Community participation in general health initiatives in high and upper-middle income countries: A systematic review exploring the nature of participation, use of theories, contextual drivers and power relations in community participation

Intimate partner violence during pregnancy against adolescents in sub-Saharan Africa: a systematic review

BACKGROUND

Adolescent pregnancy and intimate partner violence (IPV) are major public health issues that are linked to poor health outcomes particularly during pregnancy. In sub-Saharan Africa (SSA), previous studies on IPV during pregnancy have primarily focused on adults. This review examines the available evidence on adolescents' experience of IPV during pregnancy in SSA.

DESIGN

Systematic review.

METHODS

We searched multiple databases for articles that met our inclusion criteria. Included studies investigated IPV during pregnancy, including prevalence, risk factors and health outcomes among ever-pregnant adolescents aged 10-19 years old or younger in SSA. Studies were peer-reviewed studies from SSA, quantitative and/or qualitative; and published in English regardless of the year of publication.

RESULTS

Nine studies out of 570 abstracts screened, published between 2007 and 2020, met the inclusion criteria. The prevalence of IPV during pregnancy among adolescents in SSA ranged from 8.3% to 41%. Mental health symptoms, particularly depression, and anxiety, were associated with adolescent IPV during pregnancy and qualitatively linked to poor coping strategies when dealing with IPV.

CONCLUSION

This review found evidence of a linkage between pregnancy and IPV during pregnancy among adolescents. Given the long-term negative effects of IPV during pregnancy on adolescents and children, this conclusion points to the critical need for developing interventions to improve IPV detection during pregnancy in SSA among adolescents to interrupt its continuation into adulthood.

A review of strategies and levels of community engagement in strengths-based and needs-based health communication interventions

Background

Community engagement is key in health communication interventions that seek to incorporate community voices in their planning and implementation. Understanding what approaches and strategies are currently being used can help tailor programs in different social and cultural contexts. This review explores needs-based and strengths-based approaches and consensus and conflict strategies in community-based global health communications programs. Our objective is to examine the current state of the field, outline lessons learned, and identify gaps in existing programming to help guide future interventions.

Methods

PubMed and Web of Science were searched for articles published between 2010 and 2023. Studies were included if they described a community-based health communication intervention and an ongoing or completed implementation. Interventions were coded then categorized according to their level of community engagement and as single, hybrid, or complex, depending upon the number of approaches and strategies used.

Results

The search yielded 678 results and 42 were included in the final review and analysis. A vast majority 34 (81.0%) interventions utilized a needs-based approach and 24 (57.1%) utilized a strengths-based approach. Consensus as a strategy was utilized in 38 (90.5%) of the manuscripts and 9 (21.4%) implemented a conflict strategy. Interventions that combined approaches and strategies were more likely to leverage a higher level of community engagement.

Conclusion

These results showcase the complicated nature of global health communication program planning and implementation. There is a lack of interventions that use conflict as a strategy to empower communities to act on their own behalf, even when at odds with existing power structures. Complex interventions that include all approaches and strategies demonstrate the potential for global health communication interventions to be at the cutting edge of public health practice.

Co-creation process of an intervention to implement a multiparameter point-of-care testing device in a primary healthcare setting for non-communicable diseases in Peru

BACKGROUND

Point-of-care testing (POCT) devices are diagnostic tools that can provide quick and accurate results within minutes, making them suitable for diagnosing non-communicable diseases (NCDs). However, these devices are not widely implemented in healthcare systems and for this reason is relevant to understand the implementation process.

AIM

To describe the process and define a strategy to implement a multiparameter POCT device for diagnosing and managing NCDs in one region of Peru.

METHODS

A descriptive and non-experimental study, using the participatory methodologies of co-creation process. It was conducted in one region of Peru (Tumbes) to design an intervention for implementing a multiparameter POCT device. Two co-creation sessions were conducted involving five groups: community members, primary healthcare workers, these groups in both rural and urban settings, and regional decision-makers. These sessions included activities to understand patient journeys in receiving care for NCDs, identify facilitators and barriers to POCT devices usage, and define an implementation strategy for POCT devices in both rural and urban settings of Tumbes. The research team analysed the data and summarized key topics for discussion after each session.

RESULTS

A total of 78 participants were enrolled across the five groups. Among community members: 22.2% had only diabetes, 24.1% had only hypertension, and 18.5% had both diagnoses. In the patient journey, community members mentioned that it took at least three days to receive a diagnosis and treatment for an NCD. Most of the participants agreed that the POCT devices would be beneficial for their communities, but they also identified some concerns. The strategy for POCT devices implementation included healthcare workers training, POCT devices must be placed in the laboratory area and must be able to perform tests for glucose, glycated haemoglobin, cholesterol, and creatinine. Advertising about POCT devices should be displayed at the healthcare centres and the municipality using billboards and flyers.

CONCLUSIONS

The co-creation process was useful to develop strategies for the implementation of multiparameter POCT devices for NCDs, involving the participation of different groups of stakeholders guided by moderators in both, rural and urban, settings in Peru.

The application of biosecurity practices for preventing avian influenza in North-Eastern Italy turkey farms: An analysis of the point of view and perception of farmers

INTRODUCTION

Italian and international outbreaks of highly pathogenic avian influenza (HPAI), particularly in densely populated poultry areas (DPPAs), have increased over the past few decades. These emerging risks, which endanger both human and animal health and the entire poultry industry, can be effectively limited by biosecurity measures implemented at human-animal food chain interfaces. Some problems, however, persist in the application of these measures on the part of poultry farmers, prompting the need to explore those aspects and causes that limit their implementation.

MATERIAL AND METHODS

A qualitative approach was selected for the study and a semi-structured interview technique was applied to collect data among turkey farmers (n = 29) working in the north-east of Italy. The aim of this technique was to gather data on farms in order to understand the biosecurity practices adopted and the reasons for and impediments to farmer implementation, or lack thereof. This article presents and discusses the main data collected.

RESULTS

The study revealed that farmers were familiar with the biosecurity measures necessary to contain avian influenza (AI) and other poultry diseases; personal disinfection and animal isolation practices were particularly prominent. Based on the reported procedures, managerial, economic, and psychosocial factors were among the barriers behind the failure to implement biosecurity measures. These obstacles were variously intertwined and associated with the different action settings. In particular management factors, such as lack of time to apply the rules and difficulties contingent on the farm's structural characteristics, mediate the application of biosecurity measures. In terms of communication channels, the company, particularly its technicians, proved to be the primary source of information for farmers in case of emergencies, as well as the primary source of information on the application of biosecurity measures. However, other sources of information were indicated, such as word of mouth among farmers or other non-institutional figures (relatives and acquaintances).

CONCLUSIONS

What emerged, was the need to improve not only the biosecurity management skills, but also to implement forms of cooperation among the various key stakeholders in the poultry sector. The information presented in this pilot study needs to be discussed among competent authorities, public and company veterinarians, company technicians, and farmers. Furthermore, this information will help in participatory co-planning of risk prevention and communication strategies to implement a long-term, sustainable, effective approach to address future epidemic emergencies.

How does participatory research work: protocol for a realist synthesis

INTRODUCTION

Participatory research science deals with partnerships underlying research, governance and ownership of research products. It is concerned with relationships behind research objectives and methods. Participatory research has gained significant traction in design of health interventions, contextualising these to local settings and stakeholder groups. Despite a massive increase in participatory research exercises, the field remains undertheorised, and the mechanisms for improving health outcomes remain unclear. This realist review seeks to understand how and under what circumstances participatory research impacts health and social outcomes.

METHODS AND ANALYSIS

The review will follow four steps: (1) searching for and selecting evidence, (2) assessing the quality of evidence, (3) extracting and categorising data and (4) synthesising the data in the form of context-mechanism-outcomes configurations. The review will follow the Realist And Meta Narrative Evidence Syntheses: Evolving Standards (RAMESES) II guidelines for reporting realist evaluations. We categorise and synthesise data in four steps: (1) identifying outcomes, (2) identifying contextual components of outcomes, (3) theoretical redescription (abduction) and (4) identifying mechanisms. A retroductive analysis will identify mechanisms by moving between empirical data and theories, using inductive and deductive reasoning to explain the outcomes-context matches. The output will generate middle-range theories on how participatory research works, for whom and under what circumstances.

ETHICS AND DISSEMINATION

This study is a review of a published literature. It does not involve human participants. We will convene a workshop to share and discuss the preliminary results with partners and key stakeholders involved in participatory health research. We will publish the review results in peer-reviewed journals and academic conferences.

Qualitative study of states' capacity to support alcohol prevention policies during the COVID-19 pandemic in the USA

INTRODUCTION

The onset of the COVID-19 pandemic accelerated rates of alcohol purchasing and related harms in the USA. The increases followed governors' emergency orders that increased alcohol availability, including the allowance of alcohol home delivery, alcohol to-go from restaurants and bars, and curbside pickup from retailers.

METHODS

Semi-structured interviews were conducted with 53 participants involved in state-level alcohol prevention policy across 48 states. Interviewees' perspectives on changes to alcohol prevention policies during the COVID-19 pandemic, including capacity to respond to alcohol-focused executive and legislative changes to alcohol availability, were explored. Initial codes were developed collectively and refined through successive readings of transcripts using a phenomenological, action-oriented research approach. Themes were identified semantically after all transcripts were coded and reviewed.

RESULTS

Four themes were developed including: (i) alcohol prevention policies and capacity during COVID-19; (ii) industry-related challenges during COVID-19; (iii) limited pre-COVID-19 alcohol prevention capacity; and (iv) needs to strengthen alcohol prevention capacity.

DISCUSSION AND CONCLUSIONS

The pandemic exacerbated states' capacity limitations for alcohol prevention efforts and created additional impediments to public health messaging about alcohol health risks related to greater alcohol availability. Participants offered a myriad of strategies to improve alcohol prevention and to reduce alcohol-related harms. Recommendations included dedicated federal and state prioritisation, more funding for community organisations, greater coordination, consistent high-quality trainings, stronger surveillance and widespread prevention messaging. States' alcohol prevention efforts require dedicated leadership, additional funding and support to strengthen population-based strategies to reduce sustained alcohol-related harms associated with increases in alcohol availability.

Neighborhood Governance and Happiness during the COVID-19 Pandemic: An Empirical Analysis of Wuhan's Lockdown

The outbreak of COVID-19 posed a challenge to global governance, residents' happiness, and economic systems around the world. Since the crux of previous research centers on the reactions of both local and national governments, studies on how governance arrangement at the neighborhood level influences people's happiness during the crisis response remain insufficient. This paper aims to explore the relationship between neighborhood governance and residents' happiness based on first-hand data collected during Wuhan's first lockdown. This study highlights the significance of neighborhood governance in crisis response, which includes providing diverse public services, ensuring access to life's necessities, and offering prompt medical treatment. All of these factors are essential for maintaining overall satisfaction with governance and contributing to the happiness of individuals within the community. However, active governance actions do not always lead to favorable results. For example, increased group participation may lead to social conflicts among those involved, ultimately diminishing one's happiness. Furthermore, the COVID-19 pandemic has acted as a risk 'amplifier', exposing and exacerbating pre-existing hukou-based social inequalities in the governance process. The impact of the pandemic on citizen happiness is the cumulative effect of both the immediate social crisis brought on by the pandemic and long-standing structural inequalities. To improve people's happiness and establish inclusive policies, this paper advocates for a 'people-centered' urban governance that enhances public satisfaction and addresses the needs and priorities of migrant populations.

Community engagement processes in low- and middle-income countries health research settings: a systematic review of the literature

BACKGROUND

Community Engagement is an important ethical imperative in research. Although substantial research emphasizes its real value and strategic importance, much of the available literature focuses primarily on the success of community participation, with little emphasis given to specific community engagement processes, mechanisms and strategies in relation to intended outcomes in research environments. The systematic literature review's objective was to explore the nature of community engagement processes, strategies and approaches in health research settings in low- and middle-income countries.

METHODS

The systematic literature review design was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched for peer-reviewed, English-language literature published between January 2011 and December 2021 through three databases on the internet (PubMed, Web of Science and Google Scholar). The terms "community engagement," "community involvement," "participation," "research settings," and "low- and middle-income countries" were merged in the search.

RESULTS

The majority of publications [8/10] were led by authors from low- and middle-income countries, with many of them, [9/10] failing to continuously include important aspects of study quality. Even though consultation and information sessions were less participatory, articles were most likely to describe community engagement in these types of events. The articles covered a wide range of health issues, but the majority were concerned with infectious diseases such as malaria, human immunodeficiency virus, and tuberculosis, followed by studies on the environment and broader health factors. Articles were largely under-theorized.

CONCLUSIONS

Despite the lack of theoretical underpinnings for various community engagement processes, strategies and approaches, community engagement in research settings was variable. Future studies should go deeper into community engagement theory, acknowledge the power dynamics underpin community engagement, and be more practical about the extent to which communities may participate.

Community pandemic prevention and control measures and their influence on citizen satisfaction during the COVID-19 pandemic in China

At the forefront of the fight against the pandemic, the community' s measures and services would have a greater impact than ever before on citizen satisfaction. However, the influence of citizen satisfaction on community pandemic prevention and control measures (CPPCM) during the pandemic is poorly understood. This study aims to investigate the allocation of CPPCM and its impact on CS. The Chinese national data was analyzed for the outcome. (1) Pandemic prevention propaganda (PPP), disinfection (DT), and body temperature tests (BTTs) were the primary measures taken by the Chinese community. (2) The CS for pandemic prevention and control is high, and urban and central Chinese communities express greater satisfaction. (3) The impact of disinfection, body temperature tests, free supplies, and assistance purchasing supplies on CS was greater in rural areas than in urban areas. (4) Regional variations exist in the impact of CS on CPPCM. (5) The number of measures has an inverted U-shaped relationship with citizen satisfaction. This study also suggests that the government should disseminate information about pandemic prevention in a timely manner, provide basic health and medical services, and evaluate the measures taken to avoid the discount effect.

Community Participation in Primary Healthcare in the South Sudan Boma Health Initiative: A Document Analysis

BACKGROUND

Community participation is central to primary healthcare, yet there is little evidence of how this works in conflict settings. In 2016, South Sudan's Ministry of Health launched the Boma Health Initiative (BHI) to improve primary care services through community participation.

METHODS

We conducted a document analysis to examine how well the BHI policy addressed community participation in its policy formulation. We reviewed other policy documents and published literature to provide background context and supplementary data. We used a deductive thematic analysis that followed Rifkin and colleagues' community participation framework to assess the BHI policy.

RESULTS

The BHI planners included inputs from communities without details on how the needs assessment was conducted at the community level, what needs were considered, and from which community. The intended role of communities was to implement the policy under local leadership. There was no information on how the Initiative might strengthen or expand local women's leadership. Official documents did not contemplate local power relations or address gender imbalance. The policy approached households as consumers of health services.

CONCLUSION

Although the BHI advocated community participation to generate awareness, increase acceptability, access to services and ownership, the policy document did not include community participation during policy cycle.

Building Community Power To Dismantle Policy-Based Structural Inequity In Population Health

Population health strategies tend to focus on individuals' behaviors, genes, or health care access, yet it is well established that socioecological conditions are fundamental to health and strongly influenced by policy. In the US, health and other policies continue to be shaped by the country's unique legacy of racial and economic segregation. Policy reform must be at the center of population health. This requires communities to have power. We present theoretical and empirical research linking community power and health, and we share an example of our work in which communities organized to hold policy makers accountable for advancing health equity in the distribution of parks. We call this a democratic approach to health improvement and discuss how population health, whether part of public health, philanthropy, or health care, needs to focus on community power and include funding for power-building organizations. We conclude that achieving health equity requires enhancing the quality of democracy.

Evaluation of a Community Intervention to Reduce Harmful Alcohol Consumption among Adult Population: A Study Protocol

Harmful alcohol consumption is shaped by a complex range of structural, social, and individual determinants that interact with inequality axes, which can be addressed at the community level. Under the framework of Barcelona Health in the Neighborhoods, which is a community strategy to reduce health inequalities in Barcelona’s most deprived neighborhoods, a community steering group will co-design a multicomponent community intervention. Aims: to assess its effects on: (1) alcohol accessibility, availability, and consumption at the environmental level, and (2) psychosocial and cognitive determinants of harmful alcohol consumption at the individual level. Methods: Quasi-experimental design with a comparison group, and pre- and post-intervention measures. Three Barcelona neighborhoods will be assigned to the intervention or comparison group based on three criteria: healthcare data on alcohol use, socioeconomic characteristics, and population size. The intervention includes activities promoting community mobilization, law enforcement, and communication campaigns in the intervened neighborhoods. Non-participant observations in standardized census sections will be performed in public spaces to collect information on three outcomes: alcohol accessibility, availability, and signs of alcohol consumption. Data collection includes a survey to a sample of 622 subjects to detect differences on these outcomes: risk awareness, knowledge, and self-efficacy about harmful alcohol consumption and drinking patterns. Discussion: This protocol to assess the effects of a multicomponent community intervention on harmful alcohol consumption at the environmental and population level will provide evidence on effective community health interventions and enable informed decisions for policy makers. This protocol could also be used as an implementation guide for studies aimed at reducing harmful drinking in cities with similar characteristics.

A mixed-methods systematic review of suicide prevention interventions involving multisectoral collaborations

Background

Governments and third-sector organizations (TSOs) require support to reduce suicide mortality through funding of suicide prevention services and innovative research. One way is for researchers to engage individuals and services in multisectoral collaborations, to collaboratively design, develop and test suicide prevention services and programmes. However, despite widespread support, to date, it remains unclear as to the extent to which stakeholders are being included in the research process, or if they are, how these partnerships occur in practice. To address this gap, the authors conducted a systematic review with the aim of identifying evidence of multisectoral collaborations within the field of suicide prevention, the types of stakeholders involved and their level of involvement.

Methods

The authors conducted a strategic PRISMA-compliant search of five electronic databases to retrieve literature published between January 2008 and July 2021. Hand-searching of reference lists of key systematic reviews was also completed. Of the 7937 papers retrieved, 16 papers finally met the inclusion criteria. Because of data heterogeneity, no meta-analysis was performed; however, the methodological quality of the included studies was assessed.

Results

Only one paper included engagement of stakeholders across the research cycle (co-ideation, co-design, co-implementation and co-evaluation). Most stakeholders were represented by citizens or communities, with only a small number of TSOs involved in multisectoral collaborations. Stakeholder level of involvement focused on the co-design or co-evaluation stage.

Conclusion

This review revealed a lack of evidence of multisectoral collaborations being established between researchers and stakeholders in the field of suicide prevention research, even while such practice is being espoused in government policies and funding guidelines. Of the evidence that is available, there is a lack of quality studies documenting the collaborative research process. Also, results showed that the inclusion of co-researchers from communities or organizations is defined as co-creation, but further analysis revealed that collaboration was not consistent across the duration of projects. Researchers and practitioners should consider issues of power and equity in multisectoral collaborations and encourage increased engagement with TSOs, to rigorously research and evaluate suicide prevention services.

How and why do women's groups (WGs) improve the quality of maternal and child health (MCH) care? A systematic review of the literature

BACKGROUND

This systematic review was undertaken to assist the implementation of the WOmen's action for Mums and Bubs (WOMB) project which explores Aboriginal and Torres Strait Islander community women's group (WG) action to improve maternal and child health (MCH) outcomes. There is now considerable international evidence that WGs improve MCH outcomes, and we were interested in understanding how and why this occurs. The following questions guided the review: (1) What are the characteristics, contextual influences and group processes associated with the MCH outcomes of WGs? (2) What are the theoretical and conceptual approaches to WGs? (3) What are the implications likely to inform Aboriginal and Torres Strait Islander WGs?

METHODS

We systematically searched electronic databases (MEDLINE (Ovid); CINAHL (Ebsco); Informit health suite, Scopus, Emcare (Ovid) and the Cochrane Library and Informit), online search registers and grey literature using the terms mother, child, group, participatory and community and their variations during all time periods to January 2021. The inclusion criteria were: (1) Population: studies involving community WGs in any country. (2) Intervention: a program/intervention involving any aspect of community WGs planning, acting, learning and reviewing MCH improvements. (3) Outcome: studies with WGs reported a component of: (i) MCH outcomes; or (ii) improvements in the quality of MCH care or (iii) improvements in socioemotional well-being of mothers and/or children. (4) Context: the primary focus of initiatives must be in community-based or primary health care settings. (5) Process: includes some description of the process of WGs or any factors influencing the process. (6) Language: English. (7) Study design: all types of quantitative and qualitative study designs involving primary research and data collection.Data were extracted under 14 headings and a narrative synthesis identified group characteristics and analysed the conceptual approach to community participation, the use of theory and group processes. An Australian typology of community participation, concepts from Aboriginal and Torres Strait Islander group work and an adapted framework of Cohen and Uphoff were used to synthesise results. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Tools.

RESULTS

Thirty-five (35) documents were included with studies conducted in 19 countries. Fifteen WGs used participatory learning and action cycles and the remainder used cultural learning, community development or group health education. Group activities, structure and who facilitated groups was usually identified. Intergroup relationships and decision-making were less often described as were important concepts from an Aboriginal or Torres Strait Islander perspective (the primacy of culture, relationships and respect). All but two documents used an explicit theoretical approach. Using the typology of community participation, WGs were identified as predominantly developmental (22), instrumental (10), empowerment (2) and one was unclear.

DISCUSSION

A framework to categorise links between contextual factors operating at micro, meso and macro levels, group processes and MCH improvements is required. Currently, despite a wealth of information about WGs, it was difficult to determine the methods through which they achieved their outcomes. This review adds to existing systematic reviews about the functioning of WGs in MCH improvement in that it covers WGs in both high-income and low-income settings, identifies the theory underpinning the WGs and classifies the conceptual approach to participation. It also introduces an Australian Indigenous perspective into analysis of WGs used to improve MCH.

PROSPERO REGISTRATION NUMBER

CRD42019126533.

Highlighting Contributions of Behavioral and Social Sciences in Advancing Public Health: Where We've Come, Where We're Headed

CONTEXT

Social and behavioral sciences, a cross-disciplinary field that examines the interaction among behavioral, biological, environmental, and social factors, has contributed immensely to some public health achievements over the last century. Through collaboration with community organizations and partners, social and behavioral scientists have conducted numerous program interventions involving community engagement and advocacy efforts at the local, state, federal, and international levels.

CONTRIBUTIONS OF SOCIAL AND BEHAVIORAL SCIENCES

This article traces select historical underpinnings of the applications of social and behavioral sciences theories and evidence to public health and highlights 4 areas in which health education specialists have distinctly contributed to public health achievements by building on theory and evidence. Applied social and behavioral sciences have formed the basis of various health education interventions. These 4 areas include the following: (1) Theory, Model Development, and the Professionalization of Health Education; (2) Participation and Community Engagement; (3) Health Communication; and (4) Advocacy and Policy.

DISCUSSION

We present contemporary challenges and recommendations for strengthening the theory, research, and practice of health education within the context of social and behavioral sciences in addressing emerging public health issues.

Investigating into the critical factors supporting healthy independent longevity: A proposition of a conceptual model with measurements during and beyond COVID-19 pandemic

This study investigated the factors that support the elderly citizens' perceived healthy independent longevity during and beyond the COVID-19 pandemic. The Structural Equation Modeling was conducted with the 1607 dataset collected from Japan to validate a proposed model with six antecedent factors. It has been found that "Town vibrancy" and "Mobility and transportations" have the most significant impact, whereas "Health and welfare policies" and "Community bonding" have a relatively lower impact on their perceived healthy longevity. The study has provided a conceptual model with measurements for further discussions in the field of study.

Lessons learned about co-creation: developing a complex intervention in rural Peru

Background: Co-creation is the process of involving stakeholders in the development of interventions. Although co-creation is becoming more widespread, reports of the process and lessons learned are scarce.

Objective: To describe the process and lessons learned from using the COHESION manual, a co-creation methodology to develop interventions aimed at the improvement of diagnosis and/or management of chronic diseases at the primary healthcare level in a low-resource setting in Peru.

Methods: Observational study to describe the use of the COHESION manual ‘Moving from Research to Interventions: The COHESION Model’ developed for a multi-country project in low- and middle-income countries for co-creation and the adaptations needed to customize it to the local context of rural communities in northern Peru.

Results: The actual process of co-creation in Peru included co-creation-related questions in the formative research; an initial consultation with stakeholders at the micro, meso, and macro levels (e.g. community members, health workers, and policy-makers); the analysis of the collected data; a second consultation with each stakeholder group; the prioritization of intervention options; and finally the design of a theory of change for all activities included in the complex intervention. The complex intervention included: 1) offer training in specific diseases and soft skills to health workers, 2) create radio programs that promote chronic disease prevention and management plus empower patients to ask questions during their visits to primary health care (PHC) facilities, and 3) provide a small grant to the PHC for infrastructure improvement. Small adaptations to the COHESION manual were necessary for this co-creation process.

Conclusion: This study provides a practical example of the process of co-creating complex interventions to increase access and quality of health care in a low-resource setting. The process, components, challenges and opportunities identified could be useful for other researchers who want to co-create interventions with beneficiaries in similar settings.

Exploring the theory, barriers and enablers for patient and public involvement across health, social care and patient safety: a systematic review of reviews

BACKGROUND

The emergence of patient and public involvement (PPI) in healthcare in the UK can be traced as far back as the 1970s. More recently, campaigns by harmed patients have led to a renewed focus on strengthening PPI. There is a growing awareness of the benefits of PPI in research as well as a need to address power inequities and a lack of diversity and inclusion. This review was undertaken to look at evidence for theories, barriers and enablers in PPI across health, social care and patient safety that could be used to strengthen PPI and address a perceived knowledge and theory gap with PPI in patient safety.

METHODS

We searched MEDLINE, EMBASE and PsycINFO from inception to August 2018, using both MeSH and free-text terms to identify published empirical literature. Protocols in PROSPERO were also searched to identify any systematic reviews in progress. The extracted information was analysed using a narrative approach, which synthesises data using a descriptive method.

RESULTS

Forty-two reviews were identified and grouped by key outcomes. Twenty-two papers mentioned theory in some form, 31 mentioned equality and diversity (although with no theory mentioned in this area), and only 19 cited equality and diversity as a barrier or enabler. Thirty-four reviews identified barriers and enablers at different organisational levels: personal/individual; attitudes; health professional; roles and expectations; knowledge, information and communication; financing and resourcing; training; general support; recruitment and representation, PPI methods and working with communities and addressing power dynamics.

CONCLUSIONS

The review findings suggest that a commitment to PPI and partnership working is dependent on taking a whole system approach. This needs to consider the complex individual and organisational enablers and constraints to this process and address imbalances of power experienced by different groups. Addressing equality and diversity and use of a theory-driven approach to guide PPI are neglected areas. The long tradition of involvement across health and social care can provide considerable expertise in thinking about ways to strengthen approaches to PPI. This is especially important in patient safety, with a much newer tradition of developing PPI than other areas of healthcare.

Beyond clinical trials: social outcomes of structured stakeholder engagement in biomedical HIV prevention trials in China

Stakeholder engagement is increasingly recognised and institutionalised as an essential component of HIV-related biomedical research. However, we know little about stakeholder engagement's social outcomes, such as its influence on the community it engages with, in authoritarian regimes and beyond high-income countries. This study evaluates a multi-site structured stakeholder engagement programme conducted in parallel with two HIV prevention studies among men who have sex with men in China. We conducted a one-month ethnographic study and 41 semi-structured interviews with participants of a structured stakeholder engagement programme in six Chinese cities. We found that the structured stakeholder engagement programme offered community stakeholders additional and flexible funding, networking opportunities, increased clinical research literacy, and strengthened their connections with the community. However, the structured stakeholder programme generated unintended consequences in some cases. It caused community stakeholders to expend their social capital, introduced moral conflicts and created tension between stakeholders' 'community representative' and 'research assistant' identities. Our findings suggest that despite these unintended consequences, structured stakeholder engagement could effectively mitigate negative outcomes generated by such engagement if such programmes are more sensitive and responsive to the broader socio-political structure in which trials are embedded.

Community participation and empowerment in primary health care in Emilia-Romagna: A document analysis study

Community participation and empowerment are seen as fundamental for achieving equitable, people-centred primary health care. Emilia-Romagna region introduced the Casa della Salute aiming to foster comprehensive primary health care and support community participation. Since the 1990s, community involvement has been promoted to improve the regional health system. The pivotal role of third sector organisations as service providers and advocates for users' rights has been underlined. This contribution explores the evolution of the meaning and conceptualisation of community participation and empowerment in policies addressing the Casa della Salute. A qualitative document analysis study was undertaken. Three national and twelve regional documents dated between 2006 and 2019 were evaluated. The policies continuously address community participation. The Casa della Salute is seen as a designated place to promote participation and empowerment. The documents point to the need for democratic practice and shared decision-making power; third sector organisations are seen as salient community representatives and mediators. However, the policies show only a vague conceptualisation of how to empower communities; moreover, strategies to promote participation of vulnerable groups are lacking. Policies that consider the ambiguous role of the third sector, specify community empowerment, identify strategies to facilitate it and collaborate with vulnerable groups could be beneficial for further progress.

Partnerships, Processes, and Outcomes: A Health Equity-Focused Scoping Meta-Review of Community-Engaged Scholarship

In recent decades, there has been remarkable growth in scholarship examining the usefulness of community-engaged research (CEnR) and community-based participatory research (CBPR) for eliminating health inequities.This article seeks to synthesize the extant literature of systematic reviews, scoping reviews, and other related reviews regarding the context, processes, and research designs and interventions underlying CEnR that optimize its effectiveness. Through a scoping review, we have utilized an empirically derived framework of CBPR to map this literature and identify key findings and priorities for future research. Our study found 100 reviews of CEnR that largely support the CBPR conceptual framework.

Promoting women's and children's health through community groups in low-income and middle-income countries: a mixed-methods systematic review of mechanisms, enablers and barriers

INTRODUCTION

Community mobilisation through group activities has been used to improve women's and children's health in a range of low-income and middle-income contexts, but the mechanisms through which it works deserve greater consideration. We did a mixed-methods systematic review of mechanisms, enablers and barriers to the promotion of women's and children's health in community mobilisation interventions.

METHODS

We searched for theoretical and empirical peer-reviewed articles between January 2000 and November 2018. First, we extracted and collated proposed mechanisms, enablers and barriers into categories. Second, we extracted and synthesised evidence for them using narrative synthesis. We assessed risk of bias with adapted Downs and Black and Critical Appraisal Skills Programme checklists. We assigned confidence grades to each proposed mechanism, enabler and barrier.

RESULTS

78 articles met the inclusion criteria, of which 39 described interventions based on a participatory group education model, 19 described community-led structural interventions to promote sexual health in marginalised populations and 20 concerned other types of intervention or multiple interventions at once. We did not have high confidence in any mechanism, enabler or barrier. Two out of 15 proposed mechanisms and 10 out of 12 proposed enablers and barriers reached medium confidence. A few studies provided direct evidence relating proposed mechanisms, enablers or barriers to health behaviours or health outcomes. Only two studies presented mediation or interaction analysis for a proposed mechanism, enabler or barrier.

CONCLUSION

We uncovered multiple proposed mechanisms, enablers and barriers to health promotion through community groups, but much work remains to provide a robust evidence base for proposed mechanisms, enablers and barriers.

PROSPERO REGISTRATION NUMBER

CRD42018093695.

How and why do participatory women's groups (PWGs) improve the quality of maternal and child health (MCH) care? A systematic review protocol

INTRODUCTION

Community-based Participatory Women's Groups (PWGs) have proven to be an effective intervention to improve maternal and child health (MCH) outcomes in low/middle-income countries (LMICs). Less is known about how PWGs exert their effects in LMICs and virtually nothing is known about the contextual issues, processes and power relationships that affect PWG outcomes in high resource settings. The aim of this systematic review is to synthesise and critically analyse the current evidence on how and why PWGs improve the quality of MCH care. We aim to demonstrate how PWGs function and why PWG interventions contribute to social and health outcomes.

METHODS AND ANALYSIS

The protocol will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. The databases Medline (Ovid): Cumulative Index to Nursing and Allied Health Literature (Ebsco); Informit health suite Scopus, Australian HealthInfoNet, the Cochrane Library and other sources will be searched under broad categories: intervention, context and outcomes to 30 June 2019.

ETHICS AND DISSEMINATION

As only secondary data will be analysed; ethical approval is not required. The review will be disseminated to relevant organisations and presented in peer-reviewed papers and at conferences. This will be the first attempt to summarise the current available evidence on the characteristics, contextual influences and mechanisms that are associated with the outcomes and effectiveness of PWGs.

PROSPERO REGISTRATION NUMBER

CRD42019126533.