Abstract
This paper examines the effects of a Child-to-Child (CtC) health education programme designed to assist children in Pakistan to greater participation and voice in both their own education and their families' health by empowering them as change agents. The study compares parental involvement in their children's participation in health promotion activities in two disadvantaged, community-based, primary schools in rural and urban settings.
Children's health knowledge and behaviours improved as a result of the intervention but they were less successful in communicating with and influencing their families. This may have arisen from tensions between CtC assumptions and prevailing norms and beliefs in Pakistan (e.g. about family relationships, girls' security and honour). However, there was greater influence when parental education levels and socioeconomic status were higher. Parents in village communities were more accepting of children's health initiatives than city parents, perhaps because of a greater sense of security and familiarity with each other. Programmes that tackle social change must be cognisant not only of the judged desirability of their aims but also of the contextual and cultural realities of the 'Southern' societies to which they are imported.