Critics of PEAR suggest that bias arises when researchers come in close contact with and empathize with individuals involved in research, thus losing their supposed objectivity. An alternative view is that data are co-constructed by the researcher and participants while situations change when we are interacting with one other and our environments. In other words, reﬂection is at the heart of socialized knowledge. Human values enter into the research process during problem selection, instrument design, analysis and interpretation, and reﬂection is required in order to better understand and avoid the trap of subjective conclusions (Guba and Lincoln, 1989, cited in Sohng, 1995; Cornwall and Jewkes, 1995). Validity (the extent to which one is actually measuring what one wishes to measure) and reliability (the extent to which a result or measurement will be the same every time it is measured) remain important considerations. Techniques that were used in this work to improve validity and reliability included the use of standard procedures for data-collection tool development (e.g. in questionnaires), appropriate analysis of diﬀerent kinds of data (e.g. statistical software for quantitative analysis) and triangulating results obtained through diﬀerent methods (e.g. use of secondary data sources on health problems). PEAR also considers whether social action arises from the research process and whether the changes made bring about the outcomes observed – so-called catalytic validity (Heron, 1988, cited in Sohng, 1995).