inadequate health literacy. Health literacy is independently associated with disease knowledge.
Health literacy or mass education strategies is an individualistic approach which views the "responsibility for reducing exposure to risk factors in individuals, and is emblematic of a medicalized framing of health problems" (Clark, 2014a). Assumptions that increased knowledge and health literacy will translate to better practise. The "upstream social determinants of health such as marketing of unhealthy foods to children and later drift downstream by relying on strategies to directly change the behaviour of individuals has been described as a lifestyle drift" promoted by the policy makers as reductionist in nature" (Clark, 2014a). The neoliberal philosophy where the invisible hands of the market will su ce to create a developed nation seems rather tempting but these activities have a lasting effect especially as NCD'S are often interconnected and require long term solutions (Clark, 2014b Assumptions that PSS-scale and questionnaires can be used for stress amongst adolescents. "Questionnaires are supposed to eliminate observer biases, to provide a routine method of investigation and analysis which presents the same stimuli to all respondents. Rather, at every stage, a host of assumptions and interpretations are made by everyone employed on a project, which are commonly unacknowledged and uninvestigated in the presentation of results" (Murphy et al., 1998 The thousand-fold increase in the prevalence of depression and it becoming a public health problem happened largely due to the development of psychiatric epidemiology since 1950"s (Helen, 2011). The sale of psychotropic drugs is big business (Wong, 2006). The current depression paradigm is the tendency to think of depression as well as other mood disorders as objects instead of as an experience with a speci c context. Movement toward thing-like status makes mania and depression seems possible to identify, manipulate, and optimize through the technology of psychotropic drugs and through taxonomic apparatuses(Helen, 2011).

The
Descriptive cross-"Questionnaires in effect lter the social processes under study through a pre-de ned "grid" of categories prevalence of depression and their correlates and association of physical activity with physical activity among higher secondary students sectional study was designed global physical activity questionnaire (GPAQ) for physical activity and beck depression inventory IBDI-IA) for depression along with some socio-demographic variables.
Global physical activity questionnaire (GPAQ) for physical activity and beck depression inventory IBDI-IA) for depression along with some socio-demographic variables.
assumed to represent the range of possible alternative responses appropriate to the area of research. Fixed choice (yes/no) questions represent the extreme in this respect, but scaling techniques may be no less inappropriate. It is meaningless to produce measurements or quali cations of phenomena whose dynamics are not yet understood" (Murphy et al., 1998). Most studies of area effects on health are cross sectional; that is; measures of the place and of the residents' health are collected at roughly the same time. When one starts to think about socially and biologically plausible causal pathways by which place might in uence health these cross-sectional designs often appear inappropriate (Macintyre, Ellaway and Cummins, 2002). In the attempts to make psychiatry more scienti c the triumph of the styles of reasoning familiar from epidemiology and social medicine-statistical induction, probability calculus and risk estimation-has been much more crucial than the rise of psychopharmacology and neuropsychiatry. "It is nowadays almost impossible to present claims about mental health facts without supporting them by statistical analysis of data from epidemiological questionnaires or randomised clinical trials" (Helen, 2011 This suggestion is based upon the idea that "individuals should have the opportunity to live to the same age as others-that there is a prima facie right to a minimum number of life-years". The limitations of conventional health care systems are obvious. The narrowly technological approach to health care serves to block the integrated utilization of health economic and other resources. In fact highly professionalized and technological health services cannot be equitably distributed as it is neither possible nor desirable to have a hospital in every village. The task rather, is to attempt to change the composition of health services-away from hospitals and towards primary care-through their more equitable distribution and to make them part of overall economic and social development (Gish, 1979). "Since access to such public provision is often heavily unequal across locations, and within communities, this gap constitutes a signi cant weakness, especially in the context of crosssectional or inter-temporal comparative analysis. In many situations, even households that have the nancial capacity might nd it impossible to obtain adequate education and health services simply because those services are not available locally. The poverty-line approach implicitly assumes that money can buy health, education and other services at any time and in any place or that these are provided by the State" (Novak, 1995 "Self-report surveys share certain limitations that are characteristic of the self-report method. The primary weaknesses of self-report surveys are a function of the adequacy of the sample and the accuracy of measurement. The issues bearing on the adequacy of a survey's sample are ensuring representative participation and receiving cooperation throughout the survey questionnaire. Measurement accuracy is an outcome of asking questions correctly and respondent candor and memory. Although it appears that respondents are generally truthful in reporting their experiences underreporting is a threat to validity for self-report studies"  The "focus on practitioner cultural competence is based on assumptions that: (a) mental health services and interventions can reduce health disparities; (b) that these interventions are more accessible, acceptable and effective when they are culturally adapted; and (c) that practitioners can acquire speci c knowledge, attitudes and skills that will improve their delivery of effective culturally appropriate and responsive mental health services". There is modest evidence for each of these propositions. "Questionnaires rest on the assumption of a de cit model wherein laypeople are assumed to be lacking in scienti c knowledge or literacy" (Michael, 1998 "Advantages claimed for questionnaires would rarely stand up to scrutiny. They are supposed to eliminate observer biases, to provide a routine method of investigation and analysis which presents the same stimuli to all respondents. Rather, at every stage, a host of assumptions and interpretations are made by everyone employed on a project, which are commonly unacknowledged and uninvestigated in the presentation of results" (Murphy et al., 1998 "Underlying all of these models is the assumption that individuals are goal-driven, strategists who weight choices according to their own ends (i.e. They are cost-bene t decision-makers)" (Henrich, 1998). Assumption that information leads to change in behaviour. "Public health intervention that adopts the biomedical model fails to address issues of wider social injustices that are responsible for health related vulnerability and risk" (Azétsop and Rennie, 2010 "For Roland Kuhn, vital depression was a speci c disease for which imipramine was a cure, whereas Nathan Kline, the other pioneer of antidepressant medication, thought that all kinds of depressive states had a biological origin and that medication was therefore suitable for depression in general. The current standard of depression treatment contains a preventive rationale implicitly promoting medication even in less severe depressions" (Helen, 2011). Antidepressants have been also termed as "psychic energisers" and these block buster drugs (Baxter, 2006) have given rise to a new era, the antidepressant era (Jefferson, 2000) . When it comes to medical markets, under neoliberalism it exhibits a "theoretical anomaly"(Conrad and Leiter, 2004) since medicines have been traditionally and historically different than other consumer goods.
17. To assess the relationship between illness perception and Analytical crosssectional study, illness perception Questionnairerevised (IPQ-R) and beck depression inventory-ii (BDI-II).
"Questionnaires rest on the assumption of a de cit model wherein laypeople are assumed to be lacking in scienti c knowledge or literacy" (Michael, 1998 history of CVD, hypertension, and diabetes; patterns of smoking and alcohol consumption; physical activity levels (including work and leisure); dietary patterns and history of weight gain; and the presence of symptoms of CVD. Questionnaire must be designed to collect data that meet the statistical assumptions of the quantitative techniques to be used (Glasgow, 2005 Yach and Beaglehole say that globalization has contributed to the rise in chronic diseases and blame major transnational corporations and the global communications media for the marketing of tobacco, alcohol, sugary and fatty foods in nearly all parts of the world (Yach, Beaglehole and Hawkes, 2005). "Emphasising such an imperative for behaviour choice, however, obscures the circumstances in which individuals make that choice or indeed have their choices constrained". The "pricing, availability, marketing and perceptions of costs and bene ts strongly in uence choice of unhealthy product consumption". "Dietary risk factors and physical inactivity are only partially determined by individual preferences and are more so "substantially in uenced by the manufacturing and marketing practices of the food industry and by the built and social environments that permit or impede physical activity". Adopting the values of a medicalized approach immediacy, e ciency and control the use of "quick x" or "magic bullet" strategies designed to in uence individual choices rather than government policies or the activities of manufacturers is tempting in the short term, but will not have a lasting impact, especially as NCDs are often interconnected and require long-term solutions" (Clark, 2014b). Focus is on the upper, super cial, echelons of the process and is rarely of the process itself. It stands in contrast to the view dubbed "holistic" or "physiological" that stresses individuals and their adaptation -physical, psychological, social -to their environment (Baxter, 2006 Smokers were not prepared to quit because they were less motivated, not wanting to change was found associated with lower self-e cacy. "Public health workers are determined to focus on problems that interest them as researchers and not on the problems of concern to individuals" (Syme and Ritterman, 2009 "Elders generally felt that improved health should "start at home", partnerships at the community and systems levels were often referred to as more likely solutions than individual and interpersonal ones" (Hermann et al., 2010). The part by part solution to identify risk factors for anything pathological has been the trend followed by researchers. Mistreatment occurs due to lack of awareness and prevention, intervention and awareness strategies are sought for solving the problem. Mistreatment for one could be not getting to see a favourite television program and for another could be not having money for medicines. More than lack of awareness, elder mistreatment is more about values.

Conclusion
The neo-liberal research, researcher, universities, organisations are all in sync with one another and this creates a culture of doing research projects one after another. The neo-liberal researcher is bound by practices set by councils, universities, committees and so on. Since the promotion criteria of a faculty depends mainly on the number of research publications in peer review journals, the number of research projects completed, number of conferences attended and so on, the pressure of doing research and publishing them is omnipresent. Hence for example "A" an assistant professor joins a university after nishing MD or PhD and in three years time "A" can become an associate professor with an increase in pay and other facilities such as conference grants. But they are some basic conditions that "A" will have to ful l in order to get promoted such as "A" needs three research publications in peer reviewed indexed journals, received one project grant and completion of one project or study. If "A" has ful lled this in paper "A" gets promoted. This process continues till "A" becomes a professor. The other indispensible function that "A "does is teaches students a course in the university. And if "A" since as a physician "A" also caters to the patients. Now what is perplexing is the role of a teacher and a surgeon are not given any signi cant weight. "A" may be an excellent teacher and surgeon but without the minimum number of research publications "A" cannot be promoted. So despite the busy schedule "A" has, starts doing a questionnaire survey among visiting OPD patients and generates the hypotheses that, "patients coming to the hospital in red colour cars are more prone to diabetes than patients coming in black colour cars". So "A" selects the sample population, collects the data, generates the data and publishes the data in a peer review journal. Now "A" has to do several researches in this case let us keep it to three for every stage of promotion and with three years intervals. To be a professor, one begins as assistant professor then associate, additional and nally a professor.
The mantra of faculty promotion is in uenced by the practise of, "publish or perish" where for every level of promotion one needs to ful l the required number of publications. The pressure to climb up the hierarchy is desirable among all of us including academicians, researchers or any other profession. So the combination of this desire to climb up and along with the criteria set by universities the onus falls on the individual to publish. Under this system the evaluation is not affected by the views of those who are at the receiving end such as the community. To clarify my point here I again bring in "A" who quali es for promotion in three years time but without the minimum number of publications i.e. three "A" will not be promoted. To publish is a time consuming process and after teaching activities and clinical duties "A" has very less time. Also let me mention that "A" values the role of a teacher and spends time on preparing classes which the students appreciate since they learn a lot. The patients that visit "A" are also very satis ed. But soon "A" realises that it is research publications that counts and not the everyday dealings with students and patients. So "A" starts valuing research publications more and within a few years, the new students and the new patients that are affected by "A" have an opinion different than before. The students are not happy with the classes and neither is the patient that "A" deal"s with. For "A" satisfying criteria's set by the university are more important, like number of articles published and number of projects completed. As these are decisive factors for promotion and since no or a minimal value is given to opinions of patients and students, these processes begin to be devalued. Citing bias as a factor if patients and students evaluations are given credence, the notion that if there are given any weight it could become a bargaining tool. Publications are tangible products which can be seen and quanti ed where as feelings are not.
Understanding the processes behind a phenomenon and identifying the causal factors and the actors are both important. The article is a call to the native epistemic communities to climb out of the epistemic well and to develop a critical understanding. If one were to walk on the road and slip on a banana skin and fall, and the recommendation and advice received were, 'get your eye checked', and 'see where you walk', how valid would be the suggestion? Methodological process and Framework